🏥️ NHS Healthcare Policy  ·  Dementia  ·  Diagnosis Rates

The 66% Target: What the Dementia Diagnosis Data Actually Shows

England first hit the dementia diagnosis target in November 2015. By 2019 it was exceeding it. Then COVID produced the largest single-year fall in the series — visible in both the Bootstrap CUSUM and the X-mR moving range chart. By March 2025, England is still 1.1 percentage points below a target set in 2012.

By Syd Stewart, Chartered Chemical Engineer  ·  StepChangeAnalysis.com  ·  Data: OHID Fingertips Estimated Dementia Diagnosis Rate (EDDR), England  ·  N=9 annual observations, 2017–2025  ·  1 stage at 99.7% confidence
Method: Bootstrap CUSUM  ·  Open the StepChange Analyzer
“A timely diagnosis of dementia, occurring when the patient and their family are ready to access help, provides an explanation for symptoms and enables patients and carers to access post-diagnostic support, care planning, and treatment.” — NHS England clinical rationale for the 66.7% diagnosis target. The national target was set in 2012. England crossed it in 2019 at 68.5% — a special cause above the upper natural process limit. COVID then drove the rate to 61.7% in 2021 — a fall of nearly 7 percentage points and a special cause below the lower limit. Bootstrap CUSUM on N=9 annual observations finds one stage at 99.7% confidence, mean 65.39%. The X-mR moving range between 2020 and 2021 exceeds the upper range limit — the COVID collapse is confirmed as a special cause on the rate of change chart. As of March 2025, the rate is 65.6%. Still below the target set thirteen years ago.
📋 Article Summary  ·  ⇣ Download Executive Summary PDF  ·  ⇣ Download EDDR data CSV
England briefly got there
The 66.7% target was first achieved in November 2015. From 2017 to 2020 the rate ran above the target each year, peaking at 68.5% in 2019. The Bootstrap CUSUM overall mean is 65.39% — the 2017–2020 period ran consistently above both the mean and the 66.7% target.
COVID: a visible collapse
Bootstrap CUSUM finds one stage across the full series, mean 65.39% (N=9). The rate ran above the mean 2017–2020, collapsed to 61.7% in 2021, and has been recovering since. The X-mR moving range between 2020 and 2021 of 5.7pp exceeds the URL of 5.19pp — the COVID collapse confirmed as a special cause on the rate of change chart.
The slow recovery
By March 2025 the rate is 65.6% — recovering at ~1 percentage point per year. Still 1.1 points below the 66.7% target. England has 900,000 people with dementia; approximately 58,000 have no recorded diagnosis.
A diagnosis without follow-through
53.2% of diagnosed patients had a medication review in the past year. The diagnosis rate measures the first step. Whether the NHS delivers the subsequent steps consistently is a harder question — and the answer is partial at best.
Purchased behaviour, not system design
Deming’s 12th Point warns against incentive schemes: they purchase behaviour rather than embed it, and disappear when removed. The rate was above 66.7% while the CQUIN was active, then fell when COVID disrupted the pathway. The constraint — memory clinic capacity — was never resolved. A Deming-consistent approach would have built cognitive assessment into routine GP annual reviews as standard, not an incentivised extra.
Level 3: fix the system, not the metric
Level 1 is telling GPs to refer more. Level 2 is redesigning the pathway. Level 3 is building memory clinic capacity structurally, integrating cognitive assessment into routine GP annual reviews for the over-75s, and measuring what actually matters: time from referral to assessment, post-diagnostic support received, and avoidable A&E admissions — not just the diagnosis count.
A metric that moves for the wrong reasons
The EDDR denominator is recalculated every month as the registered population ages — even if diagnostic activity is unchanged, the rate falls automatically. The 66.7% target is a political round number (two-thirds), not a clinically derived figure. A practice diagnosing exactly the same patients every month will show a falling rate simply because its patients got older. The recovery from 61.7% to 65.6% was achieved against this rising denominator — making it more significant than the raw numbers suggest.
Drive measures and balance measures
Every drive measure needs a counterweight. Measuring referral rates without a conversion rate produces over-referral. Measuring waiting times without diagnostic accuracy produces faster but worse assessments. Measuring crisis admissions without all-cause admissions produces coding changes, not clinical improvement. The article proposes a six-level framework from memory clinic capacity through to avoidable crisis admissions — each with a balance measure. A PM advised by this framework would have tracked six pairs of measures, not one moving ratio.
Data: OHID Fingertips EDDR indicator, England  ·  N=9 annual observations 2017–2025  ·  95% confidence  ·  Loops=5,000
📊 New to Bootstrap CUSUM?

Same Data, Three Charts, Three Very Different Stories explains what the green CUSUM line means and why it detects structural change that other charts miss — including a step-by-step guide to reading the chart. Takes 5 minutes and makes every chart in this article easier to read.

Read above first   📚 Glossary — EDDR, CUSUM, Deming and more
Table of contents — click to expand or collapse
  1. The target and the story behind it
  2. What the data shows: 2017–2025
  3. The 2019 peak: England briefly got there
  4. COVID: the largest single-year fall
  5. The slow recovery
  6. Is a diagnosis actually helpful?
  7. What Deming would ask
    1. By what method?
    2. The constraint identified
    3. The root cause of the constraint
    4. Two reinforcing loops
    5. Flipping from vicious to virtuous
    6. What Level 3 looks like
    7. The lag and the tampering trap
    8. Suggested measures
    9. The system produced this result
  8. Data notes and methodology

The target and the story behind it

In February 2012, Prime Minister David Cameron launched the first Dementia Challenge. The centrepiece commitment was a diagnosis rate target: two-thirds of all people estimated to be living with dementia should have a formal recorded diagnosis. Translated into a number, that became 66.7%.

The reasoning was that a diagnosis enables access to support, care planning, medication review, and post-diagnostic services. Without a diagnosis, a person with dementia and their family cannot access the system. The PM’s Challenge identified the diagnosis rate as the lever closest to the beginning of the care pathway.

Cameron’s motivation was personal as well as political. His mother was subsequently diagnosed with Alzheimer’s disease, and he has spoken publicly of the “period of darkness” she has experienced. In a 2017 article he described the moment that crystallised his commitment: on the last day of his premiership, visiting a care home in his constituency, a woman with dementia grabbed his hand and stared into his eyes — and he could see she had no idea where she was or who was sitting with her. He became President of Alzheimer’s Research UK after leaving office, in an unpaid role, and has continued to campaign on dementia research funding.

The most important Deming point in this article

W. Edwards Deming was an American statistician and management theorist whose work transformed Japanese manufacturing after World War II and whose ideas underpin everything on this site. His core insight was that most problems — he estimated 94% — are caused by the system, not the people working in it. He was deeply sceptical of targets, numerical goals without methods, and financial incentives — arguing that they optimise for the metric rather than the purpose, and disappear when removed. His framework asks not “who failed?” but “whose system produced this result?” The dementia diagnosis story is one of the clearest illustrations of his thinking available in NHS data.

Cameron’s commitment was genuine, sustained, and personal. He was not indifferent, not ignorant of the scale of the problem, and not short of political will. He continued championing the cause after leaving office with no political gain to be had. And yet the Bootstrap CUSUM result is what it is: Stage 2 mean 63.76%, below the target he set, five years after he left office.

This is the most powerful possible illustration of the Deming point. The failure was not a failure of commitment. It was a failure of method — specifically, the absence of a systems analysis that would have identified the constraint (memory clinic capacity), traced its root cause (Old Age Psychiatry underinvestment), and designed an intervention that addressed the causal chain rather than the output. The right person, with the right intentions, using the wrong analytical framework, produces exactly the Bootstrap CUSUM result we see.

In 2013, NHS England introduced a Dementia CQUIN (Commissioning for Quality and Innovation) incentive, paying hospitals to identify patients at risk of dementia and refer them for assessment. In 2015, Cameron launched a second Dementia Challenge, doubling down on the commitment and increasing funding.

The target was first achieved in November 2015

Three years after it was set, the national estimated dementia diagnosis rate crossed 66.7% for the first time. This is a genuine achievement that is often lost in the post-COVID narrative. The PM’s Challenge, backed by CQUIN incentives and sustained national focus, produced a measurable structural change. By 2019, England was exceeding the target at 68.5%.

But “achieved” and “sustained” are different things. The rate reached a peak in 2019, then began a modest drift before COVID produced the sharpest single-year fall in the series — and a Bootstrap CUSUM structural step-change that has still not been fully reversed.


What the data shows: 2017–2025

The Estimated Dementia Diagnosis Rate (EDDR) is calculated monthly by NHS England and published on the OHID Fingertips platform. It compares the number of people aged 65 and over with a recorded dementia diagnosis to the estimated number expected to have dementia, based on age- and sex-specific prevalence rates from the Cognitive Function and Ageing Study II (CFAS II). The Fingertips time series begins in 2017, following a methodology change; earlier data under the old methodology is not directly comparable.

Two complementary statistical tools are used throughout this article. The Bootstrap CUSUM (Cumulative Sum) detects structural step-changes in a data series — it answers the question “did the process permanently shift to a new level, and if so when?” The X-mR control chart (Individuals and Moving Range) identifies whether individual data points are within the expected natural variation of the process, or whether they represent genuine special cause signals outside those limits. The UNPL (Upper Natural Process Limit) and LNPL (Lower Natural Process Limit) in the table below are the X-mR boundaries: values outside these limits are statistically unlikely to be random variation. Bootstrap CUSUM leads the analysis; the X-mR sharpens the picture of individual years. If you are new to these tools, Same Data, Three Charts, Three Very Different Stories explains both in plain English.

The X-mR control chart below plots each annual EDDR value against its natural process limits, identifying which years represent genuine special causes rather than routine variation.

X-mR control chart of England dementia diagnosis rate 2017-2025 showing special cause signals in 2019 above UNPL and 2021 below LNPL
X-mR Control Chart — Estimated Dementia Diagnosis Rate, England, 2017–2025. Mean=65.39%, UNPL=67.38%, LNPL=63.40%, URL=2.44 percentage points. All nine values fall within the natural process limits (UNPL 69.61%, LNPL 61.17%). The moving range between 2020 and 2021 of 5.7pp exceeds the URL of 5.19pp — a special cause on the rate of change chart confirming the COVID collapse as statistically unusual. Source: OHID Fingertips.
YearEDDR (%)X-mR signalContext
201768.0Within limitsPost-Challenge high, above target
201867.5Within limitsModest drift beginning
201968.5Within limitsPeak year — closest to UNPL (69.61%)
202067.4Within limitsFirst COVID disruption to diagnostics
202161.7Within limits (mR special cause)COVID collapse — mR 5.7pp exceeds URL 5.19pp
202262.0Within limitsStill in COVID trough
202363.0Within limitsRecovery beginning
202464.5Within limitsContinuing recovery
202565.6Within limits1.1pp below 66.7% target

The Bootstrap CUSUM chart below tests whether the series contains any structural step-changes — permanent shifts to a new mean — and if so, dates them precisely and reports the confidence level.

Bootstrap CUSUM step change analysis of England dementia diagnosis rate 2017-2025 showing two stages at 95% confidence with change point at 2020
Bootstrap CUSUM — Estimated Dementia Diagnosis Rate, England, 2017–2025. One stage at 99.7% confidence, mean 65.39%, SD 2.69%. N=9 annual observations (deduplicated), 1,000 loops, TL=5. The CUSUM rises to 2019–2020 (above the mean) then falls steeply through 2021–2022 (COVID collapse below the mean) then recovers toward zero by 2025. Source: OHID Fingertips. — Reading the chart: There is one data value per year (the red line with dots, read against the left axis). The green line is not a second data series — it is the running cumulative sum of deviations from the overall mean, read against the right axis. When the red line runs above the mean the green line rises; when it falls sharply below the mean (as in 2021–2022) the green line drops steeply, which can appear as a near-vertical line. The blue stepped line shows the stage means. The sharp vertical step at 2020 is the change point marker, not a data error.

Bootstrap CUSUM result: one stage at 99.7% confidence, mean 65.39%, SD 2.69%, N=9. With nine annual observations the series does not contain sufficient data points for Bootstrap CUSUM to confirm a structural stage change at any confidence level, despite the dramatic visual collapse in 2021. The CUSUM shape is revealing nonetheless: it rises steadily from 2017 to 2019–2020 (values above the mean) then falls steeply to 2021–2022 (values well below the mean) then recovers toward zero by 2025 — the classic inverted-V signature of a temporary disruption returning toward its pre-event level. Bootstrap CUSUM correctly reports one stage: the series is returning to where it started.

The honest statistical assessment: nine annual observations is a very small dataset. The pattern is clear visually and the X-mR moving range confirms the 2021 collapse as a special cause. But the Bootstrap CUSUM cannot declare a structural stage change from N=9 alone. More data points — either monthly observations or a longer annual series — would strengthen the statistical picture considerably.

What is a structural change — and why does it matter? A structural change (or step-change) occurs when a process permanently shifts to a new mean level — not a temporary dip or spike, but a lasting change in the underlying system that produced the data. Bootstrap CUSUM is specifically designed to detect these: it identifies when the cumulative deviation from the mean crosses a threshold that is statistically unlikely under random variation alone. A confirmed structural change tells you the system itself has changed — not just that an unusual event occurred. In this dataset the COVID collapse is visible and confirmed as a special cause on the moving range chart, but with N=9 the Bootstrap CUSUM cannot determine whether the system has permanently shifted to a new lower mean or is returning to its pre-COVID level. The recovery to 65.6% by 2025 — close to the overall mean of 65.39% — is consistent with return to the pre-existing process rather than a new structural stage. The conclusion: the PM’s Challenge did not create a detectable structural change in the diagnosis rate that Bootstrap CUSUM can confirm from this dataset. The rate was above target while the policy was active. Whether this was caused by the policy or would have happened anyway cannot be determined from N=9.

The 2019 peak: England briefly got there

The X-mR control chart gives control limits of UNPL 69.61% and LNPL 61.17% — the boundaries of expected natural variation around the long-run mean of 65.39%. With N=9 annual observations the limits are necessarily wide. All nine values fall within these limits, including the 2021 COVID collapse at 61.7% — which sits just above the LNPL. The special cause signal comes from the moving range chart: the 5.7pp fall between 2020 and 2021 exceeds the URL of 5.19pp, confirming the rate of change as statistically unusual even if the absolute level remains within limits.

In Shewhart’s terms: the process was running consistently above the 66.7% target throughout 2017–2020. The X-mR cannot declare a special cause from nine annual data points, but the consistent pattern of values above the mean in Stage 1 is clear. The PM’s Challenge, backed by CQUIN incentives and sustained national focus, had driven the rate to a level it could not sustain without that external pressure.

England crossed the 66.7% target in 2019 at 68.5%

With N=9 the natural process limits are wide (UNPL 69.61%, LNPL 61.17%) and 2019 at 68.5% falls within limits. The X-mR cannot confirm 2019 as a special cause from nine data points alone. What the data does show clearly is that England was consistently above the 66.7% target throughout 2017–2020 — a genuine achievement that is often lost in the post-COVID narrative. The question the data raises is why it required exceptional political pressure to reach and sustain a level that should be the routine floor.

The moving range chart is well-behaved in 2017–2019 — small, consistent year-on-year changes, all within the URL of 2.44 percentage points. The process was stable and improving. Then 2020 arrived.


COVID: the largest single-year fall

The 2020 observation (67.4%) sits on the lower natural process limit — first evidence of COVID disruption to the diagnostic pathway. Memory clinic referrals dropped sharply as GP surgeries reduced face-to-face activity and hospitals postponed non-urgent assessments. But 67.4% is within limits — the system had not yet structurally broken.

The 2021 observation (61.7%) is unmistakable. It sits below the lower natural process limit, and the moving range between 2020 and 2021 — a fall of 5.7 percentage points in a single year — substantially exceeds the URL of 2.44. This is a double special cause signal: the rate itself is out of limits, and the rate of change is out of limits.

The COVID diagnostic collapse in numbers

The estimated dementia diagnosis rate fell by 5.4% between March 2020 and February 2023. GP referrals to memory services returned to pre-pandemic levels quickly — but the diagnosis rate did not recover correspondingly, because referred patients entered a memory clinic backlog that the system could not clear at the rate needed.

England had approximately 850,000 people living with dementia in 2020. A fall of 5.7 percentage points in the diagnosis rate represents approximately 48,000 fewer people with a recorded diagnosis than would have been expected — people navigating dementia without formal diagnosis, without care plan review, without access to the post-diagnostic support that a diagnosis unlocks.

The 2022 observation (approximately 62%) remains below the lower natural process limit. The rate had stabilised at its low point, but recovery had not yet begun.


The slow recovery

From 2022 onwards the rate climbs steadily: approximately 63% in 2023, 64.5% in 2024, 65.6% in March 2025. The moving ranges are small and consistent — the process is back within limits and recovering at roughly 1 percentage point per year.

In November 2023, NHS England announced diagnosis rates were at a “three-year high.” Amanda Pritchard, CEO of NHS England, stated the 66.7% ambition would be met “next year.” By March 2025 the rate was 65.6% — still 1.1 percentage points short.

MetricValue
Bootstrap CUSUM: stages (99.7% confidence)1 — N=9 too small for stage detection
Bootstrap CUSUM: overall mean65.39%
Bootstrap CUSUM: SD2.69 percentage points
X-mR: UNPL / LNPL / URL69.61% / 61.17% / 5.19 pp
2021 vs LNPL61.7% vs LNPL 61.17% — borderline, within limits
2020→2021 moving range vs URL5.7pp vs URL 5.19pp — special cause
National target (set 2012)66.7%
Current rate (March 2025)65.6%
Gap to target1.1 percentage points
Recovery rate (2022–2025)~1 percentage point per year

At the current recovery rate the 66.7% target should be reached by approximately 2026. But the X-mR suggests caution: the UNPL is 67.38%, and sustaining 66.7% above the lower limit requires the rate to stay consistently above what the process naturally produces. The 2019 observation required exceptional political pressure to achieve. Without equivalent pressure or a resolved structural constraint, the rate is likely to settle in its natural range of 63–67%.


Is a diagnosis actually helpful?

The diagnosis rate is the measure closest to the beginning of the care pathway. It answers the question: how many of the people estimated to have dementia have been formally identified? But it does not answer the more important question: what happens after the diagnosis?

The NHS Primary Care Dementia Data publication reports three quality metrics alongside the diagnosis rate. In March 2025:

The medication review gap

The majority of people with a recorded dementia diagnosis had not had their medication reviewed in the past year. For a patient group with high rates of polypharmacy, cognitive impairment affecting their ability to manage complex medication regimes, and significant risks from inappropriate prescribing — including anticholinergic medications that worsen cognitive function — an annual medication review is a clinical safety requirement, not an administrative nicety.

A rising diagnosis rate is a necessary signal of progress. It is not, by itself, a sufficient one.

There is also an emerging treatment dimension worth noting. Until recently, dementia had no disease-modifying treatments — diagnosis enabled support and planning, but could not slow progression. Clinical trials of lecanemab and donanemab have now shown meaningful slowing of early Alzheimer’s progression. If these treatments enter NHS clinical practice, early diagnosis becomes not just administratively important but therapeutically urgent. The case for the 66.7% target strengthens considerably if the treatment pipeline delivers.


What Deming would ask

A numerical goal without a method

“A numerical goal without a method is nonsense.” — W. Edwards Deming

The 66.7% target was set in 2012. The rate ran above it 2017–2020. Five years after the COVID collapse it has not recovered to the target. Bootstrap CUSUM finds one stage at 99.7%: mean 65.39%, below the 66.7% ambition. The CQUIN incentive created demand for assessment without proportionately increasing assessment capacity. The result — a rate that reached the target under exceptional political pressure, then fell sharply when COVID disrupted the pathway — is exactly what a system without a resolved constraint produces.

By what method?

The rate was above 66.7% while the CQUIN was active. Deming’s 12th Point explicitly warns against incentive pay and extrinsic reward schemes: they purchase behaviour rather than embedding it, they optimise for the metric rather than the purpose, and they disappear when the incentive is removed — taking the behaviour with them.

A Deming-consistent alternative would have redesigned the system to make dementia identification routine — building cognitive assessment into every GP over-65 annual review as a standard process, not an incentivised extra. The CQUIN created demand for referral without proportionately building the assessment capacity to receive it. The method was misidentified.

Deming’s question is not “why did COVID collapse the diagnosis rate?” — that answer is obvious. His question is: why, five years after the COVID diagnostic collapse, is the rate still below a target set thirteen years ago? The data shows recovery to 65.6% by March 2025 — but still 1.1 percentage points short. The purchased behaviour was never replaced by embedded system design.

The constraint identified

The binding constraint

The constraint on dementia diagnosis is not patient awareness, not GP motivation, and not public willingness to be assessed. The constraint is memory clinic capacity — the number of specialist assessments available per year. GP referral rates recovered to pre-pandemic levels quickly after COVID. The diagnosis rate did not recover correspondingly — because the referred patients entered a backlog that the memory clinic system could not clear at the required rate.

Goldratt would identify this immediately: you cannot improve throughput by optimising anything other than the constraint. Addressing the EDDR without addressing memory clinic capacity is optimising everything except the constraint.

The root cause of the constraint

Four compounding factors

Identifying the constraint as memory clinic capacity is necessary but not sufficient. Four compounding factors drive the constraint — distinct from the causal loop links described below:

The root cause stated plainly: 30 years of systematic underinvestment in Old Age Psychiatry as a specialty — in training places, career incentives, research funding, and the prestige that attracts medical graduates. Everything downstream flows from that single workforce decision made repeatedly across successive decades.

Two reinforcing loops — the constraint tightens automatically

R1 and R2

The constraint is maintained by two reinforcing causal loops — vicious circles that tighten the constraint automatically, without any external pressure required. In causal loop diagrams, each arrow carries a polarity: S (same direction) or O (opposite direction). A loop with an even number of O links is reinforcing — a vicious circle.

Neither loop requires new external pressure to keep running. They are self-sustaining. The PM’s Challenge added exceptional pressure to a system in two reinforcing loops. The moment that pressure was removed, the loops reasserted themselves.

Two reinforcing causal loops centred on memory clinic throughput: R1 The Workforce Erosion Loop, R2 The Unmet Need Spiral.
R1 — The Workforce Erosion Loop (left) and R2 — The Unmet Need Spiral (right), both centred on Memory Clinic Throughput. Red arrows show O (opposite) links, blue arrows show S (same) links. Two O links in each loop = reinforcing. The diagram was drawn by the author.

Flipping from vicious to virtuous

Reversing the loops

Reinforcing loops can run in either direction. The same structure that drives a vicious circle will drive a virtuous circle if the starting conditions at a key node are reversed.

To flip R1 — The Workforce Erosion Loop — to virtuous, intervene at career attractiveness: mandate Old Age Psychiatry training places; pay parity with neurology and general psychiatry; redistribute tasks off consultant lists so caseload per consultant falls, burnout falls, and attractiveness rises — R1 now runs virtuous.

To flip R2 — The Unmet Need Spiral — to virtuous, increase throughput faster than demand grows: build memory clinic capacity ahead of demographic demand; integrate cognitive assessment into GP annual reviews for over-75s as standard process. When capacity runs ahead of demand the loop becomes self-reinforcing positively.

The critical insight: you cannot flip a reinforcing loop by pushing on the output. The PM pushed on the EDDR. R2 accelerated and R1 continued eroding. What flips a loop is a structural intervention at a specific node that reverses the direction of at least one link. Both require decisions with long lead times — which is precisely why they were not made, and why both loops have been running vicious for 30 years.

What Level 3 looks like for dementia diagnosis

Joiner’s Levels of Fix

Joiner’s framework asks whether we are fixing the output (Level 1), the process (Level 2), or the system (Level 3). Most dementia diagnosis policy has operated at Level 1 and 2. The CQUIN was Level 1. It is worth noting that the answers to Level 3 system interventions can often be found in Deming’s 14 Points — particularly Point 1 (constancy of purpose), Point 6 (institute training), Point 12 (remove barriers to pride of workmanship) and Point 13 (institute self-improvement). Level 3 would address the binding constraint directly:

The key distinction: Level 3 interventions do not require exceptional political pressure to sustain. They are designed into the system so that the outcome is produced routinely.

The lag between intervention and measurable result

Why results take time — and the tampering trap

One of the most dangerous traps in systems thinking is expecting rapid results from structural interventions. Level 3 changes operate on long time horizons. For dementia diagnosis specifically:

The tampering trap. Deming identified a specific and dangerous behaviour that the lag makes almost inevitable: tampering. Tampering occurs when a manager sees that the measures have not responded and intervenes again — adjusting, redirecting, or reversing the intervention — before the first intervention has had time to work. Each additional intervention resets the lag clock. The system never gets the sustained period of stable conditions it needs to produce a measurable result.

In the dementia diagnosis story, tampering is precisely what the political cycle produces. A government mandates Old Age Psychiatry training places. The EDDR does not move for three years (as expected). The next government concludes the intervention failed, reverses the mandate, and replaces it with a new incentive scheme. The lag clock resets. Each iteration is recorded as a policy failure. The actual failure is the absence of constancy of purpose — and the confusion between the lag that structural change requires and the signal that an intervention is not working.

Bootstrap CUSUM is the honest arbiter: it will not declare a stage change until the evidence warrants it. A structural intervention applied consistently over 10 years and tracked with Bootstrap CUSUM will eventually produce a quiet, statistically confirmed shift to a new mean. That is what success looks like in a complex system. It does not announce itself.

Suggested measures — and the balance measures that guard against gaming

Drive measures and balance measures

The EDDR measures the first step of the care pathway. Deming’s critique of measurement applies: a metric that captures only the initial event tells you nothing about whether the system is achieving its purpose. But drive measures alone are not enough — without balance measures, optimising any single metric produces unintended consequences (what Deming called suboptimisation).

Level Drive measure Balance measure What it guards against
InputMemory clinic capacity (sessions/year)Cost per assessmentOver-resourcing without efficiency
ProcessGP referral rate per 1,000 aged 75+Referral conversion rateOver-referral overwhelming capacity
ProcessWaiting time: referral → assessmentDiagnostic accuracy at 12 monthsFaster but lower quality assessments
OutputDiagnoses per 1,000 aged 75+Geographic and demographic equityNational average masking inequality
OutcomePost-diagnostic support within 12 weeksCarer-reported quality of supportBox-ticking support
OutcomeAvoidable crisis admissions per 100,000 aged 75+All-cause emergency admissions 75+Coding avoidance not genuine reduction

A PM advised by this framework would have been tracking six pairs of measures across the full pathway, not chasing one ratio against a 2011 prevalence estimate. The constraint — memory clinic waiting time — would have been visible from the first month it emerged.

The system produced exactly this result

Deming’s 94% rule

94% of problems are caused by the system, not the people in it. The memory clinic capacity constraint was identifiable in 2012 when the target was set. It was not structurally resolved by either PM’s Challenge. The result — a rate that briefly exceeded the target under exceptional pressure, then failed to sustain it — is exactly what a system that has never resolved its binding constraint produces.

The Bootstrap CUSUM one-stage picture — mean 65.39% across the full period, with a visible COVID disruption confirmed by the moving range chart — is the statistical record of a system that was temporarily overridden but never fixed. The same pattern appears in the GP appointments data on this site: a flat line maintained by competing pressures, not by system design. The Deming question in both cases is the same: whose system produced this outcome, and what decisions — taken or not taken — designed it to produce exactly this?


Data notes and methodology

Methodology

Data source: Office for Health Improvement and Disparities (OHID), Fingertips Dementia Profile. Estimated Dementia Diagnosis Rate (EDDR) indicator, England national level. Annual March snapshot. Downloaded via the fingertips_py Python package, 31 May 2026. Available at: dementia-eddr-england.csv.

EDDR methodology: Compares the number of people aged 65+ with a coded dementia diagnosis on their GP practice register to the estimated number expected to have dementia, using CFAS II age- and sex-specific prevalence rates. Expressed as a percentage. A rate of 100% would mean every person estimated to have dementia has a recorded diagnosis.

Series break: The EDDR methodology changed in 2017/18 when CFAS II prevalence estimates replaced earlier survey estimates. Data before 2017 is not directly comparable. This article analyses the 2017–2025 series only. Historical anchor points (target first achieved November 2015; pre-pandemic peak 67.4% March 2020; 5.4% fall to February 2023) are from published NHS England commentary and peer-reviewed literature.

Bootstrap CUSUM settings: N=9 annual observations (after deduplication of source data). 1,000 loops. Turn length 5. Confidence threshold 99.7%. Result: 1 stage, mean 65.39%, SD 2.69%. N=9 is too small to confirm a structural stage change; the visual pattern is clear but the statistical evidence is limited.

X-mR settings: N=9. Mean 65.39%. UNPL 69.61%. LNPL 61.17%. URL 5.19 percentage points. Special causes: 2021 borderline (61.7% vs LNPL 61.17%, within limits); moving range 2020→2021 of 5.7pp exceeds URL of 5.19pp — special cause confirmed on the rate of change chart.

The moving denominator problem: The EDDR denominator is recalculated every month using the current registered GP population in each age/sex band, applied against fixed CFAS II prevalence rates from 2011. This means the denominator grows automatically as the population ages — even if diagnostic activity is completely unchanged. A GP practice that diagnoses exactly the same number of new patients each month will show a falling EDDR simply because its registered population is getting older. The metric conflates diagnostic performance with demographic change. The CFAS II prevalence rates have not been updated since 2011 — if actual dementia prevalence has changed (and there is evidence it has fallen slightly in successive cohorts due to better cardiovascular health), the denominator is systematically wrong. The 66.7% target was not derived from any statistical calculation — it is simply two-thirds expressed as a percentage.

Implication for Bootstrap CUSUM: The one-stage finding (mean 65.39%, N=9) reflects the combined effect of diagnostic activity and demographic change in the denominator. The recovery from the 2021 low of 61.7% to 65.6% in March 2025 has been achieved against a rising denominator — the registered 65+ population is larger and older in 2025 than in 2020, meaning the same number of diagnoses produces a lower EDDR. The recovery is therefore more significant than the raw percentage change suggests.

📈 Part of the StepChange improvement concepts library

This analysis sits within a broader framework for understanding why improvement programmes succeed or fail. Start with Why Nothing Changes for the full picture, or go to Start Here for a guided introduction to the method.