New user? Register here:
Email Address:
Retype Password:
First Name:
Last Name:
Existing user? Login here:

Taking care for all in good faith

Terence Handley MacMath

Health is under the spotlight. The Church must engage with chaplaincy, says Terence Handley MacMath.


It is not on the official curriculum of continuing ministerial development, but it does a hospital chaplain no harm to be a patient occasionally.

'Do you tell them about the Lord Jesus Christ?' I was asked sternly by a striking young Nigerian surgeon earlier this month, as she was suturing an incision she had just made in me. I gave the answer she demanded. It was not a moment to pick a fight over the manners and means of mission.

But I believe I do tell patients about the Lord Jesus Christ, because I respect the terms on which I am invited into the NHS Trust, and because I respect the spiritual integrity of the staff and patients whom I meet.

There is currently a huge debate about health care, in Parliament and in local authorities, in health authorities, in professional associations such as the Royal College of Nursing or the British Medical Association, in ethics committees, in individual hospices and hospitals, and around hospital beds and kitchen tables.

As well as disputes about funding and organisation, there are the ageold discussions about the best means of helping people to achieve wellness: pharmaceutical, pastoral, emotional, spiritual, cognitive, and physiological.

The Church is very much involved, as are other faith communities, and our understanding of health and illness changes through scientific advances and personal experience. There are more than 250 Church of England priests working as full-time NHS chaplains, and many more working part-time, as well as some lay men and women.

There are many Christian agencies doing explicitly healing work, and many thousands of Christians work in the NHS, or for private healthcare providers, as well as a few priests who practise medicine.

Many of those who are involved in this activity wonder, sometimes, if people in the parish know anything about what is going on. In Being a Chaplain (SPCK), the editors, Miranda Threlfall-Holmes and Mark Newitt, argue that the Church would benefit immensely if it both listened to its chaplains and supported them more.

The two branches - parochial ministry and sector ministry - are intertwined. Working outside the church establishment alone does not mean that a priest can escape responsibility for the damage that institution has caused. Unlike much parish work, a healthcare chaplain's daily work involves encounters with people who have actively avoided the Church, often for years.

If Mrs Jones's last vicar refused to baptise her grandchild in the way she was used to - or, worse still, refused to baptise her grandchild at all, for whatever reason, it is not surprising if Mrs Jones eyes the approaching chaplain without enthusiasm. She may even, consciously or unconsciously, expect the same sort of rejection from the chaplain.

Because most health-care chaplains have been parish priests at some point, they can, given grace, mediate between past and present parishes and families.

Being willing simply to absorb the anger that many people carry after an encounter with the Church, or with individuals within it, is a vocation of healing in itself. It is also a theological and missiological task to help people to interpret illness, or to speak of God's judgement as liberating and healing rather than punitive and negative.

Very often, such conversations become conversions - a real turning of hearts that have been longing for God.


I LIKE working now in a hospital where the patients are from all countries of the world, where I must scrabble over communication barriers of age, culture, language, and physical and mental disability, and leap over barriers of religion. Many chaplains in hospitals work in multifaith teams. This involves enabling a group of volunteer and part-time chaplains from across the faiths, and doing reflective practice regularly with them in a multifaith dialogue.

Looking back on my hospice work, the patients who remain in my memory were not the many Christians with whom I worked closely, but a secular Jewish man, haunted by two appearances to him of the golem, a threatening anthropomorphic figure in Jewish folklore; and three Iranian Muslim women who longed to love God through the Christian spiritual life and sacra ments - albeit that they were completely at sea in a new culture, language, and theology.

There were also the 'atheists' who opened my eyes to anger, truth, humility, and love - in different configurations - and who wanted me (or anyone) to soften the rigid, protective armature of their spirit.


THERE is a difference between ministry to the healthy and ministry to the sick. Chaplains work within boundaries built from experience and knowledge of hospital protocols that cover disease, patients' experiences, and accountability. I have seen beloved vicars arrive to see a patient, blowing in a welcome, jolly, fresh blast from the familiar outside world. These visits are hugely appreciated.

But parish clergy may not be there when the patient is physically ready to talk; they cannot liaise with the patient's care team; they cannot contribute as an equal at a case conference in a complex case, or be an advocate for an individual whose needs are unexpected or difficult to meet, or help clinicians to make an ethical decision about treatment.

I am lucky to be working in a hospital that values the benefits of spiritual and religious care, and has recently increased its funding for chaplaincy to match recognised patient need. Before, though, I moved, unwillingly, from a large hospice organisation that had decided that none of the patients really needed a chaplain - or, if they did, faith leaders in the community could be relied on to provide professional care whenever required, for no fee.

The loss of health-care chaplaincy posts in the past decade has been serious, but has been disguised by the lack of centralised records. Taken with the preference of some employers for secular 'spiritual care coordinators', with secular counselling qualifications, it means that the extraordinarily transformative journey that many people make when they are ill or dying is simply unsupported, and the theological and existential questions that they have go unanswered.

The next few years will be challenging, as the NHS, under its new management structures and financial constraints, explores 'care in the community'. At its best, this is a common-sense move away from centralised, institutional care, and provides the medical element to the wrap-around care of someone who is being looked after by their friends or family.

At its worst, it does not take much imagination to see how badly things can go wrong. This presents the Church, and health-care chaplains, with a new set of problems. Will patients be expected to seek their own spiritual care? In that case, those who have links with a faith community will be expected to claim home visits from someone. He or she must hope that their visitor will be available, skilled, and experienced, and not squeamish. The ones who classify themselves as 'not religious' - probably most people I meet on the wards - will go unvisited.

Alternatively, hospitals and hospices may employ community healthcare chaplains; but this will be expensive, and will require a new way of working with clergy in the parishes they cover. The interesting parish- nurse movement may have an important part to play.


ANOTHER thing that chaplains do is to help the institution that they work in to be more overtly faithful. The part played by the chaplain in the NHS, at least, is to champion the right of all people to practise their religious faith and to make appropriate provision for this to happen. The presence of a chaplain in a collar or habit is an unspoken permission for the many other Christians in the health service to avow their faith. Religious belief has, oddly, for various good and bad reasons, become a private matter in the popular under standing. It is not, of course, a private matter.

Being Thomas Aquinas and Dawn French on the wards is only one part of the job. Another is to create fruitful relationships with doctors and managers, many of whom have health or other worries of their own. Unlike most of them, however, all chaplains should have studied ethics in some depth, and can contribute to the ethical decisions these staff must take on behalf of patients.

Because they work outside the power or status hierarchy, chaplains can be advocates, in clinical meetings, for the powerless, such as nursing or support staff and patients. A chaplain may be the only person who can risk articulating a situation from a humanitarian perspective, precisely because he or she is not trying to balance budgets, meet targets, or fight professional battles. It makes chaplains very vulnerable, but it allows the humanity of other members of the team to come into play - and, by and large, clinicians and managers are humane.


AND then there is the last boundary that all of us have to cross: health-care chaplains dare to accompany people towards death. Being present to someone in what the clinicians call 'terminal agitation', or to an other person stripped by pain or fear, takes great courage and willingness. That is because, to be truly present with them, we find ourselves strip ped of our expertise.

Here, they are leading us, and it may be a frightening journey, or it may simply be a humbling opportunity to watch with them, wait, and seek God's grace in unknown territory.

Do we tell people, then, about the Lord Jesus Christ? It is better than that: we watch for Christ's spirit to become present in the deepest human need, and celebrate.