In the United Kingdom social workers have a key role in assessing the support needs of people with dementia and arranging and reviewing services. Nevertheless, the profession has yet to engage fully with continuing developments in dementia-care research and practice. As the authors of this book acknowledge, in some settings social work with people with dementia and their carers is ‘a creative and responsive process’, while in others it ‘is limited to competent form filling’ (p. 2). Mary Marshall and Margaret-Anne Tibbs are broadly optimistic that the creative approach is on the ascendent; their purpose is to guide and encourage this trend. Social-work texts on dementia are still a rarity and this book is a substantially revised and updated edition of a work published in 1996. Given the rapid developments in dementia research and care, it also serves to update the more recent book, Social Work and Dementia (Tibbs Reference Tibbs2001).

The opening chapters provide contextual information that sets the scene for optimism grounded in realism. Chapter 1 outlines the shift from the old culture of dementia care, with its emphasis on incarceration and routine physical care, to a new culture with a focus on understanding and responding to the unique needs of each individual – a person-centred approach (Kitwood Reference Kitwood1997). Helpfully, a link is made between this approach and the social model of disability with which social workers are familiar. The case is then made for practice that draws on social and citizenship models of dementia care. The former alerts us to ways in which the experience of dementia is shaped by the interaction between impairment and a host of social and psychological factors, many of which are amenable to change once their significance is understood. The latter gives voice to people with dementia, not just as consumers of care, but as citizens with rights and particular expertise in dementia.

Chapter 2 focuses on demographic change and on different types of dementia; it highlights in particular the needs of people with alcohol-related brain damage, a neglected group whose numbers seem set to grow. Chapter 3 examines the UK policy context and its many shortcomings for people with dementia. These include the National Service Framework for Older People (Department of Health 2001), which makes minimal reference to dementia, and UK systems of care management that are characterised by episodic involvement ill-suited to the complex and rapidly changing needs of people with dementia and their carers. The slow progress of specialist knowledge amongst social workers in dementia care may, at least in part, be an unintended consequence of the commissioner/provider split, a key element of the community-care reforms of the early 1990s. This is because expertise in new approaches to dementia care has tended to develop in provider units leaving social workers, who are now predominantly commissioners of services and care managers, deskilled and out-of-touch. This chapter also acknowledges the diverse groups whose needs are still neglected, such as younger people with dementia, people from black and minority ethnic groups and prisoners.

A central message of the book is that understanding the experiences and behaviour of people with dementia and working in partnership with them and their carers is vital for the development of person-centred care. Subsequent chapters explore the complexity of this challenge, by drawing on thought-provoking case studies and a wealth of material on innovative ways of working, interspersed with helpful practical advice. There is far too much here to summarise but for the reviewer, a social-work educator, several points stood out. First, it is essential to gather as much information as possible about the life story of the person with dementia, and the history of their relationship with any carers, as the foundation for understanding. Secondly, it is important for social workers to extend and develop their communication skills, including skills in interpreting behaviour. Thirdly, social workers need to engage with dementia-specific approaches to assessment and to be alert to preferences and functioning in basic aspects of everyday life and wellbeing. For example, recognising difficulties in nutrition and food preparation, or unmet spiritual needs, paves the way to securing specialist help. Finally, social workers should pay greater attention to the importance of activities for people with dementia to avoid boredom, to stimulate cognition and for wider therapeutic purposes.

This book does not downplay the difficulties that practitioners face in tackling a complex task that requires enormous skill in policy and practice contexts that are often demoralising. An entire chapter considers how social workers can maximise existing opportunities to create positive change. The authors also acknowledge that ‘the knowledge base for the social model, let alone the citizenship model, is still woefully inadequate with far too little “evidence” of what works and what does not’ (p. 212). There are gaps in coverage: in particular, it would have been useful to have had something on decision making around the need for long-term residential care and on palliative care in dementia, to enhance understanding of key issues and decisions at this important stage. These are, however, minor quibbles about a book that provides a wonderful introduction to a rapidly developing field of practice. Although intended for social workers, it will be of interest to allied professions and to anyone who wishes to be informed, intrigued, excited and challenged about dementia care.