So, despite improvements in recent years, quality and outcomes are still falling behind increasingly high expectations of the public and people living with dementia. Evidence suggests that applying a systematic approach to service models and delivery might contribute to better outcomes.

In order to ensure any proposed revised model would be grounded in the reality of experiencing dementia, delivering services and commissioning locally, the author used a range of methods over a 6-month period in 2011 in the South West of England. These methods included:

• listening to local people living with dementia
• talking to commissioners, providers, staff and other experts in statutory and non-statutory settings
• visiting local services
• non-participant observation/shadowing practitioners, and
• incorporating evidence of good practice, policy and relevant literature.

A number of themes emerged time and again, leading to a re-think about dementia and the people who live with it. This, in turn, has led to the proposal of a new understanding of the dementia journey and a revised model of care for dementia, aimed at improving experiences and outcomes, and informing service redesign and commissioning.

Note: in this paper, the phrase ‘people living with dementia’ refers to people who have dementia and their carers and families. All names and some details have been changed to protect anonymity.