From Lucy Selman, the Revd Peter Speck, and Vicky Simms
Sir, — On 28 February, the National Secular Society published a report on the funding of hospital chaplains in the NHS (Costing the heavens: Chaplaincy services in English NHS provider trusts 2009/10). We believe the report is flawed and an over-simplistic attempt to measure the ability of health-care chaplains to influence directly the overall quality of a trust’s performance and mortality ratio.
First, the study makes the error of assuming that absence of evidence is the same as evidence of no effect (Altman & Bland 1995, British Medical Journal 311). Second, the Standards for Better Health assessment is a broad framework for trusts to monitor quality of care, and is not designed to assess the effects of an intervention.
Third, mortality rates are a poor measure of the effects of any intervention or component of care which does not have the primary aim of prolonging life, and is therefore problematic as an overall measure of the quality of health care (Shojania & Forster 2008, Canadian Medical Association Journal 179).
The study ignores the multitude of factors that have a bearing on trust performance, and misuses the assessment tool. The study also describes the trusts with lowest proportional spending on chaplaincy as the most efficient, when in fact efficiency has not been established, since no appropriate measure of chaplaincy performance is applied.
One of the three core principles of Standards for Better Health is a focus on the whole of health and well-being, not only illness, signalling the commitment of the NHS to patient-centredness. The patient is an experiencing individual rather than the object of a disease. Chaplains play an essential part in supporting individuals of any or no faith through illness and trauma.
Chaplaincy input is focused on a whole-person approach to the patients, relatives, and the staff who work within a trust, irrespective of the beliefs held by those individuals. While chaplaincy has a supportive role, it does not have any direct influence in treatment decisions or the management of service-provision, other than spiritual care.
As with chaplaincy service in the armed forces (also paid out of the public purse and, as reported in the media yesterday, also highly valued), it is the ability of chaplains to support individuals and groups experiencing personal- and professional-life stresses which is recognised by the organisations that employ them — for a minute proportion of the overall budget (0.000029 per cent of the NHS 2009/10 budget).
LUCY SELMAN, PETER SPECK VICKY SIMMS
Department of Palliative Care,
Policy and Rehabilitation
Cicely Saunders Institute
King’s College, London
London SE5 9PJ