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Case Study – Nuffield Health

Nuffield Health uses Skills for Health competencies to eliminate clinical incidents

The Nuffield Hospital Guildford, one of Nuffield Health’s 30 hospitals, identified that a competence-based approach to staff training and development would enhance patient safety, address clinical incidents, and support staff development.

After using Skills for Health competencies to develop training packages for all their nurses around the use of syringe drivers and specimen labeling, errors were reduced to zero and managers were impressed with the results. They built on this and adopted a competency-based approach to all staff induction. Following these early successes, managers used competencies to develop extended roles for Healthcare Assistants (HCA).

“The Skills for Health competencies are easy to use, they deliver what you need, and they enabled us to make a quick impact on clinical effectiveness. We use competencies for anything that we need to assess because they’re multi-disciplinary teams designed and validated. We think that’s as safe as it gets.”

Jean Holloway, Clinical Effectiveness Nurse, Nuffield Health


  • No incidents reported in three years since the programme began
  • Competences used for risk assessment to reduce clinical incidents
  • Over 100 nurses completed competency-based assessments since 2008
  • Competences support a multi-disciplinary approach and increased patient safety with more timely interventions
  • HCA role extended to assist in theatre for specific procedures with the backing of qualified staff, consultants, and theatre manager
  • Releases scrub sisters for more complex procedures
  • Patients transferred from the theatre by extended HCA post holder, freeing up registered nursing staff

How we helped

Managers searched the Skills for Health database for competencies relating to both areas of practice – monitoring and maintaining people from theatre to ward, and simple scrub procedures. The competencies were used to inform a specially devised training package which the HCAs completed over a four-month period.

Both HCAs welcomed the opportunity to extend their scope of practice. One was a level 3 NVQ HCA where managers identified competencies to enable the HCA to upskill and extend their practice around patient transfer. Another HCA experienced in theatre had their role extended so they can ‘scrub’ for specified procedures which have been risk-assessed e.g. hand lift, ENT, and some maxilo facial surgery.

Staff recognised that the up-skilled HCA carrying outpatient transfer increased her awareness and assessment skills and enabled the capacity to be released onto the wards.

The theatre example has been viewed as an unqualified success as the HCA, consultants involved, and the theatre manager has all seen this role extension as a ‘win’. Colleagues are released to do more complex activities, so making better use of their time and skills. Managers have welcomed the way evidence-based and measurable competences can be used to address clinical incidents, enabling staff to quickly pinpoint what needs to change.

What are competences?

Skills for Health has developed a bank of national workforce competences that describe the skills and knowledge required to carry out a task or function effectively. They are designed to underpin and be integral to accredited and nonaccredited education and training programmes. Since competences describe what individuals need to know and do, whoever is performing the task, they can be used.

As the Sector Skills Council, we support all health sector employers, NHS, independent, and third sector organisations. Since 2002 we’ve been working with employers to get the right people, with the right skills, in the right place at the right time. We are the authoritative voice on skills issues for the health sector and offer proven workforce solutions and tools – with the expertise and experience to use them effectively.