Mapping dementia care: from variation to evidence-informed improvement

11 Jun 2026

As the HQIP-commissioned National Audit of Dementia (NAD) releases its latest report on dementia care, Associate Director James Campbell, examines how its insights – and the work of the audit more generally – provides an important opportunity to improve care, patient experience and safety.

The number of people living with dementia in the UK is estimated to be almost 1 million, with projections indicating that it could rise to 1.4 million by 2040*. For people living with dementia, the journey through health and care services is rarely straightforward. From first concerns about memory, through diagnosis, to care in hospital and beyond, multiple services are involved, and the way they connect can vary significantly.

The latest service mapping work from the National Audit of Dementia (NAD) – which is run by the Royal College of Psychiatrists and managed by HQIP on behalf of NHS England and others- offers an important new perspective on this pathway. By examining how dementia diagnostic services are organised and delivered across England and Wales, it highlights not just where variation exists, but where improvement is most needed.

What service mapping reveals

The NAD service mapping exercise set out to understand how dementia diagnostic services are structured across the system, capturing how patients move between primary care, memory services, specialist assessment and follow‑up support. What emerges is a complex and highly variable landscape. The route to diagnosis is not consistent and the availability of investigations, treatment and support also varies between services. This variation is not simply organisational detail. It has real consequences for patients and carers:

How quickly someone receives a diagnosis
What support they receive afterwards
Whether their care feels joined up or fragmented.

Mapping these pathways is therefore an essential first step in improvement. It allows the system to move from anecdote to evidence, identifying where differences are unwarranted. Dr Charlotte Deasy, Clinical Lead at NAD, expands on the value of audit in improving care further: “By measuring what is happening, we can advocate for improvement through service level, system-wide and policy changes.”

This presents a system that understands the goal, but where delivery remains uneven

These NAD findings are reinforced by earlier work on Memory Assessment Services (MAS). The MAS spotlight audit showed that:

Waiting times for diagnosis have increased
Access to assessment, imaging and post‑diagnostic support varies widely between services
Patients in more deprived areas can experience longer waits and reduced access.

Variation on this scale means that a person’s experience of dementia care can depend significantly on where they live. The service mapping work adds a new dimension to this understanding. It shows not only that variation exists, but how it is shaped by differences in service design, commissioning and data flows across the pathway.

A wider system perspective: findings from the CQC

The challenges identified through NAD data are also reflected in national regulatory insight. The Care Quality Commission (CQC)’s research, published in March 2026, highlights that people living with dementia often face:

Delays in diagnosis and access to support
A lack of continuity once diagnosed
Variation in how well services understand and meet individual needs
Inconsistent communication with carers.

At the same time, the CQC is clear about what good care looks like. It should be:

Person‑centred and coordinated
Shaped by the individual and their carers
Delivered by staff with the skills, training and time to respond effectively.

Taken alongside the NAD findings, this presents a picture of a system that understands the goal, but where delivery remains uneven.

From diagnosis to hospital care: evidence of improvement

While variation persists, the evidence also shows that improvement is happening. Within hospital settings, NAD continues to demonstrate the impact of sustained measurement and feedback. Between 2023 and 2024:

Pain assessment increased from 92% to 98% of patients
Delirium screening increased from 87% to 92%
Carer‑reported experience improved, including communication and overall care quality.

These changes are significant. They reflect improvements in areas that directly affect safety, recovery and patient experience. They also demonstrate the value of audit data not just in identifying problems, but in supporting change over time.

National clinical audits – the largest programme of which in the UK is run by HQIP – measure care and share insights to improve and save lives. Data and outcomes from these audits help care providers to identify variation, trends and opportunities for improvement in the care and management of a range conditions. This, in turn, empowers clinicians and system leaders to focus resources where they can have the greatest impact.

In the case of dementia, the impact of this data becomes most visible when it is used locally. At South Warwickshire University NHS Foundation Trust, audit findings led to the creation of a Dementia and Delirium Outreach Team, supporting ward staff to improve care. The results included:

A 20% reduction in length of stay
A 10% reduction in discharge to long-term care
An estimated 1,608 bed days saved.

These are meaningful outcomes for both patients and the system, demonstrating how evidence can translate into tangible improvements in care and efficiency.

The role of patient and carer experience

Across all parts of the pathway, patient and carer experience remains central. Audit findings show improvements in communication and overall care, but also ongoing concerns about involvement, information sharing and consistency of care. This aligns with CQC findings that carers often feel under‑informed or are required to advocate on behalf of their relatives. Ensuring that these voices are heard, and acted upon, is a critical part of improvement. It ensures that changes to services are grounded in what matters most to those using them.

Phil, a patient with Lewy body dementia, expands on this point: “There needs to be an emphasis on providing tailored services to meet local needs, to avoid a generic model that supposedly ‘fits all’ and, in fact, doesn’t meet the needs of those living with a diagnosis of dementia. This can only be achieved by those who plan and commission services engaging with those of us who live with the disease, so that services are based on people’s actual needs.”

Audit insight

Across diagnostic services and hospital care, improvement depends on a cycle of measurement, learning and action. The National Audit of Dementia is central to this cycle, bringing together data, insight and improvement support across the dementia pathway. And there will be further insight to come from the audit, giving the opportunity to use the evidence more systematically, reduce variation and ensure that high‑quality care is not the exception, but the standard.

For people living with dementia, and for those who care for them, that is not simply a policy ambition. It is a necessity.

*Source: NHS England