The Future of Catholics in Healthcare

Talk given to Catholic and Christian healthcare professionals, and clergy and religious in care ministries, organised by the
Bristol Branch of the Guild of Catholic Doctors. 31 October, 2006.
Clifton Cathedral. Archbishop Peter Smith of
Cardiff and Bishop Declan Long of
Clifton participated.

Jim McManusAssistant Director of Health Improvement,Barking & Dagenham Primary Care TrustMember, Healthcare Reference GroupCatholic Bishops’ Conference of
England &
Wales

I work in a very deprived borough in outer
East London. Our average income is £13,000. 19% of people have achieved formal qualifications against 39% nationally and 1 in 5 deaths is attributable to smoking, one of the highest in the
UK. Our second language, African French, has changed in 18 months to Lithuanian or Polish and we have large numbers of Kosovan and other refugees and asylum seeks, and 300 families – largely African – living with HIV. Against this background we have experienced £14.9 million in cuts, cuts made from a PCT which breaks even to subside other, wealthier areas who traditionally have managed in deficit. I believe that what I do, I am called to do, as my part in participating in Christ’s ministry and as my apostolate. And I want to share with you this evening some thoughts on the future of Catholics in healthcare.

While we are also mainly Catholics here this evening, much of what I am going to say will apply equally to our sisters and brothers from other Christian families who are here as part of our gathering.

There are several reasons why I feel privileged to be here tonight:

When I was a boy, the parish I went to was privileged to have a Catholic doctor, a Catholic dentist and Catholic nurses. They were valued and honoured as having a vocation for what they did. Needless to say, our parish generated as many vocations to healthcare ministry as it did priesthood or religious life. Speaking to fellow Christians here is a privilege. So speaking to a network of the health professionals I so admired as a boy is a great honour.

There is a wonderful ecclesiology at work here tonight. The celebration of the Eucharist together has led those working in healthcare, with the local Bishop as the focus of unity, to gather round and discuss our vocation and ministry in healthcare, and consider what God would have us do. This is Lumen Gentium the Vatican II constitution on the Church, at work. This provides, I think, a model for the future of work for Catholics and Christians in healthcare ministry to assert the dignity and importance of their role. A worshipping community gathered together as Church, thinks through its role in light of the Gospel and moves out, as Church, to express its diverse charisms.

This ecclesiology at work is a model for the local Church more widely. When the Bishops of
England &
Wales had their Ad Limina visit to
Rome, they were challenge to do more to support visible ministry in healthcare. While some of this can, and should, be done nationally it is the local church which will make the bulk of any sustainable and sustained action see fruit. You have given us a model we can share with others.

I want to discuss tonight the following issues:

Catholic visibility in healthcare systems
A model for vocation to healthcare ministries
The challenges to this model
What the Church is doing
How we implement our vision

Catholic Visibility in Healthcare SystemsWe all have the experience of finding closet Christians in healthcare systems, wherever we find ourselves. In some places they are more visible than others. We are very visible in Learning Disability and Elderly Care through the work of religious. We are also increasingly visible in some social enterprises. But in the NHS, though anecdotally we are numerous and widespread, we are not so visible. Chaplains seem to be the most visible group.

We need some empirical research on this, and it may be part of the charism of social research institutes to deliver this for us. We are convinced anecdotally that Catholics are over-represented in healthcare compared to the numbers in the general population (about 8% national average according to the 2001 Census.) On an individual level this may be anecdotal, but when you get people forming part of diverse social and professional networks all saying that there are lots of Catholics in healthcare, then the issue becomes one which warrants further study, and the frequency of corroboration I think would be enough for us to assert that our perception of this is, scientifically speaking, valid.

The insight which comes from this is that the NHS and Healthcare in the
UK would not be the same without us.

There are two important things which should strike us from the readings for the Vigil Mass of All Saints’ Day, which we’ve just celebrated. First, the reading from Revelation which describes “a huge multitude, impossible to count, from every tribe and tongue, and people and nation.” While this could pass as the foreword to the NHS Directory, it describes I think, the presence of Christians in healthcare, who perform the role of being a leaven in the healthcare system. Without them, this present but sometimes invisible number, exercising their ministry as healthcare professionals, the NHS would just not be the same. We know that, but we need to prove it.

The second is the reading of the Beatitudes. When I was a divinity undergraduate, ploughing my way through Karl Barth in German, I came across a sermon in which he preached on the Beatitudes, and translated one of them as “How blest are those who know their need of God, for theirs is the Kingdom.” That moved me. And I think it explains the tension in being a Catholic or Christian in healthcare today. We try to be a leaven in a system which seems to want to despiritualise us, but somehow we need to take heart in knowing our need for God, and sharing that, in the work we do.

We do add something to healthcare, and that is a conviction that healthcare is about helping people to be truly human. It is about implementing Jesus’ statement “I have come that they might have life, and have it in all its fullness” (John 10:10.) An emphasis on the person as a spiritual, psychological and physical unity rather than a patient undergoing a procedure is crucial to our role. We do our work, yes, but we do it with a concern for the Kingdom, and the best possible end for the people we work with. We do it, therefore, in an eschatological perspective as well as a clinical one.

A Model for Vocation to Healthcare Ministries

And here, I believe, is where the issue of a model for vocation comes in. We often speak about Healthcare ministry as if it meant Chaplaincy. And while Chaplaincy is included within this, our model needs to be much wider than that. Healthcare ministry is lived out, in the
UK, in a variety of different settings:

· It is lived out by NHS staff working in the NHS, doing their role, but with varying approaches to spirituality being acceptable for public expression.· It is lived out by the parish community. In our area we are trying to get “Faith Health Champions” off the ground, and recently through the mosque we trained people to reflect on health from within their faith. We picked up 9 hitherto undiagnosed cases of Type 2 diabetes in women early enough to intervene and reduce their risk of heart disease and complications. Think what we could do in parishes, and how we could build mental wellbeing through them.· It is lived out in Chaplaincy. At the moment, because of policy changes, Chaplaincy is where we have some major threats – and opportunities – and so a lot of work has been done. More about this later.· It is lived out through Christian Health Services (CHS, not NHS) like St John of God, the Little Sisters of the Poor and the homeless primary care service here in
Bristol run by your own Guild Chairman.

All of these are vocations, all of them show different charisms. The charism of the dentist or occupational therapist, the charism of the physician or surgeon, the charism of the nursing religious.

So what are the models for our vocations? Well, I suggest there are at least two, and that these two are really complementary. The first is provided by the Healthcare Workers’ Charter, a document from the Pontifical Council for Health Pastoral Care. This document speaks profoundly of living out our vocation to healthcare and our participation in the work of Christ in doing so.

…the healthcare worker is “the minister of that God who in Scripture is presented as ‘a lover of life’ (Wisdom 11:26). To serve life is to serve God in the person: it is to become “a collaborator with God in restoring health to the sick body” and to give praise and glory to God in the loving acceptance of life, especially if it is weak and ill.

The therapeutic ministry of healthcare workers is a sharing in the pastoral and evangelizing work of the Church. Service to life becomes a ministry of salvation that is, a message that implements the redeeming love of Christ. Doctors, nurses, other healthcare workers, and voluntary assistants are called to be the living image of Christ and of his Church in loving the sick and the suffering”: witnesses to “the gospel of life”.[1]

Healing – spiritual, physical and psychological – has always been central to the mission of the Church. Healthcare workers of all kinds and charisms contribute their gifts to making this happen. As
St Paul says, “there are many kinds of gifts, but the same spirit.” See what you do as a charism, a gift, to play your part in the healing mission of the Church.

The second model, which I think is entirely complementary to the first, derives from our baptism. Our vocation to work for the health of others comes from our baptism into Christ and into the people of God. This is then sustained by the sacramental life of the Church – especially Eucharist and Confirmation – and expressed in our participation in bringing about God’s Kingdom. Our diverse charisms and ministries arising from these are all signs of the Body of Christ at work (back to Lumen Gentium again.)

None of these models minimise the fact that modern healthcare is a difficult, and even hostile place to be a person of faith. It is supremely ironic that the National Institute for Health and Clinical Excellence recommends the importance of spiritual care in guidance on palliative care for cancer patients, just at a time when spirituality is becoming a dirty word in many workplaces in the NHS.

But we do have resources to deal with this. I spoke earlier of the model of an ecclesiology. The local Church explicitly valuing, supporting, praying for and standing by us is a huge resource. Networking with each other in an atmosphere of faith is another.

But there are resources too, in the health sciences. As a psychologist and consultant in public health I am interested in The Lifecourse chronic illness, and chronic wellbeing, are best seen at population and individual level across the whole of our life. As Christians we call this our pilgrimage or discipleship. Health is an essential part of this, and by seeing health in context of life pilgrimage we can be better at caring for the whole person across their lifespan, even if we only see them rarely.

Another resource is the Biopsychosocial model of health[2], much beloved of health psychologists. This model seeks to emphasise the unity of the human person and states that our physical, psychological and social health all affect each other, and our spiritual health will too. We know from research on stress biology and stress pathways that this stands up empirically. As Christians we have a term for this, it’s called Right Relationship with God, ourselves and our neighbour, and Jesus taught us this in giving us the Great Commandment that we should “Love the Lord thy God, and thy neighbour as thyself.”
We cannot escape the social dimension of health, or the Lifecourse dimension of health. As Christians, our perspective on life, disability and life-threatening illness, seen in eschatological perspective, shot through by hope and sustained through sacraments suits us perfectly to work in healthcare. So let us celebrate this.

The trouble is, we’re not good about making ourselves visible. Claire Short MP once said Catholic Social Teaching was the Church’s best kept secret. Well, our commitment to healthcare is probably an even better kept one.

The Challenges to this ModelThe current policy climate within the NHS has not helped with this visibility. There are challenges to our model from current
UK policy, and for the Church itself.

Taking UK policy, we are at a time when the caring, sharing language of policy documents values spirituality in writing[3],[4]but seems to be embarrassed by it in practice, wanting to control it and reduce it to something performance manageable. I have empathy with this concern. I also think that this is just part of a wider trend, but that there is a way round it.

We face challenges in the NHS about authentic spirituality. Defining it, teaching it and understanding it is hugely problematic[5]. Spirituality exists in the NHS Knowledge and Skills Framework[6] but you will seek a definition of it in vain. By spirituality here I mean a set of values informed by our particular faith tradition which help and sustain us through engaging with patients and the other work we do. British policy on diversity, and particular on faith diversity, has gone wrong somewhere, largely because it has been shaped by people who do not understand the meaning of the phrase “multi-faith.” Multi-faith is most emphatically not a one size fits all, de-traditionalised, bland “concern for the other person” which is a vague extension of some kind of talking therapy. It is, or ought to be, a valuing of each faith by people who are secure in their own faith, and the creation of a healthcare environment where people can express their faith as it is without fear, and with encouragement, as being a part of their vocation to healthcare ministry. For Christians, spirituality must always be in divine perspective, seen through the lens of what God has done for us in Jesus Christ. That doesn’t mean we can’t enjoy “quiet time” in a work setting. It doesn’t mean we cannot respect Muslim, Hindu or Jain colleagues and patients. Quite the reverse – being secure in our faith means we understand why others need to be in theirs.

Refusing to allow people to wear the cross or express that they are Christians is not creating a multi-faith environment. It is creating a secular and de-spiritualised one. It is also, arguably, a contravention of the rights you have under the law[7]. Respecting people of no belief and their rights does not mean you have no right to have respect for yours. It’s also arguable that refusing to allow someone to wear a cross (even under their uniform), unless it could be justified and applied universally to all jewellery for infection control reasons, would not meet the test of reasonable and proportionate applied by the law[8].

Devotees of systems theory will suggest that the response of large scale systems on pluralisation is to try to reduce the cost of it to the system[9], and thus reducing cost always seems to default to reducing complexity. In the NHS this means we talk about valuing spirituality yet handle our clinical governance work to the extent where we have a one size doesn’t fit anyone approach with the bulk of work needed to cope with people’s needs handed to the front-line clinician and Dept of Spiritual Care replacing choice of chaplain. This whole line of development runs entirely contrary to the NHS’s own stated policy on patient choice and staff wellbeing, and spirituality itself.

But what is happening here is not just a system reducing cost. It is a social movement. Lieven Boeve, writing in the current issue of the Bulletin of the European Society for Catholic Theology[10] charts the rise of not just a secularisation of our services and systems, but a de-traditionalisation where any tradition is not valued. This, ironically, is happening at the same time that people are feeling there is “something more” to the world. This leads to a model of pluralisation which is based on a “one size fits all” approach. This will create inter-religious and racial tensions, not reduce them. And when this is expressed in a system such as the NHS, under the guidance of managing diversity, it actually runs counter to what most psychological evidence about managing diversity would actually suggest[11],[12],[13].

So, this public policy challenge brings a challenge to the Church. We need to make sure we take formation of our healthcare ministers seriously. Valuing them, encouraging them to network and share and support each other, and providing resources to reflect theologically and ethically on their work are crucial.

The Church also needs to speak publicly at national and local level to policy makers about the importance of authentic spirituality. But to do that we need empirical research to give policymakers on why it is important.

What the Church is Doing

There is action for the Church to take at local and national level. To quote Bishop Tom Williams, the Chair of the Healthcare Reference Group, we need to address this through “galvanising, not organising.” In other words, we will not achieve what we need through setting up large national systems – even if we had the funds – but through creating an environment where people can exercise their distinctive charism.

Some of this undoubtedly is national, but most sustained work (such as setting up Catholic or Christian Social Enterprises for primary and secondary care using forthcoming DH monies[14] ) will be done at local level.

What we can do at national level is speak to policymakers, and create and disseminate resources for local use. In response to issues and needs identified by healthcare workers and Catholic chaplains, a Healthcare Reference Group, chaired by Bishop Tom Williams, was brought together. This group currently has a strategy in draft which is aimed to help the Church address the issues I have outlined above.

At national level we have sought to address the crisis in Chaplaincy by producing a good practice guide and a handbook for Bishops’ Advisers (the person who advises each bishop on healthcare chaplaincy issues). These will be published by Easter. A leadership toolkit to train chaplains on leadership within the NHS to help ensure authentic Christian spirituality is valued is already in development.

A guide to the role of the Church in major incidents has already been produced in response to the 7/7 bombings[15] and work on preparing the church for a ‘flu pandemic is underway.

We will also shortly be publishing a guide for healthcare staff on the pastoral needs, and care, of Catholic patients.
Further publications will include a Catholic Theology of Healthcare, and we hope a book where Catholics in Healthcare share their stories in a way which shows others they are not alone in their struggles.

We have held two national seminars, networking Catholics in Healthcare, and will launch a website and e-network next year.

We will also market our position and influence the Department of Health and NHS Chief Executives and Non Executive Directors.

At local level, these resources can be used for formation, and you can do influencing too. The local Church can claim its networks, or collaboratives in NHS speak, as an important aspect of continuing development and clinical governance for Christians in healthcare.

How We Implement This A national body, which does everything it does on a voluntary basis (because there is no funding) can only achieve so much. So we have focused on what is proper for a national level.

We will be dependent on people exercising their charism. And here are some examples:

If you are a researcher, empirical research can help demonstrate the importance of spirituality in healthcare. There is already a body of evidence which we can use[16],[17]. While much evidence may not, as the recent NICE work on palliative care found, meet the standard of randomised controlled trials, it does sit within a properly critically appraised quantitative paradigm and can, if we approach evidence synthesis suitably. But we need to localise this for a
UK context and also by each discipline. Evidence in palliative care may not be readily agreed by thoracic surgeons, for example. That said, evidence in psychology may have to be more readily translatable for an audience in occupational therapy or nursing.

If you are a PCT or Trust Chair, Chief Executive, Non Executive Director or Senior Manager, you can use the Clinical Governance and Diversity Agenda to do something which will help. Gloucester PCT’s Chair has shared with us the PCT’s prayer groups and e-mail list. Prayer is becoming a valued word, not a dirty word, in this setting.

If you are a healthcare worker, you can quietly assert how your faith is an asset to your role – your charism – in clinical governance terms.

If you are a local Church you can form networks, bring people together, speak to the NHS locally, and explicitly celebrate the healing ministry of the Church.

On one level, what we are all engaged in is nothing less than an exercise in public theology in a climate of secularisation and de-traditionalisation. On another we are just challenging sloppy thinking about diversity and “multi-faith” which has become too ingrained in the system and too uncritically pushed. On another level, we are trying to take the vocation to healthcare seriously and make sure that healthcare workers feel supported in this. We invite you to join us, putting your charism to this.

And here are my four buzzwords for Catholic and other Christians in healthcare ministry. Here is how we move from being the Church spoken of in Lumen Gentium to the Church at work in Gaudium et Spes:

Visible – we need to be visible at national and local level. The current model of national and local work sits well with the ecclesiology of subsidiarity and Vatican II. So let’s get moving and be visible. What can you do towards this, exercising your charism?
Valued – we need to explicitly and publicly value our health and the ministry of all those engaged in healthcare. What can you do towards this, exercising your charism?
Vocation – we must celebrate and emphasise publicly and in formation, and especially to the NHS, that healthcare ministry is a vocation of dignity. What can you do towards this, exercising your charism?
Veracity – what we do must be true and authentic. Based in experience and evidence, and honest to those we work with and care for. What can you do towards this, exercising your charism?

Without living through these four “Vs”, or four tests, we are not, as a Church, authentically being Church in the sense of delivering our ministry. Moreover, we will not ensure that the NHS remains true to its fundamental values; values which, as Christians, we have shaped and signed up to across the years. “Galvanising, not Organising.”

Thank you.

References

[1] Pontifical Commission for Health Pastoral Care (1995) Charter for Healthcare Workers.
Rome: Pontifical Commission for Health Pastoral Care.[2] Engel, GL (1977) ‘The need for a new medical model: a challenge for biomedicine’ Science, Vol 196, Issue 4286, 129-136 (1978) ‘The biopsychosocial model and the education of health professionals’.Ann N Y Acad Sci. 1978 Jun 21;310:169-87. For a review of its use in literature on healthcare utilisation see http://herkules.oulu.fi/isbn9514264460/html/chapter2.html [3] McSherry W, Cash K, Ross L. (2004) Meaning of spirituality: implications for nursing practice. J Clin Nurs. 2004 Nov;13(8):934-41. See also comments in J Clin Nurs. 2005 Nov;14(10):1268-9; discussion 1270 and J Clin Nurs. 2006 Jan;15(1):117-8.[4] Genevieve Enid Kyarimpa and Jean-Claude Garcia-Zamor. (2006) The Quest for Public Service Ethics: Individual Conscience and Organizational Constraints. Public Money and Management 26:1, 31-38

[5] McManus, J (2006) Spirituality and Health Nursing Management Vol 13 No 6, 24-25. See also Baldacchino D.; Draper P (2001) ‘Spiritual coping strategies: a review of the nursing research literature’. Journal of Advanced Nursing, Volume 34, pp. 833-841. See also McSherry, W and Ross, L (2002) ‘Dilemmas of spiritual assessment: considerations for nursing practice’. Journal of Advanced Nursing, Volume 38, Number 5, pp. 479-488

[6] Dept of Health (2004) The NHS Knowledge and Skills Framework and the Development Review Process. London : Department of Health

[7] Employment Equality (Religion or Belief) Regulations 2003, SI 2003/1660 which came into effect on 2 December 2003.

[8] Hallsbury’s Laws of
England (2005), 4^th Edition, Volume 16a, 538.

[9] Doherty, T L and Herne, T (2004) Managing Public Services. London : Routledge

[10] Boeve, Lieven (2005) La theologie comme conscience critique en Europe. Le defi de l’apophatisme culturel. Bulletin ET (16) 1, 37-60.

[11] Stockdale, M.S and
Crosby, F.J (Eds) (2005) The Psychology and Management of Workplace Diversity.
Oxford: Blackwell. See also Boyle, MV and Healy, J (2003) Balancing Mysterium and Onus: Doing Spiritual Work within an Emotion-Laden Organizational Context. Organization, Vol. 10, No. 2, 351-373 See Also M. P. e Cunha, A. Rego, and T. D’Oliveira Organizational Spiritualities: An Ideology-Based Typology Business Society, June 1, 2006; 45(2): 211 – 234.

[12] Dent, E.B. Higgins, E.M and Wharff, D.M. (2004) Accessed at Spirituality and Leadership: An Empirical Review of Definitions, Distinctions, and Embedded Assumptions http://www.uncp.edu/home/dente/LQPaper.pdf on 29th October 2006.

[13] Garcia-Zamor, Jean-Claude (2003) Workplace Spirituality and Organizational Performance.Public AdministrationReview 63 (3), 355-363.

[14] See the new Social Enterprise Network for the NHS. http://www.networks.nhs.uk/networks.php?pid=155. Accessed on 7 November 2006

[15] Accessible at www.catholic-ew.org.uk/citizenship/documents/ReflectionChurchResponseMajorIncidents-JimMcManus-2.11.05.pdf

[16] C. Daniel Batson, Patricia Schoenrade and W. Larry Ventis (1993) Religion and the Individual. Oxford
University Press.[17] Koenig, H, McCullough, M and Larson, D (2001) Handbook of Religion and Health. Oxford
University Press.