How much of an impact have NVQs had in the health service - and will they be superseded by the new individual learning accounts with their broader outlook? Thelma Agnew reports

The NHS plan promises new individual learning accounts for all staff without a professional qualification - or training to NVQ level two or three. So what does an ILA do that an NVQ doesn't?

Dr Keith Holdaway, head of workforce development at Mayday Healthcare trust in London, says: 'An NVQ is a very good method of qualityassuring work, but the ILA looks to me like a good way into wider lifelong learning. It will not just be: 'You are a care assistant - learn about care assistant things', but 'learn about broader healthcare'. '

ILAs have been developed by the Department for Education and Employment. A few are already offered via Training and Enterprise Councils and chambers of commerce.

A contribution of£150 is made for over 19-year-olds prepared to put£25 into training - or discounts are offered on courses, with a bias towards computer literacy.

NHS staff can apply but the NHS plan gives the scheme a higher profile. It talks about£150 ILAs for the health service. Health secretary Alan Milburn has since clarified this. The Department of Health is to match the£150 already available from the DfEE, making£300 in total.

The NHS plan is being worked into more tangible proposals by London regional office, in a project involving Unison, the University for Industry and the Workers' Education Association. The project is led by Ian Barber, on secondment from his job as eastern region head of health for Unison. The union's successful Return to Learn course, in about 50 trusts, looks set to influence the new accounts. It teaches learning skills to people with little formal education experience.

'Investing in the training needs of this neglected group of staff was a partnership approach that benefited everybody, ' says Mr Barber.

There is nothing to stop trusts setting up their own schemes for support staff, but there is no sign of a stampede.

As the NHS plan points out, the NHS has long neglected the need to invest in the 'skills and potential' of staff without a professional qualification.

This can be seen by Mayday's analysis of its training expenditure three years ago.

Each consultant had£400 a year spent on training, works officers (professional staff in estates)£425, managers£275, nurses and professionals allied to medicine£73, administration and clerical staff£4-£5 and ancillary staff£1. Since then, spending on admin and clerical staff has jumped to£100, mainly due to the cost of computer training.

The most neglected group are the hardest to reach.

'Ancillary staff tend to be contracted out, so the issue is with the companies employing them, ' says Dr Holdaway.

NVQs have had a limited success in the NHS. The problem, says Dr Holdaway, is that support staff do not always have enough input from their assessors. Lack of time limits and the NVQ system's openended structure means assessors (often busy nurses) have no deadline and things can drift.

The NTO for 'providing health, social and protective services' has awarded 3 million NVQs since 1988 - 51,291 last year. This sounds good, but although the NTO covers 'care' services and 'diagnostic and therapeutic support', it also provides 'emergency fire services', 'landfill operations' and 'locksmithing'.

Stuart Marples - now chief executive of the Institute of Healthcare Management - believes NVQs 'have the potential to play a very big part in the future education of staff '. A few years ago he oversaw an NVQ exercise at the Royal Bournemouth and Christchurch Hospitals trust, where he was chief executive.

'At one stage we had 600 staff going though NVQs, from managers through to care workers. Some care workers, when they got to NVQ level-3, went on to do nurse training. '

Training non-professional staff looks increasingly like an vital way to compete for scarce workers. Sally Storey, director of human resources at Bournewood Community and Mental Health trust and president of the Association of Healthcare Human Resource Management, says her trust's commitment to NVQs has given it an edge in Surrey's labour market.

Pay rates for care support staff are£3,000-£4,000 lower than the local private sector, with a vacancy rate of 15 per cent, compared to 11 per cent in the independent sector. 'It is not a great difference. '

Employers with little interest in spreading the joy of learning should have other, less altruistic reasons, for extending lifelong learning to non-professional workers.