Warwick Whelan details some of the implications, for Chaplains, of recent NHS restructuring.
Hospital Chaplaincy, like other forms of ‘Sector Ministry’, has often been viewed with circumspection by parochial clergy. For many years it was seen as a convenient way to sideline clergy who were considered ill-equipped to undertake responsibilities for a parish. When Canon Eric Reid was Secretary and Director of Training for General Synod’s Hospital Chaplaincies Council (HCC) he spoke frequently of diocesan bishops telephoning to see if he could place a man ‘not quite right for a parish but would probably be all right in a hospital’!
Thanks to outstanding work by a number of early N.H. Chaplains; successive Secretaries and Directors of Training at HCC; and more recently, The College of Health Care Chaplains (CHCC), that image has largely been dispelled. Hospital Chaplaincy is now regarded as a professional task which should be recognised as an integral and indispensable part of holistic care.
In 1993, HCC, CHCC and representatives from the Free Church and Roman Catholic Hospital Chaplaincies collaborated to produce an extensive document entitled Health Care Chaplaincy Standards. They produced a map of those standards which shows the extent of their deliberations and the thoroughness with which they addressed the role of the Hospital Chaplain.
The Map of Standards describes the key purpose of hospital chaplaincies as ‘enabling individuals and groups in a health care setting to respond to spiritual and emotional needs, and to the experiences of life and death, illness and injury, in the context of a faith or belief system’. The map is then broken down into five key roles namely:-
a. Identify and assess needs for chaplaincy provision
b. Manage and develop a chaplaincy service
c .Provide opportunity for worship and religious expression
d. Provide pastoral care, counselling and therapy
e. Provide an informed resource on ethical, theological and pastoral matters.
Having described these key roles, the map goes on to break down each role into a series of tasks to be accomplished. It is a useful document because it not only sets out clearly the role of the hospital chaplain but also defines ways in which professional competence and performance can be measured; something dear to the heart of all Trust Boards.
It will be appreciated that these standards were set as an ideal though, because of financial constraints, it was accepted that they might not be implemented for some years. Nevertheless, those who worked hard and long to produce this template saw it as a working paper. In reality, its adoption has so far been very patchy. That there are some centres of excellence is not in doubt, but there is real cause for concern in many Trusts.
The Patients’ Charter makes the spiritual and cultural needs of the patient its first priority and lays emphasis upon the need for privacy and the maintenance of the patient’s dignity. Two recent reports from the National Health Service Executive and the National Association of Health Authorities and Trusts seek to help Health Authorities and Hospital Trusts to implement this clause and call for purchasers to make detailed reports on how far local arrangements are meeting the needs of all sections of the population. It falls to the Hospital Chaplain to co-ordinate the provision of religious, spiritual and pastoral care not only for patients but also relatives, staff and students. In areas where there are large ethnic minorities this provision is necessarily multi-faith and multi-cultural.
Recent developments in the way some Hospital Trusts are providing for spiritual care demonstrate a lack of commitment which is worrying. In many ways chaplains are being asked to make ‘bricks without straw’. It is true that some Trusts have created Multi-Faith Departments of Spiritual and Pastoral Care in place of the Chaplaincy, and have taken steps to establish advisory committees comprising senior hospital managers and representatives from the major world faiths, but they have failed signally to provide adequate resources. In my own setting the chaplaincy budget accounts for .008% of the Trustees’ annual budget. That same amount now has to be stretched to cover all faiths. Notwithstanding the financial restraints in the National Health Service, this is a risible amount to finance what is supposed to be an essential component of holistic care.
When I was appointed twelve years ago the Chairman of the Health Authority, the Chief Executive and the Chief Nurse formed the interviewing panel and were advised by an HCC Assessor and a Senior Priest representing the Area Bishop. It was made clear that this was a post of importance and thatI1 could expect full support. That support was forthcoming in many different ways. There was open access to the Chairman and the Senior Executives, and over a period of five years, it was possible to develop a flourishing service. Despite several management re-organisations, the service was maintained and chaplains felt involved in the whole life of the hospital community. At a recent interview to appoint my successor it was decided that a Senior Nurse and a part-time Manager from Human Resources would be adequate representation from the Trust.
Everything began to change when the Hospital became a Trust. Access to those able to make decisions became more and more difficult and the flow of ideas and suggestions for improvements in our service began to be blocked by a burgeoning hierarchy of managers. On occasion, suggestions were made which had no financial implications for the Trust but by then it was becoming clear that the Chaplaincy was receiving much lower priority.
Meanwhile, the tyranny of political correctness gathers momentum. Many senior managers and staff now think it is an intrusion to ask patients their religion. Access to patient information through the computer system is refused on the instructions of the Data Protection Officer. Without such information, it becomes impossible to identify those patients of one’s own denomination and offer an appropriate ministry. This situation is exacerbated by the speed of patient through-put.
The introduction of Project 2000 has moved nurse training into Universities and we no longer have opportunities to be involved in teaching. Most of our new nursing staff have no more than one session on spiritual care during their training usually given by a Lecturer with little or no knowledge. In consequence, we are seeing newly qualified nurses coming on the wards without knowing what the chaplains are able to offer by way of support for themselves and their patients.
In spite of these and many other difficulties which make some chaplains feel marginalised, the work continues and we remain determined to fulfil our role to the best of our ability. With real commitment from the Trust Board and a modest increase in resources we would be able to do much more and make a significant difference in the quality of patient care.
We realise of course, that we are not the only health care professionals under pressure and we are able to empathise with those who feel equally unsupported.
Warwick Whelan is the Chaplain to an NHS Hospital Trust.