2. Developments in Boards
As proposed by HDL (2002) 76 Chaplaincy and Spiritual care services have been brought within the structures of NHS Boards with greater clarity leading to increased accountability. Boards have designated an executive lead for spiritual care, often at Board level and a lead chaplain or head of service has been appointed. Boards vary in their internal organisation of chaplaincy and spiritual care services as do the names by which they are known in hospitals - Department of Spiritual and Religious Care (or Pastoral Care) is common.
2.1 Spiritual Care Policies
Each Health Board has produced a Spiritual Care Policy written with wide consultation among the health service and with the local community. These policies have been commented on and approved by the local Board of Directors. In Area Boards the local faith and belief communities were consulted so that there would be an appropriate awareness of local communities and belief groups while organising a spiritual care service which would be 'fit for purpose'. Special Boards, some of whom are spread through different areas and may not have direct patient contact, have written their policies with staff and client consultation of differing kinds.
2.2 Responsibility for Spiritual Care
Since its inception the NHS has upheld the need for hospital chaplaincy. The work of chaplains has increasingly involved the provision of spiritual care to those with little or no connection to a faith community while still providing religious care to those for whom it is appropriate. As the work has broadened to include increased staff support and education and as the integral nature of spiritual care has become understood as a core and necessary part of any health institution (which is required to provide whole person care), so there has been movement towards an acceptance that health provision is enhanced by it. The Scottish Government Department for Health and Wellbeing and the Health Boards have come to understand spiritual care as a necessary part of health service provision which can take its place alongside the other core services of the NHS.
In the past it might have been said that the faith communities, in effect the main Christian Churches, were the bodies responsible for the provision of chaplaincy. The last few years have seen a shift whereby this role now lies with Health Boards who are creating new relationships with faith communities and belief groups to ensure that religious and spiritual care addresses the diversity of the local population. There is a new landscape of discussion and consultation emerging in which all parties have new roles to understand and viewpoints to hear. Faith communities and belief groups are being used as a resource for advice in training NHS staff and for delivering religious and spiritual care; appointments to vacant chaplaincy posts come from a wider range of faith communities and backgrounds. Board Spiritual Care Committees have been useful contexts for discussion, debate and development of the service. The Scottish Inter-Faith Council has made valuable and informed contributions to the process.
2.3 Spiritual Care Committees
Spiritual Care Committees are now established in most NHS Boards. These are chaired by a Board nominee and are made up of representatives of the spiritual care staff, including the lead chaplain, local faith/belief communities and groups, patient representatives, staff representatives and the spiritual care manager.
These committees have developed their own working patterns and vary considerably in how they run and how often they meet. They are largely advisory groups and provide a lively forum for discussion. They have a key role in the governance of a Board's Spiritual Care Policy and its implementation. They hear reports, plan events and, in some case, play an active part in recruitment. They are multi faith in character with denominations; belief groups (e.g. The Humanist Society of Scotland) as well as a variety of world faith groups playing a full part. Some are more active than others.
2.4 Departments of Spiritual and Religious (or Pastoral) Care
A Chaplaincy Service in an NHS Board will deliver spiritual and religious care in accordance with the Board's Spiritual Care Policy. Board Single System working can mean that there are several Departments of Spiritual and Religious Care (local terminology varies) working as a unified service and management / leadership structures will vary from Board to Board.
The Chaplaincy Service and its Departments in hospitals or units allow for chaplains working in specialities (e.g. Paediatrics, Oncology), to plan together, audit and develop the service. Priorities can be set and resources shared on matters such as training and education, for staff, volunteers, and the supervision of students. Leadership to the service creates greater cohesion and accountability for local service delivery. Creative use of the varied talents, skills and interests of all chaplains can provide a better service and offer development opportunities to practitioners.
2.5 Healthcare Chaplaincy Training and Development/Spiritual Care Advisory Unit
In order to provide and develop more standardised and appropriate training opportunities for healthcare chaplains and spiritual care providers, the Healthcare Chaplaincy Training and Development/Spiritual Care Advisory Unit was established by the Scottish Executive Health Department in 2001. Alongside developing training for chaplains the Unit was required to promote and resource the writing of Spiritual Care polices by health boards and to report on progress to the Scottish Executive Health Department ( SEHD).
There continues to be a clear relationship between person or patient centred spiritual care, the Patient Focus Public Involvement, and the Equality and Diversity agendas. The Unit has been involved in the religion and belief strand of the six areas of diversity. This has now been largely taken on by an Education project looking at the religion/ belief strand developing towards a single Equalities Unit, now housed within NHS Health. The Scottish Health Council has taken over much of the monitoring and reviewing aspects of the work concerning spiritual care policies and their implementation and impact within health board areas.
Following an initial trial period the Unit was made permanent and became part of NHS Education for Scotland. Thus, in keeping with government policy, the training of spiritual care providers has become better integrated alongside the training of other healthcare professionals. This has also made more explicit the need for spiritual care awareness in the training and development of other health care professionals.
The Unit now has responsibility for the provision of training, developing a qualification in chaplaincy, the production and use of service standards and creating and disseminating a capability and competence framework for chaplaincy/spiritual care. The Unit has a national advisory role and has developed strong links with chaplaincy associations throughout the UK as well as with Europe (through the European Network of Healthcare Chaplains) the USA and Canada.
An advisory group, the Chaplaincy Training Advisory Group ( CTAG), was established in 2005 to work with the Training and Development Officer in the provision and planning of training and educational events and opportunities.
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