In the light of the recent recommendations of the Society of British Neurological Surgeons on safe neurosurgery, we prospectively audited the work load, availability and efficiency in the use of neurosurgical resources in our department over a 1-month period. There were a total of 130 admissions--70 emergency and 60 elective cases. Twenty-three patients referred as emergencies were denied admission, directly or indirectly, because of shortage of beds. Other emergency cases had to wait unacceptable long periods, up to 17 days, prior to admission for the same reason. For elective cases, there was a 33% cancellation rate due to lack of beds and competition with the emergency cases for the same resources. Overall bed occupancy rate exceeded 100%. We conclude that the current neurosurgical resources are inadequate and over-stretched leaving no safety margin. Neurosurgery as a core emergency service, therefore, should be given priority in NHS resource allocation.