Christopher Swift is worried by new attempts to justify hospital chaplains
A FEW months ago, I took communion regularly to an elderly patient in hospital. He was a retired GP, and a lifelong church member. On one occasion, as I was leaving, he looked up and said, “Thank you; it brings me life.” Reflecting on these words, I found it hard to imagine what other health-care intervention would engender such a reaction.
Trying to value these words in terms that have weight in the culture of the NHS is not easy, despite the growing pull towards the creation of a firmer evidence-base for modern health-care chaplaincy.
Developments in health-care chaplaincy since the advent of the New Labour administration have been remarkable. The past few years have seen a significant study of chaplaincy in the capital, two new guidance documents from the NHS, and a host of initiatives in training and accreditation.
On the surface, chaplaincy appears to be in rude health, enjoying a degree of attention few would have predicted back in the early days of nationalisation. Yet “modernisation” brings with it a host of management ideologies that pose a serious challenge to understanding what the chaplain does.
The renewed interest has been met with little in the way of a critique, perhaps because the pace of development has taken chaplains by surprise. At the same time, the close working relationship between the Hospital Chaplaincies Council and the Department of Health has militated against a broader commentary on change. There is pressure on chaplains to comply with modifications to service-provision, rather than encouragement to subject new policies to theological analysis.
RECENT WORK by Dr Jacqui Stewart at the University of Leeds raises questions about
the compatibility of service-delivery models of care and traditional forms of ministry. For Dr Stewart, the NHS emphasis on spiritual care “concentrates on an understanding of spirituality as personal, not communal; as static rather than dynamic; and as an objectifiable commodity rather than unmanipulated free gift”.
Importantly, Dr Stewart’s analysis reminds chaplains to think more deeply about the implications of change in relation to their core identity as religious representatives; and that all models of care incorporate beliefs and values at a deeper level.
For example, the whole field of evidence-based practice in the NHS suggests an evaluation of effects that are short-term rather than long-term. It is understandable that forms of treatment should be subject to evaluation based on the evidence of their impact on health, but it is also important to recognise the limitations of such studies. While a certain pill may have an established effect, how do we accurately measure the benefits to health of a hopeful and community-orientated participation in life?
The value of a chaplain’s involvement with a patient may not be fully realised for many years, and, even then, might be impossible to isolate from other influences. Evidence-based health interventions are important, but they do not show the whole picture: they do not adequately account for what “brings us life”.
I have observed that one of the most important contributions being made by Muslim scholars engaged in chaplaincy is the challenge to views in the NHS that have seen religious practice as a compartmentalised element of a patient’s experience.
With a range of strongly held religious views about same-sex treatment, forms of ablution, food, and the content of medicines, Islam (with a number of other faiths) has challenged the view of religion as a set of abstract beliefs making few demands on the practice of care. These local experiences represent a significant questioning of the secular frameworks previously offered to chaplains in the NHS.
In the struggle for resources, it is the benefits to health demonstrated by controlled trials that attract the greatest attention. Qualitative research, which is perhaps most conducive to an examination of what chaplains are about, tends to be both less funded and more sceptically regarded by many decision-makers.
Without a critique from the faith community that informs their presence in the NHS, chaplains might
be encouraged by the dominant health-care culture to adopt strategies of professional development that are politically potent, while at the same time becoming increasingly detached from their basic raison d’être.
I heard a chaplain arguing that bedside communions for patients were valuable because they were “proven to lower blood pressure”. However well intentioned — or true — such a statement is, it has little to do with chaplaincy. We are not there to demonstrate a short-term physiological effect, but to work in helping people to re-negotiate the hopes and faith that are often assaulted by the experience of illness.
IN the introduction to NHS Chaplaincy, the recently published Department of Health guidance document, it is stated that the text makes “no theological or doctrinal definitions”. The idea that a document dealing specifically with chaplaincy and spiritual care can claim some kind of a-theological neutrality is surprising. Chaplains need to seek a much more intelligent consideration of their role if their significance is to be realised in the NHS.
As a chaplain, I find that the challenges posed by this time of torsion are daunting and pertinent. What we are witnessing arises from deep shifts in underlying values and claims to truth. For centuries, chaplains avoided most of these pressures because their epistemological basis was rooted in the Church. Now, as the NHS takes a firmer grip on its chaplains, there appears to be a more urgent demand for chaplains to manufacture a basis for their work in the registers of clinical practice and management theory.
The effect of being held in the grip of traditional understandings of faith-representation and care, while also being turned towards a professional identity defined by NHS management, is to induce acute torsion within chaplaincy.
The possibility still exists, though, that chaplains will be able to negotiate an appropriate space within NHS structures, while retaining the key aspects of their faith identity and manner of ministry. From an Anglican perspective, this must surely embrace the notion of the chaplain as the gift of a person to a place.
At my licensing as chaplain at Barnet Hospital in 1997, the Bishop of St Albans, the Rt Revd Christopher Herbert, spoke of the need for chaplains to have a “defiant language system” against an easy accommodation with the language of the NHS.
As chaplaincy feels the pressure of “modernisation”, it has the obligation to look at where this road is leading — and whether the destination will allow space for the language of fear, hope, suffering and love.
The Revd Christopher Swift is President of the College of Health Care Chaplains and Head of Chaplaincy at the Leeds Teaching Hospitals NHS Trust.
