HOSPITAL chaplains are witnessing acute stresses and strains in the NHS, in a ministry now as much geared to the needs of staff as of patients; current pressures were showing the value of that trend towards staff well-being, the president of the College of Health Care Chaplains (CHCC), Dr Simon Harrison, said on Monday.
“What Covid began is now very much continuing,” he said. “My colleagues and I are in emergency departments daily, visiting to support patients wherever they are found. There’s nothing we’re doing that’s new. Everyone is in different ways putting their hand to the pump.
“But what we learned from Covid is that you need to see staff where they are: to be alongside them on the front line. It’s not about waiting to be called, but about going out proactively to see how they’re doing on a good day or a bad day. The thing chaplains do which is relatively unique is brief encounters: a lot of these, in the moment — very real, confidential if required, but in the moment.”
Canon Mia Hilborn, a Hospitaller and chaplaincy team leader at Guy’s and St Thomas’ NHS Foundation Trust, in central London, described the added pressure from the sheer numbers in hospital, including many who no longer needed to be there. but had nowhere to go as a result of the shortage of workers in the care system.
“There’s a shortfall if everyone is well. But if they take leave or are off sick, then it’s a major shortfall,” Canon Hilborn said. “There are no extra people to do the work; they just don’t exist any more. When they do come into work in the social-care industry, it is non-stop.”
Some patients in that situation were frightened to go home because they didn’t know who would be looking after them, or had been recently bereaved and were very lonely, she said. “We are still dealing a lot with the outworking from people who died during the pandemic. It’s left an indelible stain on their psyche and their spirit. And a lot of NHS and social-care staff died as well: every department has someone who has been bereaved, and they’re emotionally drained and tired.”
Central London, and Guy’s in particular, has had the added problems last year of riots and marches in the vicinity of Parliament, traffic chaos that has held up ambulances, and — in an area where most staff cannot afford to live — the need to buy in hotel rooms for them on the days when transport isn’t functioning.
“It sometimes feels like you are in a pressure bubble,” she said. “We are spending a lot of time supporting staff, and that has been huge, but also spending a lot of time trying to get things right. I think, when we were in the pandemic, people responded on a sixpence to help in whatever way they could.
“Now that we have these added pressures, things could very easily slip. In this hospital and, I’m sure, in many others, the Trust is trying hard not to let things slip and become the norm. We are speaking to families, patients, staff, local people, to try and sort anything out, not just let it go. We’re trying really, really hard to not become sloppy, and to listen to people.
“I spent a lot of time on that today with one particular community group. You can’t ignore people in need. And that revitalises you, because you can actually do something. It gives you a sense of purpose, and inspires you to go and do a bit more. Little things you can do is a big resilience factor.”
AlamyThe London Ambulance Service emergency operations centre in Newham, east London, on Tuesday
Chaplains are absorbing anxieties from the patients themselves about the situation in the NHS. “They [the patients] tell you nurses are working flat out. A lot of them, if they haven’t been in hospital before, are surprised how physically hard people work. They realise it’s not hype, that it’s real, that it takes a lot of work to look after sick people, and it’s good work as well, although people get really tired.
“You see people literally every day saving lives, and it’s awesome. One of the great joys is there is a lot of joy. We get involved in a lot of sadness and hidden sadness — part of that is why we’re here — but you can have a giggle in the sluice room, force a bit of joy into every day. If you get stuck into anxiety when you’re listening to someone, it can drag you down as well. But, if you can get inside it and turn it around, it won’t follow you home.”
The Lead Chaplain at South Warwickshire UFT, the Revd Ricarda Witcombe, reflecting on the added pressures on hospitals, suggested that Covid felt almost like “Better the devil you know.”
“This is actually so much more than Covid now,” she said. “There’s too many patients and not enough beds, and that feels more pointed.”
Staff support was part of a normal day’s work, she said, but one of the challenges was to be there for staff in a meaningful way when they were too busy to stop or even pause. “Pervasive exhaustion is everywhere, because this is another stage on [from] what was already the worst thing,” Ms Witcombe said.
“I meet people who say, ‘I never thought it could get any worse, but it has.’ I was chatting to one of the senior nurses last week, asking if it was the same as other winters, and she said, No, not only has she not felt this scared before, but this was a broken system now, that just couldn’t meet the needs of the people.
“In my position, I work on the basis of keeping doing everything I can: do the little things, and keep on doing them. We have always done a lot of witnessing patient pain, in the classic, ‘I’m here with you,’ and hand-holding of the patient. We don’t physically hold the hands of the staff, but there’s value in witnessing, even though it leaves us feeling a bit hopeless and useless.
“I was in the emergency department, and the sister in charge showed me her computer screen: a whole screen of patients needing to be admitted, and there was nowhere for them to go. There is nothing you can say. All I can do is to say, ‘Yes, it’s awful, and you’re doing a really good job,’ and get out of the way. We are here, and we witness what’s happening. I think there’s power in witnessing, but it’s not easy.”
Like Canon Hilborn, she and her colleagues are absorbing patients’ general anxiety about the whole precarious situation — particularly patients who feel that they are “blocking a bed”. “They’re not blocking it: there’s nowhere else for them to go. They feel they are making things worse by just existing.
“We hear patients talk about how they can see the stress the nurses are under, and, of course, no one wants to add to it. Nobody wants it to be like this. Everyone you see in ambulances waiting to unload is a life.”
Despite all of this, her answer to the question “Do you ever wish you were in another job?” is an immediate and emphatic “No. It’s the people we see. The situations might be more intense, but, for us, the job never changes.”
She speaks of the Christmas tree in the chapel, overladen this year as never before with paper stars and leaves carrying pleas, prayers, and messages. “It was a whole mix of different things, but expressing so much love and care and desperation and hope. I guess the quantity indicates the intensity of what the whole place is going through.”
The stars and leaves will become the centrepiece of a chaplaincy away day, when handfuls will be taken away by volunteers to be prayed for. She describes it as “Epiphany gold”.
Dr Harrison concludes: “I wouldn’t use words like ‘relentless’: we just continue. As things were challenging with Covid, they are challenging now. We continue to be present. It’s fairly non-stop. We have been learning and evolving as we go in terms of reflecting on best practice; a better sense of what good looks like in contemporary health care.
“We are being well used in the NHS — which, ironically, is something positive. This current period of challenge just exemplifies that. Negative stories do nothing to help the morale of staff, and that is itself a challenge, but one into which we jump every day.”