With the increased emphasis on value for money in the health service, skill mix and staffing levels require careful planning. Alastair McElroy, David Rogers and Murial Smith describe a development evaluation project they have initiated

The recent, and continuing, reforms which have been implemented in the health service have placed reprofiling and skill mix firmly on the management agenda (1). Purchasers will place contractual demands on providers for increased levels of service, at higher standards, to be delivered at the same cost. 'Ihis emphasis on value for money will mean that regular reviews of skill mix and staff utilisation will be essential (2,3). Those providers with up-to-date, readily accessible data regarding the number of staff, as well as the required knowledge and skills, will clearly enjoy a competitive advantage over those without (4). However, previous attempts to quantify numbers of staff required in relation to patient dependency levels have often proved artificial and dysfunctional.