Hospital chaplaincy Modern, dependable? By Helen Orchard Sheffield Academic Press 166 pages £10

The last occasion on which HSJ featured an overtly religious subject was probably in July 1996 (Is God good value? The rise of NHS chaplaincy).

In today's high-tech and evidence-based health care - not helped by some glamorous TV serials - the relationship between the material and the spiritual hardly receives any significant mention.

In the 'new'NHS, activity, outcome, performance, quality and, of course, patients, are overriding concerns.

This is exacerbated by the increasing lack of adherence to traditional religions in the secular and postmodern culture currently affecting Britain.

So, is there a place for God (whose unduly patriarchal images are repugnant to many) and his religious 'representatives' in healthcare today?

Assuming that God is not the sole possession of any one faith or institution, how do we ensure that patients and staff get proper access to services in a multi-cultural context?

It is timely that Helen Orchard, an NHS performance manager, has produced this empirical and thorough study of chaplaincies in the London region.

Indeed, it is the major work on spiritual care in hospitals for some 30 years.

Financed by the King's Fund, the research involved a questionnaire and studies of five major trusts (including interviews), and posed the question: 'Are there service models identifiable for chaplaincies in acute trusts, and to what extent can their performance in meeting the needs of the local diverse population be assessed?' It is therefore not about the chaplain's pastoral work as such, but more about the perceptions of a particular service.

Orchard has competently devised an illustrative framework with 15 bi-polar questions, and for comparison, each case study is placed diagrammatically to assess its overall approach.

There are those chaplaincies which are more closely aligned with their religious sponsoring body while the remaining tend towards more responsive employer-defined parameters.

The notion of effectiveness is discussed by engaging the three dimensions of equity, integration and utilisation.

The book also explores whether chaplaincy adds value to service-delivery and the trust as a whole.

The study ends with an interesting 'trickle-down' explanatory theory of spiritual care delivery; essentially chaplains owning up to the fact that others (volunteers and staff ) are empowered to take on much of their traditional role of the spiritual care of patients.

Important general issues are raised, especially for senior managers who have line management responsibilities for chaplaincies: their location within the overall management structure, autonomy and role diversification of chaplains, difficulties of auditing performance, Anglican dominance within current staffing, professionalism, and - not least - the inequity of service provision for faith groups other than Christian.

Nevertheless, a question remains, despite the chaplains' need for self-preservation: are perceptions and receptions of the divine only mediated through those professionally charged with providing spiritual care?

I should think not.

Multi-faith facilitator, University Hospital Birmingham trust.