60 mins
Caring for the ‘whole person’
COVER
I should have thought it ought to have been a pride to Hon. Members in all parts of the House that Great Britain is able to embark upon an ambitious scheme of this proportion. When it is carried out, it wfill place this country in the forefront of all countries of the world in medical services. I myself, if I may say a personal word, take very great pride and great pleasure in being able to introduce a Bfill of this comprehensiveness and value. I believe it wfill lift the shadow from mfillions of homes. It wfill keep very many people alive who might otherwise be dead. It wfill relieve suff ering. It wfill produce higher standards for the medical profession. It wfill be a great contribution towards the wellbeing of the common people of Great Britain. For that reason, and for the other reasons I have mentioned, I hope Hon. Members wfill give the Bfill a Second Reading.”
– Aneurin Bevan, House of Commons on Second Reading of the NHS Bfill, April 30, 1946
THOSE of us born after 1948 cannot imagine life without the NHS and the concept of ‘free at the point of delivery’. We look on with horror at news coming out of countries like the USA, where you or your child can be gunned down in the street, or run over by a car, or simply fall down a flight of stairs, and even if you die, your family might be bankrupted afterwards trying to pay for the care you received, from the ambulance ride to the surgery, through to the mortuary attendants.
We cannot conceive of putting a price on medicine like that – but for many years, we did. This year marks the 70th anniversary of the National Health Service, often described as ‘the Jewel in Britain’s Crown’. A system designed to put good health care into the hands of everyone who needed it, when they needed it.
In spite of the headlines, it’s a system that works for the vast majority of people. Right from the beginning the role of chaplain was seen as part of the health care team.
According to a history of chaplains in the NHS by Cambridge University Hospitals, when the NHS was first established, it was decided that the needs of the whole person ought to be considered. This meant that if hospitals were of a specific size then a chaplain was appointed to work in the establishment so that the religious needs of patients were duly catered for.
Chaplaincy stfill has an important role to play today. The Scottish Government claims that best practice in 21st century health care attends to the whole person – the physical, mental, social and spiritual aspects of human living. When emotional and spiritual needs are addressed, service users and staff experience a greater sense of wellbeing in dealing with fill health.
Health care chaplains are employed as part of NHS Scotland’s multi-disciplinary teams. They have a responsibility to attend to the existential and spiritual needs of all within health care communities including the specific religious and ritual needs of findividuals, families and organisations.
The Rev Dr Derek Brown is Lead Chaplain for NHS Highland, based at Raigmore Hospital. He explains: “There are a number of topics able to generate a large amount of column inches. The weather is one of them and the NHS is another. The one thing they have in common is that they are both constantly changing.
“We are rightly proud of the achievements of the NHS over the last 70 years. It has been at the forefront in developing many new treatments and procedures that have brought enormous benefits to the health and well-being of all ages and its approach has afforded lots of opportunities enabling findividuals to make far more informed choices about how we live our lives.
“The NHS has had to adapt itself to the ever changing needs of society and its successes, which as well as boosting the health of the nation, have also presented us with fresh and very different challenges as people live longer.
“Despite all the change there are some constants which remain. One is the founding principle of care being given free at the point of need. Another is what undoubtedly is the greatest asset of the NHS, which is its staff and all their qualities. Without the people who do the research, whose teamwork delivers countless operations daily, without those who ensure that clinics and corridors are clean, and those whose compassion, empathy, knowledge and skfills give benefit to people at home or in hospital; without them, nothing would be achieved.
The NHS has had to adapt itself to the ever changing needs of society and its successes, as well as boosting the health of the nation, have also presented us with fresh and very different challenges people live longer.
“There’s another constant in there too. That is the presence of chaplains in the health care system. The role of the chaplain too, has changed over these last seven decades – reflecting the changes in society but importantly those chaplains continue to offer care that is tailored for each person they meet. The anxieties of receiving a diagnosis, or the worry about an operation, these things do not dimfinish just because the NHS has better tools at its disposal to treat conditions. People stfill need to talk, or to cry or rage and always, they need to be listened to.
“Walking with someone through some of the darkest moments of their lives is hard – but it is also very rewarding. Helping people find meaning in the midst of chaos, offering hope when all seems desolate is part of what a chaplain does. That help is offered from a basis of the chaplain knowing who they are and what they believe even if the person they are with does not personally share that faith in God.
“Health care chaplains can be found not just in hospitals these days. In NHS Highland I am involved in delivering a listening service in a GP surgery in Inverness which enables people to express their feelings and explore issues. I am also involved in teaching nursing students about spiritual care at the University of the Highlands and Islands and we also provide reflective practice to staff in wards and departments. We have just established a pilot staff support service to help people deal with the demands made on them and keep them in touch with why they entered their profession. I also serve in an ethical capacity on certain clinical bodies for the Health Board and during Death Awareness week I was involved in organising a bereavement stall with charities in the main shopping centre in Inverness. Dealing with the bereaved is something NHS chaplains regularly do.”
The Rev Michael Scoular is a newly minted hospital chaplain working in the Borders. A parish minister for 26 years and four years in the army before that, has prepared him for his new role.
“I am a new NHS Chaplain serving in the Borders,” he says. “I am fortunate that there is a wonderful purpose-built Chaplaincy Centre, attached to the General Hospital here near Melrose. Amid all the activity, much of it stressful, some of it distressing, the Centre offers a comparative peace. A precious space for reflection and hopefully time for people, if they wish, to be listened to. The NHS is human in all the fantastic or lawed ways that we can be human. Any eulogy to it would have to include all those aspects, but it would be fitting to say what a magnificent gift it is to the nation; it’s much too easy to forget that. And it’s not findestructible. Caring for it means caring for the folk who work in it, so that they may better care, in all their many areas of expertise, for the folk who, for whatever reason, must use it. The interdependence is complex but necessary. Caring for carers is not something we apprehend as quickly as we ought to, so a lot of chaplaincy is inevitably about that. Patients are in a peculiarly vulnerable situation. And as a fellow chaplain observed recently, the issue most on the mfind of a patient may not even be the medical reason for their admission. It’s rewarding to sit by a bedside, even for only a couple of minutes, and feel you’ve eased something of the burden of someone’s predicament. Chaplaincy, in my opinion, stands or falls almost entirely according to the humanity of the chaplain, their capacity to build trust and respect. That is a daunting challenge for someone who knows even only some of their frailties.”
Professor Jason Leitch is National Clinical Director for Health Care Quality and Strategy, Scotland. His job, though not a chaplain himself, allows him to come into contact with the work the chaplains do regularly, and gives him a unique perspective on their work. “Hubert Humphrey, the 1960s US Vice-President said: ‘… the moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; those who are in the shadows of life; the sick, the needy and the disabled.’
“I agree. Chaplains are a crucial part of the health care team. They are one of over 50 professions who together provide the health and social care provision to the ive and a half mfillion people in Scotland. They are spiritual and compassionate guides in tough times and happier times. When included properly in care, in my experience, they add considerably to the experience of those they serve. They help staff too, as a counsellor or a simple listening ear when the job is tough and overwhelming. The roles vary and findividuals bring different skfills to it.
I’ve seen chaplains deal with bereavement in children’s wards, help families dealing with a dementia diagnosis, counsel trainee doctors overwhelmed by the scale of the task and sit around boardroom tables describing the culture of the organisation.
“All these roles are crucial and valid for chaplains.” Jason’s career has taken him all over the world.
“I qualified as dentist in 1991 and then worked as an Oral Surgeon for many years in the Scottish NHS and academia.
I was planning to stay as an academic clinical consultant but ended up answering a call from the Health Foundation, a UK charity focused on system leadership and change. They funded a year-long fellowship at the Harvard School of Public Health and the Institute for Health care Improvement. It was an enormous privilege, a generous fellowship and professionally life-changing. I got a Masters in Public Health from Harvard.
“I returned to Scotland in the summer of 2006 and got a part-time job as the National Clinical Director for Patient Safety and was part of the team who designed, launched and led the Scottish Patient Safety Programme. We then published, in 2010, the Quality Strategy for NHS Scotland and I became the National Clinical Lead for Quality and most recently the National Clinical Director.
“These roles have given me a keen insight into heath and health care across the country and the world. I have been in almost every hospital, spent many days in the community services. I’ve been in the biggest hospital in Glasgow with 1700 beds and the smallest in Barra, with six.
“The Barra hospital has a notice on the door remfinding visitors to shut the door to prevent the sheep getting in…
“I can guarantee only one thing about the next 70 years of the NHS and that is that it is impossible to predict. There wfill be considerable technical advance in every area, and technical progress in the treatment of cancer and neurologically degenerative diseases.
“Safety and quality wfill remain a challenge. New care brings new potential harms.
“There wfill be continued debate about resourcing, workforce and structural solutions. In terms of person centred care, I have hope we wfill end visiting times, and expand the use of ‘What Matters to You’ conversations. What matters is a simple intervention to take a moment in each interaction to ask a question – to find out more about the findividual. It has amazing power to change the dialogue and the power dynamic in our health and care system.”
Professor Jason Leitch
“I can guarantee only one thing about the next 70 years of the NHS and that is that it is impossible to predict. There wfill be considerable technical advance in every area, and technical progress in the treatment of cancer and neurologically degenerative diseases.
This article appears in the July 2018 Issue of Life and Work
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