Archbishop of York, Dr John Sentamu, recently spoke of the need to remember the spiritual needs of patients in NHS care – and was promptly accused of bringing back medieval exorcism! In the following week, the Royal College of Nursing published a new online training resource to equip nurses in spiritual care, after a survey of its members two years ago showed that they felt hopelessly ill equipped to deliver a type of care that the majority considered a fundamental part of good nursing.
The GMC and BMA acknowledge the need for spiritual care, but when a seriously ill friend of mine asked the GMC if not receiving spiritual care from his consultant was in some way negligent, they could only give the vaguest of answers, despite the well-researched benefits of doing so.
The National Secular Society continue to campaign for all chaplains to be funded by religious bodies, rather than the NHS, as they do not regard spiritual or religious care (a term they seem to mistakenly use interchangeably) as being a core NHS function.
At the same time, we see a GP reprimanded for talking about Jesus to a patient, a nurse suspended for offering to pray with a patient, and countless other cases where complaints have been brought (invariably by third parties) against a health professional for talking about any issue of faith with patients, even when this has been at the patient’s own behest.
Looking at these stories in summary, you could easily conclude (possibly quite correctly) that when it comes to caring for the spiritual needs of patients, the left hand of the NHS does not know what the right is doing! There is a growing body of evidence that spirituality, faith, religious observance etc, have an impact on health (mostly good, some bad). This body of research is growing, although to be fair, most of it is very local and small scale, so even when done well it is hard to draw too many general conclusions from the findings.
At a conference earlier this month in Amsterdam we discussed these issues at length as they relate to the training and education of nurses. One of the key points was that there is a need for multi-centre studies across countries and religious and secular world views to try and get away from small scale local studies. One early multi-centre study identified that those nurses and midwives with a clear faith or belief system were the ones most willing and able to give spiritual care. While this is unsurprising, it is a nostrum that is now backed up by hard evidence from a study across centres in Wales, Netherlands, Norway and Malta.
Furthermore, spirituality is not singular – it is different for different communities and individuals. The spiritual care of a British agnostic is a different matter to that given to a French Muslim or a Maltese Catholic. And this also highlights that spiritual care (broadly speaking attending to the need for meaning, significance, purpose, hope and connection) is different from caring for religious needs (e.g. maintaining a relationship with God through prayer, religious services, reading scriptures, etc.), even if the latter may help those of faith address the former.
For Christians working in healthcare, our faith has always informed our understanding of the spiritual needs of our patients. It requires us to show compassion, and an awareness of the deepest needs of other suffering human beings. We need to have a spiritual attentiveness to, and presence with, our patients as well as a readiness to speak gently and respectfully of the faith that we have within us if asked. And we should be able to provide such care without fear.
In the UK, only Scotland and Wales have produced any standards or guidelines for good practice in spiritual care in the NHS, but in England there is not even a move in that direction. It may be a coincidence that almost every single case of a doctor or nurse facing disciplinary cases for talking about faith and spiritual issues with a patient has been in England. But I doubt it. Until the NHS in England starts taking this seriously, the current confusion in spiritual care will continue.
More training, more research, better guidelines, all will probably help, but I suspect that in a secular culture, which is still unsure of the meaning of ‘spiritual care’, misunderstandings will continue to occur. And, as many recent reports on how poorly we care for people in the NHS have shown, in a health system increasingly obsessed with measurable outcomes, budgetary controls and ‘productivity’, alongside the gradual erosion of the Christian faith from the public sphere, the human dimensions of care – compassion, kindness, the recognition of the spiritual dimensions of our humanity – will inevitably get more and more squeezed to the edges.