Hospital Chaplains Revisited – a dialogue
Last year, I hosted a guest post by my friend Chiron, arguing in favour of hospital chaplains. Now I understand a petition (or rather two petitions) relating to hospital chaplains will be considered by the Welsh Senedd this week, so I thought it was time to revisit some of these issues. But as we’re coming from different positions, this time it’s a back-and-forth between us.
Hi Chiron, I’ve been sent some interesting information about a bit of a to-do that’s kicking off in Wales on the subject of hospital chaplains. Apparently, your guest post for my blog has been brought into the discussion, so I thought you’d be interested to take a look. Any thoughts?
Hi RA, I’d certainly be very interested in seeing what form this ‘to-do’ is taking. The post I contributed to your blog was principally about one of the errors that secularists make when they’re talking about NHS chaplaincy: that it’s a ‘religious ministry for religious people’. As I said in your blog, that’s simply not true.
If there is any public discussion going on in Wales (which I wasn’t aware of till you contacted me) I hope it’ll be more accurate and nuanced than has been the case in the past few years in England.
Here’s some of the details I’ve been sent. The starting point is a petition for chaplains for be funded through a charitable trust, rather than out of NHS funding. It’s an intriguing proposal, and one that seems to me like a neat solution. In addition, there’s a counter-petition which is being dealt with at the same time basically supporting chaplains and asking for them to be provided in more settings.
In principle, I don’t see any particular objection to chaplaincy being charity funded: as the petitioners say, plenty of other things are. In practice, there are problems – just as there sometimes are with other charity funded services. The main problem is that with any externally charity-funded service in the NHS, what the NHS gets is what the charity wants to give them. If the NHS wants something slightly different, tough. The NHS’s relationships with charities are not always smooth.
It’s also odd that the petitioners seem to think charities are entirely funded from voluntary contributions. Actually, a lot of them have contracts with the NHS which the NHS pays for out of core funding – the cost to the NHS is less than if it funded the service itself, but the cost isn’t zero.
One solution, I suppose, would be to fund chaplaincy not from an external and independent charity, but from each Trust’s own charitable fund. But there are still problems: not all Trusts have a good charitable fund, and there’s a general unwillingness these days to use charitable funds to fund salaries.
I think we should note that NHS Wales is rather different from NHS England – I think hospital Boards in Wales have a lot less say in how they spend their money than Foundation Trusts in England. I’m open to correction, but I think in England it would be less easy for NHS England to tell Trusts (beyond the basic, core services), ‘You must fund X, you must not fund Y’.
That’s an interesting point about control, but it might be an argument for careful drafting more than anything else. There are not only charitably funded resources like Macmillan Nurses and Air Ambulances which are used and controlled appropriately by the NHS, but Trusts are well used to using various sources of funding to employ staff in line with the aims and policy of both NHS and Trust.
Foundation Trusts, while not relevant to the Welsh case, could be more complicated. I’m not sufficiently familiar with the legislation to be able to say whether the DH would have any meaningful control if a Trust ended up employing a range of dangerous fundies, but the source of the funding doesn’t change that. It’s a risk wherever the funding comes from.
At the moment it’s not the DH that keeps chaplains – if you’ll pardon the allusion – on the straight and narrow. It’s the fact that we’ve evolved good professional governing bodies, good management skills, and we don’t want to have to handle the complaints that would rightly flood in if we were to employ ‘dangerous fundies’. The management and governance only really began to evolve, I think, when we became able to shift our loyalties rather more in the direction of the NHS. Those systems would also have to be rebuilt under a charitably funded system.
Again, I’m not saying it couldn’t be done. I’m not even saying it shouldn’t, necessarily. But I do think the present petition is naïve and underestimates the task of decoupling chaplaincy from an NHS of which it has become very much a part. (Either that, or it isn’t naïve, knows perfectly well what’s involved, and hopes it will spell the end of chaplaincy as a profession. But let’s not assume slyness or malice.)
This may be something that can’t be covered properly in the course of this conversation, but where do you see the significance of the NHS being both employer and funder? How, specifically, do you see chaplains changing if they were charitably funded?
I’ve got no more than anecdote to support my point about SLAs (Service Level Agreements) I’m afraid – I don’t know if there’s any writing looking at the NHS’s use of them out there. They can be very useful things, for instance when you want one or two people doing a particular kind of job and don’t want to set up a whole department around them. So you enter a SLA contract with an organisation that does provide (roughly) what you want. However, I don’t know many NHS managers who have a good word to say about SLAs. The problem is that, in effect, line management stays within the NHS organisation, but higher level management, strategic planning, and HR stuff usually lies with the outside organisation. So if the outside organisation wants to, say, change what it provides, there’s not much the NHS ‘hosting’ organisation can do about it.
For example, some years ago the cancer information charity CancerBackup merged with Macmillan Cancer Care. Macmillan wanted to provide information services in a rather different way than CancerBackup had, and I heard on the grapevine that it took some NHS Trusts some time to adjust to the changes – but they had no choice but to accept those changes.
However, another thought, quite separate from this line of thought, occurred to me the other day. If the question is, why should NHS employ in-house chaplains in particular, then why not look at hospices? Twenty years ago, in the region where I work, virtually no hospices had in-house chaplains. They all relied on support from local faith communities. Then one or two began dipping a toe in the water. When I was employed by a hospice, I was the first paid chaplain they’d had, and one of the first in the region.
Within two years, the hospice board was commenting favourably on how chaplaincy had become integrated with the hospice as an organisation. It had come to be about much more than just day to day patient care. The experiment had been a success. (And when I left some years later, my replacement was appointed on more hours: the hospice wanted more of what they’d had.) Now, virtually every hospice in this region does have in-house chaplaincy. Now, why would the NHS want to go in the opposite direction?
So there you are. I’m not exactly persuaded by Chiron’s objections, and it still seems to me that charitable funding is a good way of squaring the circle, but he’s given me a lot of food for thought. At least, I hope that if chaplains in Wales do end up being funded through a charity, someone takes care over the details.