Costing the Heavens

The National Secular Society (NSS) claimed on Monday that its study of expenditure on hospital chaplaincy by NHS provider trusts in England had demonstrated that the service yields no clinical benefit.

The NSS press release and accompanying 12-page report, written by Robert Christian (a member of both the NSS and the British Humanist Association) and entitled Costing the Heavens, can be downloaded from:

By means of an enquiry under the Freedom of Information (FoI) Act, the NSS asked all 227 English NHS provider trusts (both acute/specialist and mental health) in August and September 2010 how much they had spent on chaplaincy services in the financial year 2009/10. There was a 100% response. Ambulance trusts and primary care trusts were out of scope (since they do not generally provide inpatient services).

The NSS then compared the percentage of each trust’s total income spent on chaplaincy services with the trust’s performance on the Care Quality Commission’s Standards for Better Health and the Standardised Mortality Ratio (the latter applicable to acute trusts only).

These measures represent the appropriate national quality benchmarks of health outcomes for 2009/10, although, as NSS acknowledges, they have been criticized as methodologically limited.

Total direct (pay and non-pay) expenditure on chaplaincy services was £29 million. Where like-for-like comparisons were possible, this was an average (inflation-beating) 7% above the figure obtained by the NSS in a comparable study published in April 2009, which remains available at:

However, ‘statistical analysis showed that there was no relationship or positive correlation between how much hospitals spent on chaplaincy services and the overall quality of their patient care.’ These findings are visualized in graphs 2-4 of the report.

There were wide variations in the proportions that similar hospitals spent on chaplaincy (graph 1), and the NSS calculated (tables 1-2) that, if all NHS trusts brought their spending into line with the best-performing trusts, annual savings of £18.6 million would be made. This sum, according to NSS, would pay for 1,000 nursing assistants or a brand new community hospital every year.

Commenting on the results, Keith Porteous Wood (NSS Executive Director) said: ‘The National Secular Society is not seeking to oust chaplains from hospitals, but their cost should not be borne by public funds, especially when clinical services for patients are being cut.’

‘We have proposed that chaplaincy services should be paid for through charitable trusts, supported by churches and their parishioners. If churches really support “the big society” then they will stop siphoning off NHS cash to fund chaplains’ salaries.’

It is unclear how this NSS survey relates (if at all) to another recent study, also based on data obtained under FoI, reported in the Daily Express which produced an estimated expenditure of £30 million on hospital chaplaincy in England in 2009/10. See our coverage at:

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8 Responses to Costing the Heavens

  1. Clive – are you going to comment on whether you consider this anaysis to have any merit. In my view it is rather like comparing the amount a school spends on sport with their maths GCSE results, then arguing that sport has no benefit as it does not improve maths results. It was described by Rev Dr Malcolm Brown, director of mission and public affairs for the Archbishops’ Council of the Church of England, as ‘a laughable misuse of statistical information’.

    I wonder whether you agree.

  2. Clive Field says:

    Dear Mouse, BRIN naturally seeks to be impartial in such matters. I have deliberately kept my powder dry at the moment, pending responses to the report from faith communities, when I may well post again. All I would do at present is to make the obvious point that the methodology employed by NSS (which is probably the only one they could have used at national level) can do no more than suggest possible indirect linkages betwen chaplaincy spend and health outcomes. Direct links of cause and effect would inevitably be harder to establish, not least because chaplaincy spend constitutes such a tiny proportion of the total NHS budget and because health outcomes are affected by a wide range of clinical and other inputs. Ideally, we would need multivariate rather than bivariate analysis. But perhaps the NSS itself would wish to respond to Mouse’s challenge?

  3. Clive Field says:

    Further to my response to Church Mouse on 2 March, I have been trying to keep an eye on Christian reactions to the NSS report on hospital chaplaincy, but they seem to have been relatively muted. However, BRIN readers may like to note a letter to the editor of the CHURCH TIMES (18 March 2011, p. 13) from three members of staff of the Department of Palliative Care, Policy and Rehabilitation at King’s College London. They describe the NSS report as “flawed and an oversimplistic attempt to measure the ability of health-care chaplains to influence directly the overall quality of a trust’s performance and mortality ratio”. Their reasons for suggesting this are set out in some detail. Unfortunately, the letter is only available online to subscribers of the newspaper at:

  4. Clive Field says:

    The NSS, through Robert Stovold, issued a two-page statement on 31 March 2011 in response to the criticisms contained in the CHURCH TIMES letter which is referred to in the preceding response. The statement can be found at:

    Some points in the NSS statement are also summarized in Stovold’s letter printed in the CHURCH TIMES of 8 April 2011 (p. 15). One of his main arguments is that the burden of evidential proof lies with those who claim that hospital chaplains are associated with positive health outcomes.

  5. Lucy Selman says:

    The letter written by me with colleagues at King’s College London and published in the Church Times is available here:

    If you can’t access it, I am happy to send it to you (my email address is available on our webpage at King’s College London). We have written a reply to Mr Stovold’s statement, focussing on the scientific flaws in the NSS report’s metholodogy. We hope it will be published by the Church Times next week.

  6. Clive Field says:

    Further to Lucy Selman’s post of 14 April 2011, the second letter by the King’s College London team, prompted by Mr Stovold’s statement of 31 March, was published in the CHURCH TIMES of 21 April (p. 15). It argues that the outcome measures used by the NSS are inappropriate for the purpose. The letter is available online to the paper’s subscribers at:

  7. Lucy Selman says:

    Thanks for posting, Clive. The letter is open access now should anyone else be interested in reading it.

  8. Pingback: British Religion in Numbers: news

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