Janice Bond is a senior occupational therapist with Sussex Partnership trust. She works on a joint health and social services support scheme for people with dementia

There are three elements to the dementia support service - a respite and assessment unit, a day unit, which is open seven days a week and can take up to 25 people a day, and a community outreach team providing support in the home to patients and their carers.

With only a few specialist dementia services around, these are all very positive initiatives. However, the health and social services joint venture has brought problems which have hindered staff integration. Not enough careful thought has been given to how the two cultures will work together.

The management structure is complex. We still have a health manager and a social services manager and I think the staff find it difficult to know who to go to with certain issues or queries.

What also does not help is having support workers with the same job description, but employed by different people, with differences in their annual and sick leave entitlement, working to different medication policies and reporting to separate managers. The issue of integrating the workforce needs to be taken seriously.

One thing needed is a single-line management structure. It has been talked about for a year or more.

We have to rewrite some of the statutes governing how we provide services. Such logistical concerns are key to any joint venture.

The training programme, particularly for the support workers, is very comprehensive. But the pace of change has been slow and I think that is to do with staff motivation.

Many of the joint venture workers have been redeployed from existing services. I don't think they have the same interest in developing and learning new skills as somebody who actively seeks a position in a specialist dementia team.

I understand the difficulties of having to find jobs for employees when services close, but moving them somewhere they wouldn't necessarily choose to work can be a real negative for a new service.