An Address by the Rt Revd Christopher Herbert
Lord Bishop of St Albans
Day with Hospital Chaplains: 28 June 2006
at Charterhouse

I have been the Chair of the Hospital Chaplaincies Council for about eight years and I thought I would take this opportunity to provide an overview of where hospital chaplaincy now is.  I hasten to add that this is a personal view - but one which, I hope, will be suitably wide-ranging and a bit provocative.

The Context: The NHS Organisation

In preparing for this address, I went onto a number of websites because I wanted to try to trace some of the major changes that have affected healthcare in this country over the past decade.  The exercise was fraught with difficulty, not least because most of the official websites seem to have no sense of history.  The Department of Health, to be fair, has a site for old news, but it only covers the past five years.  I came away from my search thinking that I had been trying to navigate my way around and through an Orwellian bedlam.  No doubt there will be someone who can suggest a simple site which will answer the easy question, 'What have been the major changes in the NHS during the past ten years?' - but I could not find it.

I describe this as an Orwellian bedlam because all the sites seem to concentrate on the latest spin story and have wiped the memory of the organisations that they represent.  Let me, nevertheless, try to rehearse a few of the changes in the context in which chaplaincy now operates.  You will recall that in the 1990s, under the Conservative Government, there was a radical reshaping of the Health Service: a 'purchaser/provider' split was introduced into the system.  I remember that in those days (I was then a Bishop's Adviser in Hospital Chaplaincy in Surrey) we were concerned that chaplaincy could come under real threat if the purchasers failed to see its relevance.  I spent much time going round the 'purchasing' powers-that-be and discovered, in spite of my misgivings, that chaplaincy was not under serious financial threat - partly, I think, because in financial terms, it was not a major cost.

Then came the creation of Trust hospitals; would they treat chaplaincy with appropriate seriousness?  We were worried about job cuts but in fact the number of whole-time hospital chaplains increased.

In April 2002 Primary Care Trusts (PCTs) were established, just over three hundred of them, responsible for the control of over 80% of the NHS budget.  Four years later, in 2006, those three hundred PCTs are being reduced to 152.

In 2002 twenty-eight strategic Health Authorities were brought into being; four years later they are being reduced to ten.  Twenty-nine ambulance Trusts are being reduced to twelve.

In 2002 the creation of Treatment Centres was announced.  Originally there were to be eight by 2005 but in fact twenty-five had already come on stream by that date.

In 2004 Foundation Trusts were launched, with all the concomitant hullabaloo about league tables and financial risk and management.  ('They will have more control over their budgets and services ... and will be able to borrow money on the financial markets' - BBC).

In the year 2000 the Health Development Agency was founded - and only five years later, in 2005, it was folded into NICE, which changed its name to the National Institute for Health and Clinical Excellence.

In June 2006 the Department of Health announced, with a fanfare, that a new 'Social Enterprise Unit' would be set up, whose purpose was 'to encourage innovation in health and social care'.  Presumably it will have a shelf life of approximately five years.

There have been other innovations, like NHS Direct, whose website is coy about when it began (it was in 1998).  There are sixty-six NHS Walk-in Centres - the nearest to me is about ten miles away from where I live and so is really only available to those who are mobile.  Then there is the NHS's National Programme for IT, running significantly behind schedule and above budget.  Originally budgeted at £2.3 billion, present estimates are £20-£30 billion and rising.  Patient choice via 'Choose and Book' is only available in a few locations - and all the evidence is that managing and updating these systems is going to be intensely demanding.

No doubt there have been other major structural changes which I have missed, for example, 'Agenda for Change' - but giving this very simple and partial overview illustrates all too clearly the rate of organisational change, all of which impacts upon staff, patients and chaplains.  I have to say that it feels very short-term, over-frantic and lacking in long-term strategic goal setting.  My initial point hardly needs saying - my experience, meeting personnel at all levels of the NHS, is that the rate of change is more than the organisation, as an organisation, can really absorb and for those on the frontline it feels random.  When people cannot cope with the rate of change and cannot see its purpose, their morale and their sense of worth are severely damaged.

Let me highlight at this point, therefore, two areas in which chaplaincy can and does play a very significant rôle for the staff:

Firstly, you are there, in a sense representing timelessness, in an organisation that is driven by a sense of time-urgency.  Your pastoral care of the staff, through your steadfastness and reliability, is of enormous significance.

Secondly, where an organisation has lost any sense of its own story (it can remember its birthday in 1948 but has been too traumatised by endless random and sudden change to remember anything else of its life) it becomes subject to the whims of politicians and tabloid journalists.  The latest agony, for example, over the costs of the Herceptin drug, leads to immediate reaction - because no one has the history, and therefore the sense of perspective, in which such decisions need to be made.  You, as chaplains, are frequently the carriers of the local story: you are the story-creators, the bringers of shape - and again, at a local level, the importance of that should never be underestimated.  However, as a Church, we might do well to encourage someone (a research institute?) to keep a running story of the NHS as it has come to be, and then publish it as part of the training package for all new entrants.  Maybe such a document already exists?  More of this later ...

The Context: Government Legislation

Some of you will be aware that I have been deeply involved in two pieces of legislation over the past few years: firstly the Mental Capacity Bill, which received the Royal Assent in April 2005; and secondly, Lord Joffe's Assisted Dying for the Terminally Ill Bill, which was 'defeated' in the House of Lords a few weeks ago.  The Mental Capacity Bill will have a very important part to play in the way people with dementia and the mentally disabled and mentally ill are treated.  The Bill itself took fifteen years to come to fruition and is, I believe, a noble piece of legislation because it tries to ensure that all of us, regardless of our mental condition, are to be treated with absolute respect.

The Assisted Dying for the Terminally Ill Bill, as you know, set out initially to introduce euthanasia and assisted suicide onto the Statute Book.  In spite of changes to the proposed Bill, including the dropping of euthanasia (but placing emphasis upon assisted suicide), the Bill was defeated.  It is a subject which is not going to go away - and one which has implications for all chaplains. 

In the case of the Mental Capacity Bill, there is a huge gap between the Bill and the understanding about the Bill among those who could be most involved in its outcomes - and although I have been able to go to a couple of hospital post-graduate centres in my own diocese to talk about it, I am conscious that for all the other hospital Trusts in the country, the opportunity to discuss the Bill firsthand with one of the legislators has not existed.

In brief, then, I count it a real privilege to be a bishop in the House of Lords and to have been able to play a full part in two major health-related Bills.  I have been deeply indebted to the staff of HCC and of the MPA (Claire Foster and Christopher Jones, in particular) and I want to put on record how much we owe to these employees of our Church.  They are outstanding.  If the Church of England fails to keep healthcare legislation under close scrutiny, all of us, chaplains included, will be the poorer.

And what are the implications in this for chaplaincy?  You have, in Church House, a source of information with direct links into Parliament, via officers and bishops.  That is a great gift but it carries a responsibility which we would do well to acknowledge and use wisely.  And whilst chaplains inevitably and rightly have to be aware of their professional limitations as NHS employees, nevertheless, the opportunity is there for you, via HCC or one of the bishops in the House of Lords, to help shape healthcare legislation. 

The Context: Changes in Chaplaincy

When I took over the chairmanship of HCC, I became conscious of a multiplicity of organisations concerned with chaplaincy: HCC, the Churches' Committee for Hospital Chaplaincy (the ecumenical body), the College, various subgroups looking at accreditation.  Then there came into being the Multifaith Group for Healthcare Chaplaincy (MFGHC); and latterly, in relation to the NHS, the South Yorkshire Workforce Confederation; and even more recently, the Lead Chaplains associated with South Yorkshire.  It would be disingenuous of me if I did not say that the relationships between some of these bodies has been, and remains, tricky.  It is a great personal sadness to me that this is the case - but the fact of the matter is that chaplaincy has become contested ground.

From an historical perspective it is reasonably easy to see what has happened.  For much of the twentieth century, for cultural and historical reasons, the Church of England took the lead in relation to hospital chaplaincy.  This can be illustrated anecdotally.  When I was ordained, almost forty years ago, it was assumed that it was the 'vicar's' duty to visit his parishioners who were in hospital, whether they were churchgoers or not.  Visiting was straightforward: you went to the hospital, asked for details of those from your parish who were in hospital, and then you visited them.  My college principal, in one of his lectures on Pastoralia, gave us canny advice: call every nurse 'Sister', every Sister 'Matron', and when you see Matron, genuflect.  It was good advice then, it is a period piece now.

The growth of the ecumenical movement in the 1960s and 1970s meant that the Church of England learnt to be more cooperative with other churches but, as far as chaplaincy was concerned, a few anomalies arose.  Nevertheless, it was felt important to have an ecumenical body under the umbrella of 'Churches Together' - or the British Council of Churches, as it then was - in which areas of common concern could be explored.

As Britain became increasingly multicultural and multifaith in the late 1980s, the 1990s and in the first decade of the twenty-first century, it was felt right to have an organisation which would represent the views of non-Christian faiths in relation to hospital chaplaincy - and so the MFGHC was born.  It was and is supported by the Church of England and has drawn heavily upon the expertise of HCC and the C of E in its early years.  In fact, it was HCC which took the lead to set it up.

Then there is the College.  It is not for me to say much about the College, except that I do believe in an individual's right to belong to a trade union or a professional association - and in their right not to belong.  I confess that I think there is confusion of rôle when a trade union wants to provide and accredit the educational standards of its participating members, but I know that there are others who take a contrary view. 

Suffice it to say, the advent of the College's educational proposals and claims has meant that HCC has had to rethink its own rôle.  Where we are now, in HCC, is interesting.  I believe we should be offering a distinctive, professional and theologically well-grounded package of training for any ordained Anglican priest or licensed lay minister who wishes to become a chaplain, or who wishes to explore their own further development once in post.  To this end we are developing courses and will continue to encourage the provision of higher education courses by outside bodies.  It is only right and proper that Anglican clergy should be equipped for the very demanding and challenging vocation of being a hospital chaplain.

I believe that what we need, however, is not only training in skills but also to develop a passion for a theology which will inform and enhance the work of chaplains, especially in the field of medical ethics.  I do not, for one moment, underestimate the need for that kind of Anglican in-service training.

There is another element, however, which we must address - and that is the spiritual part of our formation.  Perhaps I can put it like this: no matter how 'professional' the chaplain, if their inner lives are withered, then their ministry is bound to suffer.  This is not something peculiar to hospital chaplains, it is true of all of us who are priests.  However, there are particular demands within hospital chaplaincy which are unique: the lack sometimes of any regular worshipping community; the endless distraction of urgent requests; and, deeper still, the existential questioning, in a sometimes fiercely secular environment, of whether our faith has any relevance at all.  I believe, therefore, that as Anglican chaplains, we need to take with the utmost seriousness our own personal, spiritual formation, rooting ourselves in the depths of experience of our Church in such matters; being people of prayer, of godly learning; people for whom the sacraments are at the heart of our ministry.  That is all quite personal, but if prayers are not being said daily, if the sacraments are ignored, if meditation on the scriptures through the offices does not happen, our ministries are bound to become thin and weak and institutionalised.

But let me add another dimension - and, again, I recognise that for some chaplains this may be a matter of controversy.  The dimension I want to add is that of the priest as 'representative'.  Perhaps I can put it like this: as a bishop I am very conscious that I am representative of my diocese, of the Church of England, and of the one, holy, catholic and apostolic Church.  I am not simply myself.  This is a very unfashionable thing to say and be, because as a society, we seem to prize personal fulfilment above everything else; society has a real problem with anyone in a representative position, be they monarchs or judges, or Members of Parliament or priests.  One way in which that representative function is expressed is through the bishop's licence - not, be it noted, the licence of a given personality, but the licence of the bishop.  I recognise that some hospital chaplains feel that they are ignored by the ecclesiastical 'system' - and anecdotes abound about fellow clergy who refer to hospital chaplains in disparaging ways.  Let me say, as gently as I can, I have also heard similar things said by hospital chaplains about parish clergy.  In my view, both in hospitals and in parishes, clergy are in places of mission, one setting is not easier than another, each has their unique demands and challenges.  The representative rôle, however, is even deeper than that; as priests, you and I are representative of God in Christ.  Putting it as straightforwardly as that is to indicate how demanding and how privileged that calling is.

Whilst there is much debate and talk about generic chaplaincy, I think that this represents an avoidance of what it truly means to be representative not of the Trust (though that may be included) but of the Church and through the Church, of the holiness, love, compassion, mercy and being of God.  It is from God we derive our being and it is to God that our being is moving - through grace and through Christ.

The Future

In spite of some of the systemic difficulties I have outlined, I think that we are beginning to see some new shapes emerging for HCC and for the Church of England's rôle in relation to chaplaincy - and for that I am very grateful.  In brief, at HCC we need to concentrate our efforts on

·                    the provision of Anglican theological and spiritual education and challenges for those who, as Anglican priests, deacons or licensed lay ministers, feel themselves being called to be hospital chaplains

·                    the provision of Anglican theological and spiritual education and challenges for those who are already in post

·                    making use of the unique position we have in relation to legislation concerning healthcare - and doing so, with friends from other Churches and other faiths, as long as neither they nor we are compromised

·                    providing a thoughtful critique of healthcare provision in our country, and keeping its story

·                    providing the central hub of a network in which insights about health and social wellbeing, spirituality, belief and practice can be shared.

But there are two other areas which I also want to highlight before I conclude.  One of the drivers of change in the NHS is the development of new drugs and new technologies.  Many of these press on ethical issues - and here, I believe, chaplains can and do play a major rôle.  That rôle is expressed in three ways:

i)                    in conversations around the hospital

ii)                   in taking part, where possible, in the training of medical personnel

iii)                 in serving, where possible, on hospital ethics committees.

There are, of course, professional ethicists in university departments of philosophy and we may have much to learn from them, but my experience of some ethicists does not lift my heart.  There are those who take an entirely utilitarian view of human life and they need to be challenged.  The BMA ethics committee, frequently consulted by the media, was not, in relation to euthanasia, entirely even-handed.  As chaplains we have a basic set of assumptions about the value, purpose and destiny of human life and whilst those assumptions are always open to challenge, we really must not underestimate our own capacity to ask searching questions of the ethical assumptions of others - and that can be as much about the euphemisms used by hospital executives surrounding certain procedures as it can be about specific and focussed ethical issues.  If we are to play a full rôle in these debates, we need to keep up our own ethical sharpness - and that means in-service learning.

The second major task confronting us is how to address chaplaincy in relation to short-stay hospital admissions and to the increasing rôle of community-based medicine.  GPs provide over 300 million consultations per year; the average length of stay in hospitals is 2-3 days.  This provides a real challenge for local churches and for hospital-based chaplaincy - and, it seems to me, this could be the next major development in chaplaincy.  I recognise that there are some pioneering community-based chaplains, particularly in the field of mental health, and I suggest we might have much to learn from them.

And finally ... the challenges that have faced HCC over the past eight or nine years have not been inconsiderable.  HCC itself has had to cope with major upheavals in the structures of Church House, following the Turnbull recommendations; there have been several physical changes of venue; and cutbacks in staff.  It has not been at all easy - but Edward Lewis, Tim Battle, Mary Ingledew and, before she retired, Liz Paffey, have given outstanding service to our Church and to chaplaincy.  I thank them very, very much indeed for all that they have done.

There is, however, more to be done in the future - and I have outlined some of the challenges we face.  Beneath everything that chaplains do and are, at the moment, there lies, I believe, a profound theological and spiritual question.  As Anglican priests our vocation is expressed and contained within the ordinal:

A priest is called by God to work with the bishop and with his/her fellow-priests, as servant and shepherd among the people to whom he/she is sent.  He/she is to proclaim the word of the Lord, to call his/her hearers to repentance, and in Christ's name to absolve, and to declare the forgiveness of sins.  He/she is to baptise, and to prepare the baptised for Confirmation.  He/she is to preside at the celebration of the Holy Communion.  He/she is to lead his/her people in prayer and worship, to intercede for them, to bless them in the name of the Lord, and to teach and encourage by word and example.  He/she is to minister to the sick, and prepare the dying for their death.  He/she must set the Good Shepherd always before him/her as the pattern of his/her calling, caring for the people committed to his/her charge, and joining with them in a common witness to the world.

In the name of our Lord we bid you remember the greatness of the trust now to be committed to your charge, about which you have been taught in your preparation for this ministry.  You are to be messengers, watchmen, and stewards of the Lord; you are to teach and to admonish, to feed and to provide for the Lord's family, to search for his children in the wilderness of this world's temptations and to guide them through its confusions, so that they may be saved through Christ for ever.

Remember always with thanksgiving that the treasure now to be entrusted to you is Christ's own flock, bought through the shedding of his blood on the cross.  The Church and congregation among whom you will serve are one with him: they are his body.  Serve them with joy, build them up in faith, and do all in your power to bring them in loving obedience to Christ.

Because you cannot bear the weight of this ministry in your own strength but only by the grace and power of God, pray earnestly for his Holy Spirit.  Pray that he will each day enlarge and enlighten your understanding of the Scriptures, so that you may grow stronger and more mature in your ministry, as you fashion your life and the lives of your people on the word of God.

We trust that long ago you began to weigh and ponder all this, and that you are fully determined, by the grace of God, to give yourselves wholly to his service and devote to him your best powers of mind and spirit, so that, as you daily follow the rule and teaching of our Lord, with the heavenly assistance of his Holy Spirit, you may grow up into his likeness, and sanctify the lives of all with whom you have to do

The context for the exercise of that ministry is not a parish or a parish church but, for the most part, within hospitals.  The major, underlying principles of the ordinal are being exercised by you with diligence and passion and commitment - and, on behalf of the Church, as it were, I want to express thanks for all that is being done.

The challenges, the spiritual and theological challenges, ahead of us are great but I rejoice that part of our Anglican way of doing theology is 'conversational' - that is, it is engaged with context whilst cherishing the eternal verities.  If God was in Christ reconciling the world to Himself, then that is the universal, the cosmic process in which we are all, by grace, caught up and in which we are called by God to participate.  It is the movement of the compassionate, healing, love of God through Christ that is the source and the end of our ministries.  Through God's mercy I pray that those truths will continue to inform and shape all our lives now and on into the future.

©            Christopher William Herbert,  2006

This page was added 27 May 2009