Key statistics 

• autism affects around 2% of the population, though diagnosis rates vary by gender and ethnicity 

• autistic people die between 16 and 30 years earlier than non-autistic peers 

• the suicide rate among autistic adults is approximately nine times higher than in the general population 

• in Wales, only around 0.5% of people are formally diagnosed as autistic, suggesting many individuals remain undiagnosed 

• 76% of autistic people report that their GP does not make reasonable adjustments during healthcare appointments 

• 62% of autistic adults report difficulty booking GP appointments by telephone compared with 16% of non-autistic respondents 

Key messages 

• health and social care policies in England and Wales often fail to address the needs of autistic adults 

• delays and barriers in diagnostic pathways prevent many autistic people from accessing services and support 

• healthcare environments and systems are frequently inaccessible, including sensory environments and communication methods 

• lack of clinician understanding of autistic communication, distress and pain contributes to poorer health and social care experiences 

• access to services often depends on diagnosis, creating inequities for those who remain undiagnosed 

• social care systems can be difficult to navigate and may place unrealistic administrative demands on autistic people 

• policy failures across health and social care contribute to unmet needs, poorer health outcomes and increased mortality among autistic adults 

Policy implications 

• improve accessibility of diagnostic services and reduce delays in autism diagnosis 

• ensure healthcare providers implement reasonable adjustments for autistic patients 

• develop accessible service communication methods, including alternatives to telephone-only contact 

• increase autism-informed training for health and social care professionals 

• improve integration between health services and social care to reduce gaps in support 

• ensure autistic people are meaningfully involved in the co-production of policy and service design 

Gaps 

• there is limited discussion of how health and social care barriers differ across demographic groups within the autistic population 

Commentary 
This chapter analyses how social policy structures in England and Wales contribute to persistent inequities experienced by autistic adults, particularly within health and social care systems. The authors frame these issues through the concept of epistemic injustice, arguing that autistic perspectives are frequently excluded or marginalised in policy development. 

Within healthcare systems, autistic people face barriers at multiple stages of access. Diagnostic pathways are often slow, confusing and difficult to navigate, meaning many autistic individuals remain undiagnosed and therefore unable to access services that require formal diagnosis. Even when a diagnosis is obtained, adjustments within healthcare settings are inconsistent, and many autistic patients report that clinicians do not adapt communication styles or appointment structures to meet their needs. 

Healthcare accessibility is further limited by structural features of service delivery. For example, many services rely heavily on telephone communication for booking appointments, which presents a significant barrier for autistic people who experience communication challenges in this format. Sensory environments in clinical settings, such as bright lighting, noise and crowded waiting areas, also create barriers to accessing care. 

In the social care system, autistic adults may receive personal budgets to organise their own support. However, the administrative and organisational demands associated with managing care can be particularly difficult for individuals who already experience executive functioning challenges. As a result, the system may inadvertently disadvantage those with the greatest support needs. 

The chapter argues that these barriers reflect structural inequities embedded in policy design rather than individual shortcomings. Policies are frequently developed without meaningful involvement of autistic people, which leads to services that do not reflect lived experience or accessibility needs. The authors therefore emphasise the importance of co-produced policy development, where autistic individuals contribute directly to the design of services and social policies that affect them. 

From a health and social care equity perspective, the chapter highlights how systemic barriers across diagnosis, healthcare access and social care support contribute to poorer outcomes for autistic adults. Addressing these inequities requires structural reform, including accessible service design, improved professional understanding of autism and stronger inclusion of autistic voices in policy development.