The effective clinical skills and knowledge of healthcare professionals are absolutely vital for the safe care of patients. Understanding the skill mix across the workforce, their progress in developing professionally and any areas that are falling behind is also essential in providing effective and efficient care. And supporting staff in their professional development underpins retaining a motivated and happy clinical team across the organisation.

Competencies are also where policy meets the real world – policies show intent, competencies show action. And if you don’t know if your clinical teams have the clinical skills stated in the policy, how can you say whether that policy is working?

But there is a huge amount of complexity underpinning these vital competencies. There are hundreds of different competencies from a wide variety of sources, which need to be assigned correctly and consistently to thousands of nurses and other healthcare professionals. Staff turnover (permanent and temporary) means repeating this for hundreds of new joiners each year.

The competencies themselves are complicated – paper forms spanning tens or sometimes hundreds of pages for each person. Each has its own forms, rules and guidelines – challenging individually, impossible collectively.

These paper forms make any form of monitoring competencies impossible. Completed and in-progress forms stay in folders in rows of shelves on hospital wards. There is no data to track progress, no way of understanding any of the underlying trends, no ability to see if progress is being made or the organisation is going backwards.

And given the scale of this all, even if you had the resources, this is no task for Excel. A hospital may have tens or even hundreds of millions of data points to report, track and monitor.

Paper records also mean that competencies are not portable – they are physically anchored into those folders. So when staff move, their records struggle to move with them. This is a challenge within a hospital (cross-covering shifts), and an impossibility across different hospitals.

Hospitals are faced with an unenviable choice:

• Take every person’s word for it on their existing competencies
• Re-assess existing competencies for incoming staff

This is even worse for temporary staff; they can’t develop their competencies or bring evidence of their existing skills, so are forced to work at lower levels than their skills could allow.

Simultaneously across the country hundreds of different people are independently writing competency assessments for fundamentally the same skills. Even where competency standards have been published by external bodies, most are not in a form that can be directly used by healthcare providers, so assessment standards will need to be re-written.

And this reinvention doesn’t just come with the cost of wasted time, it comes with risk. No organisation will get this consistently right across all competencies, across the whole workforce.

A great shame in all of this is the vital clinical time that is being wasted, throughout the process

• Time writing up manual competency assessments for all staff
• Time writing competency documentation, assessments, reports or plans – all for material that exists elsewhere already
• Time re-assessing existing competencies for new joiners (doubly-so, as this is time for both the manager and the new member of staff)
• Excess supernumerary time, for drawn-out and unmanaged induction of new staff
• Time wasted on repeated onboarding checks of temporary staff, in addition to underutilising their skills

Hospital leaders are left with no information or insight, and no assurance to provide patients, commissions or regulators. But this is vital information, and there are critical questions that are going unanswered

• Do the staff on each ward have the appropriate skills for the patient they care for?
• Where are staff learning and developing, and where are they being neglected?
• Which competencies have expired or need updating, and which staff need re-assessing?
• Which parts of the clinical skills are a teams strong at, and which do they struggle with?
• How are staff progressing through induction and becoming part of the numbers, and where are they being delayed as supernumerary?