|
Inaugural
Norman Autton Memorial Lecture
delivered
by The Revd. Prebendary Peter Speck
on 28 October 2002
at The Conference Centre, Church House, London
Norman
Autton 1920-1998
It is
82 years [ and one day ] since a baby was born in Neath, South Wales
who was to have a profound effect on the development of chaplaincy
within the hospitals of this country. That baby was Norman William
James Autton whose memory we honour in this inaugural lecture today.
It
is a great honour to be invited to give this lecture in memory of
Norman, in the presence of his wife Kate and such an illustrious assembly
of health care chaplains, many of whom themselves span many decades
of chaplaincy. Norman
devoted his whole ministry to healing - whether in formal hospital
ministry as a chaplain, through his role with the Guild of Health,
or his efforts to enhance the skills of clergy through his work at
Church House and elsewhere. In the mid 1950’s Norman was appointed
chaplain to the Deva Psychiatric Hospital, Chester. The NHS
was still fairly new and whole-time chaplaincy even more so. Norman
had entered a psychiatric hospital – not the easiest starting point
and quickly discovered that he, like most clergy, was not very well
equipped for the role, especially in terms of understanding mental
illness and the workings of a large psychiatric unit. Seven years
later he was to produce his first book (1963) on the pastoral care
of the mentally ill.
The
dye was cast and his commitment to training and the equipping of clergy
to make a professional contribution to health care began. Training
courses were developed and many here today attended the courses for
theological students at St George’s Hospital, Hyde Park Corner,
and elsewhere, and were enthused to engage in hospital chaplaincy
themselves.
Norman
was formative for me in a slightly different way. As a teenager in
the parish of Shotton, N Wales, I listened to Norman preach on several
occasion in the late 1950’s. Gerald Davies (our curate) was a friend
of Norman’s and would invite him to preach. I well remember this eloquent
preacher struggling to deliver his sermon and master a very profound
stutter. I admired his courage and tenacity and wondered how he coped
with such an impediment in a psychiatric setting. Local people who
worked in the Deva sang his praises and his ministry was much appreciated
by patients and staff alike. In later life I was impressed by the
way in which he had (virtually) overcome the stammer and often would
use humour to overcome the problem. E.g. story told by Norman of patient
he visited. Norman said "would you like to p,p,p,pray with you?" "Yes"
said the man "If it helps you"
I
later trained at Queen’s College, Birmingham and read Norman’s books
in the Library of Pastoral Care and found them immensely practical
and insightful.
The
seeds of hospital chaplaincy were germinated within me at that time
and I could see it as a way of bringing together my science background
with the theological / pastoral training I was receiving in Birmingham.
Norman
was a priest within the anglo-catholic tradition and so a sacramental
approach was the obvious model for him – and for many of us
at that time. He recognised the need for clergy visiting people in
hospital to be professional in their manner and approach. This, for
him, meant being clearly rooted in a priestly role. [In
Pastoral Care of the Bereaved he talks of the poise of
the priest as a silent prayerful presence]
Later
he broadened his view to recognise that those of other traditions
also needed to be professional within their ministerial tradition
– But the key word all the way through was ‘professional’.
This professionalism
was, however, to be conveyed to patients in a warm and caring way,
but leaving no doubt that they had been in the presence of a priest.
Following his time at Church House (5 years with HCC) he returned
to Wales and the new University Hospital at Cardiff as its chaplain.
He remained there until his retirement in 1985 but continued on the
staff of Llandaff Cathedral until 1992. Norman continued to write
and produced two further books
The
foundation left by Norman has three main building blocks:
-
Priesthood
-
Professionalism
-
Training.
Held
together by humour, integrity, compassion and …I would add perhaps
…… stubbornness (for I believe he was not always the easiest of people,
as is so with most pioneers !!)
While
Norman was developing this foundation the NHS was changing; and has
undergone numerous (or rather continual) change since then.
The
expectations of patients, the demands on staff, the demands of government
and the DoH have all changed. Newman said "To live is to change,
and to be perfect is to have changed often" However, the demand
for perfection in health care provision can be very costly in human
terms. There is a great need to ensure that human values are not eroded
by a "measure everything" and a "continually improve" culture. It
is interesting to reflect on what I perceive as an unconscious recognition
of this, in that spiritual / religious care has been a continuing
part of the NHS and health care provision since the initial Act of
1947
through
to the present as we now await the update of HSG(92)2 – the Multi-Faith
guidance for healthcare chaplaincy
Following
Norman there were various key figures who shaped and developed the
foundation of healthcare chaplaincy, and strove to ensure that chaplains
continued to bridge the gap between the vulnerable patient and (what
we may term) disease-attacking, invasive medical approaches.
Robert
Clarke, John Browning, Frank Longbottom, Geoffrey Holden, Roger Grainger,
John Foskett, Christine Pocock, Ronald Rose, Howard Tripp and other
Catholic clergy, etc etc. Some wrote, some contributed to a variety
of working parties, and chaplaincy organisations, but all participated
in the Annual Study Course at Oxford (arranged by the HCF at Somerville
or St Catherine’s) where much of the education, innovative changes,
and exploration of a variety of styles and models of chaplaincy took
place…. And …. we have seen a variety !!
In
1949 a prominent medical journal wrote:
There
is no evidence that the health of the nation has benefited from
the first year of the NHS. On the other hands, thanks to the integrity
of an ancient and honourable profession, no great harm has been
done ….
This
comment could also apply to some aspects of health care chaplaincy
in that, from the perspective of the present NHS, we have not always
been very good at presenting evidence of benefit, but we have demonstrated
that we are an ancient and honourable profession. In our current climate,
however, we do need to be developing evidence that what we do,
and how we do it, is beneficial, and is best practice and of value
to patients, staff and the organisation as a whole. BUT
….. how do we do this ?
I
would like to suggest that there are several aspects to this which
will call upon a variety of skills from chaplaincy practitioners
of all faith groups. Since no one person can undertake and deliver
the answers to what I believe are key questions for the future,
there is a need for a collaborative approach, both within chaplaincy
and with other professionals who may already possess some of the
required skills. I suggest that the main questions
to be addressed are:
Q.1 What are we appointed to do? = deliver spiritual care within
a health care setting, but what is spiritual care? What
is spiritual care? = brief presentation of definitions etc.
Q.2 How
should we actually be doing it?
= the role of a chaplain, the role of volunteers, what it means
to be ‘professional’.
Work
of Michael Wilson "Hospital – a place of Truth" (1971) and Heije Faber
(1971) My own book in 1978 Loss & Grief in Medicine,
the development of the NEW
Library of pastoral care with authors
such
as
John Foskett, Ian Ainsworth-Smith, myself, the work of Roger Grainger,
Mark Cobb, David Stoter, David Lyall etc and a recognition of the
need to look wider than the Christian understanding of pastoral care
to consider the insights from within other faith communities. These
were developed in "Our Ministry to Others" HCC (1987) Julia Neuberger
(1987) the Olumide study in 1989 and an unpublished Warwick University
study by Beckford and Gilliat in 1996. There was a more critical analysis
of pastoral care by Stephen Pattison. More recently we have seen a
rash of publications from the publishers Jessica Kingsley "Spiritual
Dimension of …….. " which includes the publication of Spirituality
in Health Care Contexts ed. Helen Orchard and containing several
thought provoking chapters from chaplaincy practitioners and researchers.
Tony Walter (Sociologist, Reading) also writes provocatively in Palliative
Medicine that chaplains must stop pushing responsibility for spiritual
care onto nurses and others because, he maintains, THEY are the prime
resource for patients and staff for religious need and ritual and
for discerning the spiritual unrest and anxst that many patients experience.
AND one
cannot fail to mention [slide Hospital Chaplaincy – modern, dependable]
the very interesting (if controversial) report by Helen Orchard [2000]
which asks some uncomfortable, and searching, questions about what
(the surveyed group of chaplains) were actually doing with their time.
Q.3 How do we know, and show, we have achieved what is required
to those who employ and pay us? = Audit, statistics etc.
There
is little doubt in my mind that we should be collecting data appropriate
to what we are doing. Not as slaves to data collection and audit (as
a defence against patient involvement) but linked directly to
the delivery of care to real people. (cf. Menzies "task centred nursing")
We
work in a business planning culture with a strategic – operational
dynamic. For too long many have believed that accountability is to
God alone and not to the earthly boss who pays them.
If
we are to get anywhere near professional status in the NHS then we
have to have clear accountability as to how we spend our time and
what the Trust is getting for the money it pays us out of a public
purse. Clinical governance is for all who have direct ‘hands on’
care of patients and that includes chaplains. If not then what are
we doing there?
Q.4 How
do we know that what we do is best or even good practice? =
research (qualitative and quantitative)
Far too
easy to say that spirituality and religion cannot be investigated
and that to try to do so is blasphemous. In medicine I would argue
there is an ethical imperative to undertake research in order to extend
knowledge and so ensure that our clinical / pastoral practice is evidence
based. (hence the creation of NICE) Should spiritual care be any different?
Some studies have been undertaken in the USA, but need to be
critically appraised and the different cultural setting recognised.
More recently studies are beginning to be developed here in the UK
Very
important to look critically at the various studies eg. Are the USA
studies which look at religion and mortality / morbidity actually
looking at the effect of religion per se or at the life style, diet,
social support which may come with being actively religious? Religious
belief may be a motivating force but the key factors in outcome may
be different etc. The various prayer studies also seem to pre-suppose
a deity who will comply with request to help some and not others!
A penny-in-the-slot approach.
Q.5 How do we let others know what we have discovered? = Publish,
in the right places. + Training
The
Journal has published some interesting articles on the role of the
chaplain and various case studies and personal accounts. It is not
so research-based as the American Journal of Pastoral Care (articles
freq. Contributed by chaplains). It is sad that some recent and qualitatively
useful studies have not been published eg. Woodward (1999) doctoral
thesis on the Role of the acute hospital chaplain is unpublished,
as is the work of Beckford and Gilliat on the Church of England and
other faiths in a multi-faith society. Chaplains need to get more
articles into the Health Service Journal, the nursing press and the
Church press. However,
it is not just a matter of publishing – articles, research findings
etc need to be in the right journals if they are to be evaluated
properly by the DoH and NICE. [eg. Evidence for value of spiritual
care in palliative care guidelines is thin!!] Focus
on Journals which are multi-professional, cited and international.
In my time on the editorial board of Palliative Medicine we
were able to publish some reflective qualitative as well as quantitative
studies. If chaplains can form alliances with other professional researchers
within their Trusts then there is a greater likelihood of getting
papers published. Multi-centre, well designed studies are also more
likely to be published. It takes time to get from hypothesis and investigation
to a published paper. I believe that the future foundation of chaplaincy
could become eroded if we ignore this increasingly important building
block. The development of the MA in Health Care Chaplaincy, and other
courses, should be encouraging people to publish and share what they
do, how they do it and the evidence base [qualitative and quantitative]
for what they do. Training
must reflect current best practice and research evidence. Wherever
possible there is great benefit in such training be multi-professional.
I am often saddened to see how few chaplains in palliative care settings
are able to attend the national and international conferences. There
are also very few papers presented by chaplains at such venues. Maybe
the annual conference could incorporate a multi-professional day,
and enhance the confidence of chaplains to present and discuss issues
in such a forum?
CONCLUSION
Norman
Autton developed his chaplaincy role in the 1950-60’s on an understanding
of PROFESSIONALISM as being rooted in a priestly vocation and ministry
that was expressed within a sacramental framework. Within society
and the NHS for a long period there was tacit agreement that the professionalism
of chaplains could therefore be taken for granted, since they had
been selected by God/ the Church, trained and ordained into a professional
group whose competence, confidentiality and loving care for people
was par excellence. The status of clergy as members of a profession,
therefore, carried over into the secular setting. In
recent years this assumption has been challenged on many fronts –
and not just in terms of media scandals. The very fact that we have
had heated discussions about chaplains and confidentiality, data protection,
registration, supervision and multi-professional working, and whether
or not chaplains actually want to be seen as health care professionals
- all indicate a changing attitude both within and outside of chaplaincy.
One of the sources of distress for some chaplains is the fact that
many still feel the organisational Church does not seem to want to
support or own them since they have "left the church". However, there
needs to be a strong umbilical cord between chaplain and church
for much pastoral care in effect is being offered in a missionary
setting; with both ends communicating with each other. Isolation can
be damaging mentally and spiritually for both the chaplain concerned
and those being ministered to. As
priests and ministers we know that, as part and parcel of our calling
and vocation, we must be founded in God. This understanding motivates
and sustains us in our pastoral encounters. But … the language and
the method by which we express and explain our vocation and role to
the secular world in which we live and work will determine the extent
to which we continue to be valued and employed within that
secular setting. If all other disciplines have to demonstrate that
what they offer is of value and can enhance the quality of life and
well-being of the patient then why should chaplaincy be exempt?
There
is a tension between the language and norms of the secular setting
and the inner language of our calling in faith.
I
Tim 6 captures this very well when Paul reminds Timothy in verse 20
of the source of true knowledge; having already re-directed those
who have become distracted by worldly values.
Chaplaincy
is about helping people take hold of "the life that really is life"
– but we must make sure that we do not lose hold of that life ourselves.
I believe
it falls to the College, HCC, The Faith Communities, MA students and
individual chaplains to respond positively to the challenge of holding
this tension creatively, in order that there will continue to be a
credible [patient-centred, evaluated] foundation for future generations
of multi-faith health care chaplains to build upon. This will be not
only to the benefit of patient care, but to the glory of (what the
existentiaIist theologian Paul Tillich called) The Ground of
our Being, who is our surest and most credible foundation.
|
