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Dependency, skill mix and grade mix and their effects on health visiting practice.

The use of dependency in assessing types of skill mix and of grade mix in health-visiting practice is discussed. With regard to the present system, where computer information systems may be used to give an indication of the skill mix required, the emphasis on efficiency rather than effectiveness is discussed. Note is made of the disproportionate emphasis of physical over psychological, social and emotional needs. The implications of skill mix and grade mix in the community setting are discussed, with special reference to the advent of health-care assistants, nursery nurses, and other non-health-visiting staff. Finally, the inevitable influence of politics on health care, and its relationship to skill mix, grade mix and dependency is considered.