How much does health chaplaincy cost?

By Matt Wardman
9 Apr 2009

This week the National Secular Society has published a report, An investigation into the cost of the National Health Service’s Chaplaincy provision (*.PDF Adobe Acrobat file). There has been a good deal of media coverage, and a lot of different, and possibly contradictory, numbers appearing in different places.

The NSS states that using the Freedom of Information Act, it undertook its own research into the cost of chaplaincy services after the government said it did not keep centralised figures on such spending. The NSS has now sent the report to the Health Minister, Alan Johnson, calling on him to review chaplaincy services with a view to ending taxpayer funding for them.

I should make it clear at the outset that I always adopt a sceptical approach to the National Secular Society, due to considerable past experience of watching their claims and peculiar public relations strategy. In this case, I think there are some clarifications needed.

There are three documents on the National Secular Society website: First, an “overview” press release by NSS president Terry Sanderson: ‘Religious demands costing NHS over £40 million a year’. Second, the raw data from a survey of medical service providers (*.PDF document). Third, the report sent to the Department of Health (*.PDF document).

Looking at all this, it seems to me that here are three sets of questions that need to be answered, concerning:

1. The integrity and accuracy of the research. As I shall demonstrate below, it is not clear where some of the plethora of different numbers quoted in different places to different audiences have come from.

2. The scope of the research. This is purely financial, and makes no comment on the medical value of chaplaincy services. I would suggest that the NSS has a habit of shaping its research to fit its own assumptions and campaigning agenda. In this case the unwritten assumption is that chaplaincy services can have no medical value, I suggest as a result of NSS's own doctrine. They are put across as only providing “religious services” as if such [spiritual and pastoral] services existed in a sort of religious bubble; they don’t.

It is fascinating to compare the “research conclusion” (April 2009, *.PDF document) with the “submission to the Shadow Health Minister’s Consultation on Hospital Chaplaincy” (September 2008, *.PDF document) before the research project was finished. They are two peas in a pod, apart from the April 2009 proposal “that a large scale opinion poll be carried out by the Department”, as the NSS tried and found difficult.

I would support thorough research into the question, but it should be a survey of patients undergoing medical treatment rather than evaluation of public opinion - since health policy should be based on medical evidence rather than popular prejudice. The results should be evaluated medically alongside other services.

3. The assumptions behind the research. The whole thing is presented as “Religious demands costing NHS over £40 million a year”, while the reality is that these are services which NHS policymakers have chosen to provide, rather than some sort of cosmic establishment-supported mugging of the public budget by extremists.

There are also important questions to be asked about the research itself.

* How many nurses can we get for how much money today?

The headline claim - note from the report sent to the minister, not the press release - states that: Salary cost of NHS chaplaincy services: 32,014,475 pounds. This figure is for “staff salary and associated on-costs only”. It does not include the provision and maintenance of chapels, churches, prayer rooms/centres etc. The cost is equivalent to the cost of around 1,500 nurses or over 2,600 cleaners.

That cost for chaplaincy figures seems to involve all the personnel on-costs, while I am not convinced that the figure for nurses does so. The claim is that a nurse costs the NHS £32 million pounds, divided by 1,500, which equals £21,300 pounds, looks more than dubious. A quick internet search reveals an article from the BBC in 2007 which said: Spending on the NHS has rocketed in recent years, and the average nurse’s salary is now 25,000 pounds - not megabucks, but certainly not peanuts either.

If the salary of an average nurse was £25,000 pounds two years ago, as reported, I’ would be interested to know how the figure - which must involve on-costs for the comparison, or at least break them out and provide a justification why comparable numbers have not been used - has somehow reduced from £25,000 plus perhaps 30% to £21,000 in 2 years. That 30% is my estimate of nursing on-costs. I have asked the Royal College of Nursing for the accurate numbers.

By the time the BBC was interviewing Terry Sanderson, somehow “£32 million for around 1,500 nurses”, which was what the NSS told the Government, had undergone a secularist divine intervention and morphed into: “the £40m figure was equivalent to employing 1,300 nurses or 2,645 cleaners.”

If the second figure is accurate, we need to hear that the National Secular Society has admitted to the Department of Health that it got its initial headline conclusion from its official report wrong. In any case the different assumptions need to be explained to the people they have briefed. The 1,500 number has also made its way into at least one newspaper.

* Is the data in the Raw Data Table actually raw?

The document concerning Raw Data from a Survey of Medical Service Providers in England states that it contains figures for “Salaries per annum - This figure represents staff salary and associated on-costs only” for health service providers in England. For each provider, it also includes “Staff - Whole time Equivalent” i.e., how many FTEs there are in chaplaincy service.

The NSS calculate three figures from this document: Total spend in hospital trusts responding to the survey in England: 26,722,494; total Full-time Equivalent staff (FTE): 545.1; and total spend per chaplain (including salary and on-costs): £48,953. This is the simple ratio of 1 and 2.

Elsewhere (in the press release) the NSS quote their £32m figure, and say: “The headline figure only takes into account the salaries of the chaplains, it doesn’t take account of National Insurance contributions, pension payments, administration costs, office accommodation, training, the upkeep of chapels and prayer rooms,” said Terry Sanderson, president of the NSS. “We can conservatively add another 20% to the headline figure taking it up to 40 million.”

(Ironically, one should note, the figure in the headline on this press release is actually £40 million.)

Some of that sounds like “associated on-costs” to me, as mentioned in the “raw data” document. The BBC report repeats this confusion: “But the NSS said this [the £32 million figure] took into account only the salaries of the chaplains, and excluded national insurance contributions, pension payments, administration costs, office accommodation, training, and the upkeep of chapels and prayer rooms.”

That statement is not what the NSS stated in its own raw data document, which leaves more confusion. It is not clear what is included where.

I am not going into questions such as broad brush assumptions being applied across all chaplains, when it is far from clear that part-time chaplains have comparable “on costs” or “overheads”. For example, my current and past soundings suggest that many part-time employed chaplains don’t even bother with the NHS Pension Scheme. If they want to add these sorts of numbers, and convince us that their work is anything like rigorous, the NSS needs to prove their assumptions to be justifiable, rather than just assume them and start shouting.

* More unexplained numbers

In the NSS press release, the NSS also comes up with a figure of £57,000 pounds per chaplain from somewhere (not mentioning his own £48,953 figure above):

Terry Sanderson commented: “The average cost to the Health Service of a chaplain is 57,000 per annum. I’m sure if patients were asked where they wanted their money spent – two and a half nurses or more than four cleaners rather than one cleric – it is clear that nearly all would opt for the nursing or cleaning staff.”

The £57,000 figure is not obviously related to anything else that is calculated anywhere else, and the “two and a half nurses” gives a “cost per nurse” of £22,800, which is different from the £21,000 reported to the government, and also different from the £25,000 briefed to the BBC.

Perhaps it is significant that none of this “interpretative” calculation appears in the submission to the government, since they might get confused as well.

It is also worth a note that the “English” figures - which are the highest by some way among the different countries that make up the UK - somehow end up being used in most of the articles about the “National Health Service”, without qualification.
Clarification is needed about this, too.

In summary, I have emailed the National Secular Society requesting clarification on several points:

1. That the data in the raw data table is the raw data received from the trusts, i.e., that it does not include any adjustments to the numbers you received back from the Hospitals and Trusts. If the data is adjusted, what has been done?

2. The source of the figure for the average cost of a nurse, and whether this is salary only or includes “on costs” such as National Insurance and Pensions, offices and training etc. The comparison with Chaplaincy costs including on-costs (as documented in the data table) suggests that it is the latter.

3. The extrapolation from £26.72 million from Trusts responding to £32 million overall. Where does it come from?

4. Terry Sanderson stated: “The average cost to the Health Service of a chaplain is £57,000 per annum.” Where does this number come from?

5. The NSS would prefer chaplaincy to be funded by church resources. Have they identified these resources, which would make for a stronger argument.

There is a debate to be had here, but it cannot be on the basis of questionable or ambiguous data.

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© Matt Wardman is an internet consultant, commentator, freelance writer and Project Manager based in the UK. He is founder and editor of The Wardman Wire, which focuses on politics, culture, media, commentary and technology. WW is an online magazine and discussion site in the form of a multi-author weblog. Its contributors include members of all the main political parties, and none.

This article is adapted with kind permission from one also appearing on The Wardman Wire. Debate and response, including any forthcoming from the NSS, can be found here.

The full roster of Ekklesia's reporting and features on the hospital chaplaincy issue can be found here.

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