Scottish Journal of Healthcare Chaplaincy

Vol 6 No 1 May 2003

EDITORIAL


In the course of the opening act of worship at the recent ‘Chaplaincy for Tomorrow’ conference, of which more in the Autumn edition of the journal, the chaplain made reference to the words of Christ to the church at Philadelphia (Rev. 3:8) :-‘Behold, I have set before you an open door, which no one is able to shut'. The metaphor of the open door set be-fore us seems particularly apposite and resonant in the context of healthcare chaplaincy today. The long awaited and much anticipated publication of the Guidelines on Chaplaincy and Spiritual Care in the NHS in Scotland is evidence that a door is well and truly open, enabling a level of communication, sup-port and mutual working between chaplains and the institutions we serve, which has the potential to lead to the enrichment of both. Particular encouragement can be found in the document’s early exposition of the background and broader role of chaplaincy. The changing role of chaplaincy in a changing society is set out with clarity, and what to many has proved an immensely helpful explanation of the distinction between religious care and spiritual care is given. There follows a sensitively framed description of the nature of spiritual need and spiritual distress with which healthcare chaplains are called upon to deal, and an affirming acknowledgement of the importance of spiritual care to the person centred health-care which the modern NHS aims to provide. Much of this is hardly news to some of us; yet it will help greatly in our sometimes less than coherent attempts to explain to our colleagues in healthcare the nature and value of what we do.

The devil, as they say, is in the detail. And the detail is being worked out in every healthcare area in Scot-land, as spiritual care committees meet to consider the integrated planning and delivery of spiritual care services across the area they serve. Chaplains have the opportunity to be fully involved in this process, and to be influential in shaping the future direction of the chaplaincy service , perhaps to be more pro-active in this than ever before.

One of the many fascinating aspects of this whole debate over the nature and future of chaplaincy is about the language used, or rather, the different languages which co-exist, perhaps at times a trifle un-easily. Andrew Hill, writing from a Unitarian perspective, chooses to preface his remarks on the guidelines with a poem which for him captures the very essence of spiritual care. It describes the ‘white haired man’ who incarnates the love which creates wholeness, healing and holiness wherever and for whomever it touches. Pass on now to the world which Chris Johnson inhabits for the purposes of his contribution, as he takes on the challenge of managing chaplaincy service delivery in the NHS of today, and employs the language of management in a rigorous and clear sighted manner. It surely can be said that the two approaches are not mutually exclusive, and yet to look from one to the other is to catch something of the dilemmas, even anxieties with which chaplains have to deal at this time of great change. In our efforts to come in from the cold, as it were; in our eagerness to learn and to embrace the language of NHS managers; in our attempts to de-fine spirituality in such a way as to command the broadest possible agreement, are we, as some fear, in danger of losing something of the poetry, the spontaneity, the sheer and of-the-moment indefinability of the Spiritual, or even of stripping it of its transcendent, Godward aspect? Does the perceived recognition and status of becoming a ‘department of spiritual care’ bring with it, as several of our contributors fear, a demotion of the spiritual to just one more discrete element of healthcare, when in truth it should underpin the whole?

And yet, despite these and other concerns of a more practical kind, our contributors welcome the guide-lines, and see them as evidence of the door which is open to us. Here we are offered a chance to shape our future; an opportunity for affirmation, recognition of our training, support and resourcing needs; a forum in which to listen and be heard (a thing difficult to do from our traditional peripheral stance, as Mike Ward reminds us), and to engage creatively alongside other healthcare professionals in this oh so practical and oh so mysterious business of healing. Perhaps there is a sense in which chaplains have to lay aside what could be interpreted as the arrogance of assuming that we are always different, apart, not subject to the same scrutiny as our colleagues, not under any obligation to explain ourselves in a language other than our own.

There is surely much to be gained. The challenge for chaplaincy is to grasp the nettle, and to think long and hard about our role, our value, and our values. Deep rootedness in our various faith communities surely gives us the courage to do this, so that we and our healthcare colleagues together may be effective in the pursuit of excellence, motivated by that ‘moral passion’ which we have in common.

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CONTENTS


GUIDELINES ON CHAPLAINCY AND SPIRITUAL CARE
IN THE NHS IN SCOTLAND

NHS HDL (2002) 76

Pages 3-12

[Read Guidelines]

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SPIRITUAL CARE IN NHSSCOTLAND
SCOTTISH ASSOCIATION OF CHAPLAINS IN HEALTHCARE

Derek Brown

Pages 13-14

The author welcomes ’Spiritual Care in NHS Scotland’ as evidence that spiritual care provision has been acknowledged as a vital part of NHS healthcare. The establishment of spiritual care committees will enable a strategic overview of spiritual care services, and will give chaplains themselves the opportunity to influence the direction and future shape of chaplaincy. Welcome too is the emphasis upon the support, training and development of chaplains. However, concern is expressed over the issue of funding the proposed changes, in the absence of any pledge of new money from the Scottish Executive.

Derek Brown is chaplain at Raigmore Hospital and the Highland Hospice, Inverness, and is President of The Scottish Association of Chaplains in Healthcare.

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SPIRITUAL CARE IN NHSSCOTLAND
SCOTLAND REPRESENTATIVE ON THE COUNCIL OF THE COLLEGE OF HEALTH CARE CHAPLAINS

John Birrell

Pages 15-16

On behalf of CHCC Scotland, the author welcomes ‘Spiritual Care in NHSScotland,’ while recognising that much depends on its local implementation. Its clarification of the nature of spiritual care, the role of the care giver and the sharing of patient information is timely. Reservation is however expressed about the role of the proposed Spiritual Care Committee.

John Birrell is chaplain at Perth Royal Infirmary and Scotland Representatives on the Council of the College of Health Care Chaplains

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SPIRITUAL CARE IN NHSSCOTLAND
THE ASSOCIATION OF HOSPICE AND PALLIATIVE CARE CHAPLAINS (SCOTTISH BRANCH)

Alison Wagstaff

Pages 17-18

 ‘Spiritual Care in NHS Scotland’ emphasises spiritual care as broader than religious care, and makes clear the importance of well resourced spiritual and religious care within healthcare. In response, chaplaincy must become more accountable and professional. There are implications for ongoing training and registration of chaplains, and this may well create difficulties for part time and volunteer chaplains, as well as for church authorities. However, the Guidelines are to be welcomed as a means to improving practice in healthcare settings.

Alison Wagstaff is chaplain at St Columba’s Hospice, Edinburgh, and chairperson of the Association of Hospice and Palliative Care Chaplains (Scottish Branch).

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SPIRITUAL CARE IN NHSSCOTLAND
RESPONSE OF A PART TIME CHAPLAIN

Ken Coulter

Pages 19-20

While welcoming some of the provisions of ‘Spiritual Care in NHSScotland’ the author regards part time chaplains as being ‘conspicuously absent’ from the guidelines, despite the implication that their numbers might increase if more faith communities decide to appoint. Concern is expressed that the lack of attention to the development of part time chaplaincy might seriously undermine what has hitherto been considered to be an important aspect of the chaplaincy service.

Ken Coulter is chaplain at Stobhill Hospital, Glasgow

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SPIRITUAL CARE IN NHSSCOTLAND
A MANAGER’S RESPONSE

Mairi McMenamin

Pages 21-23

Spiritual Care in NHSScotland’ carries forward key emphases of earlier policy documents, regarding patient centred services, patient involvement, and cultur-ally appropriate services. It reflects the values of openness, respect, accountabil-ity and inclusion. The challenge is to reflect upon the values which underpin change, and to apply them to create a positive spiritual environment within healthcare. The guidelines are welcomed as moving in the direction of a truly person centred NHS.


Mairi McMenamin

(Author’s details are available on request from the editors)

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SPIRITUAL CARE IN NHSSCOTLAND
A NON-RELIGIOUS PERSPECTIVE

Roderick McKenzie

Pages 24-26

‘Spiritual Care in NHSScotland’ seeks to differentiate between religious and spiritual care. Yet the latter is not adequately addressed as a separate concept, and the definition which is given of it is unduly dependent upon established psychological theories. The author poses the question as to whether the education of staff in spiritual care, as opposed to religious care, ought necessarily to be the province of the chaplaincy at all.

Roderick McKenzie is Community Psychiatric Nurse at Osprey House, Invenress.

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SPIRITUAL CARE IN NHSSCOTLAND
A UNITARIAN RESPONSE

Andrew Hill

Pages 27-28

The author identifies the best practice of spiritual and religious care as encompassing the ‘non-religious, alternatively religious and differently religious’, an approach which accords well with the Unitarian tradition. He therefore welcomes the recognition in ’Spiritual Care in NHS Scotland’ of the breadth of spiritual care which the NHS chaplain is called upon to provide, but expresses concern lest ‘the spiritual element’ should become simply another NHS specialism,  when it is the concern and province of all.

Andrew M. Hill is minister at St. Mark's Unitarian Church, Edinburgh

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SPIRITUAL CARE IN THE N.H.S.SCOTLAND
THE PERSPECTIVE OF A HOSPITAL PHYSICIAN

David Short

Pages 29-32

A retired hospital physician considers the practical implications of the
Scottish Executive Health Department (SEHD) Guidelines on Spiritual Care in the NHS Scotland. Whilst welcoming the move toward the recovery of a spiritual dimension in health care, and the recognition of the specialist role of hospital chaplains, he expresses two concerns. The first is the danger of too superficial and ill-defined an attitude to the spiritual need of patients. The other is whether the rank and file of healthcare workers will be prepared to give time to this
additional burden, or feel equipped to do so.

David Short is Honorary Physician at Aberdeen Royal Infirmary.

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MANAGING CHAPLAINCY SERVICE DELIVERY
Chris Johnson

Pages 33-38

Audit, accountability and clinical performance all form what is now understood in the National Health Service (NHS) as Clinical Governance (CG) and it has profound implications for all who work in the NHS including Chaplains. CG is something they will need to comprehend and implement. This paper seeks to describe the service the Chaplaincy provides, our customers are identified, as are the difficulties of assessing whether or not we can/are delivering a quality service. I consider what criteria/performance indicators I would be looking for from an economical, efficient and effective Chaplaincy department. Then as a “customer facing organisation”, I explain some of the difficulties of finding out what our customers think of our service/role and cite examples of surveys from other Trusts.

Key words: Chaplaincy, Clinical Governance, customers, effectiveness, quality, value for money

Chris Johnson is Chaplaincy Manager, Bradford NHS Trust.

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OFF THE EDGE? A THEOLOGICAL ASSESSMENT OF SCOTT’S “PERIPHERAL STANCE” OF CHAPLAINCY
Michael J Ward

Pages 39-43

In the light of the recent Scottish Executive Health Department (SEHD) Guide-lines, the author examines the validity of the late Tom Scott’s “peripheral stance” of institutional chaplaincy, with specific reference to contemporary healthcare chaplaincy. Scott’s views are discussed in the context of the premise of secularisation. By drawing on Gill’s critique of Hauerwas, the author cites recent events in the aftermath of the Alder Hey inquiry to claim that healthcare chaplaincy can be defined as a central activity: one that is socially significant and capable of influencing society. By redefining chaplaincy as a form of “community church” (Moltmann), the author concludes that the question of the precise locus of chaplaincy is transcended by adopting a “double strategy” that enables chaplaincy to maintain an authentic Christian presence but at the heart of the hospital community.

Key words: secularisation, spiritual care, peripheral, double strategy, community.

Mike Ward is chaplain for NHS Orkney

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PALLIATIVE CARE : A THEOLOGICAL FOUNDATION THE SPIRITUAL DIMENSION OF PALLIATIVE CARE IN THE LOCAL CHRISTIAN COMMUNITY
George Beuken

Pages 44-46

n the last of his four part exploration of a theological foundation for palliative care, the author, writing from a Roman Catholic perspective, considers the place of the local Christian community in the holistic care of the sick. The Christian community plays a vital role in such care, and needs to be equipped to fulfil this calling by the establishment of pastoral care teams. The ‘body of Christ’ cares for its members, and such care extends beyond the care of the terminally ill to encompass the care of the bereaved. Through such attention to emotional and spiritual need, the Christian community bears witness to the continuing compassion of Christ.

Key Words:  Holistic, palliative care,  pastoral care, spirituality,  bereavement care,  befriending.

George Beuken is Pastoral & Spiritual Director at St. Andrew’s Hospice, Airdrie.

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BOOK REVIEWS

Pages 47-51

Books Reviewed

Psychotherapy and spirituality: integrating the spiritual dimension into therapeutic practice
Schreurs A.

Jessica Kingsley Publications, 2002.


Rehabilitation Counselling in Physical and Mental Health
Etherington K.
ISBN 1-85302-968-8
Jessica Kingsley


Supportive and Palliative Care in Cancer: an introduction
Regnard C. & Kindlen M.
ISBN 1-85775-937-1
Radcliffe Medical Press

Ethics, Management and Mythology: Rational Decision making for Health Service
Professionals.

Michael Loughlin
ISBN 1 85775 754 X
Radcliffe Medical Press


Dying and Grieving: A Guide to Pastoral Ministry
Alan Billings
SPCK
ISBN 0-281-05526-2


Reclaiming the Sealskin – Meditations in the Celtic Spirit
Heppenstall-West A.
ISBN 1 901557 66-9
Wild Goose Publications

Addiction: Pastoral Responses
Dann B.
Abingdon Press, Nashville
ISBN 0-687-04504-5

This is the Day: Readings and meditations from the Iona Community
Paynter N. (Ed)
ISBN 1 901557 66 9
Wild Goose Publications

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THE ORERE SOURCE 

The Rev. W. Noel Brown, A CPE Supervisor, Northwestern Memorial Hospital, Chicago.is the editor and puiblisher of THE ORERE SOURCE, a bi-monthly compendium of his abstracts from the pastoral care literature. 

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