Spiritual Care and Chaplaincy

Guidance on Spiritual Care inthe NHS in Scotland

4. The Appointment and Employment of Chaplains

The integration of spiritual care within Health Boards' responsibilities has provided an impetus for change. In the past the initiative for chaplaincy appointments came largely from the faith communities and the health boards had official advice to enable this to happen. The responsibility for a spiritual care service now lies within the NHS. Partnership between Health Boards and local faith communities and belief groups is essential. The present chaplaincy and spiritual care workforce is populated by several categories including:

Whole-time Chaplains: Directly appointed and employed by Health Boards with Agenda for Change banding and responsibility to develop their work in accordance with the Knowledge and Skills Framework. Employed to work with the whole healthcare community, staff, patients and carers, such chaplains are appointed to deliver and facilitate spiritual and religious care as appropriate.

Part-time Chaplains: Appointed by the health boards on exactly the same terms as whole time chaplains but with proportionate hours.

Denominational or Faith Specific Chaplains: appointed jointly by the faith community and Health Board but not generally direct employees of the health service. These have a particular responsibility for those of their own faith community. They work as part of the chaplaincy service and appointments will be made by local arrangement between the Health Board and the faith community.

Sessional Chaplains have historically been appointed to "an office" by their denomination without employment status and usually with a whole community role (even if assigned to set wards).

Honorary Chaplains represent a particular faith or belief group and are called upon when needs arise, with expenses paid. Such representatives are appropriately trained and subject to normal appointment procedures for chaplaincy volunteers.

Volunteers: trained to work within the parameters of the spiritual care policy and the Health Board's volunteer policy. They are normally assigned and supervised by a chaplain.

Healthcare Staff: expected to provide spiritual care as appropriate, to know the importance of listening, to show respect and sensitivity for those of all faith/belief groups in accordance with spiritual care policy and to make appropriate referrals.

Appointments are now made through standard NHS procedures and in accordance with needs provision and the health board establishment. The amount of chaplaincy provision will be decided in relation to needs assessment and the expectations and activities of the service. Guidance is available in the Chaplaincy provision section of this document.

The professional chaplaincy associations have a common Code of Conduct and it is strongly advised that chaplains and volunteers work within the parameters of this Code.

It is important that all chaplains as part of their employment contract must either have undertaken or be committed to undertake the basic induction training course as delivered by the NES Healthcare Chaplaincy Education and Training unit. A new postgraduate certificate of chaplaincy is planned and this or an equivalent qualification will be essential training for future entry into the profession. Continuing Professional Development ( CPD) is expected to a level similar to other healthcare professions.

It should be noted that visiting Ministers, Priests, Rabbis, Imams etc are not chaplains but should be given access to those patients who wish their presence when it is convenient for the patient, the ward and the 'faith or belief' visitor. The department of spiritual and religious care has a responsibility to offer advice and facilitate this activity where appropriate.

4.1 Composition of Spiritual Care Department Staff

Chaplains will normally be appointed on the basis of their qualifications, pastoral skill and experience rather than any particular denominational or faith community basis. It is recognised however that it will help if the chaplaincy staff is equipped to provide for the spiritual and religious needs of a large proportion of patients, staff and carers. Where there is a particular need which is not catered for by the normal employment processes it is possible for the Board to seek an agreement with a faith community/belief group for a local service. Any such contract would mean that an appointment would be joint and the faith community/belief group and the Board would share a joint accountability for the service. Any chaplain working with this sort of agreement would be accountable to the head of department for his or her work within the institution and also to their faith community/belief group. The appointment would be by interview although there may be nomination arrangements.

It is understood that most faith communities/belief groups give pastoral or religious care through visiting their own adherents. It is the duty of the Spiritual Care Department to facilitate such visits. Any faith community or belief group may request for one if its number to be recognised as the local contact/representative for the group or alternatively as an 'honorary chaplain' if such a system is in operation.

4.2 Whole-time and Part-time Chaplains

Several Health Boards have been amalgamating sessional or part time posts, thereby increasing the number of whole time posts. This is often in recognition of training needs, on-call responsibilities, professional development and the increased ability to integrate with other healthcare professionals. There will remain many areas where part time chaplaincy is seen to be preferable and more practical, particularly in some smaller healthcare units.

4.3 In Good Standing

The past assumption that all chaplains would be ordained clergy of recognised Christian denominations is no longer appropriate. Already several of the chaplaincy workforce are not ordained although Health Boards usually wish some of the team to have this recognition and ability to exercise the more common functions of ordination such as sacraments. It was felt that as a level of accreditation all chaplains should be "in good standing" with their faith community/belief group. As chaplains develop their professional credentials with a code of conduct, mandatory training modules and work towards regulation as a healthcare profession, and as they come from increasingly varied backgrounds, it is increasingly being questioned as to whether the description 'in good standing' is entirely appropriate as a condition of employment.

Where this form of accreditation is considered by a faith/belief community to remain a valid requirement for its clergy or practitioners to continue to practise a ministry in any setting, then there may become situations where a chaplain's conduct does not contravene a health board's employment policy, but would be in conflict with that community, and serious difficulties could arise. However it still remains as an area of understanding and trust between a patient, member of staff or carer to know that a chaplain is a bona fide member, representative or leader of the faith/belief community in which he or she is based. It is therefore recommended that health boards in appointment and review of chaplains take this seriously into account but do not regard it as being an over-riding factor when, by other professional standards and codes, the chaplain is still fit to practise.

In recent chaplaincy literature the need to be grounded within a faith community or belief group is seen as necessary, more for the individual chaplain's continuing pastoral and spiritual development and support, than simply as a form of accreditation.

Chaplains who are explicitly denominational (faith community or belief group) based in their appointment must have both the express authorisation of, and be in good standing with, their denomination, faith or belief community.

4.4 Use of Assessors

It is common practice for professions to use external assessors as part of the recruitment and selection process and this is recommended when Health Boards are filling a vacancy in their chaplaincy service. An assessor ought to be an experienced chaplain from a different Health Board and will bring a dimension of perspective and consistency to the interview and assessment of candidates. When the vacancy is in an area of specialised chaplaincy (e.g. paediatrics or mental health) the assessor ought to work in this field. As chaplaincy vacancies are relatively infrequent, the involvement of knowledgeable chaplains and human resources staff is important. The Spiritual Care Development Committee, through its executive officer, can provide names of suitable assessors. Work is being done on a UK basis to develop and train a panel of assessors who might undertake this work in the future.

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