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HOSPITAL/HEALTH
CARE CHAPLAINCY
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A
Celebration of Healthcare Chaplaincy: Luke 17. v.19 “Get up, go on your way: your faith has made you well” This service is a celebration of healthcare chaplaincy and its role within the modern NHS. I wish to thank you for inviting me to preach on this occasion. After more than 30 yrs as a healthcare chaplain I believe there is much to celebrate. In the Gospel reading we have heard again of the healing of the ten lepers. What is of special significance is that Jesus sent them to see the priest and it was as they went that they were physically restored. Nine then went on their way, but one returned to Jesus to give praise to God and Jesus responded by saying “Your faith has saved you”. In other words this particular man moves from being disease free, to being healed and restored at a deeper level than the other 9 – he has now found true health/ salvation/ wholeness in a restored relationship with God as well as with his family and community. During a recent visit to S.India I met with doctors who practice Ayervedic medicine and we discussed healing. They said if you want treatment you go to the hospital, if you want healing you go to the temple. In the UK and the West we combine the two through the provision of chaplains. There
has long been a close relationship between the church and those
caring for sick people and as hospitals grew so did the provision
of chaplaincy to meet both the religious and wider needs of sick
people. The Lunacy Act of 1890 specifically appointed an Anglican
chaplain in each mental hospital. When the 1946 NHS Act went before
parliament chaplaincy had been written into it – so that there were
28 whole-time chaplains within the teaching hospitals at the start
of the NHS in1948. Today there are over 450 whole-time chaplains
in post and approx. 3500 part-time chaplains from various faith
traditions. The
last 60 years have seen enormous changes in the way in which health
care is delivered, and increasing pressure to deliver services which
are timely, cost-effective and person centred. The technological
advances, development of new treatments and approaches have led
to ethical dilemmas which could not have been envisaged when the
NHS was formed [eg. Resuscitation, life support in ICU, Embryo research
and gene therapy….] One constant factor throughout all this change
and development has been the need to retain the focus on a person
who presents with a disease and not simply on the interesting disease
itself. In addition we have also needed to ensure that that person
is seen in the context of his/her family and community – which in
our pluralistic society may be very different from the local community
in which health care is provided. I learnt whole-person approach
v. early in my career. Lady in side room seen by a dozen people
on morning she was admitted, all of whom examined parts of her.
I was end of the line. She was reading a magazine. Didn’t look up
as I introduced myself but threw the bedclothes back and said “which
bit do you want” – to which I replied “I want all of you” and thankfully
she laughed. Alongside
the large number of different professional groups involved in providing
health care (in the many different settings) there has nearly always
been a chaplaincy service. In small hospitals this has been part
time, but in the larger or specialised units it has been whole time.
In the early days the chaplain was usually Christian and primarily
focussed on a religious ministry or word, sacrament and pastoral
care. Nowadays chaplaincy is increasingly multi-faith, as reflected
so well in this service. It is also clear that many people entering
health care do not practice a religious faith but still seek an
opportunity to explore issues often described as ‘spiritual’. We
now recognise that religious people are often a sub-group of those
who have a spiritual life that is important to them, and that many
with a spirituality might not choose to express it in a religious
way. This is true for staff as well as for patients and families.
Chaplaincy has had to adapt to this change and discover ways of
supporting patients who might not want religious ritual but do want
a broader pastoral care = opportunity to explore the possible meaning
and purpose of what was happening to them. The various re-organisations
within the NHS also highlighted the need to focus on staff and their
support needs in the face of what felt like ‘constant change’. At
the heart of all re-organisation of services must be the person,
and respect for that person – be they patient or care-giver. However,
as recent events show that has not always happened and a separate
agenda has been developed around issues relating to “respect and
dignity”. As
we consider the patient’s experience we can see that they undertake
an outer and an inner journey: The
outer journey from the time symptoms arise leads them to the
GP, the Out/Pt dept and possibly after investigation to become an
in-patient for either medical, surgical or psychiatric treatment.
If all goes well they will then subsequently return home and back
into their family and community. Alternatively they may deteriorate
further and eventually die in hospital, hospice or at home. The
inner journey arises out of the questions, anxieties and fears
that can develop as patients seek to understand their symptoms and
the implications of the illness. If the event is life threatening
then the patient may also have particular existential issues to
address – relating to life, the universe and everything. Some of
this inner journey may be difficult to explore unless the patient
meets someone who can support them while they face these issues. To return to the gospel reading, Jesus discerned that what the 10 people with leprosy needed was more than physical restoration or wellness, but that anything deeper would require a more personal response - only one of the 10 achieved this. Maybe as the others reflected on their ‘good fortune’ later they may have expressed a deeper response to their encounter with Jesus. As in much of chaplaincy the outcome may not be immediately measurable. The
more personal agenda/inner journey and questions of patients requires
a particular relationship of trust. It is not always easy or possible
for staff to achieve this because of pressures of workload, especially
during staff shortages, or the pressure of targets. Against this
background the chaplain can play a key role in various ways.
Much
of this has been accepted as true for many years, but recently the
role and relevance has been questioned. In some cases the provision
has been cut back because it’s value could not be measured [as reflected
in the recent Theos report www.theosthinktank.co.uk
]. However, contrary to some media reports, it is not true to say
there is no evidence to support the importance of providing for
spiritual care within health care. Over
the past 15 years there has developed a significant body of evidence
to show that approx. 70% of people entering health care have a belief/spirituality
that is important to them. These people may not necessarily be religious
but they want to have their values, beliefs and spiritual concerns
recognised and valued as part of an holistic approach to their care.
In the US there is also a strong set of research evidence to demonstrate
a significant link between spiritual/ religious belief and sense
of well-being, reduced incidence of depression and anxiety in elderly
patients, reduced death distress in dying patients and greater ability
to cope with difficult diagnoses [eg the nuns in the Chicago study
into Alzheimer’s, whose disciplined life enhances their ability
to cope with memory loss]. While I accept the cultural background
in the US is different to the UK there is also a growing number
of UK studies which show similar findings. The Caring for the
Spirit (NHS) initiative and the NICE guidance on supportive
care for adult cancer patients (2004) support this statement
and endorse the inclusion of spiritual care as a key component of
palliative care and health care in general. Interestingly, a large
proportion of these studies have been undertaken by doctors, nurses,
psychologists and others, peer reviewed and published in well respected
scientific journals. If we are to endorse a whole-person approach
in health care then there needs to be easy access to experienced
providers of spiritual care who are also familiar with the health
care setting. The
health care setting is changing again: through shorter in-patient
stay, the development of polyclinics and more clinical work being
undertaken in the primary care setting. The recent Tooke report
[Modernising Medical Careers www.mmcinquiry.org.uk
] stresses the need for doctors to re-appraise their role and I
suggest the same is true for chaplains. If chaplains are to continue
to be a valuable resource they will also need to reappraise their
role in the light of the new ways of delivering health care. Chaplains
will need to be aware of the existing research evidence, to ensure
it informs practice, and collaborate with other professions in research
activity to develop our understanding of what happens in the pastoral
encounter. Given that chaplaincy costs less than 0.1% of the budget
for most Trusts [figure = 0.09% in the Theos report] I suggest that
cutting back their service will make little difference financially,
but a great difference to the patient and staff experience - as
well as affecting the perceived genuineness of the organisation
to enshrine a set of values which puts people at the centre of care. During
my time as a chaplain I was asked to see the parents of Stephen
– a 15 yr old who had gone climbing with friends in the peak district.
Some loose rocks tumbled down and caught Stephen, knocking him off
the cliff face. He was admitted to the neurosurgical unit and tests
showed his brain stem was probably irreparably damaged. I was asked
to see his parents in the waiting room. As I entered Stephen’s mother
raced across the room towards me. She grabbed the lapels of my jacket
and screamed at me “How could God allow this to happen?“ and then
proceeded to kick my shins. It was very painful. I gradually moved
her back to the settee and sat her down and said that I was clearly
making her more distressed by what I represented. I would leave
but return later – and limped out. A short while later I returned
and Stephen’s mother was calmer, apologetic and wished to talk.
It was the 1st time Stephen had gone off with friends
to climb and his parents recognised they had to let go and trust.
Mother, although she said she was not religious, had offered up
a quick prayer and then got on with their day. They both felt God
had let them down, he should have stopped gravity, and I had got
it in the neck for God. The neurological tests showed Stephen was
not going to recover and I asked if they would like me to be with
them when he came off the ventilator. They said yes and later asked
me to offer some prayers for Stephen and for them. Stephen died
shortly afterwards and they left the hospital. With their permission
I put them in touch with their local Vicar who subsequently took
the funeral, and I heard no more until….. 18 months later at Christmas
I received a card to say thanks and to let me know that on the day
Stephen fell they had both been to see a solicitor to file for divorce.
They had felt Stephen’s fall was a punishment and that was why God
did not hear their prayer. However, they had since cancelled the
divorce, were still together, and had recently been Confirmed in
their local Church. My intervention in their life had initially
triggered great distress and, while I was able to be with them as
Stephen died, I was not sure what the outcome would be except that
Stephen was clearly going to die. However, that pastoral encounter
together with the work of the parish priest led to growth
and healing that could not have been measured in outcome terms when
they left the hospital. Frequently
outcomes from pastoral care have a long time-frame which are often
related to significant encounters early on in the process. Chaplains
frequently hold/contain the pain, the hope and the optimism for
people as they move through some dark places together - in a way
that is not always possible for other staff. It is chaplaincies’
quiet & competent presence within the secular setting that can
symbolise so powerfully to a healing that is truly holistic and,
I believe, Holy. Thanks be to God, for the years of faithful service provided by Healthcare Chaplaincy in this City and elsewhere. May it continue to be developed and supported in the future. |
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This page was created 25 October 2007 |