Managing Spiritual Care?
Contemporary
Healthcare Chaplaincy
and Public Policy
The Revd Dr Andrew Todd
Assumptions &
Approach
• A consideration of the continuing ambiguity of
chaplaincy – between faith communities,
other organisations and public policy
• Consideration of the framing of chaplaincy by
organisational and political agendas – and the
significance of current adaptations
• Conclusions about healthcare chaplaincy now
and the implications for understanding the
interaction of religion, spirituality and health
Historic Strength
• Pastoral care rooted in attentive and inclusive
listening – a non-judgemental approach to
patients and staff
• Earned respect that enabled a constructive
critical engagement with the organisation
• An amateur approach to healthcare – that
enabled chaplains to see the human person
• Holistic healthcare rooted in seeing the whole
person
Holistic healthcare
Holistic healthcare – ‘a state of complete
physical, mental and social wellbeing and not
merely the absence of disease or infirmity’
(WHO Constitution 1946)
Contextual Factors 1
• Multi-specialist healthcare - competitive
• Evidence-based practice
• Cost-benefit analysis and the drive for
efficiency - economic finitude; hierarchies of
provision?
• Contested statutory basis for Chaplaincy
• Contested public role – Worcester 2006 (Swift
2009); Data Protection (Welford 2011); NSS
campaign
Chaplaincy
Adaptations 1
Finding a role within the organisation:
• Professionalization
• Capabilities and Competencies (NHS Education
Scotland)
• Assessment of spiritual care needs and
appropriate intervention
• Emerging statutory Basis for Chaplaincy –
Scotland (from 2002); Wales (from 2010);
England still working with 2003 Guidelines
• Authorisation and Regulation (UKBHC and
MFGHC)
Outworking 1
• Re-positioning chaplaincy – a task-based
approach with increased accountability
• Specialist role with patients and relatives may
occlude role with staff
• Specialist approach may also work against
connectedness and seeing the whole person
• How does the chaplain relate now to the
organisation – by becoming managers of a
specialist spiritual care service?
Contextual Factors 2
• Equality of opportunity and respect for
diversity – ‘equal care for equal need’
• Patients’ rights; patient choice; patient
experience – ‘no decision about me without
me’
• Holistic healthcare – integrating the
‘spiritual’?
• Perception of spirituality as individual need
(alongside other healthcare needs)
Chaplaincy
Adaptations 2
Articulating contemporary chaplaincy practice:
• Spiritual (as distinct from religious) care
offered by chaplains, nurses, others
• A response to human need for meaning,
identity, hope…
• Respects diversity of belief and patient choice
• Offers equality of opportunity
• Generates a chaplaincy role not limited to
religion (alongside multi-faith provision)
Spiritual Care
‘Listening to the patient’s experience and the
questions that may arise; affirming the patient’s
humanity; protecting the patient’s dignity, self
worth and identity; ensuring that spiritual care is
offered as an integral part of an holistic approach
to health, encompassing psychological, spiritual,
social and emotional care, and within the
framework of the patient’s beliefs or philosophy of
life.’
National Institute for Clinical Excellence (NICE) (2004). Improving Supportive and
Palliative Care for Adults with Cancer: The Manual.
Outworking 2
• More rhetoric than practice? (Swift, 2009)
• Difficult to distinguish (Welford 2011)
• Multi-faith and ‘generic’ models of chaplaincy
(Todd 2011)
• Subordinates religion (one way in which
spirituality is expressed)
• Characterises spirituality and religion as distinct
• Marginalises chaplains’ ‘spiritual’ skills rooted in
their religious practice
• Individualisation of care may counter
connectedness and therefore holism
Consequences for
Chaplaincy
• In much of the above, chaplaincy speaks to those
who run the NHS – less attention is paid to other
audiences (especially the patient)
• The evolving specialist language and role widens the
gap between chaplaincy and more traditional faith
practice
• The scope for the ‘empty handed healer’ (Swift
2009) may be both wider (more ‘inclusive’) and
more constrained (more task-based and
accountable)
• The humanitarian amateur may be out of fashion
(but still in action)!
Holistic healthcare?
Elements of a shift of practice?
• Professionalisation – a more instrumental
specialism?
• Compartmentalisation (religious/spiritual)
• Implications for faith-based skills and the
development of new skills (spiritual need
assessment)
• One specialism within multi-disciplinary
healthcare, rather than a connecting humanity?
• But – legitimatory rhetoric, not fully embedded in
practice (yet!)
References
Welford, Layla. 2011. Spiritual Healthcare and Public Policy:
An investigation into the legal and social policy frameworks
of healthcare chaplaincy. Cardiff University, PhD Thesis
Todd, Andrew. 2011. Responding to Diversity: Chaplaincy in
a Multi-Faith Context, in ed. Miranda Threlfall-Holmes &
Mark Newitt, Being a Chaplain. London: SPCK, 89-102
Swift, Chris. 2009. Hospital Chaplaincy in the Twenty-first
Century: The crisis of spiritual care on the NHS. Farnham:
Ashgate.