[영문]A major policy plank in health and social care involves rebalancing ?skillmix? or occupational grademix to effect cost efficiency savings. In line with this, there has been a large expansion in recent years in the employment of care assistants/support workers. This article focuses on the largest employment area for these occupations ? healthcare. It draws upon commissioned research projects to detail the context for the introduction of these new grades, to highlight issues in practice and usage to date, and to analyse tensions between policy objectives around efficiency and equity in the employment of these workers.