By Derek Brown
by Margery Collin:
A reading from Finding my way home by Henri Nouwen, about “peace is to be found in weakness” followed by prayer.
10 years ago, chaplaincy in Edinburgh Hopsitals associated with specific chaplains, along with part time help. These individuals treated the Hospitals as their parish. Now this has changed. Now no part time generic chaplains in Edinburgh's acute Hospitals.
Sandy's story is a city story of acute hospitals. Edinburgh Royal Infirmary and Western General Hospital were separate Trusts. No chaplaincy team work or support between the two. Then Lothian Universities NHS Trust. Integrated working across various sites. Chaplaincy as one team with need for Lead Chaplain with Line Manager. Lead Chaplain is line manager for all other chaplains in that Trust.
All part time chaplain posts in the Trust amalgamated to make full time posts. So smaller hospitals do not have their own dedicated chaplain.
£300000 per year to fund the chaplaincy team costs more to employ full time equivalents than previous cost of part time chaplains. Denominational chaplains now included in budget. Some funding still from endowments.
Method of working.
Change from routine visiting, with chaplains responsible for specific ward visits to:- all staff responsible for spiritual care, so that ward staff refer appropriate to “spiritual care champions” (re chaplains). So chaplains working on “response to need” as identified by ward staff.
In addition chaplains go to units identified as likely to have patients with greatest needs. Chaplain visits specific to those patients identified as “a visit from the chaplain would make a significant difference to this patient's journey through the hospital system” totally systematised approach to referrals.
no payment for Episcopal chaplains. Roman Catholic Chaplains still payrolled. Nominated by Bishop, appointed by Trust.
Bolton Hospitals Trust model used by chaplains for writing up their work. Each day a narrative of work has to be written.
Honorary faith community contracts, with a signed agreement about role, insurance, name bade, includes pagan and humanist.
Consequences of “values neutral” approach need consideration. Demography requires “Christian Ministry formation” in team: majority of population “believe without belonging”
Logging of out of hours work over a year showed the on call team worked one moth's worth of hours on out of hours call-outs.
A question: is the future direction of chaplaincy a continuation of Christian ministry or more being a “utilitarian functionary”.RESPONSES AND QUESTIONS:-
Ilness often results in return to church by lapsed members.
Data protection issues make access to patients difficult.
Reply to above from Sandy: In his Trust, honorary Roman Catholic Chaplains (Priests) visit after mutual contact by lay Roman Catholic chaplains identify need.
Reality in NHS is that it is about “valve free” and “neutral needs assessment.”
Sandy's view is that his faith will continue, but chaplaincy will cease to become the Church's ministry.
Is not “Ministry” our whole Christian life rather than a specific part of it? And so meeting patient need is ministry.
Sandy: yes. But how to see this as part of philosophy of care. How, therefore, to conduct, for example, a non-religious funeral?
Unconditional positive regard of counsellor parallels love of God therefore ‘non-religious' includes God –
Sandy: Yes, I believe that. But if the other person does not, what is the reality within the counselling relationship?
If we accept that spiritual awareness need have no religious aspect, why should “religious people deliver spiritual care?
Why are religious people not the right people? Is it not who the patient feels comfortable with that is important?
Sandy: Yes. Meeting the need of the individual crucial. But if a patient says “I'm not religious” should Sandy himself visit or call in humanist chaplain?
Is the answer to Sandy above (No. 5) not “what the patient feels is appropriate is correct?”
Ability to get alongside and meet patient needs is important, not specific religious affiliation.
(Further response to 5) the experience of chaplains who have wrestled with looking at belief in relation to life experience is useful in helping patients match whatever their belief – system about life is in relation to their hospital experience.
Also NB difference in perception between how chaplain of any religious group sees himself, and how patients perceive that chaplain.
Sandy: Newest appointment at Western General is hospital appointment not Church of Scotland. Representative from ‘faith' background on selection committee from Edinburgh Inter Faith Association, not a specific faith, lay Roman Catholic appointed as generic chaplain. The whole process has to be inclusive.
(from chaplain directly appointed) Audit should reveal what is needed.
Sandy: That is not enough. We audit what we do, not what we do not do. We need to be meeting needs of those “out there” who are not wrestling requesting their needs are met.
Comment that there should be an audit done on patients to find out if their needs are being met.
Comment that research say s that patients do not know what ‘spiritual' means so talk in terms of religious needs.
Need to emphasise positive elements within change. Generational issue involved: younger people more secular, and certainly less denominational. Maybe current chaplains? “comfort zone” are being shaken.
All this shows need for strong chaplains' association. Neither Church nor NHS can “decide” on identity of chaplains. We need to do this for ourselves as chaplains, and for the churches and for the NHS. We need to continue this despite what is happening in England. Re LHCC and Dept of Health.
In the future will “chaplains” be all “humanistic” and trying to offer care to a few Christians?
Response: people interested in spirituality but not organised religion.
Sandy: apology for pessimism. Aim was honest and realistic look at now and the future. Very little atheism in society. We are not on “secular humanist” road but it will get harder to justify why a particular faith group should be responsible for providing generic service.
How do “spiritual care champions” prioritise?
Sandy: You cannot go wide and deep equally effectively. Current system has helped those in specific, high need but those who have lost out are long term patients, especially in smaller hospitals.
That there is “spiritual care” is significant. We should be part of Allied Health Professionals. General visiting develops staff relationships: how to maintain relationships with staff if only responding to needs?
Sandy: responding to need maintains relationships with staff in high need areas. However need areas lose out.
Comment about spiritual care competencies by hospice chaplain new to Scotland. All carers will have to be seen to have training in spiritual care competencies, not just chaplains. Result will be spiritualty promoted in wider way.
Roman Catholic chaplains have never been appointed as generic chaplain to whole hospital.
Challenge to working on needs assessment.
Sandy: new ways of taking patient histories should enable better needs assessment. Spiritual and / or religious need when a patient is not necessarily coterminous with religious affiliation as recorded on admission document.