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Hospital chaplaincy under fire

16 October 2015

At a time of great pressure on the NHS, Gavin Drake assesses the value of hospital chaplaincy


THE National Health Service is short of money. No news there. But the extent of the crisis is huge: current estimates show that by 2020 the NHS will be running an annual deficit of £30 billion.

To plug the gap, the chief executive of NHS England, Simon Stevens, has promised to deliver £22-billions’ worth of efficiency savings; while the Prime Minister has pledged to increase annual funding by at least £8 billion.

The make-up of the efficiency savings are not clear; but one area of expenditure which is already being targeted by campaigners is chaplaincy. An investigation by The Independent earlier this year, using the Freedom of Information Act, revealed that the NHS spent £23.5 million on chaplaincy services in the past financial year — an increase of £1.5 million on the year before.

The National Secular Society (NSS), which has long campaigned against all aspects of faith in the public square, is stepping up its campaign against hospital chaplains. They want religious chaplains to be funded by faith groups, or the NHS to appoint secular spiritual-care providers.

“If hospital chaplaincy is to remain a specifically religious service, then the NHS shouldn’t be paying for it,” the campaigns manager at the NSS, Stephen Evans, said. “If NHS trusts consider it cost-effective to offer emotional or spiritual support to staff and service-users, then those positions should be open to any professionals with the skills to provide necessary support, regardless of their religion or belief.

“In a religiously diverse and largely irreligious society such as ours, it makes little sense to organise patients’ pastoral care around religious identities.”

THE increase in expenditure on chaplaincy services appears to suggest that the secularists’ argument is falling on deaf ears. Not only is the overall figure going up, but NHS trusts that once decided to cut chaplaincy are now increasing it.

In 2006, the Worcestershire Acute Hospitals NHS Trust was criticised by MPs when it proposed to make all but one of the chaplaincy team at its three hospitals redundant, and to stop paying part-time visiting chaplains.

In an Early Day Motion, MPs reaffirmed their support for “the vital role provided by chaplains of all faiths and denominations for both patients and staff”, and said that “chaplains have a crucial role in ensuring that patients are treated in a holistic fashion.” In 2013, the trust increased the number of chaplains it employed from three to five.

The Bishop of Carlisle, the Rt Revd James Newcome, the Church of England’s lead bishop for health-care issues, said: “The actual cost of chaplains compared with the cost of the NHS is absolutely minute. It is 0.02 per cent of the NHS budget. There are about 500 full-time equivalent chaplains, and there are about 1.5 million NHS employees.”

In addition, he said, “most chaplains organise, develop, and run a team of volunteers; and there are more volunteers operating in our hospitals as chaplains — often from faith backgrounds, but not invariably — than there are chaplains.

“If the NHS didn’t have paid chaplains, it would have to provide for the religious, spiritual, and emotional needs of their patients in some other way, and they would find it cost a lot more than having chaplains.”

Hospital chaplains tend to be a soft target, because, Bishop Newcome says, “it is not always easy to quantify the work they have done. With a doctor, you can say that they have done X number of heart transplants, or whatever it is.

“With a chaplain, it is more difficult. You can say that they have visited so many people, but it is not so easy to say what the effect is.

“When they have done surveys, it shows that 90 per cent of nurses reckon that [having chaplains] makes a significant difference to the health and improvement of their patients. And only five per cent of nurses reckon that they could do the same sort of work.

“Most recognise that they are simply not qualified to do it, and they are very grateful to have chaplains as part of the team.”


GUY’s and St Thomas’ NHS Foundation Trust, in south London, employs Roman Catholic, Church of England, and paediatric chaplains; a team of 13 trainee chaplains, including Anglican, Jewish, Muslim, Pentecostal, and Humanist; and a host of bank chaplains representing the breadth of religious expression — including Humanism.

“That’s the broad mix of what we need here,” the trust’s head of spiritual health-care, the Revd Mia Hilborn, said. “You look at your census figures, you look at your patient make-up, and you make sure you have a broad enough group to match those requirements.

“If I was working at the Royal Free, in Hampstead, I would need more Jewish chaplains, because of the variety of Jewish people living there. If I was working in Newham, I would have to have many more Muslim chaplains, because of the number of Muslim people in the area. My team is incredibly diverse, because where we are in London no one people-group dominates.”

But she is equally clear that the majority of hospital chaplains are not there simply to minister to their own religious group.

“You can be a religious chaplain and simply provide religious care to your own,” she said, “or you can be a generic chaplain, which means that you speak to anybody. Everybody in my team has to be a religious chaplain, but they may operate as both.

“Nearly all of the substantives, apart from the Roman Catholic, operate in a generic capacity. That means that you are entirely patient-led.

“So you go to an individual, whether it is a patient, carer, or staff, and the conversation is entirely led by the individual you are speaking to. You would respond to questions, and use various forms of listening to draw somebody out so that they would begin to make sense of their own world-view.

“You would respond to questions about your own world-view, about what gives you meaning; but it is about the patient, and about helping them come to their own understanding and meaning about what is going on. But you are very open and honest about who you are, where you are coming from, what your own belief system is. You don’t try to pretend to be something you’re not.”


MOST of the chaplains’ time is not spent with people who have a religious background, but with those who have either a lapsed faith or who have never been part of a faith community.

“The people who have very strong beliefs — whatever that is in — are usually quite happy,” Ms Hilborn says, “but the people who are muddling along in the middle somewhere, aren’t completely sure, or have an unformed spiritual or belief system — these are the people that research shows are most likely to have mental-health issues, or spiritual-distress issues at times of illness or trauma.”

She explains that there is a difference between emotional distress and spiritual distress; and that a patient’s fears about pain, dying, and hell can make people physically more sick.

“These are the people we tend to concentrate on, and the people who want to talk to you the most. You tend not to do religious care with those: you may do a blessing, or a prayer, but you are less likely to do sacramental care; but you would do plenty of spiritual care with those people.”

The chaplains do not simply care for those who are close to death. “The NHS is there from the cradle to grave; and so is the chaplain,” Ms Hilborn says.

“So the chaplain is there for people who are trying to get pregnant; people who are pregnant; people with babies, children; those with problems in adulthood; and then, towards the end of life, when somebody becomes terminally ill.

“And if there was nobody to look after them, no next of kin, then the care would be up to the funeral as well.”

It is this sort of comprehensive care that wins over most Health Service managers. Mike Taylor chairs the Cumbria Partnership NHS Foundation Trust. He said this week: “In my experience over the past five years as a trust chair, and observing some of the work of some of the chaplains in our community hospitals and other wards, it is clear to me that their contribution to the well-being of patients is invaluable.

“I have particularly seen the work they do with our elderly patients, including those in our palliative-care ward, and it is clear that the comfort and solace they provide is an evident support and enhancement of the medical care being given. They may be chaplains from a religious order, but their non-intrusive and gentle support for those needing comfort and assurance is wonderful to see.

“They cost us very little, and give much more in return.”


AS THE debate about the NHS spending priorities continue, so, too, will the arguments about who funds hospital chaplains. But Bishop Newcome is convinced that many of the arguments are based on a false premise. “It is very important to stress that chaplains are therapeutic, not evangelistic,” he said.

“I think very often the criticism that comes from the Secular Society seems to assume that chaplains spend their whole time caring for those from their own faith, and trying to convert those who aren’t. Nothing could be further from the truth. They spend most of their time with people who aren’t from their faith.

“They are not trying to convert them: they are simply listening to them, and helping them with some of their very acute needs.”



TWO ministries that promote the ministry of healing are amalgamating this year. The Guild of Health and the Guild of St Raphael are unifying, and an official celebration is to be held on 24 October at Chester Cathedral. This also marks the 100-year anniversary of the founding of the Guild of St Raphael.

Both guilds are dedicated to encouraging the sacrament of healing, and to bringing together Christians in the medical profession with ministers, to engage in research into health — especially the link between physical, mental, and spiritual well-being.

The vice-chair of the new Guild of Health and St Raphael, the Revd Stanley Baxter, says that it is more a reunion than a merger: “The Guild of Health was founded in 1904. But, in 1915, a group left to form the Guild of St Raphael, because they weren’t keen on its being interdenominational. They also felt that there was not enough emphasis on the sacramental life.

“But that was 100 years ago. Everything has changed since then — and now we’re coming back together.”

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