Dementia training tiers 1, 2 and 3 explained for care providers

The Dementia Training Standards Framework sets out three tiers. Tier 1 is dementia awareness for everyone working in health and social care. Tier 2 is for staff who regularly work directly with people living with dementia. Tier 3 is for supervisors, managers and leaders. The framework was updated in February 2026.

That last sentence is the reason to read the rest. The framework has been the national reference for dementia training since 2015, and a refreshed version landed in February 2026 with updated language, evidence and external references. Most training matrices I look at still map to the 2018 edition, and most providers do not know their eLearning supplier has not updated either

What the three Dementia training tiers actually mean

The tiers describe how much dementia knowledge a role needs, not how senior the person is.

The framework was commissioned by the Department of Health and Social Care and developed by Skills for Health and Skills for Care. It sets out 14 subjects, from dementia awareness through to end of life care and leadership, with learning outcomes written separately for each tier.

Tier 1: dementia awareness. For everyone working in health and social care, whatever the role. In a care home that means the cook, the maintenance person, the administrator, the activities coordinator, agency staff and volunteers, alongside every care worker. It covers what dementia is, how it affects people, and how to be respectful and supportive.

Tier 2: skills and knowledge for direct care. For staff who regularly work directly with people living with dementia. Care workers, senior carers, nurses, and often the activities lead. It covers person-centred approaches, communication and interaction, responding to distress and behaviour, and supporting wellbeing.

Tier 3: leadership in dementia care. For supervisors, managers and leaders who shape services and lead teams. Registered managers, deputies, team leaders and anyone who trains or supervises others. It covers service design, evidence-based practice, quality improvement and leading a dementia-capable team.

The framework is incremental. Tier 2 assumes Tier 1. Tier 3 assumes both. And not every role needs every learning outcome in its tier: the expectation is that the team collectively covers what the service needs.

What changed in February 2026

The framework has been fully reviewed. The tier structure and the 14 subjects remain, but language, terminology, expectations and external references have all been refreshed, and outdated content removed.

The update aligns the framework with current policy, including the NHS 10 Year Health Plan and its emphasis on personalised, community-based services and integrated health and social care. It also draws more directly on the voices of people living with dementia.

For a registered manager, the practical consequences are small in number and easy to act on:

• Your training matrix may still cite the 2018 version by name. Update the reference.

• Your eLearning supplier should be able to tell you which subjects and which tier their content maps to, and whether that mapping has been reviewed against the 2026 edition. Ask them in writing.

• Any internally written dementia content should be checked against the refreshed language before it is delivered again.

  
  

None of that is urgent in the way a safeguarding concern is urgent. But if an inspector asks what standard your dementia training is built to, "the current national framework" is a better answer than a document that was superseded six months ago.

Not sure which of your staff sit in which tier? Bring your team list and the situation your staff find hardest to a 20-minute Dementia Training Needs Review, and leave with a tier map and a recommendation on what to deliver in a room.

The mistake almost everyone makes

Tiers are not qualification levels, and they are not the same as Oliver McGowan training. Three confusions come up repeatedly.

Tier 2 is not Level 2. Tiers describe depth of dementia-specific content. Levels describe the academic weight of a qualification. A Level 2 award in dementia awareness may well deliver Tier 1 outcomes and only part of Tier 2. The two systems are unrelated and the numbers happening to match is a coincidence that causes real confusion on training matrices.

The Oliver McGowan Mandatory Training is a different requirement. It covers learning disability and autism, and it is not dementia training. Completing it does nothing for your dementia tiers, and completing dementia training does nothing for that requirement.

The Care Certificate is not enough on its own. Standard 9 covers awareness of mental health, dementia and learning disability. That is genuine Tier 1 content, and it is a good start for a new care worker. It is not Tier 2, and a care worker supporting people living with dementia every shift needs Tier 2.

If your matrix has a single column headed "Dementia" with a tick in it, you cannot currently tell which of these three things you have bought.

What each tier looks like in practice

Tier 1 works well online. Tier 2 does not, and the evidence and the guidance both say so.

Research on dementia education across the tiers found that Tier 1 content had the strongest effect on staff knowledge, Tier 2 on staff attitudes, and Tier 3 on staff confidence. That is a useful finding for planning, because attitudes and confidence do not shift by reading.

NICE NG97 goes further and recommends that providers give additional face-to-face training and mentoring to staff who deliver care and support to people living with dementia. NHS England's simulation-based DEALTS 2 resources exist for exactly this group, which tells you something about how Tier 2 was designed to be delivered.

So a realistic delivery model looks like:

Tier	Who	Delivery that works
1	All staff, including ancillary, agency and volunteers	eLearning, at induction, refreshed periodically
2	Care workers, seniors, nurses, activities	Facilitated session with scenario practice, then workplace observation
3	Registered manager, deputies, team leaders, trainers	Leadership-focused session, supervision, service improvement work

What CQC will actually look for

Not the tier label. Whether the person can do the thing, and whether you can show it.

There is no regulation that names the tiers. Regulation 18 requires that staff receive appropriate training and that they are competent for the work they do. The framework is how you demonstrate that your training is built to a recognised national standard, which is a strong answer to "how do you know your training is any good?"

It is a weak answer to "how do you know this care worker can support Mrs A when she becomes distressed?" That question is answered by an observation, with a named assessor, a date, what was seen and what happens next.

This gets sharper under the framework coming at the end of 2026. CQC's draft adult social care framework replaces 34 quality statements with 24 key lines of enquiry, removes numerical scoring and reintroduces rating characteristics, which are plain descriptions of what each rating looks like in practice. An inspector will be matching your service against a description.

Tiers on a matrix describe your intent; observations describe your practice.

Map your team to tiers this month. Then work out which Tier 2 staff have only ever had Tier 1 content, and which have never been observed. That gap is your training plan.

FAQ

Is dementia training mandatory in adult social care? 

There is no single regulation naming the Dementia Training Standards Framework or its tiers. Regulation 18 requires appropriate training and competent staff, and NICE NG97 recommends specific dementia training for all staff supporting people living with dementia, with additional face-to-face training for those delivering care. In practice, a service supporting people with dementia and no dementia training would struggle in an assessment.

Does the Care Certificate cover dementia training? 

Partly. Standard 9 covers awareness of mental health, dementia and learning disability, which maps to Tier 1 content. Staff working directly with people living with dementia need Tier 2 on top of it.

How often should dementia training be refreshed? The framework does not set a frequency. Annual refreshers are common practice. A more useful trigger is evidence: an observation showing practice has drifted, a pattern in incidents involving distress, or a change in the needs of the people you support.

Does Tier 2 have to be delivered face-to-face? Not by regulation, but NICE recommends face-to-face training and mentoring for staff delivering dementia care, and the Tier 2 outcomes are about responding to another person rather than recalling facts. Online content can carry the knowledge; the response needs rehearsal.

Do we need Tier 3 if we are not a dementia-specialist service? If your registered manager or team leaders supervise staff who support anyone living with dementia, yes. Tier 3 is about leading and improving dementia care, not about specialism.