Published: 15/07/2004, Volume II4, No. 5914 Page 26 27

Hospital trusts must now take steps to address their patients' religious needs.Some are already doing so, as Jeremy Davies reports

As a busy trust chief executive or chair, the role of spirituality in healthcare probably appears rather lower on the list of things that keep you awake at night than, say, performance targets or the manifold implications of payment by results.

But chief nurse Sarah Mullally - also the Department of Health's lead director on patient and public involvement but about to leave her post to become a full-time Church of England minister - warns that in the choice-based culture of the new NHS, patients will no longer put up with having their spiritual needs ignored. Faced with a choice between a trust geared up to caring for patients in a holistic way and another which treats them like a series of clinical episodes, patients will, Ms Mullally argues, vote with their feet.

Bradford Teaching Hospitals foundation trust, which organised the conference on raising the standard of spiritual and religious care in the NHS at which Ms Mullally set out her stall, has gone further than most in addressing the religious needs of its patients and staff.

The trust, 34 per cent of whose patients and 15 per cent of whose staff are from black and minority ethnic backgrounds, employs one of only three full-time Muslim chaplains in the UK, for example, along with other chaplains and volunteers from different faiths.

Last year the organisation created its own spiritual healthcare policy. It has produced resource packs for each ward, providing information on different faiths and their likely needs, and is piloting the inclusion of 'spiritual assessments' in patient notes in paediatrics, oncology and women's services.

The multi-faith chaplaincy team runs staff training on grief and paediatric bereavement, and the organisation's equality strategy has support of staff in a cultural and religious sense as one of its priorities.

Every new member of staff at the trust now receives a 20-minute session on spiritual provision as part of their induction programme.

All trusts should now be taking note of spiritual issues.

The Employment Equality (Religion or Belief ) Regulations 2003, which have applied since December 2003, make clear that organisations' recruitment and selection procedures and employment practices must treat everyone fairly regardless of their religion or belief.

And the Human Rights Act, introduced in 2000, enshrines in law individuals' right to religious observance.

Controversially, Bradford has, again, gone further than most trusts by offering to circumcise boys of Muslim parents on a private basis - the NHS will only fund circumcisions if they are clinically indicated.

'But 2,000 out of 6,000 births in our maternity unit annually are Muslim babies, so That is around 1,000 boys who might otherwise be circumcised in much less safe surroundings, ' explains the trust's director of equality and diversity Dilshad Khan. 'The service is going well, and we joke that It is a snip at£50!'

Taking a long hard look at chaplaincy provision is perhaps a more universal way in which trusts can better address patients' religious needs, and since November 2003 there has been no shortage of guidance on how to modernise that aspect of trusts' service (see box).

The Hon Barney Leith, chair of the Multi-Faith Group for Healthcare Chaplaincy, says chaplaincy has already 'come a long way since it was about the local vicar turning up and you therefore knew you were about to die', but it still has a long way to go.

The multiplicity of faiths represented in British society, and their varied and uneven geographical distribution, means even the most enlightened of trusts can find it challenging to tap into an appropriate level of expertise from the various faith groups, he says.

'On one level this is about capacity - whether or not the team reflects the make-up of the local community, staff and patients, ' says Mr Leith. 'On another, It is about making sure different faiths liaise effectively: how would the chaplaincy team of a trust in a leafy shire cope if a bus-load of Buddhists crashed on a nearby motorway, for example? Would they know what kind of support Buddhists might need, and how to access the people who could provide that? And how can we be sure that someone claiming to represent their faith community has the authorisation to do so?'

Nationally, chaplains are lobbying the DoH for more resources to bring about a step-change in the profession over the next five to six years; individually, chaplains are increasingly doing the same within their own trusts.

But the profession is keen to make clear that spirituality is a much broader concept than religion.

People affected by illness or loss may or may not need their souls looking after as well as their bodies; and that, say chaplaincy leaders, is the case regardless of whether they are likely to draw succour from the Koran, the Bible, a simple chat with a friendly stranger over a cup of tea, or, just as importantly, being left alone.

Ms Mullally says healthcare professionals and the organisation in which they work 'need to recognise that in healthcare we join people on their life journey and for a time we travel with them'.

'We need to better understand who they are and how we can work with them as partners on that journey.

Central to this is understanding them as individuals who have many dimensions, including a spiritual one.' l NHS chaplaincy: what the DoH says In NHS Chaplaincy: meeting the religious and spiritual needs of patients and staff , published in November 2003, the DoH provided guidance for trusts on how to develop their own frameworks for chaplaincy/spiritual care.

The guidance covered everything from confidentiality and data protection issues to provision of sacred spaces, bereavement services and major incident planning.

As part of this document, the Multi-Faith Group for Healthcare Chaplaincy recommended a formula for calculating appropriate levels of chaplaincy time.

Caring for the spirit: a strategy for the chaplaincy and spiritual healthcare workforce , published by South Yorkshire workforce development confederation, recommended ways of modernising chaplaincy across the NHS, with a view to developing it into a more coherent profession made up of five clear career stages.