The budgets of NHS Trust Hospitals are continually under scrutiny in an endeavour to reduce operating costs. Skill mix, the balance of professional staff to non-professional staff, is a part of this process and the NHS has introduced a new level of staff called "health care assistants" (HCA). Examines the role and training of the HCA, and the reaction of professional nurses to their introduction into the area of patient care. Highlights areas of concern in relation to HCA training, selection techniques, and the absence of national guidelines which would ensure the quality level of HCAs produced. There is evidence of some managements leaning towards "cheaper" staffing, i.e. using HCAs to replace professional nurses, and the conclusions give rise to some concern in quality of patient care and in the falling morale of professional nurses.