Chaplaincy teams in the National Health Service are good value, bringing added benefits and resources to clinical treatment, say health specialists in response to a call to stop their official funding.
The cost of health care chaplaincy is “a bargain”, say its defenders. It amounts to a fraction of one per cent of the NHS’ total £90 billion budget.
The Department of Health, the Patients’ Association, managers and users have all spoken out in support of chaplains since the National Secular Society (NSS), which campaigns against religion in public life, wrote to Health Minister Alan Johnson earlier this week suggesting that spiritual and pastoral care should be funded by churches and religious groups exclusively, rather than by the taxpayer.
The NSS’s research and its conclusions have been questioned from a number of quarters. Political commentator Matt Wardman has identified a range of methodological and statistical issues which need addressing and has written seeking clarification.
Critics say that the NSS report also ignores research on the benefits of spiritual care in health, including the review evidence of the National Institute of Health and Clinical Excellence (NICE), which produced a report including numerous references to the role of chaplains in March 2004, as well as raising questions about the shape and development of such services within an overall care plan.
Stephen G. Wright FRCN MBE, Visiting Professor at the University of Cumbria, in the Faculty of Health, Medical Sciences and Social Care, argues that “there is a direct correlation, demonstrated in abundant well-researched studies, between religious/spiritual practice and health.” He adds: “I’d be happy to send the NSS a list of these studies.”
Philosopher Mark Vernon, who is an agnostic, says of chaplains: “Their work is not amenable to a cost-benefit analysis. But that does not mean it has no value or effect, just that it has to be assessed in human rather than statistical terms.”
Other resource benefits generated by chaplaincy are also being overlooked, claimed the Rev Dr Chris Swift from Leeds Teaching Hospitals NHS Trust.
He said: “For every chaplain paid for by the NHS, there are ten volunteers who befriend patients. I think we do need a closer look at what it is that chaplains bring to the NHS, because I believe we bring more than £40 million worth of value. Who else provides a 24/7 call service with the small numbers we do?”
Canon Nick Fennemore, who is head of chaplaincy and bereavement for Portsmouth Hospitals Trust, added: “We have got a well-established team visiting 35,000 patients a year, plus families and relatives. We have specialist skills and are highly trained to offer the best care to people.”
“There seems to be a huge misunderstanding about what we do,” he said. “Some people think we just deal with death, but that’s only part of the job. We are here any time, day or night.”
The Rev Mark Burleigh, head of chaplaincy for the University Hospitals of Leicester NHS Trust, argues that chaplains have a crucial role. “The chaplaincy at Leicester's hospitals is an integral part of the personalised care we provide to the wide variety of patients we treat," he says.
The 17 chaplains in the University Hospitals work different hours. Some are full-time while others do around four hours a week. More than 100 people from different faiths also volunteer to spend time with patients and their families in hospital.
Mr Burleigh added: “These include Buddhist, Christian, Hindu, Jewish, non-religious or humanist, Muslim and Sikh people.”
In the past year the team has visited 13,000 in-patients and supported their relatives, he said. The service also extends to an emergency out of hours service to be with patients who may be dying.
Mr Burleigh explained: “Chaplains are there to give support to those who face emotional distress arising from questions concerning life, death, meaning and purpose. These questions can be acutely highlighted by illness and suffering.”
“Not everyone who comes into hospital has links to their local faith communities who could provide the spiritual and emotional support they need. Our chaplains and volunteers do a very demanding job, in difficult circumstances and they are highly valued by patients, their relatives and our staff,” he said.
A spokeswoman for University Hospitals of Leicester NHS Trust itself said as well as providing support to patients, the chaplains help with other work across the Trust. They sit on a number of groups including the clinical ethics committee, service equality panel and managed bereavement services at Leicester General Hospital and Leicester Royal Infirmary.
Some posters to websites where the NSS call to scrap funding for chaplaincy has been reported have supported the idea. “But many of them do not seem to know what chaplaincy is about, assuming it is about the self-promotion of churches or proselytising,” a health manager told Ekklesia. “In fact modern chaplaincy is about delivering care and support to people from all walks of life, taking into account their beliefs, religious or otherwise, but not favouring one group of people over another.”
In a further press statement, NSS president Terry Sanderson was dismissive of the response from health professionals. He said: “Although the chaplains have put up a spirited fight defending their corner, many people contacted us and the various message boards that were discussing it, to say that they had no idea at all that the chaplains were paid from public funds. Many people simply assumed that they were clergy working for the churches but based in hospitals. That’s what we think it should be.”
However chaplaincy supporters say that this is precisely what it isn’t and shouldn’t be.
One patient, Rosemary, commented in an online discussion: “Chaplains provide comfort to those who are in pain, frightened, or dying. They relieve nurses of the responsibility of holding hands and calming distressed patients so they can do what they are trained for. All educated people know there is a relationship between mental stress and physical health. Providing comfort and reassurance for those in stress (and being in the hospital is always stressful) is contributing to their medical care.”
“If the chaplaincy team in my Trust were pro-rata replaced by nursing staff, it would not even begin to scratch the surface of our nursing shortage. There is much waste in the NHS but, in my opinion, the chaplains and their holistic outlook are not part of it,” said a respondent in the Nursing Times, commenting on NSS claims that chaplaincy is diverting money from clinical services.
The Centre for Spiritual and Pastoral Care Studies at Glasgow Caledonian University has a particular interest in health practice. “There is increased attention directed towards spirituality in health, education and the environment,” its statement of philosophy says. “Health carers, teachers, chaplains, clinical and pastoral practitioners all value core qualities such as love for others, compassion, creativity, sensitivity and the ability to find meaning in human relationships.”
Times newspaper commentator Melanie Reid wrote yesterday: “In many areas secularism has much to recommend it. In this instance [the NSS] are wrong and mean-spirited. There has never been a greater need for a spiritual presence in hospitals. Chaplains, in my experience, do not proselytise; they simply afford patients the kind of time, care and compassion that medical staff can no longer give them.”
Writing in The Independent today, Terence Blacker says that "the £40 million of public money spent in our hospitals on spiritual comfort is money well spent, but only if it caters for all faiths, including those who have no faith at all."
The needs of the non-religious are not being taken as seriously as they should be, he suggests. This is a point the British Humanist Association has been raising, given the very small number of humanist chaplains available.
Simon Barrow, co-director of the religion and society think-tank Ekklesia, commented: “What this debate has indicated is that there is a need for more serious discussion about the role and funding of spiritual and pastoral care in the health service. This is something including, but certainly not limited to, considerations of religion. Chaplaincy has grown into something much more inclusive and professional than it used to be and this is a positive development. The NHS is not there to fund church or religious groups, but it can quite legitimately employ the skills and expertise of people from such bodies, alongside others, in meeting the palliative and whole-person needs of patients of all beliefs and none.”
The call for an end to taxpayer funding for the NHS chaplaincy service has been described as "erroneous and simplistic" by Unite, the largest trade union in the country, which includes the College of Health Care Chaplains (CHCC).
The full roster of Ekklesia's reporting and features on the hospital chaplaincy issue can be found here.