Dementia care is in transition, and the potential exists for a radical reform of the provision of services to people with dementia. Recent developments in Scotland based on the report of the Royal Commission on Long Term Care, With Respect to Old Age, provide an example of the possibilities and opportunities available to governments for creating services based on principles of equity and justice. It is timely therefore to consider the implications of recent government reports for the development of dementia care provision. This paper explores the social and political context of formal dementia care provision and considers the implications of recent government reports for the future. The historical discourses surrounding the term ‘dementia’, and where and who cares for people with dementia, provide insights into the options available to policy makers. A brief exploration of the economic context of dementia care provision, and of the historically low level of political interest in dementia care, provides a backdrop to recent political initiatives that seek to redress this omission.