THE coronavirus has swept away any idea that chaplains are optional extras or “genteel outsiders”, the president of the College of Healthcare Chaplains, Dr Simon Harrison, has said.
“In the first wave of the virus, there was a bit of the ‘Perhaps the chaplaincy should stay away for a bit until we get over this,’” Dr Harrison, who is also lead chaplain at the Royal Devon and Exeter NHS Foundation Trust, said on Monday. “That has long passed.”
Staff support is significantly more embedded into the infrastructure, to the extent that some trusts have newly recruited dedicated staff chaplains.
The impact of the virus on chaplaincy teams themselves has also heightened the sense of being part of the hospital team. All were now hands-on and very busy, Dr Harrison said.
“There is a lot of fatigue and ongoing anxiety among chaplains, but collegiality is at an all-time high. Staff support feels like the direction of travel for so many more.”
Every fortnight, in Dr Harrison’s own hospital, chaplains, psychological and occupational-health teams, and the unions meet to talk.
“It’s ongoing-tiring,” he acknowledged. “People didn’t really envisage this third wave of the variant strain. There is a real hope that it is just a few more weeks of things getting more challenging, and then there will be a gradual easing, but we know that the work will go on for month and months as we ease back from coronavirus patients and start getting those whose cancer and other surgery and treatments has been delayed.
“It will be tough right through to the summer. At the moment, we are keeping our hopes down, but feeling a clear sense of purpose and engagement.”
Dr Harrison is working in the Nightingale hospital in Exeter, which opened just before Christmas. The last to be built, and to the highest specifications, it is taking patients from all over the region.
One in seven or eight patients in Exeter are referred to the chaplaincy: a figure that, if replicated around the acute hospitals, would be double the normal referral rate. “Partly it’s because people have had such difficult journeys. I’ve been in several situations — three or four in the last four weeks — where one partner has died and the other has survived,” he said.
“They are basically going home to an empty house and very little social infrastructure, because the neighbours can’t come in. Those are really difficult, and difficult for the staff.”
“We are standing upright, but we are just standing upright. I think that would be the truth for all the great hospitals as well.”
Canon Mia Hilborn, Hospitaler and head of the spiritual health-care and chaplaincy team at Guy’s and St Thomas’ NHS Foundation Trust
“I don’t know that we are even on our second wave of exhaustion level. I think we’ve gone way beyond that now. It’s sobering even for a major-incident hospital. It’s nothing that anyone has ever encountered before; so we are literally learning as we go along.
Lambeth PalaceThe Archbishop of Canterbury visits a patient as a volunteer chaplain in St Thomas’ Hospital, Lambeth, in London
“But all the hospitals in the country are tired. We had our first coronavirus patient in February last year, and we haven’t had a day since March when there wasn’t a Covid-19 patient in the hospital. We’ve got hundreds at the moment — more than we have ever had — and the busiest time is right now, particularly in critical care.”
Chaplains are at the bedside of many patients dying alone. “You can be alongside someone; you can sit with them; you can’t do the holding of the hand that you used to; but you can speak on the phone to the family who wants to know whether they look upset or peaceful.
“You can pray if it’s a Church of England patient, or someone who has requested prayer. You would pray for peace and quiet and calm for them so that they have a peaceful end.
“Some families are very upset that they can’t come in and visit. You talk to them and they are literally on the edge. It’s harder for the families than it is for the patients, in all honesty. The not knowing and the fear of not being able to see for yourself is awful. Awful.”
‘I didn’t recognise you with your PPE’
She cannot speak highly enough of the Covid-19 volunteer chaplains, who include the Archbishop of Canterbury: “They are worth their weight in gold to help the team, which is in and out, in and out. One day you might have five people off sick or isolating, another day 11.”
Money has come from a charity to enable chaplains and psychologists to support staff over the next 18 months. Much care has gone into supporting the BAME community in the hospital team and outside, on whom the impact of the virus has been much higher.
“We are still learning all the time: hardly a day goes by when we don’t say, ‘This is new. What shall we do now?’” she reflects. “We’re also remembering to have joy, because there is so much sadness and tiredness and bereavement that it’s easy to forget to be joyful at certain times. We arrange things that force us to think about something that isn’t negative or really hard. We are just plodding through.”
The big questions are sure to come, she says, but not while the crisis is still at the epicentre. Of the institution that is chaplaincy, she can say with certainty, “I think we are pushing at open doors. Almost everywhere in the hospital, people are very glad we’re there. Seeing us kind of floating about, a substantial proportion of the staff think, ‘Well, it can’t be so bad if the chaplains are still here.’”
She gets many calls in the night: five nights in the last nine. “It’s very hard to wind down. It’s about resilience, looking for joy, remembering your spiritual sources of support and prayer. You need prayer every single day to keep you going.
“It has taken many months for staff to begin to process the shock and trauma associated with the beginning of the pandemic.”
The Revd Dr Guy Harrison, head of spiritual pastoral care and consultant in staff support of Oxford Health NHS Foundation Trust
“In October, we began to receive requests from individual staff and staff teams for support. For some, it had taken this long to feel safe enough to begin to open up,” Dr Harrison said. “For others, they were and continue to be exhausted, but needed somewhere to express their ongoing distress and grief at the loss — yes, sometimes loss of friends, family, and colleagues, but mainly of life before Covid-19. Then the latest massive increase in Covid patients began to take its toll.”
Along with many other trusts, Oxford had a number of significant resources for staff to draw on for support, and there was evidence that staff were accessing them, Dr Harrison said.
“However, levels of trauma-associated illness, including PTSD, are predicted to increase. Examples of staff burnout are also on the increase. As a mental-health trust, we expect to see a massive rise in referrals from the general population, including our own and neighbouring trust staff.
“It has been pretty tight at times. Lockdown continued in care homes: we didn’t have any break from that weariness.”
Dr Chris Swift, director of chaplaincy and spirituality at Methodist Homes for the Aged
In the latest ONS analysis, care-home residents accounted for about a quarter of Covid deaths in England and Wales registered in the first week of the year. In the first wave, the figure was about 40 per cent. But figures from England’s care regulator suggest a growing number of deaths: more than 800 in the first week of January, and over 1200 in the second.
“The real next step is to see what happens as vaccines afford immunity. Without vaccination, 2021 would seem like groundhog day,” Dr Swift said on Tuesday. “Chaplains have been innovative in finding different ways of doing things. We’ve a lot more visiting pods at places, and separate buildings outside, and, because our chaplains are employed as part of the team, they have been able to be right alongside staff.
“They’ve been trying to mitigate the impact. Homes have had to minimise people moving about and interacting over a long period, and that’s not desirable. We’ve been going to the residents as much as we can in these situations, depending whether a home is in an outbreak or not. Chaplains spend time listening to people’s concerns, talking to relatives on the phone, passing messages to and fro.
“There will be a lot of learning to come from all this. We realise older people in care homes, where there’s intergenerational contact, may be better off than those living on their own behind a closed front door in this situation.”
“A key element to any calling is our presence in times of need and distress.”
The Revd Andy Dovey, lead for chaplaincy and spiritual care with bereavement services, Croydon University Hospital
Chaplains at Croydon have varied their hours to ensure that they can be at the morning handovers of staff coming off shift, and to assure the next shift of their presence. Particular attention had been paid to the new influx of doctors doing their first ward rounds, Mr Dovey said.
“Health-care chaplains remain at the forefront and frontline ministering to all that are providing that critical care, medical, pastoral, spiritual, and religious rites to those in the extremes of their lives,” he said.
“This last year has seen chaplaincy and spiritual care departments in our health-care trust go over and beyond our call of duty and to relentlessly provide our presence to all those in need. The benefits that these can bring to our health-care trusts cannot be measured in financial terms, nor can we realistically apply metrics and targets.
“The benefits are in the well-being of those that we encounter.”