2.1. Topic 1. Acknowledgement of a Changing Healthcare Chaplaincy Field
Healthcare chaplaincy has traditionally been of a Christian nature—more specifically, the Church of England. The Church of England chaplains were there at the very start of when the NHS took its first breath in 1984, and it has therefore traditionally been seen as a Christian service.
Over the years, the emphasis on chaplaincy being a Christian profession changed and other faith-based chaplains emerged within the NHS in order to provide care to those of other faiths and to respond to the changing demographics. These faiths included Muslim, Sikh, Hindu, Buddhist, Baha’i, Interfaith and many more. Although these were different faith backgrounds for which to provide chaplaincy care to patients, staff and visitors, they all had in common that they were faith-based—which meant that they related to a higher power or a God.
Although historically chaplaincy has been viewed as a service relating to a higher power or God, a societal change occurred. An increasing number of people steer away from traditional faith frameworks and the old framework of chaplaincy care had to adapt to the societal changes.
Orton (
2008, p. 114) states that changes in demographics mean that “pastoral care needs to have an emphasis on spiritual support if it is to respond to patients or other faith traditions or with secular beliefs”. Orton specifically addresses the need of including pastoral care within holistic healthcare settings. She goes on by stating that “the traditional systems for the provision of pastoral care in health care settings reflected the historical contexts within which they were located. In England, with an established church and a centralized health care system, chaplaincy has traditionally been dominated by a formal relationship between the NHS and the Church of England” (
Orton 2008, p. 115). In this model chaplaincy was solely seen as a faith-based role.
Orton (
2008) describes the shift from a faith-based chaplaincy role to becoming a more inclusive service: “In the same way that the service model has moved from a religion-focused, clergy-dominated model to a multi-faith, spiritual approach, so pastoral care has moved from a predominantly religious and sacramental role to a broader role responding to the diverse spiritual needs of individual patients, their families and staff as well as meeting religious needs” (
Orton 2008, p. 116).
Hay (
2013) confirms that since the mid-twentieth century, there has been an increasing embrace of individual expression of spirituality, whether religious or non-religious, and a move away from worldview affiliation. This comes to the foreground not only in scholarship, but also in journalist studies and in governmental reports.
It has been established that currently, 53% of the general population in the United Kingdom identifies itself as “non-religious”, and an even higher figure amongst the British youth: 71% of 18–25-year-olds (
Humanists UK 2017). However, this does not mean that young people do not seek pastoral or spiritual guidance. The NSPCC (UK child line) has demonstrated that the younger generation is engrossed in existential questions of life when they try to make sense of their situation. A survey of three hundred General Practitioners in the United Kingdom indicates that 78% of youngsters between 11–18 years old experience more mental health problems than five years ago (
Campbell and Doward 2016). The NSPCC (child line within the United Kingdom) confirmed that one in three phone calls made by children and young adolescents concern specific mental health conditions. Phone calls used to be trending around pregnancy, bullying and physical or sexual abuse, however, the focus has now shifted towards struggling with loneliness, suicidal thoughts, depression, anxiety, and self-harm; according to Peter Wanless, NSPCC chief (
Campbell and Doward 2016). These topics are more of an existential nature which relates to young people making sense of their situation. Responding from an existential–spiritual perspective could therefore be helpful for these youngsters identifying as non-religious.
Due to the people steering away from traditional religious frameworks, chaplaincy services had to revisit their practices. This led to the introduction of the NHS chaplaincy guidelines in 2015. This document refers to and incorporates societal changes with regard to chaplaincy work. The NHS guidelines underline that the term “chaplaincy” is no longer “affiliated to any one religion or belief system” (
Swift 2015, p. 6). The guidelines explain that “healthcare chaplaincy is a service and a profession working within the NHS that is focused on ensuring that all people, be they religious or not have the opportunity to access pastoral, spiritual or religious support when they need it” (ibid.). This was the first time that chaplaincy resources referred specifically to the inclusion of the non-religious and therefore responding to the societal changes. This then supported the development of humanist pastoral care to function as an alternative option for providing equal care to those who do not have a religious faith or the opportunity to speak confidentially about their worldview, values, and morals. Although faith-based chaplaincy has in the past provided care to people who do not hold a faith, the alternative of providing like-minded care from someone holding a similar worldview was introduced.
Humanists Entering Chaplaincy Teams
The start of humanists entering chaplaincy teams resulted from a scoping exercise held in 2011 by HUK where they posed the question: “Is there a need for a non-religious pastoral care service that operates in a way like religious chaplaincy?” (
O’Donoghue 2017, pp. 56–57). After conducting interviews, surveys, focus groups and even a pilot project, non-religious people described that they felt that they did not receive the same support as those that were religious. Additionally, non-religious people mentioned that they did not want to receive pastoral and spiritual support from someone with a religious view, even more so in end-of-life situations. They therefore welcomed the idea of having support from a likeminded person with an aligned (non-religious) worldview (ibid.).
A training consultant worked over a two-year period to establish a systematic approach to provide a high standard of pastoral care. Furthermore, the role of a pastoral carer was researched, and this led to creating a job description which in turn contributed to the person specification of the role. The person specification led in its turn to a competency model which needed to be met by individuals who wanted to join the accreditation course. The competency model was used as assessment criteria and was demonstrated throughout the training.
For each program, applicants are screened to see if they can support their teams in the institutions they work for and if they are willing to support the developing network of non-religious pastoral carers whilst being happy and capable to work with colleagues and service-users of other belief systems. In addition, a systematic approach is in place to support new members from beginning to end.
The Non-Religious Pastoral Support Network (NRPSN) was created in 2016 to receive recognition and acceptance as the chief provider of non-religious pastoral care. HUK provided funding and support to set up this initiative and HUK staff and volunteers helped to establish it. The program however was aimed to provide pastoral support to the non-religious and not only to people who identified themselves as humanists.
Humanists UK then polled on the perception of the public about what a chaplain was to them. The public opinion of chaplaincy remains primarily tied to a Christian image: while 83% of the public think that a chaplain could be a Christian, only 6% feel that they could be Jewish, 5% Muslim, 4% Buddhist, 5% Hindu 4% Sikh and 5% non-religious. 75% of non-religious respondents felt unlikely to want or require support from a religious chaplain, and 45% expected that they would wish to receive non-religious pastoral support (
Humanists UK 2016). Furthermore, according to
Hurst (
2020), there was a survey that studied the inclusivity of faiths and beliefs chaplaincy websites and about 91% scored very poorly on inclusivity.
Hurst (
2020) describes this outcome as “Anglican dominated, faith-centric, resistant to change and no longer fit for purpose” (
Hurst 2020, p. 18).
Savage (
2015) conducted a study at his own Trust to record how many non-religious patients were visited by the multi-chaplaincy team. The outcome was that only 4.1% of non-religious patients were visited. This differentiated tremendously from those of faith that were visited regularly. A rough estimation by
Savage (
2015) was that about 45% of patients in his Trust would have held non-religious beliefs. Therefore, it appeared that non-religious patients did not have equal opportunities to receive pastoral and spiritual support. He states that it was not the case that chaplains did not want to visit non-religious people, but that it could be the case that they wanted to talk to someone likeminded. “For example, a patient with Christian beliefs may sometimes want to talk to a Christian chaplain or a patient with Hindu beliefs to a Hindu carer. It is not unreasonable to suppose that a patient who is not religious may sometimes want to talk to a carer who is not religious” (
Savage 2015, pp. 67–68).
One article by the BMJ stated that “recent research by YouGov for Humanists UK found high demand among the public for someone to talk to about pastoral or spiritual matters in times of crisis. Almost 90% of those asked, however, said that they perceived chaplaincy as offering only Christian support. Many people who might benefit think it is not for them” (
Hurley 2018). The article additionally identified, with the help of previous stats from faith-based colleagues over the years, that “Chaplaincy” is still very much seen as Christian terminology, but last year about 80% of our conversations were of an existential nature, pastoral. About 20% were tied to specific rituals or services such as Holy Communion. “Most are about making sense of the situation in hospital. Why is this happening to me? What have I done wrong? How am I going to cope with this life altering illness or injury?” (
Hurley 2018).
It was hard getting a paid role as a humanist chaplain, since there appeared to be an old trend that most paid vacancies for chaplaincy required a bachelor’s or master’s degree level in theology. HUK was striving to promote equality and diversity in recruitment, to make vacancies more inclusive for minority faith groups and for those with non-religious worldviews. Training students to BA and MA level helped towards creating a professional route that would eventually lead to more inclusive chaplaincy teams and opportunities for paid employment. There are now roughly 10+ employed Humanist chaplains working within healthcare and prisons in the U.K.
2.2. Topic 2: Worries about Chaplaincy Funding
The changing chaplaincy context leads to concerns about funding. Since 2015, HUK has challenged chaplaincy vacancies that are solely advertised to attract a Christian chaplain. Letters had been sent out to potentially take legal action on grounds of equality and diversity if they would not reconsider diversity of religion and beliefs of the local population. The Chief Executive of HUK wrote: “We are committed to ensuring that all people with non-religious beliefs have access to pastoral support, just as religious people have access to such support, and look forward to expanding our own contribution as part of our growing community services work”(
BHA 2015) (
Kyriakides 2017, pp. 19–22). Humanists would be entering chaplaincy teams to provide an alternative to faith-based support. Due to the action letters sent out by HUK, some NHS Trusts suspended appointing chaplains, or others worked hard to implement an Equality Impact Analysis to reflect their local faith and belief demographic. As
Kyriakides (
2017) also rightfully points out, HUK’s agenda was very different to the National Secular Society (NSS). HUK wanted to provide pastoral and spiritual care to non-religious people rather than defunding chaplaincy services altogether. Even now, chaplains commonly mistake the NSS for HUK which has caused tension for humanists entering chaplaincy teams. However, humanists stand for the universal declaration of human rights of which one tenet is that everyone shall have the right to freedom of thought, conscience, and religion. Hence, humanists are not here to antagonize or replace, but instead to help support those with non-religious worldviews who would like to speak to someone like-minded. There are some statements on chaplaincy funds that are aimed at humanist groups.
Ross and McSherry (
2020) state that humanist groups compare “spiritual care and infrastructural conditions in financial terms and aim them at one another. Humanists present spiritual care providers and hospital infrastructure as competing for financial resources. As if both were a straight contrast, a zero-sum game” (
Ross and McSherry 2020, p. 114).
Billings (
2015) additionally points to critics who might use the decline of religion to reduce public spending to serve their own case. The NSS calculated exactly how much money could be distributed to other professionals if chaplaincy was axed: “The national Secular Society, for example, pointed out how much could be saved by axing chaplaincies in the NHS (estimated 40 million) and what that might equate in nursing (1300) or cleaners (2645). The British Humanist Association argued strongly that the state had no business supporting something that was harmful to people’s welfare” (
Billings 2015, p. 38). Although HUK is mentioned by Billings in the same paragraph as the NSS, it is important to point out that HUK does not have plans to defund chaplaincy, but wants to ensure equality, diversity, and inclusion to provide chaplaincy support to all faiths and beliefs by diversifying its chaplains and representing its patient demographic. The NSS however kept campaigning to end funding for chaplains as they believed that state institutions should not have a religious role (
Savage 2019, pp. 96–97).
Funding concerns started with challenging vacancies to be inclusive and open to not just those who held a faith which led to suspending some recruitment in NHS Trusts. Understandably, this led to some emotional reactions of those wanting to recruit, especially when there were assumptions made that HUK was of a similar stance to the NSS regarding defunding chaplaincy services. Further concerns then came to light with regards to recruiting those who were non-religious and how this development could detract from Christian sessions.
Kyriakides (
2017) discusses in his doctoral research that if HUK is successful “to fund non-religious carers in chaplaincy departments, this is likely to reduce the number of Christian chaplaincy sessions and affect the Christian ethos of chaplaincy departments” (
Kyriakides 2017, pp. 19–22). Surely it should not be one or the other? And it may be rather short-sighted from a faith-based point of view to believe that if chaplaincy were to be made more inclusive to accommodate all faiths and beliefs that this should draw away from the Christian colleagues. This signals the problem chaplaincy services are facing; that chaplaincy is still perceived as a mostly Christian service even by some chaplaincy practitioners such as
Kyriakides (
2017).
Hurst (
2020) tries to address funding challenges from a different viewpoint. He believes that a qualitative survey could help justify the use of public money and establish the demand for pastoral, spiritual and religious care. In addition, this could give information about what the service should look like and how to name such a service to make it inclusive. He continues with his argument to say that “a robust system of care could also include a check, such as BACP’s Certificate of Proficiency, to ensure that staff are working to a patient’s needs” (
Hurst 2020, p. 18).
Funding for chaplaincy services is still rather tight throughout the NHS, although perhaps with new non-religious practitioners entering the service it could give a new boost to chaplaincy services and refocus its practices; making chaplaincy visible in organizations again to attract additional funding avenues.