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Rapid Responses: Rapid Responses published:
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NHS Chaplaincy in multi-ethnic Britain
- Padmanabhan Badrinath, Catherine Stevenson (10 September 2004)
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why is there a christian Bias in hospital chaplaincy ?
- Susheel Oommen John (13 September 2004)
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All faiths?
- John P Heptonstall (13 September 2004)
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Hospital Chaplaincies
- Anthony D Clift (15 September 2004)
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Non christians May Not Want or Require Chaplains
- Steven A Fielding (20 September 2004)
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Re: Non christians May Not Want or Require Chaplains
- Phil Peacock (21 September 2004)
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Hospital chaplaincy units show bias towards Christianity? A response from a Chaplain..
- Helen C Blackburn (21 September 2004)
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Re: Re: Non christians May Not Want or Require Chaplains
- steven a fielding (21 September 2004)
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Padmanabhan Badrinath, Specialist Registrar & Recognised Clinical Teacher Southend on Sea PCT & University of Cambridge, Harcourt Avenue, Southend on Sea, SS2 4HE, Catherine Stevenson
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Dear Editor, We applaud the efforts of Sheikh et al(1)in highlighting the disadvantages to non-Christians with regard to facilities for worship at the hospitals in England & Wales. However, the sample selection adopted by the authors has the potential to distort the results and possibly the conclusions. The authors studied a random sample of 100 trusts from a total of over 200 hospitals (177 in England) with a response rate of 72%. In the 2001 Census(2)71.6% stated their religion as Christian, 5.2% as other religious faiths, 15.5% with no religion and 7.3% did not state their religion. It is possible that the outcome variable facilities for chaplaincy care might vary by the multi-faith proportion of population served by the hospital and of the workforce. Hence the authors should have used a stratified random sample based on the distribution of the multi- faith population proportion served by these trusts. Although such figures are not readily available, religious distribution of the population by output areas, wards, local authorities and government regions is available online from the Office of National Statistics2. We do not expect the same level of multi-faith religious facilities in Berwick-uopn-Tweed, where the non-Christian population is 0.24%, as in Birmingham, where it is 19.8%; a difference of over 80 fold. There is also a possibility that the non- responders were the trusts who do not have facilities for multi-faith denominations or those serving a very small proportion of non-Christian population. NHS guidance states that “different religions have specific requirements and more than one space is likely to be required, with flexibility of furnishing and use of religious symbolism to allow for use by different faiths”(3). The guidance highlights “access to equipment out of normal working hours, including Bibles, Korans, prayer mats, Hindu tapes etc”; an issue not covered in the survey by Sheikh et al. The Hospital Chaplaincy’s Council has produced an information sheet(4)on “Worship space for worship, prayer and reflection”. According to this sheet “in a hospital where multi-faith proportions are not particularly high, it might be worth considering having a distinct Christian chapel. Another room could be set aside for the use of other faiths - with appropriate washing facilities etc”. This approach is probably partly reflected in the results of the survey with 98 out of the 105 chaplains being Christian. Some trusts, although having only a Christian chaplain, do provide an opportunity for other faiths to access these services. The website of the Royal Berkshire and Battle NHS Trust states “Chaplains or ward staff can contact leaders of other faith communities when requested” (5). It is imperative that the religious needs of multi-ethnic Britain should be met by the NHS, but the provision of these facilities to meet these needs should be undertaken with careful consideration of the actual requirements and the availability of resources in consultation with the local communities. Dr.P.Badrinath MD,PhD,MFPH. SPR in Public Health & Recognised Clinical Teacher, Southend on Sea PCT & University of Cambridge, Southend on Sea, Essex, SS2 4HE Ms.C.Stevenson BA. Research Assistant, MRC Epidemiology Unit, Cambridge. References 1.Hospital Chaplaincy unit show bias towards Christianity. http://bmj.bmjjournals.com/cgi/content/full/329/7466/626 accessed on 10th September 2004 2.National Statistics. http://neighbourhood.statistics.gov.uk accessed on 10th September 2004 3.NHS Chaplaincy. Meeting the religious and spiritual needs of patients and staff. http://www.dh.gov.uk/assetRoot/04/06/20/28/04062028.pdf accessed on 10th September 2004 4.Hospital/Health Care Chaplaincy. Information sheet. Worship facilities for worship, prayer and reflection. http://62.140.207.19/nhscsc/infosheetworshipspace.htm accessed on 10th September 2004 5.Royal Berkshire and Battle Hospitals NHS Trust. Chaplaincy. http://www.rbbh.nhs.uk/20_patients/10_going/20_chaplaincy accessed on 10th September 2004 Competing interests: PB is a practising Hindu and is currently training in Public Health in the National Health Service. CS is an atheist. |
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Susheel Oommen John, Consultant The Leprosy Mission India, CNI Bhavan , New Delhi 110070
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Aziz et al have illustrated in their letter that there is an undue advantage to the christian faith in hospital chaplaincy units. The study was done using a telephonic questionnaire addressed at the chaplaincy units, its is not surprising that 98 of the 105 full time chaplains were christians. In the UK one would presume that there is an equal employment opportunity, and if many of posts of the chaplains are occupied by "christians" it might be simply because many christains chose chaplaincy as a career choice or a vocation where as not many from the other faiths did so. Being a chaplain is no easy task, to be able to understand human suffering and being able to offer some comfort to the hurting body and a wounded soul could be quite demanding.While being so demanding its not very rewarding financially. The christian faith since the days of Christ has been closely associated with the sick and the suffering,and the christian faith compels a follower of christ to be compasionate, as a result there have been so many medical missionaries travelling to far flung places. would this also be seen as an undue advantage to the faith ?, where a follower of a particular faith voluntarily opts to do medical service in a remote and needly place. It would be rather derogatory to point a finger at a faith that has been so closely associated with sickness and human need,its probable that there is a dominance of christian faith in healthcare and hospital chaplaincy just merely because none other exist. Competing interests: Susheel Oommen John is a practising christian and a medical missionary working with people affected by Leprosy |
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John P Heptonstall, Director of The Morley Acupuncture Clinic and Complementary Therapy Centre Leeds LS27 8EG
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Sir Is there a law which prohibits clergy of any faith requesting authorisation for, then making, announced hospital visits to benefit any patient who wishes to accept such a visit from them? If not, where's the problem? I note that the missionaries Susheel Oommen John cites made great efforts, and still do, to reach the faithful - do the authors not find that route just as acceptable? Regards John H. Competing interests: None declared |
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Anthony D Clift, GP part retired MD FRCGP Middleton M24 4DZ
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Anthony D Clift MD FRCGP D(Obst)RCOG 151 Manchester Old Rd Middleton Manchester M24 4DZ 0161 643 8081 15 September, 2004 To Editor BMJ BMA House Tavistock Square London WC1H 9JR Dear Sir Hospital Chaplaincies It was like a breath of fresh air to read the letter of Sheikh et al Vol 329 p 626, who clearly show an interest in practising the faith with which they have been brought up, and want those in similar circumstances to have that advantage when in hospital. Locally we have enjoyed this as Christians for a long time at North Manchester General Hospital, and I have only praise for the hard work of the Catholic and C of E chaplains who have been of great help to myself, and my wife, in times of major illness and are kept very busy indeed. Of course some other faiths place a lot of emphasis on dietary habits and this also is well catered for at the hospital. I find it bizarre that at the same time, recent regulations appear to have denied designated chaplains access to information of a patient’s religion, so that they have no idea of who on a ward is of a particular denomination. I suspect this is an odd interpretation of the Data Protection Act and smacks of political correctness at the expense of due care, at a time when patients may well benefit from the help of their minister and when they and their relatives may be too apprehensive to push their case. Surely the default situation should be to note religion on the records and inform the minister on his rounds. It has worked for a hundred years, so what has changed? I wonder if the assessors take all this into account when giving star ratings, and if not, then why not. Competing interests: None declared |
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Steven A Fielding, sho orthopaedics West Wales General, Carmarthen
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I feel I might have something to contribute to the replies to the letter from Sheikh et al. I worked for over 5 years (happily)in the coronary care unit of the Manchester Royal Infirmary, until 2001, as a nursing auxiliary. The centre of Manchester serves a wide variety of communities. Every sunday for 5 years without fail (to my recollection) I asked every patient if they wished a visit from a member of the chaplaincy. Manchester Royal has a selection of chaplains from different faiths.I can say that in 5 years I can recollect only 1(one) non christian asking to see one of the chaplains. This was memorable becuse it was so exceptional. The christian patients frquently replied yes. The Roman catholics more frequent than Church of England. I presume the reason for this is that christians require the presence of a chaplain to fulfill the duties of a christian. Do other faiths have the same requirement? If other faiths do not have that requirement do they require a chaplain of the same faith to fulfill their needs? My own experience, despite being anecdotal,would make me doubt the validity of Sheikh et al's criticism of access to chaplaincy staff. This is for two reasons. 1/ If patients do not wish to have access to chaplaincy staff of their own faith (or any other) how are they disadvantaged? 2/ Chaplaincy staff (of any description)would never turn down a request to comfort or console or just visit a patient or relatives. The role of Chaplain goes far beyond that of religous duties. If an individual requires a chaplain for reasons other than a religous duty surely this does not have to be from somebody of the same faith. Perhaps a questionnaire to patients asking what they require from a chaplaincy might clarify if they are disadvantaged by not having somebody of the same faith to attend. My last point is to strongly disagree with the statement that non christians are disadvantaged by the quality of chaplaincy care. I felt this was a slur to the chaplaincy care provided every day up and down the country. The quality of care was not assessed by Sheikh et al's questionnaire and therefore should not have been commented on. I felt it implied that members of the chaplaincy would not care for non christians to the same degree as christians. I feel that this should be challenged. Anybody who sees a chaplaincy in action would know this not to be true. To clear up any doubts about conflicting interests I am a non christian. Kind regards Competing interests: None declared |
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Phil Peacock, 3rd yr medical student University of Bristol, Bristol, UK
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I'm slightly bemused by a statement in Dr Fielding's rapid response. Discussing why Christians are more likely to ask to see a chaplain, he writes, "I presume the reason for this is that christians require the presence of a chaplain to fulfill (sic) the duties of a christian". I would be interested to hear in what ways Dr Fielding believes that someone needs to see a chaplain in order to fulfil their 'Christian duties'? I can't think of anything myself. Competing interests: None declared |
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Helen C Blackburn, Chaplain Sheffield Teaching Hospitals NHs Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF
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Letter - response to BMJ letter [BMJ 2004;329:626 11 September] Re: Hospital chaplaincy units show bias towards Christianity In response to the letter of 11 September on the so-called ‘bias’ of hospital chaplaincy departments towards Christianity, I should like to share some thoughts. I have recently finished a research project entitled Listening to the voices of faith: the provision of spiritual and religious care for the six main faith groups in Sheffield. The benefactor whose estate financed my project, Dorothy Dixon-Barrow, was devoted to the cause of equality of health services across the different ethnic communities in Sheffield. The project was funded as a contribution to that cause. The project had two distinct parts: a national overview of ‘multi-faith’ provision and local research by means of a questionnaire and interviews. I wanted to see what the national provision of ‘multi-faith’ facilities and staffing were so that this could be a benchmark against which Sheffield could be measured. During the project I conducted a national written survey which was completed by 132 out of 176 Acute Hospital Trusts in England and Wales. This represents a 75% response rate. Historically the provision of spiritual care in hospitals has traditionally been the province of the Christian hospital chaplaincy. As the UK has become more mixed – racially, culturally and in matters of faith – it has become more necessary to provide such care in a way which reflects the beliefs of the growing number of members of what might be described – in the British context – as minority religions. I would not describe the present situation as ‘biased’ towards Christianity – it is a fact that the Christian Chaplaincy provision and model of working has satisfied the country’s spiritual and religious needs for years but of course it no longer does. So adaptation and change is needed – ‘bias’ suggests a deliberate approach which I don’t think is an accurate description. There is a widespread acceptance of the need not to neglect the needs of patients belonging to minority faiths. The NHS itself accepts this in the DoH 2003 report as does the original Patients’ Charter 1991. A further document Caring for the Spirit: a strategy for the chaplaincy and spiritual healthcare workforce [SYWDC 2003] produced by South Yorkshire NHS Workforce Development Confederation actually spells out how improvements can be made to give equity of provision and this document has been sent all Chief Executives. There is commitment from many Chaplains to work towards redressing the present imbalance in provision but there often are huge problems in persuading Trusts to provide facilities and to pay for minority faith chaplains. The persistence of a few Chaplains does result in change but the problem is that there is no consistency. So provision up and down the country for Muslims and/or other faiths is uneven and patchy. There is no correlation between the demographics of a particular geographical area and the provision of multi-faith facilities and staffing in the local hospital. A further problem exists which is that the “minority faiths do not have a formal tradition of ‘chaplaincy’ nor do they have personnel who function as an approximate equivalent to a chaplain” [Gilliat-Ray 2001]. It takes time to educate and encourage faith communities that there is a task for them to do and that it is their voices which now need to be heard. Only in partnership with different faith communities can the situation be addressed and this is already happening. My survey has revealed that Chaplains regularly have contact with religious groups in their areas. Out of the 132 responding hospitals the total number of groups contacted were 534. The largest number of groups was Muslim and Christian with the rest being evenly split between Hindu, Jewish, Sikh, Buddhist and others. In conclusion, the NHS needs to match its aspiration with commitment. Christian Chaplains are at the forefront of pressing for change but there needs to be a greater partnership with other faiths to help the NHS deliver what it promises. Helen Blackburn
References Blackburn, H., Listening to the voices of faith: the provision of spiritual and religious care for the six main faith groups in Sheffield. 2004. (Available in PDF format via www.sheffieldfirstforhealth.net with link to Dorothy Dixon-Barrow Award) Gillat-Ray, S., 2001. Sociological Perspectives on the Pastoral Care of Minority Faiths in Hospital. In Spirituality in Health Care Contexts. H. Orchard, ed. Jessica Kingsley Publishers. p137 SYWDC. 2003. Caring for the Spirit: a strategy for the chaplaincy and spiritual healthcare workforce. Competing interests: None declared |
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steven a fielding, sho orthopaedics west wales general carmarthen
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In reply to Phil Peacock As I understand Christians often take bread in rememberance of the sacrifice of Jesus. This is often blessed by a priest. Roman Catholics more specifically need a priest to fulfill the need to confess their sins. When I mentioned the duties of a Christian I had these in mind. Although I would happily be corrected if I am wrong and these aren't an important part of the worship of a christian or in fact can be carried out by somebody who is not a priest. Kind regards Competing interests: None declared |
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