Taking into account the findings from this project, a revised model of care for dementia is proposed in Table 4, using the model elements described earlier (guiding principles, the condition itself, the person with the condition, service aims and structures, and effectiveness).
Note that statements about existing approaches are necessarily simplified. Of course, not all services or communities are currently working according to existing approaches or within any one model. Indeed there are many positive practice examples from existing services. The emphasis is on where we can move to, rather than on where we are moving from.
The model incorporates a revised values base that leads to an understanding of dementia as a long term condition that affects memory, physical & mental health and social experience and behaviour. It is experienced not only by the person with the dementia symptoms but also their family and friends. It can be treated in its early stages and there are a series of relatively predictable needs and phases (a journey) that can be understood, sometimes prevented, planned for and alleviated. The person with dementia needs to be seen, not as a frail old person without mental capacity, but as a person with a personal and social identity. They have a life story, a family, a community and a social network. They can continue to enjoy a good quality of life, make decisions and contribute to society. He or she will need help at times and will certainly need increasing levels of support as the condition progresses.
Critical to the refreshed model is a radically different framework for type, range and placing of services and opportunities. Rather than a traditional approach in which primary care is seen as the initial gateway into specialist mental health services, with some complementary voluntary sector additions, this new model envisages a range of statutory and non-statutory services and opportunities working together and integrated at a commissioning with primary care in the lead, and specialist dementia services at times of specific, defined need (Figure 2).
