Evaluation under uncertainty: Autism, dyslexia and the epistemic architecture of fragile healthcare systems

This paper develops a general mathematical theory of evaluation in healthcare grounded in operational fragility and regime-based management. Using national autism and dyslexia assessment systems in England, it formalises evaluation as a stochastic and information-theoretic process rather than a neutral record of clinical reality. Evaluation outcomes are shown to emerge through mutable methodological regimes, probabilistic authority functions, and shifting forms of classification governance. The framework defines explicit fragility parameters (𝜆, 𝜎2 regime/𝜎2 measurement), derives six formal theorems describing discontinuity, information decay, variance bounds, and authority non-commutativity, and validates them empirically with NHS data (2022–2025). Rather than extending qualitative critiques of measurement and classification, the study constructs a falsifiable mathematical architecture in which inference, authority, and system observability replace objectivity as the central analytic categories. The resulting regime-aware evaluation model generalises across healthcare and education systems and provides operational metrics for epistemic stability and system fragility.