AT THE end of last July, the National Health Service introduced a reform which barely attracted any press attention, but which the Department of Health believes could have an important impact on the way that healthcare is delivered. A chaplain has been appointed to each of the four regions of England. The move is part of an initiative to bring hospital chaplaincy up to date and to make spirituality an integral part of the health service.
The Rev Susan Hollins is the lead chaplain of the Eastern Region, which includes London, Essex, Bedfordshire, Hertfordshire, Norfolk and Suffolk. She currently works from a small house attached to Watford General Hopsital. Apart from the selection of prayer stoles lying on a chair, it could be any administrative office.
Ms Hollins wears a dog collar and currently runs a group of three other chaplains in the Watford area. However, when she takes on her new position — scheduled for November — much of her time will be spent travelling the country. She elaborates: “It will be my job to bring good management to chaplaincy and to ensure that high standards are met.”
The chaplaincy service currently employs about 425 full-time chaplains, almost all of them members of the Church of England. There are only ten Roman Catholic chaplains and three Muslim ones. In addition, there are roughly 3,500 part-time and 10,500 volunteer chaplains from various religious groups.
The role of the chaplain traditionally entails visiting patients in wards to offer pastoral care. If a patient wants a prayer book, spiritual guidance, or a quiet area for prayer, the chaplain is designated to help to provide these services. In addition, if a patient has any trouble meeting religious dietary requirements, the chaplain is likely to get involved. Chaplains will also conduct funerals — often for stillborn babies or for patients with no relatives.
Chaplains will not proselytise. “We’re not allowed to do that. Chaplaincy is about support,” says Ms Hollins, “If (patients) want me to put them in touch with a sympathetic local church I will do so, but I’m not here to get converts.” However, she does admit that chaplaincy is often a “good advertisement for Christianity.”
There are obviously times when people are particularly keen to see a chaplain. Tim Battle, project officer for the National Chaplaincy Strategy, elaborates: “People want to discuss end-of-life issues or start-of-life issues. If a patient realises he or she is not going to get better, or if a patient has a child with some kind of condition that isn’t going to go away, they often feel the need for religious counselling.”
Ms Hollins claims that chaplaincy has a unique role. “We want to ensure that there is a spiritual dimension in the health service. A lot of what we do might be considered social work, but a social worker isn’t trained in pastoral work or counselling.”
Under government plans, the role of the chaplaincy is set to become more important. In May the NHS produced a policy document entitled Caring for the Spirit, setting out aims for chaplaincy over the next three years. Caring for the Spirit points out that the role of chaplains is often too narrow. It urges chaplains to work together much more closely. As with every other aspect of the new NHS, chaplaincy must be audited to ensure that the public is getting value for money.
Ms Hollins believes that there is much work to be done. “As the NHS has developed, chaplaincy has often become a forgotten relative. Chaplains should be included more in the planning of the hospital.” She also suggests that, especially with recent advances in medical science, chaplains should be regarded as an “ethical resource” to help hospitals deal with tricky moral problems. Ms Hollins will head a spiritual healthcare development unit, which will involve chaplains, management and faith groups, who will all work in a “collaborative”, exchanging ideas and looking for ways to make chaplaincy more effective.
For Ms Hollins, this could make chaplaincy more responsive to the needs of patients. “For the first time the NHS will own spiritual care. Spiritual care is a crucial part of every patient’s pathway. Chaplains will work collaboratively with other disciplines.”
Training will be available to chaplains. According to Caring for the Spirit: “Individual chaplains and lay helpers will be trained on site and in theological formations.” In practice this could mean seminars and day release courses for chaplains, who would receive lessons in counselling and management. Theological seminaries would also be expected to give prospective clergy some training in hospital chaplaincy.
The spiritual healthcare development units would work with other staff — doctors, nurses and managers — to make them understand the significance of chaplaincy. Ms Hollins accepts that implementing the new system will not be easy. “Faiths can be very different. In Islam, for example, there isn’t the concept of pastoral care, which you find in Christianity.” Indeed, some faith groups have reservations. Rabbi Martin van den Bergh represents the Jewish community on the multifaith group of the Hospital Chaplaincy Service. He worries that the Church of England is too dominant and that not enough money is available for minority faiths. “We need a financial commitment,” he says.
And many chaplains resent the new managerialism. “There is some unease among chaplains,” states Ms Hollins. “They feel that management does not fit in with their role. They feel that their job is impossible to audit. But this is not a reservation that I share.”
Ms Hollins believes that the next three years could bring a major shift in opinion. “Currently, nurses are often embarrassed about asking patients their religion: they can’t see the relevance. I hope that, if we do our job properly, then this will cease to be a source of embarrassment. Looking after spiritual needs will just be a natural part of healthcare and finding out someone’s religion will be as natural as finding out their bloodgroup.”
