NHS England Chaplaincy Guidelines 2023
NHS England Chaplaincy Guidelines 2023
NHS chaplaincy
Guidelines for NHS managers on pastoral,
spiritual and religious care
Contents
Foreword 4
A note on language 5
1. Introduction 6
2. Overarching principles 9
3. Staffing 13
4. Recruitment 15
5.1 Supervision 20
5.2 Continuing professional development 21
5.3 Research 21
6. Volunteers 22
8. Facilities 25
9.1 Complaints 27
9.2 Regulation 27
Appendices 35
Foreword
People experience life-changing moments within NHS services every day. They may be
undergoing challenging treatment, receiving difficult news or reaching their final hours of life.
While people turn to the NHS for issues with their health, we know that supporting their
pastoral, spiritual and religious needs is integral to their overall care. Access to this support,
through our NHS chaplaincy services, plays an important role in delivering personalised care
and reinforces our core values of respect, dignity and compassion.
Our chaplaincy services also provide a vital source of support for our staff which we saw
especially during the height of the COVID-19 pandemic. I’d like to offer my own personal
thanks to our chaplaincy colleagues for supporting patients, their families and our staff in
unpredictable and extremely challenging circumstances.
In the NHS Long Term Plan, we committed to delivering more personalised care to our
patients and ensuring that we listen to their choices, values and preferences. This new
guidance makes an important contribution to that process, and I thoroughly recommend it to
everyone who is involved the delivery of pastoral, spiritual and religious care within the NHS.
This guidance has been developed with the input of people from a wide range of faith and
belief groups and backgrounds. I want personally to thank all those involved and all the
people who continue to work with us in our shared goal of providing high quality and
inclusive chaplaincy services within the NHS.
Chaplaincy is a vital part of NHS care – for patients, for their families and carers, and for
NHS staff. Chaplaincy services should be offered fairly and equally to everyone without
discrimination.
A note on language
The terms ‘chaplaincy’ and ‘chaplain’ are used in these guidelines to reflect the profession,
which is known as healthcare chaplaincy, and the existing main healthcare chaplaincy
bodies in England, as listed in Appendix 2.
The term ‘chaplaincy’ is used in these guidelines to refer to the pastoral, spiritual and/or
religious care and support that the NHS is expected to offer to all its users. For some, this
has the connotation of the Christian tradition on which it was at one time based: however, by
using this term in these guidelines we intend it to encompass care and support available to
individuals of all religions and beliefs.
For clarity, where reference is made in these guidelines to ‘all religions and beliefs’, this
encompasses non-religious beliefs and the absence of a religion or belief.
Those who practise chaplaincy are described in these guidelines as ‘chaplains’. Again, this is
intended to refer to individuals who provide pastoral care, whether with a spiritual or religious
dimension.
While the terms above have been adopted in these guidelines, NHS organisations should
use the terminology that they feel will best be understood in their local contexts, provided
that due consideration is given to inclusivity and equality. A glossary of terms can be found in
Appendix 2.
1. Introduction
“The NHS provides a comprehensive service, available to all irrespective… of religion or
belief.”
“We value every person – whether patient, their families or carers, or staff – as an individual,
respect their aspirations and commitments in life, and seek to understand their priorities,
needs, abilities and limits.”
“Respect, dignity, compassion and care should be at the core of how patients and staff are
treated not only because that is the right thing to do but because patient safety, experience
and outcomes are all improved when staff are valued, empowered and supported.”
“We ensure that compassion is central to the care we provide and respond with humanity
and kindness to each person’s pain, distress, anxiety or need. We search for the things we
can do, however small, to give comfort and relieve suffering. We find time for patients, their
families and carers, as well as those we work alongside. We do not wait to be asked,
because we care.”
To fulfil the commitment in the NHS Constitution to value every person, it is important that
the NHS not only cares for people’s physical and mental health but also supports them with
any spiritual, pastoral or religious needs they may have in relation to their care.
Patients may view their condition or illness in the context of how they view other aspects of
their life, which may not be explained adequately through a biopsychosocial approach alone.
The human elements of compassion, hope and understanding, and the relationship between
carer and cared for can be a crucial element of the healing process.
In relation to those who work in the NHS, the NHS People Plan commits to practical actions
that employers and systems should take, focusing on:
• looking after our people – with quality health and wellbeing support for everyone
• belonging in the NHS – with a particular focus on tackling the discrimination that
some staff face
• new ways of working and delivering care – making effective use of the full range
of our people’s skills and experience
• growing for the future – how we recruit and keep our people, and welcome back
colleagues who want to return.
Providing resources for people in the NHS to receive pastoral, spiritual and religious care
plays a part in this.
In this guide, we use the term ‘chaplaincy’ to describe pastoral, spiritual and/or religious care
available to all, irrespective of religion or belief. NHS clinicians and others involved in caring
for NHS patients may provide an element of such care, but the specialist role has
traditionally been described as ‘chaplain’ and that is the term widely adopted internationally,
both within and outside healthcare.
In the NHS context, chaplaincy care should be available to everyone – without discrimination
on grounds of age, disability, race, sex, sexual orientation, gender identity, or any other
protected characteristic – and the term is understood to be inclusive of all religions and
beliefs.
The purpose of these guidelines is to set out for NHS managers of chaplaincy services in
England guidance on how to run and manage a safe, effective and inclusive chaplaincy
service, with some examples of how NHS bodies across the country are operating such
services. The guidelines are not intended to describe how chaplains should perform their
duties.
This edition replaces the last guidelines published in 2015, reflecting changes in society and
the NHS since then. This edition is also written recognising the importance of chaplaincy
services in the NHS during the COVID-19 pandemic, when chaplaincy support played an
important part in supporting patients, families, carers and staff at a time of severe stress and
trauma.
enables the pastoral, spiritual and religious needs of the individual to be understood and
addressed.
Chaplains, with the appropriate authorisation, may perform rituals consistent with the
individual’s religion or belief, such as those associated with birth, marriage or death.
Chaplaincy services should be managed and run in such a way to enable such ceremonies
or rituals to be performed by someone who shares the religion or belief of the person for
whom they are being performed. They may also facilitate and lead collective ritual such as
acts of remembrance and celebration.
Chaplains are often involved in the initial response to crisis situations and major incidents
because of their pastoral skills. They provide support for people in distressing or traumatic
situations when they are often at their most vulnerable such as pregnancy loss, sudden
infant death, psychosis, self-harm, diagnosis of life-threatening conditions, and end of life
care. Chaplains also provide support to NHS staff, students and volunteers involved in these
situations and contribute to staff wellbeing and resilience initiatives such as meditation
sessions and Schwartz Rounds.
Chaplains in the NHS often also contribute to the wider organisation and health and care
system. They may sit on multidisciplinary care teams, management and leadership groups,
ethics committees and equality, diversity and inclusion (EDI) groups. Chaplains contribute to
and lead training on pastoral, spiritual and religious care; they provide clinical supervision;
contribute to safeguarding and the welfare of children and young people; conduct audits,
service evaluations and research; and help plan for and provide support in emergencies or
major health incidents.
They may also sit on bodies such as health and wellbeing boards; they may be members of
charitable bodies and collaborate with other professionals in community settings and with
chaplaincies in other sectors. Chaplains also connect with faith groups and belief
communities which can help the organisation understand local needs and create
opportunities to improve services and address health inequalities.
Note: Examples are included in these guidelines of how NHS bodies across the country
are currently operating chaplaincy services. We recognise different approaches may be
appropriate in different circumstances to best suit the populations being served.
2. Overarching principles
2.1 Equality, diversity and inclusion
NHS organisations have a legal obligation to comply with the public sector equality duty both
as employers and when providing services to the public. This requires NHS organisations to
have due regard to the need to eliminate unlawful discrimination, harassment and
victimisation, to advance equality of opportunity and to foster good relations between people
who share a protected characteristic and those who do not.
All care, including chaplaincy, should be made available equally and without discrimination to
all patients, families and carers, and staff, regardless of any protected characteristic an
individual may have (such as religion or belief).
Chaplaincy services should be based on the needs expressed by service users, not just
service providers. NHS managers should play a key role in advancing the equality of
opportunity and inclusivity of underrepresented groups in these services. Patients from a
diverse range of backgrounds and those sharing protected characteristics, and those who do
not, should be included in drawing up local policy and shaping the provision of services.
While chaplains are expected to support people of all religions and beliefs, chaplains from a
particular religion or belief group may also deliver religious or belief-specific care for service
users who seek their support. For example, a Catholic chaplain who may be appointed
following an open recruitment process may provide Catholic liturgical services to patients,
families and carers, and staff.
Care for people who share the chaplain's particular religion or belief cannot be the exclusive
focus of their work, but nor must chaplains be expected to perform rituals or ceremonies
from religions or traditions which are not their own or to give advice counter to their own
beliefs. Chaplaincy services should be managed, resourced, and run in such a way to
ensure that the service can be offered and provided to all, irrespective of individual
chaplains’ religions or beliefs.
Some people understand ‘chaplain’ as a term linked to religion and particularly the Christian
tradition. To avoid confusion, the addition of a prefix to denote the individual chaplain’s
religion or belief system – such as Humanist chaplain, Jewish chaplain or Muslim chaplain –
can be helpful.
In some cases there may be grounds for a post holder to have a particular protected
characteristic under the Equality Act. In law, this is known as an ‘occupational requirement’
which may be a particular religion or philosophical belief, and this must be justified and
proportionate to achieving a legitimate aim. An equality impact assessment must be
conducted before an occupational requirement can be determined.
2.2 Leadership
Each chaplaincy service should have a designated manager – sometimes referred to as lead
chaplain, head of department or chaplaincy manager. This person is responsible for the
delivery of a safe, effective and high-quality service that is well integrated within clinical
services as set out in these guidelines.
It is good practice for chaplains to work as part of a chaplaincy team rather than as lone
individuals and time and resource should be available for ongoing team development.
Effective teamwork and compassionate leadership is particularly important for chaplains as it
helps build the necessary safety, trust and mutual support to sustain them in their
emotionally demanding role.
Chaplaincy should develop close working relationships with key departments such as
bereavement services, given their frequent involvement with end-of-life care and their
support of people who are bereaved. Chaplains can support patients with their funeral plans,
and they can have a key role in funerals arranged by the NHS organisation. In these cases,
for example in circumstances where there are no family or friends able or willing to make the
Chaplains should work with EDI leads to ensure their services are open and inclusive. EDI
leads can support chaplains to communicate the breadth and potential impact of their
services. This should encourage uptake by all, irrespective of religion or belief, using
language that is readily understood by both patients and staff and respectful to all.
For avoidance of doubt, NHS policies on disclosure and barring must be followed in relation
to chaplains and chaplaincy volunteers, who may work closely from time to time with
potentially vulnerable adults and children. Chaplains should also adhere to safeguarding
policy within their organisation and undergo relevant training. The lead chaplain has a duty to
ensure that the staff and volunteers in the service follow safe practice.
In accordance with NHS policies for record keeping, chaplains should keep clear and
accurate records relevant to their practice, which not only supports safe and effective care,
but also helps ensure continuity of care and MDT co-ordination, while providing evidence of
their practice and decisions. Records, in whatever form they are kept, should be subject to
audit against quality standards.
As part of a learning culture it is good practice for managers to seek feedback on the work of
chaplains and volunteers. It is recommended that managers/lead chaplains make occasional
follow-up visits to patients, families, carers or staff who have received a visit from a chaplain
or volunteer to seek their feedback and ask chaplains’ colleagues for any observations about
the chaplain or the service. This can inform the appraisal process.
It is expected that chaplaincy will be included in quality and Improvement committee reviews,
for example to help shape the organisation’s work on patient safety, patient experience and
effective patient care.
Chaplains, including those on honorary contracts (see section 4.5), must complete regular
training in IG and confidentiality, in a similar way to all other organisational employees, and a
record must be kept of all training undertaken. Chaplaincy volunteers should also receive
training on IG and confidentiality.
3. Staffing
Chaplaincy staffing requirements will vary from organisation to organisation and should be
based on the principles of effective workforce planning. In so doing, managers should take
account of the profile and needs of service users (including out-patients), working patterns
(including any requirement to maintain round the clock or out-of-hours services), the job
plans of staff, the overall functions and objectives of the department, and service user and
staff outcomes. Planning should also ensure that the composition and focus of the team
gives due regard to the religions and beliefs represented in the patient population.
It is good practice to allocate management/professional leadership time for the lead chaplain,
and supervising chaplains based on the number of whole-time equivalent chaplains in the
team, depending on circumstances in each provider organisation and recognising that small
teams may require an increased allocation to meet organisational expectations.
Certain settings, such as palliative and end of life care, mental health services, community
and specialist paediatric care, and primary and community care, may call for a different level
of staffing and specific skills and experience relating to the complexity of needs in these
disciplines – see chapter 10.
The chaplaincy team may comprise not only paid staff but also chaplains who have an
honorary contract, and volunteers. It is often the case that organisations choose to have
arrangements with volunteers from minority faith communities or other beliefs with relatively
low local representation to support chaplaincy staff to meet the needs of all service users.
Visiting ministers of religion or pastoral carers from belief groups specifically requested by
patients do not generally form part of the team.
In planning the proportion of time chaplains have for the variety of activities required in their
role, allowance should be made for chaplains to fulfil a range of tasks besides supporting
people with their pastoral, spiritual and/or religious needs.
• Attending MDTs.
• Liaising with health and social care staff to coordinate patient care.
• Liaising with funeral directors and the bereaved and conducting funerals.
The on-call system should follow relevant local and national on-call guidance, terms and
conditions and chaplains providing on-call should have sufficient training and experience to
fulfil this duty.
Where a 24/7 service is provided consideration must be made of the staffing needed to
ensure that it is sustainable and that chaplains are not unduly burdened. Healthcare
professionals should alert chaplains in advance when they believe that their services may be
required out of hours.
It is good practice to aim for chaplains to reach patients within one hour when called in an
emergency. When called, the on-call chaplain should assess the needs of the patient and
provide the necessary care and support where they are able to do so. In situations where the
patient has particular care and support needs because of their religion or beliefs that the on-
call chaplain is unable to provide the on-call chaplain should where possible involve another
chaplain who is able to provide that care and support.
Alternatively, it may be possible to set up partnerships or service level agreements with local
groups or communities to support an inclusive and equitable service according to service
needs.
4. Recruitment
Chaplains may work either in paid roles or under contract but unpaid (honorary). This
chapter considers recruitment of paid staff and honorary chaplains – see chapter 6 for
volunteers.
Recruitment of paid chaplains and honorary chaplains (see section 4.5) should follow
established good practice for NHS recruitment and should be in line with equality legislation.
As for all NHS recruitment, employers must carry out pre-employment checks set out in NHS
Employers’ Employment Standards.
Before any recruitment is undertaken, a full equality impact assessment (EIA) should be
completed to understand whether a post needs to be restricted. There is generally no need
or justification for job descriptions and person specifications to specify that the post holder
should be of a certain religion or beliefs, as chaplaincy services should be available to all
irrespective of religion or belief.
However, after completing a thorough EIA, it may be decided that someone from a specific
religion or belief group is required to do the job (known as an ‘occupational requirement’).
Appropriate advice on the recruitment process should be obtained in such a situation and
appointees should nevertheless meet the relevant capabilities and competences for the post.
The appointment process, including interviews, should be conducted by people who are
appropriately qualified and consideration should be given to including a patient
representative. It is recommended that an NHS manager and another healthcare
professional sit on the appointment panel and at a level commensurate to the post being
appointed to.
The UKBHC can provide professional appointment advisors to assist with the recruitment
process from the outset, including sitting on an appointment panel, and their use is strongly
recommended – particularly when recruiting lead chaplains.
Paid chaplains are employed in the NHS under the terms and conditions of Agenda for
Change (AfC), which includes national job profiles. Three chaplaincy-specific profiles have
been published:
Chaplain 6
Level Role
Other national job profiles may apply to certain chaplaincy roles such as professional
manager or clinical researcher.
It should be noted that Band 5 posts are intended for trainees and that adequate training
resources, protected learning time and supervision should be available when recruiting at
this level.
4.2 Advertising
Vacancies must be openly advertised. It is recommended that roles are advertised through
the NHS Jobs website as this promotes equality and diversity in recruitment. Other media
may also be useful to attract a wide range of applicants. Where an occupational requirement
has been proven, jobs may also be advertised in specialist publications.
UKBHC’s Healthcare Chaplaincy Bands and Duties Framework sets out the following
qualifications for chaplains:
While these qualifications are desirable, they are currently not a statutory requirement, and
from an equalities perspective, the employer may recognise other qualifications and
professional experience as equivalent: this might be a degree in psychology or sociology, for
A selection process should be based on evaluating the essential and desirable knowledge,
skills, values and behaviours stated in the person specification (PS). A successful selection
process may include not only questions from a panel but also clinical simulations consisting
of a chaplain-patient encounter observed by those experienced in chaplaincy.
The simulation may be followed by time for the candidate to give a written reflection about
the chaplain-patient encounter. At head of chaplaincy level, the process could include a
presentation to a multidisciplinary audience, stakeholder panels and written work.
While candidates must be willing and able to ensure the provision of chaplaincy services to
support people of all religions and beliefs, it is expected that, prior to appointment, the
employer seeks endorsement, where possible, from the religion or belief community of the
desired candidate if possible.
(Some belief groups, such as the Church of England and the Catholic Church, may require
that candidates intending to practise as chaplains have licences or mandates from them.)
A copy of the job description (JD) and person specification should be provided so that the
endorsing body can have a good understanding of the duties and requirements related to the
specific role for which the candidate has applied. Endorsement should state that the
candidate is of good standing, is deemed safe to practise, and that the candidate has the
religion or belief characteristics that they claim.
The Network for Pastoral, Spiritual and Religious Care in Health (NPSRCH) maintains a
register of religion or belief groups, each of which can provide endorsements for chaplaincy
candidates. Where a religion or belief group is not registered there, application should be
made to the head office of the organisation concerned.
Note that endorsement on its own is not sufficient for evidence of suitability or competence
for the role.
4.4 Registration
UKBHC maintains a voluntary register of chaplains accredited by the Professional Standards
Authority. Registrants are required to meet the standards for competence, professional and
ethical behaviour that are set out in its Code. NHS organisations should expect all chaplains,
whether UKBHC registered or not, to abide by that Code.
Honorary chaplains should not replace the role of a paid chaplain in a chaplaincy service but
extend the core provision already in place and contracts should be issued only for fixed time
periods. Honorary contracts should not be used for chaplaincy volunteers, unpaid
placements or work experience opportunities.
Where suitably experienced members of faith communities or belief groups are recruited to
act as honorary chaplains, it is required that they meet the standards expected of paid
chaplains in that role. It is also essential that they have an explicit agreement covering the
extent of the role and its limits. They should be endorsed by their religion or belief community
where possible and should receive an equivalent level of training and supervision to paid
chaplains.
Recruitment of honorary chaplain posts should follow the same good practice used in the
NHS (see above). If hosting an honorary chaplain employed elsewhere, NHS hosting
organisations should ensure that they have the necessary assurances from the proposed
honorary chaplain’s employer that the appropriate employment clearances, including identity
checks, have been conducted in compliance with the NHS Employment Check standards. In
cases where there is no other employer, the host organisation should ensure that all checks
are undertaken to a satisfactory standard.
After appointment, employers should ensure that chaplains undertake CPD and receive
regular appraisal and supervision, with their training needs identified as part of their annual
appraisal. This will support chaplains to become effective in their role, work safely within the
NHS and sustain the capabilities necessary to care for people at times of vulnerability,
suffering and death. Job descriptions, job plans and budgeting should allow for this.
Employers will also have their own mandatory training with which all staff, including
chaplains, will be expected to comply.
NHS employers should offer or provide access to training in subjects allied to chaplaincy for
chaplains to attend. It is recommended that this includes but is not limited to training in how
the organisation works, service improvement, teamworking, communication skills, cultural
competence, mental capacity, record keeping, major incidents, and palliative and end of life
care. Chaplains should be made aware of opportunities to work across directorates to build a
breadth of knowledge of the organisation.
5.1 Supervision
Entry level chaplains (Band 5) should receive regular management and clinical supervision
and be offered opportunities for work shadowing, mentoring and reflection, during which
significant aspects of their work can be discussed as a means of learning, enhancing
reflexivity and developing their professional identity and capability.
Chaplains (Band 6 or above) should receive regular clinical supervision from another suitably
qualified person – preferably neither within their department nor their line manager – to
enable them to reflect carefully on the spiritual assessment and interventions they carry out.
This recognises the burden of chaplaincy and the high level of responsibility that chaplains
have towards their service users, staff and their organisation. In instances where there is no
suitable supervisor within the setting or organisation then a suitable supervisor will need to
be identified from outside their immediate organisation.
Good practice is for sessions to use anonymised case discussion to facilitate learning,
reflective practice, managing of boundaries, avoidance of dependence and attention to
safeguarding issues or general safe practice. They can be individual or group sessions and
can be conducted in person or online. Both the Association for Pastoral Supervision and
Education and The Institute of Pastoral Supervision & Reflective Practice set standards in
this area.
In the North and Midlands, lead chaplains meet monthly and other chaplains quarterly to
support each other. This includes time for peer reflection on what is working and what
needs further consideration; training sessions provided by peers; and collaboration on
research. Chaplains from specific faith groups but from different sectors, such as prisons
and universities, meet with healthcare chaplains to develop professional practice.
5.3 Research
Research produces new knowledge and insights that can help improve practice and bring
benefits to patients and those who chaplaincy supports. It is good practice therefore to
encourage chaplains to develop their knowledge and skills in research including the ability to
critically interpret and translate findings into practice. The UKBHC has a research standard
to guide the conduct of research in chaplaincy.
6. Volunteers
Volunteers can add significant value to chaplaincy provision in all sorts of support roles.
They should be regarded as complementary to rather than replacements for substantive
posts, but it is good practice to consider the diversity of volunteers alongside those in
substantive roles.
As with all volunteers in the NHS, it is important that they are properly selected, recruited
and trained and are subject to appropriate management and supervision. General guidance
may be found in Recruiting and Managing Volunteers in NHS Providers – a practical guide.
While the chaplaincy service will manage and support the day-to-day activities of chaplaincy
volunteers, managers of chaplaincy services should link with their organisation’s Volunteer
Service Manager who can advise and support with the recruitment, training and support of
volunteers. It is good practice to use positive action to recruit volunteers of all religions and
beliefs.
6.2 Supervision
Volunteers, who must receive an induction when they start, should be supervised by a
chaplain (Band 6 or above). After appointment, they must complete relevant mandatory
training, which must include EDI, safeguarding and IG training.
It is expected that they attend at least one annual training event focusing on safe chaplaincy
practice and they should be encouraged to engage in supervision and reflective practice
appropriate to their role, which has been shown to improve service user outcomes.
Chaplains (including honorary chaplains) can make their services known, for example by
walking around in an acute setting and talking to patients, their families, and carers. It should
be made clear that the service is for everyone, whatever their belief or religion.
It should be made clear that staff, patients, families and carers may self-refer to a chaplaincy
service. Clinical staff should also be trained how to introduce and describe the service to
patients, families or carers and how to refer them.
The chaplaincy service should make people aware that in addition to providing chaplaincy
care and support services, they are there to support people to practise and express their
religion or beliefs while in hospital, including observing religious festivals/dates, with
adjustments made as necessary to ensure they can participate.
The provision of chapels, prayer rooms, quiet rooms and other spaces should be made
known to service users and staff. If only one area is designated for service user and staff
use, it should be described in inclusive terms, for example ‘room for reflection’ or ‘quiet
room’, to avoid suggesting that it is for use only by people of particular religious or other
beliefs. An additional space designated for multi-faith use, if required, may be described as
such.
It is strongly recommended that all staff be made aware of the service as part of their
induction and be reminded about it from time to time – especially if major incidents occur or
if, for example, there is an unexpected staff death.
Clinical and other relevant staff should be trained in relevant screening and know how to
refer to the chaplaincy service at all times. It is good practice to note consent as part of any
record of referral kept.
It is good practice for the chaplaincy department to keep managers and staff informed about
a calendar of religious and belief festivals.
An app to enable chaplaincy services to be accessed from a mobile phone has been
developed by Bradford Teaching Hospitals NHS Foundation Trust, and the Trust
welcomes enquiries about it via [email protected].
8. Facilities
8.1 Office space
Chaplains require office space, phones and networked computers, and these should always
be provided. Administrative support and data should also be provided where relevant.
Chaplains must have access when necessary to confidential working space, such as an
office, where they can offer one-to-one support to carers, friends and families and staff.
The design and provision of spaces should give due regard to the diversity of religions and
belief needs in the population served, such as provision of ablution facilities. Some
organisations make available holy books or guidance examples for prayer and reflection.
Rooms should contain storage or screens for religious artefacts and facilities, so that they
can be reset for others after use.
Spaces that are shared by different belief groups or faith communities need to feel useable
and welcome to all while being able to meet specific needs at certain points in the day or
times of the year (eg Muslim prayer times).
Facilities therefore should be managed to ensure that respectful cooperation among all users
can be achieved and the faith communities and belief groups should be consulted and
involved.
For example, retrofitted chapels may not be appropriate as quiet rooms for use by people
with non-religious beliefs or people of certain faiths. In this case, a separate space may be
required and designated as a ‘quiet room’, ‘sanctuary’ or ‘room for reflection’.
Quantitative measures (eg referrals, numbers and type of interactions by chaplains, lengths
of contacts, response times) have a part to play and should be collected and reported.
Qualitative information on user experience/ outcomes is also important to help assess the
impact of the service and to guide its development.
Bradford Teaching Hospitals NHS Foundation Trust keeps records of incidence, location
and nature of interactions which yield quantitative data. Qualitative data is recorded (as
case studies, reflective accounts, feedback from families, survey responses, intervention
summaries, etc) to analyse expressions of need and range of responses. Data is used for
service review, to measure impact, to monitor inequalities, trends and performance, to
review staffing and volunteering, to allocate resources and to support research activities.
University Hospitals of Leicester NHS Trust produces an annual report in which it records
a wide range of quantitative data. It also builds a picture of the activities of the chaplaincy
department by including items such as:
It is strongly recommended that feedback on the chaplaincy service is sought from patients,
families and carers, and staff. Organisations may wish to include questions about it in patient
and staff surveys, such as the friends and family test, provided they have the means to
analyse the results.
The Scottish Patient Reported Outcome Measures (PROMs) is a measure that has been
used successfully to assess the impact of chaplaincy interventions.
9.1 Complaints
If a member of the public has a concern about a chaplain or the chaplaincy service, they
should follow the NHS patient complaints procedure and in the first instance raise the matter
locally using the organisation’s standard complaints or whistleblowing process. Staff should
follow the provider’s complaints procedure.
Complaints against chaplains registered with UKBHC should be reported to that body.
Any upheld complaints should be reported to the endorsing religion or belief group of the
individual concerned and any other relevant professional bodies, which will have their own
codes of conduct and processes to follow.
9.2 Regulation
The Care Quality Commission (CQC) notes that everyone has the right to expect person-
centred care that meets their needs and preferences, and to be treated equally with dignity
and respect. It is committed to regulating to advance equality and protect people’s human
rights.
CQC checks whether “staff understand and respect the personal, cultural, social and
religious needs of people and how these may relate to care needs, and … take these into
account in the way they deliver services.”
It also assesses whether “people [are] given appropriate and timely support and information
to cope emotionally with their care, treatment or condition”. The CQC Inspection Framework
for End of Life Care requires inspectors to check how services provide psychological, social
and spiritual support to patients at the end of life. NHS organisations should have robust and
well-implemented chaplaincy policies and procedures, against which the CQC can evaluate
service provision.
The NHS Standard Contract states that providers must take account of the spiritual,
religious, pastoral and cultural needs of service users and that NHS Trusts and NHS
Foundation Trusts must have regard to these NHS chaplaincy guidelines.
• “An individual plan of care, which includes food and drink, symptom control and
psychological, social and spiritual support, is agreed, coordinated and delivered with
compassion.”
• “The dying person, and those identified as important to them, are involved in
decisions about treatment and care to the extent that the dying person wants.”
• “The needs of families and others identified as important to the dying person are
actively explored, respected and met as far as possible.”
The role of chaplains is identified in relation to all of these as part of the MDT.
Job planning should take into account a chaplaincy department’s commitment to out-patient,
day therapy and community services including domiciliary settings. Chaplains will be
regularly involved in supporting patients’ families’ pre-bereavement and in many instances
will play a significant role in bereavement care, including in the arrangements for patients’
funerals and the organisation and conduct of memorial services and related events.
The Association of Hospice and Palliative Care Chaplains (AHPCC) seeks to identify and
promote good practice in providing chaplaincy at the end of life and provides study
conferences for chaplains working in a palliative care environment.
It is not required that NHS organisations employ a dedicated specialist palliative chaplain,
but all chaplains should be skilled in this area whatever the context of their work or their
organisation.
Chaplains must, however, be able to call on a network of chaplaincy volunteers or local faith
or belief groups to serve the needs of patients with specific beliefs so that appropriate
customs at the end of life can be observed and respected.
It is good practice for hospice chaplains to follow these NHS guidelines, even though they
may be funded partly by the NHS and partly by independent hospice charities.
Social problems such as housing difficulties, poverty and isolation are not uncommon as well
as emotional difficulties or needs. It is therefore important for chaplains in mental health to
be skilled in pastoral care and counselling and to be adaptive in response to their users’
broader welfare needs.
Chaplains can address service users’ pastoral, spiritual or religious concerns, and often
reduce a sense of isolation, increase resilience and play a part in their recovery. They can
also support families and carers.
Most mental health chaplaincy work can be undertaken without requiring a specific religious
or belief background from the chaplain, but people with mental illness often express a wish
to receive care from a chaplain of their own religion or belief system or gender, and it is good
practice to make provision for this.
Chaplains working in mental health settings often have long-term relationships with service
users, given the ongoing care needs for people with enduring mental health conditions and
the potential for readmission to an in-patient unit following a relapse.
The relationship the service user has with the chaplain is often built up and founded on trust
over many years, leading potentially to a distinctive dimension to mental health chaplaincy.
While some service users will still require more episodic care interventions, to ensure
consistency of care for those needing longer term interventions, it is good practice for NHS
organisations with long-term mental health service users to employ their own mental health
chaplains who ensure a personalised care approach is taken.
Many service users, including those detained or treated under the Mental Health Act, may
not trust the institution responsible for their care and can be wary of their prescribed
medication and their care team in general. They may, however, regard chaplains as ‘allies’
who will not ‘impose’ treatment on them. Consequently, chaplains must exercise skill in how
they conduct themselves as part of a multidisciplinary team.
For chaplains working in children and adolescent mental health services (CAMHS), the
considerations that apply to paediatric care (see 10.3) may also apply. Similarly for children
and young people (CYP) moving between CYP and adult mental health (AMH) services, the
principles of transition may need to be considered.
In all engagements with service users, chaplains must recognise the vulnerability and
inherent risk of the people they work alongside, including their increased risk of experiencing
abuse or harm from others.
Chaplains in mental health require training in working with people who may also present a
risk of harming themselves or others and who may be susceptible to suicidal ideation. Since
chaplains can often find themselves working alone when seeing service users in the
community, managers should ensure they recognise the need for vigilance as well as
maintaining professional boundaries.
Given these complexities, chaplains working in mental health settings need time not only for
preparation in their service user and possibly family engagement but also for
‘decompression’. Supervision separate from line management should always be put in place.
Volunteers in these settings should also be given additional support and be in receipt of
pastoral supervision on a regular basis. Job plans and descriptions should consider not only
the time needed for preparation and supervision, but also allow for the extra time needed to
visit patients or service users in the community (see Appendix 1).
Given that chaplains in mental health often have a wide overview of services because of
their visits across its different settings, they can often provide useful insights at Board level.
Note: Only chaplains who are qualified counsellors or therapists are permitted to conduct
counselling/therapy. If qualified counselling or therapy is needed, chaplains who are not
qualified in this way should make an onward referral to the appropriate service.
Any decisions for therapy should be discussed with the treating MDT to ensure clear roles
and responsibilities and avoid overlap or confusion in interventions the person is receiving.
Chaplains working in specialist paediatric units require enhanced training tailored to this
context and taking account of ethical and safeguarding considerations as well as issues of
capacity and consent.
It is recommended that chaplains working with children and young people have a good
understanding of child development, family systems and family dynamics and social factors,
to allow them to interpret the wishes of the service user and the views of their family/ care
givers and friends in relation to religion, belief and spirituality.
The age of the patients means that sustained support to the family may also be needed.
When supporting children or young people in Mental Health settings it is important to work
with the network around the child or young person.
Engaging with the spiritual needs of children and young people requires highly skilled and
imaginative care, sometimes involving forms of play as an intervention. It is important to
have skills to engage with both verbal and non-verbal children/young people across the
developmental age range.
A PGC in paediatric and maternity chaplaincy is available from the Centre for Paediatric
Spiritual Care at Birmingham Children’s Hospital through Newman University. Accredited
modules at level four and level seven in spiritual care and paediatric chaplaincy-related
topics are available at Staffordshire University.
Volunteers will need to be suitable and comfortable to work with young people, including
those with life-limiting conditions and their families/ care givers.
As well as providing support to patients – including people with mental health conditions
being cared for in the community – and their families and carers, chaplains in primary and
community care can also play an important role in supporting staff.
Some GP practices provide a chaplaincy service, but this is a relatively recent development
and one that is encouraged. If such a service is introduced, it is recommended that particular
effort is put into making staff and patients aware of it and how to access it.
The Association of Chaplaincy in General Practice (ACGP) facilitates the setting up of this
service within General Practices and provides advice on training and professional support.
There are also examples of good practice in Scotland – for example at NHS Tayside.
Primary and community care services are encouraged to explore the possibilities for
providing chaplaincy remotely, using video-conferencing and other forms of new technology.
It is envisaged that this may enable isolated patients and service users who are part of
smaller religious or belief communities to be supported and valued.
Nevertheless, it should be remembered that some people may be unable to use or access
the technology, so it will not necessarily be suitable for everyone.
Appendices
Appendix 1: Healthcare chaplaincy bodies
The main healthcare chaplaincy bodies in England offer further guidance on good practice. A
list is provided below.
Appendix 2: Glossary
ACGP Association of Chaplaincy in General Practice
Faith Religion
Honorary Unpaid
IG Information governance
JD Job description
PS Person specification
Schwartz A forum where all staff (clinical and non-clinical) can come
rounds together regularly to discuss the emotional and social aspects of
working in healthcare