Book Review, Christopher Swift, Hospital Chaplaincy in the Twenty-first Century: The Crisis of Spiritual Care on the NHS

A Reflection by Kate Bradford, a Chaplain in a Paediatric Hospital.

This reflection focuses on the summary history of chaplaincy contained within the first section of Christopher Swift’s book. 

Christopher Swift presents a comprehensive guide to the major issues surrounding hospital chaplaincy conducted within a public health system. The context of the book is British but there are many parallels that could be drawn with the chaplaincy system we have inherited within the NSW health system.

Swift, as a chaplain, held a senior hospital position within a NHS Trust. He writes as an insider with a clear understanding of what it is to be a chaplain, negotiating simultaneously the expectations placed on a chaplain by a secular government and the institutional church.

Swift places chaplaincy within its historical context by providing a brief but fascinating history of chaplaincy and hospitals. During medieval times hospitals were initially within the monasteries. Illness and spirituality were regarded as intimately connected, concern for the body together with care of the soul, the hospitaller/chaplain  played a central role within these institutions. The role of doctor and chaplain merged. The surgeon was enjoined to ‘warn and persuade’ the patient and to call in the physician of the soul.

The care of the sick underwent major changes with the Reformation as hospitals came under government control. The role of the chaplain changed significantly and accountability for the institution was primarily to the Government. Previously the role of the chaplain involved ritual and sacraments but as the church reformed,  the role changed to the  more verbal ministries of teaching of Scripture, instructing and providing words of comfort.

Over time religion remained central to hospitals, but the focus on eternal salvation diminished and concern for the cure of souls subtly shifted to cure of bodies. The doctor was expected to play a role in the moral improvement of the patient expecting the patient to offer thanksgiving and prayer. As science and medicine advanced the public role of chaplain further declined and then ultimately retreated to the private world of the bedside.   

The historical context of chaplaincy was located very much within the area of Christian life and faith. Chaplaincy was primarily concerned with matters relating to spiritual health and the revelation of God rather than psychological health. 

It is interesting to note that this historical view of chaplaincy has some significant differences from the modern Clinical Pastoral Education (CPE) movement that began with Anton Boisen in the 1920’s in the Worcester State Hospital, Massachusetts. Anton Boisen was a liberal clergyman who suffered a number of distinct periods of severe psychosis. Boisen observed that a crisis could precipitate religious quickening, and that when a person’s fate hangs in the balance, people think and feel intensely about the things that matter most. The CPE model focuses on these issues in its care, drawing heavily on counselling models for its method.

Drawing on the perceptive insights provided by Anton Boisen, we need to hear the patient as a living document. But Christopher Swift has done us a great favour by reminding us of the rich Christian heritage we have as chaplains. On wider reflection if we, as chaplains, hear only the patient but do not listen to the true and living document that is the Word of Life and submit to the Spirit of Christ, we have done great disservice to the patient, and as such our care has not been Chaplaincy. 

Copyright Kate Bradford 2011

Swift, C., Hospital Chaplaincy in the Twenty-first Century: the Crisis of Spiritual Care on the NHS. (Ashgate, Surrey), 2009.