Image: Foundation Degree.How a ground-breaking Foundation Degree will enable care home staff to provide routine clinical patient care for the first time. Available from October, the new qualification will bring welcome motivation for care staff by offering relevant career progression and enabling them to enhance the comfort and treatment experience within the care environment.

This work was developed as one of the Skills for Health Higher Education Demonstration sites. It brought together a partnership between Skills for Health, Foundation Degree Forward, University Campus Suffolk and MOVE Lifelong Learning Network, in response to the escalating health care needs of the rising elderly population in Norfolk and Suffolk care homes, the Foundation Degree offers major benefits for the sector across the UK.


The Skills for Health HE Demonstration sites are exploring the optimal methods for education pathway design to meet the needs of employers building upon Competences using a set of principles known as the Learning Design Principles. Care homes in Norfolk and Suffolk were helped through this project.

In recent years, the dramatic expansion in the UK’s elderly population has placed increasing strain on primary care nursing services, and demographic projections suggest this is a trend set to continue. The independent healthcare sector is affected too; many care home residents have long term conditions that require regular treatment or monitoring, which has traditionally been provided by external community nursing care.

Nowhere is the pressure on services more intense than in Norfolk and Suffolk, where popularity as retirement areas has made care homes a substantial employment sector. With the 60+ age group accounting for over 25 per cent of the counties’ present populations, by 2014 the over-sixties will be the largest single population group (set against the under 20s, 20-39yrs and 40-59yrs age groups), and by 2029 they will outnumber any other segment of the population by 2:1.

Current Position

Norfolk and Suffolk care homes are finding an increasing need to request visits from community nursing services in order to deliver key elements of patient care such as dietary monitoring, support for individuals with diabetes, wound-dressing and other routine procedures.

Whilst community nurses carry out treatments, care staff stand by and watch – unqualified to provide or assist in the treatments themselves. The situation is unsatisfactory for both time-pressured community nurses and care staff, whose capabilities are being under-utilised. For many carers who enter the job to provide care, there is no logical career progression route. Progression is usually only available into management positions, which may not appeal to individuals who have taken on a role in order to care for others. As a result, retention rates among carers are low.

Business Need

The rapid expansion in the elderly population and their inevitable healthcare needs, presents the NHS with a rising long term bill for community nursing care. Care home owners and managers are under equal pressure to meet the growing demand for care, and currently struggle with recruiting and retaining their key care staff. Homes must compete for staff alongside other sectors, and need to offer an attractive employee package, both to potential new recruits and existing staff. This includes fulfilling job roles as well as a structured career progression route.

Ian Turner, Chairman of the National Association of Nursing Homes explains:

"We have experienced staff who have given us devoted service for 10 or 15 years and who feel that the registered manager’s award is not for them. If we are to motivate and retain our care staff, we need to offer them professional development opportunities in clinical care – and prevent them taking their skills and experience elsewhere.

Equally, we have increasing staffing needs, and in today’s competitive recruitment market we are finding that potential new employees are keen to know that there is a structured pathway in place for career progression."

Issues and challenges

Prior to settling on a solution, a number of issues and challenges needed to be taken into consideration:

  • Both the NHS and the independent healthcare sector need to increase their capacity and capability to accommodate rising service-demand from an expanding elderly population with long-term healthcare needs.
  • Growing pressure on community nursing services means lengthening patient waiting times for patients in care homes requiring routine clinical care.
  • Care homes need to provide opportunities for staff to expand and advance their skills in order to recruit and retain the volume of employees required to meet future demand.
  • Care homes identified that staff development would need to be either fully work-based or take the form of blended learning to reduce time spent out of the workplace and overcome travel issues experienced in remote parts of Norfolk and Suffolk.
  • To be successful, any new qualification would need to offer transferability and credit accumulation – in addition to ongoing information, advice and guidance in the form of a mentoring system.

The Solution

A collaboration was formed between Skills for Health, Foundation Degree Forward, University Campus Suffolk and MOVE (the region’s Lifelong Learning Network), to examine how care home needs could be met and devise a solution.

The result is a new Foundation Degree for care staff that offers a blend of work based and theoretical learning – and provides credit accumulation and transfer to ensure its long term validity and viability.

University Campus Suffolk worked alongside Foundation Degree Forward to develop a Foundation Degree programme that offered blended practical and theoretical learning. Interest spread and the Strategic Health Authority (SHA) and Skills for Care also joined the collaboration, providing a breadth of expertise to develop a robust and fit-for-purpose qualification.

The resulting Foundation Degree in Continuing Care, was validated on 9th June 2008.

The Benefits

Whilst the benefits to the independent healthcare sector are significant, they also extend to the wider health sector.

… benefits to the care home sector

  • The new progression route and resulting enhanced role for carers will help improve staff retention, and the resulting decline in staff turnover should lead to a better experience for patients.
  • Patient care and levels of comfort will be enhanced through the more timely provision of treatment by familiar care-givers.
  • The use of competences promotes greater efficiency within re-defined roles.
  • Increased staff flexibility will lead to greater efficiency and potential savings within homes.

… to the wider health sector

  • Whilst working under the long arm supervision of community nurses, the enhanced carer will ease the burden on community nursing services and provide a cost reduction to the commissioners.
  • The delivery of timely care and treatment by care home staff is intended to reduce the number of hospital admissions.
  • The availability of care home staff who are qualified to provide enhanced care will reduce the instances of patients having to occupy hospital beds because there is insufficient capacity to deliver the care they need in care homes.
  • As a result of this work, Strategic Health Authorities are showing interest in developing a similar qualification for primary care staff.

Looking to the Future

The first Continuing Care Foundation Degree course will start in October 2008. There is already considerable interest in the degree without the need for any promotion or advertising activity.

With nationwide demand for this type of education expected to spiral, Skills for Health will be making the Foundation Degree content available to interested universities throughout the UK for them to customise to local needs and local university approval arrangements.

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