Open Access Open Badges Research article

The relationship between staff skill mix, costs and outcomes in intermediate care services

Simon Dixon1, Billingsley Kaambwa2, Susan Nancarrow3*, Graham P Martin4 and Stirling Bryan5

Author Affiliations

1 School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK

2 Health Economics Unit, Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK

3 Centre for Health and Social Care Research, Sheffield Hallam University, Montgomery House, 32 Collegiate Crescent, Collegiate Campus, Sheffield S10 2BP, UK

4 Department of Health Sciences, University of Leicester, Adrian Building, University Road, Leicester LE1 7RH, UK

5 Centre for Clinical Epidemiology and Evaluation, University of British Columbia, Seventh Floor, 828 West 10th Avenue, Research Pavilion, Vancouver BC V5Z 1M9, Canada

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BMC Health Services Research 2010, 10:221  doi:10.1186/1472-6963-10-221

Published: 29 July 2010



The purpose of this study was to assess the relationship between skill mix, patient outcomes, length of stay and service costs in older peoples' intermediate care services in England.


We undertook multivariate analysis of data collected as part of the National Evaluation of Intermediate Care Services. Data were analysed on between 337 and 403 older people admitted to 14 different intermediate care teams. Independent variables were the numbers of different types of staff within a team and the ratio of support staff to professionally qualified staff within teams. Outcome measures include the Barthel index, EQ-5D, length of service provision and costs of care.


Increased skill mix (raising the number of different types of staff by one) is associated with a 17% reduction in service costs (p = 0.011). There is weak evidence (p = 0.090) that a higher ratio of support staff to qualified staff leads to greater improvements in EQ-5D scores of patients.


This study provides limited evidence on the relationship between multidisciplinary skill mix and outcomes in intermediate care services.