11. Chaplaincy Provision Levels
HDL (2002) 76 provided suggested ranges and ratios concerning the number of beds or people justifying one session of chaplaincy time, i.e. three and a half hours. It also included suggestions of time which may be spent by chaplaincy staff on other activities such as teaching, worship, sacraments, pastoral counselling, administration and head of department duties. As spiritual care and the chaplaincy teams who are the specialist spiritual care providers become more integrated as part of the holistic care and support offered to all patients, carers and staff, it has become increasingly clear that ratios on their own are no longer adequate.
Previous advice has suggested the number of beds and members of staff count towards one session of chaplaincy provision, which led to a baseline requirement that a District General Hospital of around 300 beds would require a whole time chaplain. Such an assumption and such criteria are no longer particularly helpful for several reasons, e.g:
(a) Patient stay times are generally shorter leading to a greater throughput of patients in wards than ever before. Those who are hospitalised for long periods are usually acutely ill and require high intensity care.
b) The spiritual and religious care service is now far more integrated into local service delivery structures and chaplains are regarded and used as professionals who offer a unique service alongside other healthcare professionals. The constant availability of chaplains to a hospital or unit is crucial to an effective spiritual care service.
c) Chaplains are involved in delivering training and education on spiritual and religious care, bereavement, religious and cultural issues, etc, often working in conjunction with Practice Development and Training and Development staff.
d) Professional development, research, planning, record keeping, reviewing and developing the department with managers, have all become part of the service.
e) A strict interpretation of the European Working Time Directive will require a minimum of 3 whole-time chaplains in post in order to provide an out-of-hours service. Even in the smallest of units, one member of staff cannot work during the day and also provide an out-of-hours service.
f) Work with equality and diversity groups, spiritual care committees and other committee work is now expected of chaplains to a far greater extent.
g) Government documents and papers such as 'Religion and Belief Matter' have raised the profile and need for a planned and properly resourced spiritual and religious care service.
It is now commonly expected that senior or lead chaplains undertake roles involving the training, mentorship or supervision of students and volunteers.
Care in community which is being provided increasingly and especially by mental health chaplains does not relate meaningfully to bed numbers.
Managers within the NHS are increasingly requiring spiritual care departments to justify their staffing levels. In order to respond to this in a competent and meaningful way, the departments must learn to describe the work they do, and the benefit they bring to their clients. This must be done in ways comparable to other healthcare professions and understandable to those who make such staffing decisions amid numerous claims on finite resources. Each department should aim at producing a business plan which describes the value that dedicated spiritual care or chaplaincy brings to the whole institution and outlines the current activities, professional developments, service priorities, and the resources required to meet these priorities.
The diversity activity of chaplains is now supported by the Standards for NHSScotland Chaplaincy Services (2007) and by the Capability and Competence Framework for Healthcare Chaplains in NHSScotland ( NES 2008). These documents describe what the service should consist of and what skills are required of chaplains.
The plan for each department should include a considerable degree of strategic and numeric information, including:
Organisation's role and mission - how does the spiritual care service contribute to the fulfilment of this? How does the institution relate to the local/national community and how does it perceive the place of spiritual and religious care in the workplace and in the care of individuals?
Institutional variables such as the acuity levels, how sick patients are, how far do patients have to travel, any particular faith or belief groupings, numbers of deaths per week.
Current spiritual care staffing with the variety of skills and training needed, the requirements of the service and departmental strengths, weaknesses, opportunities and threats ( SWOTs).
Current activities including where time is spent, numbers of referrals and sources, teaching, pastoral care, protocols which require spiritual/pastoral care involvement, funerals.
On call requirements (see, e) above)
Identification of activities to meet priorities through effective assessment and documentation processes, effective referrals and tracking of activities in ways relevant to organizational goals, departmental scope and professional requirements. Production of a business plan with cost/benefit analysis.
An analysis of needs and a description of the service required will develop a picture of the level of staff provision necessary within a health board. It must also be acknowledged that where a spiritual or pastoral care service is well understood and pro active, the usage of the service increases dramatically (Allan and Macritchie, SACH Journal 2007).