17 July 2013

What is the opposite of competence?

One of the key responsibilities of a professional regulator is to ensure that professionals are competent when they join the register and remain competent throughout their working lives. HCPC sets standards of competence (called proficiency) to do just this, and at the moment we are in a phased review of these for 15 out of 16 of the professions we regulate. This involves extensive review, consultation and further revisions in order to ensure that the standards remain fit for purpose and up to date. Good regulation depends first and foremost on having robust and credible standards which reflect professional practice in meaningful ways.  

 However, there is much more to maintaining competence than good standard setting. More than twenty years ago, I worked on a research project looking at the nature of professional competence in my own profession. Phil Davies and I published a series of papers describing in some detail the methodology and results of this work (1). We observed that competence is always more than the sum of its parts, and it is often if not always context sensitive – that is, influenced by the context in which practice plays out. It is also as much about the underlying values of the practitioner as it is about the ‘technical’ knowledge and skills.

 I was therefore particuarly pleased to attend a lecture  in Edinburgh last month which reinforced some of these points, taking a fresh look at competence from the perspective of the onlooker (2). Professor Zubin Austin from the University of Toronto described how a patient or service user’s perspective on competence will differ from an educational or a legal or a  professional perspective. Patients and service users want accessibiity, affability and acknowledgement. They want kindness as well as knowledge. There has been much to reinforce this in the recent debates about the training and supervision of care assistants (3).

 Perhaps the most potent point Zubin made was that, in his view, the opposite of competence is not incompetence, but disengagement. Professionals become disengaged, not deliberately or suddenly, but incrementally and often in ways that go unnoticed for months or even years. The events in Mid-Staffordshire would seem to support this, too. 

 The challenge for us all is how do  we address this engagement issue? How do employers, educators, peers and regulators work together to help individuals to stay connected? Zubin’s assertion is that systems and relationships need to reinforce good behaviours not just focus on bad behaviours. Think of competency in a different way.

Anna van der Gaag



(1) van der Gaag, A. Davies, P. (1992).The professional competence of speech therapists: IV: Attitude and attribute base. Clinical Rehabilitation 6,4, 325-332.

 (2) Austin Z. (2013) How competent are we at assessing competency?

Keynote, CLEAR Congress on Professional and Occupational Regulation, Edinburgh, June 27-28,  2013 www.clearhq.org

(3) Cavendish C. (2013) What the NHS needs is a degree of kindness.The rest can be taught. Sunday Times, 14.7.13.