Educate to communicate

There are plenty of challenges in providing high-quality,
seamless patient and service user-centred care. Among them is a
growing awareness that all staff need appropriate literacy,
language and numeracy (LLN) skills to carry out new and changing
roles with confidence and efficiency. LLN encompasses English for
speakers of other languages, and LLN skills, also known as basic
skills and skills for life, are essential in health and social

To address the national LLN gap, which is reflected in the UK’s
massive national health and care workforce, the government’s Skills
for Life funding rules entitle every adult without a level two
qualification (GCSEs at grades A*-C or equivalent) to free LLN
training. Added to this is an increased emphasis by the National
Learning and Skills Council on user and employer-led LLN training
and delivered in the workplace wherever possible.

But the first instinct of many employers, under pressure to
implement national occupational standards, agenda for change and so
on, is denial in the face of the unfamiliar. It’s a perfectly
understandable reaction which may in part be based on a
misapprehension of what basic skills are.

Managers who have tried to address the issue are confronted by a
baffling array of training offers, many of which fail to fully meet
the needs of the organisation or its staff. And faced with the
prospect of sitting in a classroom at a local college learning
maths and English, many staff who lack level two qualifications
will decline the training offer, and may even feel threatened by

But LLN is not just another initiative that can be opted into
when all the others are done and dusted. It is all about the
delivery of health and social care priorities and strategies.
Substitute the words “communication” and “measuring and
calculation” for literacy, language and numeracy and the message
becomes very clear. All staff, whatever their role, need sufficient
communication and calculation skills to understand and follow
procedures correctly and safely, and to accurately interpret the
needs of, and relay information to and about, the people for whose
health and well-being they are responsible.

Research on behalf of the then Topss England (now Skills for
Care) highlighted the problems with not engaging with the LLN
agenda.(1) Managers interviewed for the research were clear that
lack of basic skills in staff exposed a social care business to
risk on three fronts:

  • Breaches of health and safety or other regulations, inspection
    failure or even legal action.
  • Poor quality care for service users.
  • Difficulties with staff recruitment, retention, training and
    NVQ achievement.

The research concluded that “poor recording and reporting
standards, not understanding written information and instructions,
not understanding numbers and poor oral communication lead to poor
handover at the end of shifts, poor quality records and paperwork,
the risk of errors and accidents and a lower standard of care for
service users”.

The Health and Social Care Stakeholders’ Forum of the National
Learning and Skills Council is aware of the importance of LLN
skills in health and social care, and of the difficulties providers
in the public, private and voluntary sectors have in accessing
appropriate training.

As part of a wider action plan, the forum is funding a project –
Essential Skills for Health and Social Care – to develop a national
framework for embedding LLN into health and social care strategies
and organisations, and to ease employer and staff access to
high-quality LLN training. Public sector union Unison, a member of
the forum, is leading the project and drawing on the work of the
growing network of union learning representatives.

During the first stage of the project, from October 2004 to
January 2005, research consultants worked to identify the level and
range of LLN provision in health and social care. Their report,
Promoting Skills for Life in Health and Social Care, completed this
month, sets out the national policy context, identifies existing
good practice, and highlights the needs of, and issues for,
employers and managers in the sectors. The steering group examines
the recommendations in depth this month.

The second stage of the project involves two strands of

  • Making the case for embedding and mainstreaming LLN training
    within organisations. A series of free regional events will take
    this message to employers and other stakeholders in Birmingham (13
    May), Leeds (20 May), Bristol (10 June) and London (17 June).
  • Working with 10 partnerships across the country to test and
    evaluate models of good LLN delivery practice. The partnerships
    will include employers, training providers and funders and aim also
    to involve health and social care providers from the private and
    voluntary sectors as well as statutory services.

The partnerships will offer manager awareness training, LLN
needs assessment, workplace training, developing individual
learning plans linked to personal development plans, and national
tests in literacy and numeracy.

Evaluation will be integral to the package, but there will also
be an opportunity for employers to gain richer data about the
impact of LLN learning by linking with researchers from the
National Research and Development Centre based at the Institute of
Education, in London. The centre is carrying out rigorous research
into the longer-term impact on staff of workplace LLN learning in a
variety of sectors.

There are many good reasons to engage in the LLN agenda, both
for organisations and key staff who have missed out on the
opportunity to develop their skills and build their confidence.
Evidence is growing that they don’t leave after acquiring LLN
skills, but gain a new enthusiasm for their work, and respect for
the employer who has shown it values them. With so much to gain,
why not give it a try?

  • For full details of and places at the free regional events,
    please contact Brenda Hurst at 
     If you are a health and social care provider who would like to
    know more about any aspect of the project, or if you have a good
    story to tell about the impact of basic skills learning on members
    of your staff, please contact the author.


Literacy, language and numeracy skills (LLN) are necessary for
staff in health and social care to carry out their roles
effectively. This article looks at how health and social care
organisations involved with the National Learning and Skills
Council are developing a framework for improving the LLN skills of


  1. C Eborall, Basic Skills in Social Care, Topss England, 2004.
    Available at

Further Information

  • For a description and evaluation of employer and union learning
    partnerships, see Helen Rainbird et al, Learning Partnerships in
    Health and Social Care, Unison, 2001. No charge, e-mail
  • For information on the work of the National Research and
    Development Centre for adult literacy and numeracy, including
    research in health and social care, go to
  • For a free employers toolkit that puts the business case for
    LLN in the workplace and provides guidance to embedding LLN into
    organisations, e-mail, quoting
    reference ETKV2-2004
  • For a range of useful information and good practice examples in
    LLN provision, visit the Workplace Basic Skills Network at

Contact the Author

E-mail:, or
phone: 020 7551 1676

Brenda Weston manages the Essential Skills in Health and
Social Care Project at Unison Open College. Formerly a policy
researcher and research unit manager, she has also been a social
services planner, working in joint health and social services
strategic planning teams and consulting service users about
community care service development.


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