The NHS spends millions each year on employing more than 900 hospital chaplains to provide religious and spiritual care to patients even though the proportion of the population defining itself as non-religious is growing.

There were 916 NHS chaplaincy posts in 2015, according to new data from the Health and Social Care Information Centre. The number has fallen almost 20% in the past five years, down from 1,107 in 2010.

The cost to the health service is estimated to be upwards of £25m, covering full-time and part-time positions – the equivalent of more than 1,000 junior nurses.

Reflecting the rapidly changing nature of faith and belief in the UK, NHS chaplains are becoming more religiously diverse and even non-religious, with the first humanist chaplain to take a paid post beginning work this month. In the 2011 census, about a quarter of the population said they had no religion.

The vast majority of chaplains are Anglicans, but others are Catholics, members of Free churches, Muslims, Jews, Sikhs, Hindus and Buddhists. Staff chaplains are supported by thousands of volunteers.



Official guidelines issued by the NHS last spring defined chaplaincy as “focused on ensuring that all people, be they religious or not, have the opportunity to access pastoral, spiritual or religious support when they need it”.



Chaplains respond to “calls of increasing complexity” owing to the changing nature of communities and increasing diversity of religions, beliefs and cultures, say the guidelines.



In addition to meeting religious needs, chaplaincy managers “must consider how best to determine and deliver spiritual care to those whose beliefs are not religious in nature”.



Chaplaincy posts have traditionally been only open to individuals authorised by faith institutions. But the appointment of Jane Flint as part-time humanist chaplain in Leicester – a post funded by Leicester Hospitals Charity – may herald radical changes to the basis of NHS chaplaincy in the future.

Chris Swift, the head of chaplaincy services at Leeds teaching hospitals, foresees – and supports – an increase in humanist chaplains in the years ahead, while emphasising a “staggering” pace of change at present.



“If you look at the sweep of history, there has been phenomenal change in the past 20 years after chaplaincy being virtually static for about four centuries,” he said.



When Swift, an Anglican, started work as an NHS chaplain 20 years ago, his colleagues were almost exclusively Christian. Now his team of full- and part-time chaplains includes two members of the Church of England, two Roman Catholics, one Methodist, one Free church member, two Muslims and one Jew; plus Sikh, Buddhist and humanist honorary chaplains.



There were no typical days for NHS chaplains, said Swift, but time was mostly devoted to one-to-one sessions with patients. Chaplains only see patients who have asked to be visited, or have been referred by a relative, a faith leader or ward staff.



“We always confirm with the patient that he or she wants to see a chaplain. When I train chaplains, I say, ‘You are the guest of the patient,’” said Swift. Chaplains never touted for business, he added.

Members of his team were often paged outside regular working hours with urgent requests usually relating to end-of-life care.



“Being admitted to hospital often gives people an intimation of their own mortality, a reminder that things can and do change,” said Swift. “This does present for some people a need for a conversation partner, someone who isn’t going to be fazed or frightened by talking about death. People want someone who has the time to listen intelligently.



“It’s challenging work. Often you know very little about a person or a family, and you have five or 10 minutes to work out what they need at an extraordinarily painful moment.”



His team also conducted two or three “contract funerals” each week, of NHS patients without relatives or financial support.

Leeds’s honorary humanist chaplain had been in place for about a year. “We felt there was a need for someone coming from a perspective that wasn’t religious.” Demand for humanist chaplaincy was “developing”, Swift said.

Although the proportion of the general population who identified themselves as non-religious was increasing, the hospital population was older and therefore more likely to regard themselves as religious, he said. “There’s about a 10-year lag between the hospital population and the picture given to us by the [2011] census.”

The Secular Medical Forum is opposed to ringfencing NHS posts for people authorised by religious institutions, saying the money spent on chaplains would be better used to employ more healthcare professionals and to train existing staff in pastoral care for patients regardless of belief.



“Our concerns are really about the conflation of religion and spirituality,” said its chair, Antony Lempert. “As society has become more secular and diverse, there are key questions about how chaplains should be funded, appointed and what they should be doing.”



Representatives of particular faiths wishing to minister to NHS patients should be paid for by their religious institutions, he said.



The National Secular Society echoed those views. “We’re not trying to banish chaplains from hospitals, but we think there should be a separation between religious care and emotional support for patients,” said its campaigns manager, Stephen Evans.



“The latter is perfectly reasonable, and is already provided by health professionals. Religious care should be provided by religious groups if there’s demand. There’s no need to organise [emotional] care around religious identities, particularly in a country characterised by widespread indifference to religion.”



Brendan McCarthy, the Church of England’s adviser on medical ethics, said both spiritual and religious care were important components of the health and wellbeing of patients.

“As stated in its constitution, it is the responsibility of the NHS to provide comprehensive holistic care for all patients, and for some patients that includes religious care,” he said. Chaplains were also trained to give more generic spiritual care, he added.