Discovering meaning, purpose and hope through person centred wellbeing and spiritual care: framework

4. A professional specialist workforce

4.0.1 The primary responsibility of specialist spiritual care givers is to promote the spiritual wellbeing of health and social care communities and all who are part of them, including service users, carers, staff and volunteers.

4.0.2 Their responsibility is to deliver person-centred spiritual care and to promote the wellbeing of all service users working as an integral part of inter-disciplinary health and social care teams.

4.0.3 Despite accounting for a very small proportion of the workforce, NHSScotland Chaplains are internationally known for their innovative practice and research. Since 2002, healthcare Chaplains in Scotland have moved to working in a person-centred way providing specialist spiritual care. This is on a continuum from generic pastoral care to specialist spiritual care.

4.0.4 For Registered Chaplains, spiritual care is the reason for their employment, and they are expected to be capable of acting and understanding solely within the area of spiritual care. They are expected to take their place as members of the multi-disciplinary healthcare team and to fulfil a meaningful role within the healthcare community^[48]. This should apply equally if practicing in a social care environment.

4.0.5 Registered Chaplains can support the paradigm shift required for the delivery of care as agents of transformation and collaborative change at different levels:

• Micro (individual) level
• Meso (team, department, community or locality) level
• Meta (organisational, systems, national or international) level^[49]

4.0.6 Strategic leadership is, increasingly, a fundamental part of the day-to-day remit of spiritual care staff and is integral to the delivery of spiritual care services. To support and extend this strategic and leadership role there is a need to develop a mechanism for local and national leadership training, mentoring and coaching for all Registered Chaplains.

4.1 Formation, Training & Development

4.1.1 A Registered Chaplain’s work involves the use of the self. The ideas of practical wisdom and professional formation are used to try to capture the essence of this, along with the process of formation to describe the deep reflection and personal exploration required.

4.1.2 There is a need to develop training which supports a personal journey of self-discovery, formation and learning which nurtures and ignites transformation. This will ensures that both current and future spiritual care staff are equipped to undertake the roles and duties expected of them.

4.1.3 It is not helpful or possible to break chaplaincy work down into a series of tasks or competencies. The UK Board of Healthcare Chaplains (UKBHC) Competences for Registered Chaplains (approved for use in Scotland by the UKBHC in March 2020) therefore takes the approach of clarifying the required knowledge, skills and behaviour^[50].

4.1.4 There is a need to encourage the professional workforce to engage meaningfully in lifelong continuing professional development. It is also vital to support newly registered chaplains as they start their vocational journey.

Recommendation 20: The Scottish Government, in collaboration with the Scottish Spiritual Care Professional Leads Group, NHS Education for Scotland, and other partners, should establish a short life expert working group to agree a national approach to an education, induction and a formative learning programme for early career Registered Chaplains.

4.1.5 Registered Chaplains are ideally placed to become strategic leaders who can plan and develop services that bridge health and social care settings.

4.1.6 Leadership skills and training are fundamental in creating not just a harmonious working environment, but also to enable any team to stride forth and lead local and national objectives. It is imperative that adequate leadership and management training are put in place that supports the role of those who manage spiritual care teams and their needs to maintain a thriving and developing service.

Recommendation 21: NHS Education for Scotland and Scottish Social Services Council will work in partnership with Scottish Spiritual Care Professional Leads Group and other stakeholders to deliver a programme of spiritual care education and development opportunities for spiritual care teams. This should include;

a) initiatives to strengthen and nurture the leadership capability of all Spiritual Care Teams

b) initiatives to further enhance the strategic leadership skills of spiritual care leaders and Registered Chaplains

4.2 Career Structure

4.2.1 Currently, within healthcare settings, there is no recognised career pathway or staffing structure for Registered Chaplains (including national job descriptions and person specifications) which support career progression and performance management for Spiritual Care staff.

4.2.2 Spiritual Care Teams have much to learn, and gain, from the work undertaken by the “Transforming Roles” programme^[51]. There needs to be robust strategic oversight, direction, and governance to develop and transform the delivery of spiritual care to meet the current and future needs of Scotland’s health and social care system.

4.2.3 The development of spiritual care requires new models of care, delivered by multidisciplinary, integrated teams. It is now time to consider how we redesign, transform, and develop roles.

4.2.4 There may be value in exploring an “Assistant Chaplain” role based on the work undertaken to develop assistant practitioners in other healthcare professions.

4.2.5 There may be value in exploring the current “Nursing, midwifery and allied health professionals (NMAHP) development framework”^[52] to consider if it has relevance or transferability for Registered Chaplains. Such a model would support the development of core knowledge, skills and behaviours in four pillars of practice, at Levels 5-8 of the Career Framework for Health^[53]. It would also enable profession specific and specialist knowledge, skills and behaviours to be added.

4.2.6 Moving through the levels is associated with increasing breadth and depth of knowledge, skills and behaviours across the four pillars of practice, widening engagement and increased responsibility and experience.

4.2.7 Career development can happen in different ways. Staff may wish to develop higher levels of responsibility, knowledge and skills (vertical progression) or to remain at the same level of the career framework but build on existing knowledge and skills to focus on a particular career pathway e.g. Facilitation of Learning or Leadership (horizontal progression)^[54].

4.2.8 Currently the minimum SCQF level for entry as a Registered Chaplain is Level 9 (Ordinary Degree). It is neither necessary nor desirable to map all post-registration education to academic levels, but where it is appropriate, the following can be used as a guide:

Job Title	Career Framework level	Minimum associated SCQF level	Agenda for Change Banding
Associate Practitioner			Band 4
Trainee Chaplain			Band 5
Registered Care Chaplain	5 Practitioner	Level 9 – Ordinary Degree level	Band 6
Specialist Registered Chaplain	6 Senior Practitioner	Level 10 – Honours Degree level	Band 7
Lead Registered Chaplain	6 Senior Practitioner	Level 10 – Honours Degree level	Band 7
Head of Department	7 Advanced Practitioner	Level 11 – Master’s Degree level	Band 7 / 8
Consultant	8 Consultant Practitioner	Level 11/12 – Master’s/Doctorate level	Band 8

4.2.9 It has been identified that there is a lack of consistency in staffing of spiritual care teams across NHS health boards. There is also a need to simplify the plethora of chaplaincy titles and roles used across the UK, and define roles and duties in a language and framework that employers can understand, and which aligns to Agenda for Change.

Recommendation 22: The Scottish Government in partnership with NHS Education for Scotland and the Scottish Spiritual Care Professional Leads Group should establish a short life working group to develop a proposed carer pathway for Registered Chaplains.

4.2.10 The UKBHC have developed role descriptors with indicative Bands in accordance with the NHS Agenda for Change job evaluation framework^[55]. The Scottish Terms and Conditions Committee (STAC) have agreed a protocol for sharing job descriptions between Health Boards.

4.2.11 Considering the size of the spiritual care workforce, there is an opportunity to use a “Once for Scotland” approach to agree standardised job profiles and descriptions. While each health board is responsible for local job evaluation, shared standardised job descriptions would be a welcome resource for employing bodies^[56].

Recommendation 23: The Scottish Government should to establish a short life working group to agree profession specific role descriptors aligned to Agenda for Change using a “Once for Scotland” approach.

4.3 The Appointment and Employment of Registered Chaplains

4.3.1 In the past the appointments to Spiritual Care Teams came largely from the faith communities. However, the responsibility for the provision of a broader spiritual care offer now lies with health and care providers.

4.3.2 The employment of spiritual care staff should be based on their qualifications, experience, pastoral/relational abilities and capacity to demonstrate a mature, reflective, spiritual world view. Applicants should be registered or working towards registration with the UKBHC.

4.3.3 The UKBHC provides advice on good practice for appointments^[57] including ensuring that an experienced Registered Chaplain acts as a professional assessor on any interview panel.

Recommendation 24: Employing bodies should follow good practice as set out by the UK Board of Healthcare Chaplaincy and national Partnership Information Network (PIN) Polices regarding the recruitment of Registered Chaplains.

4.4 Supervision / Reflective Practice

4.4.1 Currently there is no agreed policy for the provision, or type, of supervision offered to Registered Chaplains. To ensure ongoing safe and effective practice spiritual care staff and formational development, Registered Chaplains should be have access to agreed levels of paid, professional pastoral supervision during working hours.

Recommendation 25: The Scottish Spiritual Care Professional Leads Group, in partnership with key stakeholders should develop and implement a policy which outlines principles and guidance to support the consistent provision of supervision and opportunities for reflective practice for all spiritual care staff.

4.5 Registration

4.5.1 In 2017 the Professional Standards Authority (PSA) recognised the UKBHC as an “accredited register”. The UKBHC has a Code of Conduct^[58] and standards for service (including competencies and capabilities. The UKBHC maintains a professional register of “Board Registered Chaplains”.

4.5.2 Registration requires staff to demonstrate their unique body of knowledge, entry and training pathway, standards, competencies and engagement in continuing professional development. Professional registration promotes high standards of spiritual care, which is patient centred, safe and effective.

Recommendation 26: The Scottish Government should continue discussions with the UK Board of Healthcare Chaplaincy to support the mandatory registration of Registered Chaplains within Scotland.

4.6 Continuous Professional Development and Formation

4.6.1 Continuous professional development (CPD) and formation is the way in which staff can learn and develop throughout their careers so they keep their skills and knowledge up to date and are able to practise safely and effectively ^[59].

4.6.2 There is a recognised need for all Registered Chaplains to engage with lifelong formational learning. It is also recognised that this learning will take a variety of different forms, including inter alia, personal study, reading journals and books, courses, further academic study, undertaking research, journal clubs and becoming involved in special interest groups^[60]. Annual appraisals should be a vehicle through which ongoing learning is reviewed and appraised.

4.7 Service Delivery

4.7.1 There is disparity in models of spiritual care being delivered within NHSScotland and mixed views regarding the professional identity of Registered Chaplains. A national service specification would help to define standards of care and services expected from specialist spiritual care teams. Such specifications would describe core services and what spiritual care teams do, and do not, provide. Such a development would bring consistency to the delivery of spiritual care services and highlight the effective interventions Registered Chaplains can provide. It is also good practice that services are evaluated through regular auditing, using approved tools such as the UKBHC Audit Tool^[61].

Recommendation 27: The Scottish Government, in partnership with the Scottish Spiritual Care Professional Leads Group and health boards should develop a national service specification for spiritual care services.

4.8 Staffing Levels

4.8.1 A more consistent approach to workforce planning against agreed service delivery models and standards, would support staff to feel engaged and empowered to deliver their roles in a more effective way, and support staff wellbeing^[62].

4.8.2 A workforce planning model that delivered a consistent, sustainable and high quality spiritual care service across health and social care settings throughout Scotland by adopting a ‘Once for Scotland’ approach would be a positive progression

4.8.3 The Health & Care (Staffing) (Scotland) Act 2019^[63] will be enacted from April 2024, and whilst spiritual care is not in scope of the legislation, the Act provides a set of principles, standards and ambition that spiritual care would wish to align to.

4.8.4 The resources available through the “Healthcare Staffing Programme”^[64] within Healthcare Improvement Scotland, will support and inform health boards to consider the principles of workforce planning and staffing requirements for this specialist service. This includes the use of professional judgement resource, considering local context and specialist service delivery as well as the skills and experience needed from those delivering the service.

4.8.5 It is recommended that the application of the “Spiritual Care CEL (2008)”^[65] workforce planning models along with a professional judgment tool is used to determine appropriate staffing levels.

4.8.6 Certain settings, such as palliative and end of life care, mental health units, community and specialist paediatric care, and primary and community care, may call for a different level of staffing and specific skills and experience relating to the complexity of needs in these disciplines.

Recommendation 28: The Scottish Spiritual Care Professional Leads Group should engage with resources and activities available locally, regionally and nationally, to inform workforce planning that enables the provision of high quality spiritual care across NHS Scotland.

4.9 Governance & Line Management

4.9.1 Currently there is variation in how spiritual care is managed. Unlike other healthcare professions there is currently no nationally agreed governing structure or professional lead to monitor and support professional practice in this area.

4.9.2 As a person-centred service, it is good practice that spiritual care services are managed alongside similar clinical services: this will often mean within the Nursing or Allied Health Care Professionals Directorate or grouping.

4.9.3 For the sake of equity health boards should ensure that the same opportunities, resources and governance structures which are available to other health professions are made available to Registered Chaplains and Spiritual Care Teams.

Recommendation 29: Health boards should manage spiritual care within Nursing, Midwifery and Allied Health Professions and ensure that spiritual care services are aligned with person centred care.