The NSS has been running a blog and fairly fiery Facebook discussion on the cost of NHS chaplaincy. Specifically they put the cost of chaplaincy to the NHS at £23.5 million pounds. This, they note, is a £1.5 million increase on the last financial year “despite falling levels of religious adherence”.
First, some context. Spread across 230 NHS trusts, with a 2015-2016 overall NHS budget of an eye-watering £115.4 billion, the amount spent on chaplaincy is pretty trivial. Furthermore, no NHS trust is obliged to have chaplains (unlike prisons, where the role is a statutory one). Therefore, given the extreme cuts across NHS departments it seems a fairly safe assumption that most NHS trusts that retain their chaplains see some sort of value in them – or else they would surely have followed the example of a few from a few years ago and cut them completely. Still, £23.5 million is £23.5 million and chaplains should not be immune from having to justify their value for money.
With that in mind, here are a few markers that might make that case:
1. Chaplaincy as a time and money saver.
Patients who feel listened to and have their broader pastoral needs met while in hospital are far more likely to be positive about their treatment (reported in the media here, but also part of a growing academic study). They are less likely to complain when things go wrong and more likely to recover faster and, therefore, be moved out of the hospital earlier (freeing up beds). At the very least this leads to better feedback response for the hospital and at the more extreme end can reduce costs on patients both in terms of avoiding complaints procedures and clearing beds needed by other patients.
Chaplains play an essential role in this. As figures who spend their time actually talking and listening to patients, calming them down and engaging with them on a personal level – rather than simply as part of the diagnostic process – they have a huge amount to offer in terms of meeting that pastoral need.
Among chaplains to GPs there is emerging evidence that the chaplains actively save the NHS and GP surgeries money. It is often the case that many people, particularly older patients, don't really need to see a GP. Their problems are either not strictly medical or simply can't really be addressed by medical options. They do, however, take up time and appointments. By offering a chaplaincy service there is evidence that suggests that these frequent visitor patients come to feel better, and use their GPs less, thereby clearing time and money for other purposes. Since the chaplains come at a fraction of the cost of a doctor or even a nurse they are an excellent value financial move.
There is a real demand for chaplaincy among patients. One mental health trust approached during our chaplaincy research has done research which demonstrates high demand among their patients for more work meeting their spiritual needs. More generally there is evidence that a majority of patients both value spiritual care and feel that it is often insufficiently met at present (in other words there is an argument for more widely available chaplaincy work – not less).
It is worth noting that while church attendance nationally is falling it is far higher among older people – the same demographic that overwhelmingly makes up patients in Britain's hospitals.
For further evidence of demand one only has to look at how busy many of these chaplains actually are. One annual report from a hospital recorded 201 emergency call outs for chaplains, including call outs for out-of-hours advice on 52 occasions. In total, they had 827 referrals across the year and made over 14,600 visits. An average of 23 patients each week received Holy Communion within this one hospital.
Let there be no doubt - patients want and value their chaplains.
3. Secondary roles and value to the NHS
Chaplains do not only provide pastoral and spiritual care (though that is clearly essential to their role). They also perform a range of tasks in hospitals. Minority faith chaplains are often used as translators. Other chaplains serve as mediators, calming down irate families or explaining the treatment and calming patients. In mental health trusts chaplains did an enormous amount of work helping to identify the limits of religious beliefs (i.e. identifying what might be seen as an odd, but legitimate religious belief within certain traditions, and what is a symptom of their mental health condition).
For a number of other secondary roles performed by NHS chaplains see our chaplaincy report A Very Modern Ministry: Chaplaincy in the UK.
4. An already heavily subsidised model
An argument I have seen made on several occasions is that if faith groups want chaplains they should pay for them. To which the basic reply is – they do. One senior religious figure estimated that the cost of training a chaplain paid by the religious group in question was £10-15,000 per chaplain. The vast majority of people doing chaplaincy work in Britain's hospitals are either entirely unpaid or paid only expenses. A number of religious groups (notably Sikhs) make it a point of policy to not accept any pay for the role. From our research we found that the vast majority of chaplains in all fields, including healthcare were not paid a salary. Full time paid chaplains in the NHS probably account for 300-400 chaplains. The total number of people involved in chaplaincy in the NHS is probably not too far short of 20,000.
Where, then, does the cost come in? There are certainly paid chaplains, and part-time paid chaplains, and expenses paid to some chaplains. Much of the cost, however, I imagine, is tied up in the cost of management, accountability, co-ordinating chaplaincy teams, training, safeguarding and other such costs which are simply going to be unavoidable in any work in which employees are working with vulnerable people.
Facts and figures from this blog are drawn from our chaplaincy report A Very Modern Ministry: Chaplaincy in the UK, which is available here.
Ben Ryan is a Researcher at Theos
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