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Purpose
– The purpose of this paper is to describe the loss of autonomy and control as the core problem in dementia and highlights the individuality of the lived experience of dementia. It analyses the failure of dementia services to keep the individual central to their design and identifies that failure as the unavoidable result of methodological error.


Design/methodology/approach
– The paper guides the reader through the conceptual error in dementia service design and highlights the disconnect between clinical symptomatology and the lived experience of the person with dementia. The analysis continues with the fact that dementia diminishes those brain functions central to the lived individuality, a characteristic which should inform service design.


Findings
– The paper proposes an approach, building on these insights, to build a personalised care plan and resource centre, thus filling the gap system-level design of dementia services are bound to leave open.


Practical implications
– The paper presents a pragmatic approach using a digital, portable and editable care planning tool and personalised resource centre, which can be populated by the person with dementia and/or carer(s) with facilitation from, e.g. trained volunteers or others.


Social implications
– The care planning tool will have a range of functions, including facilities to aid staying in touch with relatives or peers (or anyone else, dependent on personal preferences), enable building peer-to-peer support networks and thus minimise social isolation and loneliness.


Originality/value
– There is limited understanding of the reasons why dementia services struggle to be user-friendly, accessible, transparent and responsive. The paper provides new insight into why this is comprehensively the case and its description of a digital healthcare platform, owned and formulated by the person with dementia, directly builds upon this insight and identifies how such a device can form part of a solution.

Background: Psychiatry along with other medical disciplines has been under siege in the UK and the USA for a number of years and for a number of reasons. These have varied from various medical scandals and funding changes to political imperatives and public expectations. Changes in the knowledge base have added yet another dimension to this debate.Material: The subject is explored using historical figures and their writings and an overview of historic views on the psychiatry profession.Discussion: The demise of the psychiatrist as an expert and the profession of psychiatry as an expertise can be related to both real and perceived factors. Unlike, for instance, the language used by cardio-thoracic surgeons, the language used in and for professional communications in pyschiatry has become very similar to that used in lay discourses on psychological and relationship matters in the general population — partly as a result of the Freudian project successfully insinuating itself into 'common knowledge' and partly as the influence of media grows across the globe. This language has been misappropriated by a wide variety of non-experts, who then speak and interpret it as if they are specialists and any challenge from professionals is seen as self-protection and heresy. As psychiatrists, we do not use technology in a persuasive way as other branches of medicine tend to and this takes away a powerful symbolic conveying 'expertise'. Increased consumerism adds yet another dimension to this discourse.Conclusions: The patient is definitely the expert on how their illness affects their life, but it is the psychiatrist who is the expert on the illness rather than simply focusing on disease. It is time for the profession loudly to proclaim itself for what it is and what it can and cannot do.

Dementia is increasingly and widely recognised as a serious health and social challenge, in the developed world as well as in the developing world. The need therefore to design and implement dementia care services of high quality is becoming more and more vital, particularly given the likelihood of ever increasing demand in a world, which likely sees resources at best remaining at current levels. Designing and Delivering Dementia Services describes current developments in the design and configuration of dementia services. It offers an informative and detailed overview of what constitutes high quality care, considering the circumstances patients and carers may find themselves in. For dementia to get the priority it deserves, a number of factors are important and the book charts the invaluable contributions of various Alzheimer's Associations and Societies: this provides a focus on dementia strategies and plans at national levels: the book reports on the state of affairs regarding such strategies and provides a unique insight into the process of how one of these was developed and implemented. Recognising the need to prove that service developments lead to a higher quality of care, increased productivity and increased efficiency, the book links the resulting picture to service-based research methodologies, with an emphasis on the strengths and limitations of that research. Contributions from 17 countries on 4 continents give an overview of the state of affairs across the world, paying attention to successful - and less successful - initiatives to improve dementia care. The book furthermore provides pragmatic approaches to ensure planning becomes reality, highlights the need for structured workforce development, education and training and describes the opportunities afforded by assistive technology. This book is of prime informative and practical