There are times when in the midst of all the flurry of publications, reports and essays something appears and often falls under the radar because there is so much happening at the same time. In a week where we have witnessed huge debates in the UK Parliament over a former Prime Minister, a launch of a new approach to independence from the Scottish Government and ongoing issues over health and social care, a couple of days ago the Scottish Government published a framework with a whole set of recommendations called: Discovering meaning, purpose and hope through person centred wellbeing and spiritual care: framework.

It might not be on the top of everybody’s weekend reading but might I suggest it should be. I need to be upfront and declare an interest because I had the privilege of chairing one of the small working groups who fed in ideas and views from the social care and health sectors into what the report contains. But I have honestly to say that it is a great read, its recommendations clear and concise, and it has the potential to really change and add maturity to the way in which people are supported both in social care and in health services – if we grant an adequacy of resource and priority to embedding its suggestions.

Now I fully accept that in the midst of a funding crisis, at a time when we are struggling to recruit and retain social care and indeed health care staff, when the burden of regulation and requirement is breaking the back of so many in our care and support leadership – that a report with a whole host of more things to do and implement might seem to be as welcome as a sunbed in the Sahara but I think that would be an unfortunate dismissal of a report which can indirectly address some of our current system and workforce pressures.

But at the start of any discussion on spiritual care we have to address the issue of its definition and its relevance especially when so many people equate spiritual care directly and exclusively with religious faith and tradition. The report helpfully seeks to do both. The Ministerial introduction states:

‘Historically, spiritual care and religious care were one and the same, but that is no longer the case. Spiritual care is there to help all who need it, regardless of their personal faith, beliefs or life stance. Spiritual care doesn’t fit easily into traditional models of care and, at times, in our modern world some may struggle to see or understand the relevance of spiritual care in our health and social care system. Spiritual care supports people by acknowledging hopes and fears and building resilience to cope with challenging or changing circumstances. Spiritual care helps us to connect to deeply held values and beliefs which inform our life, our work and our relationships. It is in the context of such relationships that questions around change, identity, illness and loss can be explored. It enables carers and those cared for to walk together as companions, supporting each other when life is raw and painful, or our certainties are shaken. Such mutually beneficial and respectful relationships must be at the heart of our health and social care system, allowing individuals to be heard and valued.’   (page 4)

When I have myself written about why I believe spiritual care is of fundamental importance and why its receipt should be viewed as a human right, I have been very aware of the extent to which trying to define it can feel like trying to grab hold of a jelly on the one hand and that trying to sharply define and designate it feels like doing a disservice to its very essence. The report captures this well when it states:

‘We all have a part of us that seeks to discover meaning, purpose and hope in those aspects of our experience that matter most to us. This is often referred to as “spirituality”; informing our personal values and beliefs, and affirming that tears, laughter, pain, and joy are all part of the human experience.

It is recognised that the spiritual is a natural and integral dimension of what it means to be human. Within health and social care, it is widely accepted that questions of meaning, purpose, hope (or the lack of it), identity and relationships can become acute when wellbeing and stability are challenged or threatened by illness, injury, or loss in oneself or in a loved one. At such times people often need spiritual care.’ (page 5)

We are all of us more than the raw bones and sinew, the flesh and mechanics of our human body and frame. Spirituality has to do with the heart and pulse of being human. It is the soundless language which communicates our deepest emotions of love, anger, fear and belonging. It is the rhythm which gives form to many of our innermost thoughts and feelings. It is the space where we rest in the awareness of meaning beyond comprehension and experience beyond description. To offer spiritual care is to give opportunity, time and place to enable an individual to explore and to express who they are as a human individual. It is at the hard times and moments, the transitions of living and loving that spiritual care finds sharper relevance and poignancy but I would suggest it has relevance in all moments when care and support is exchanged.

A set of Expert Working Groups on key topics within spiritual care was established by Scottish Government and through their work the Report makes specific recommendations developed around four key areas of focus:

• A skilled and compassionate workforce
• The development of spiritual care in community and social care settings
• Data collection and evidence base
• A professional specialist workforce.

I am not going to rehearse all of the recommendations here, but I am delighted that there is such a clear focus and emphasis upon social care within the report.  Historically spiritual care was mainly centred upon and delivered in acute and secondary care settings. As a past occurrence that is understandable but is no longer defensible as we increasingly recognise and live with the inter-reality of health and social care in our personal and professional lives. Spiritual care has to speak to the delivery of clinical care in the community as well as to social and primary care delivery.

However, this re-orientation of emphasis and focus should not be at the expense of the generations of work undertaken in hospitals but rather spiritual care in the community and in social care should seek to build upon that expertise and knowledge.

The first recommendation of the framework puts it as plainly as is possible:

‘Recommendation 1: Health and social care providers should ensure that spiritual aspects of care are assessed, recorded and regularly reviewed within care plans in all health and care settings and services.’  (page 10)

Spiritual care is not an added extra, something to be thought of when all else is ticked off, but rather it is intrinsic to holistic care and support because it addresses the whole person.

The report describes the implications of what this widening of scope and focus means for our social care system from commissioning, workforce development and capacity through to regulatory oversight and inspection. It has many recommendations, but they will only take flight and have any impact if they are owned and championed by the leaders and professionals working in our social care sector and understood by the citizens who receive care and support as their right and obligation.

That may take some time, but it starts with an honest conversation that challenges stereotypes and builds an appreciation of the unique and irreplaceable contribution of spiritual care within the delivery of all care and support. It will involve discovering whether the tools and techniques being used in spiritual care from Community Chaplaincy Listening to Values Based Reflective Practice speak to a different context such as care homes or homecare and housing support services. It will necessitate an investment not just in changing induction programmes and developing training resources but sitting down with the women and men who deliver the diverse range of social care supports and care and discovering what works for them and what makes the translation from recommendation into implementation a reality. Critically it will require commissioners and funders at times of straitened economic pressure to appreciate that spiritual care is not a marginal priority but intrinsic to modern rights-based, person-led, social care and support. Lastly and perhaps most critically for the workforce it will require frontline staff to be supported to be open to the discovery that spiritual care is something which can add benefit and value to their own wellbeing as well as to their art of caring for others.

I strongly encourage you to read the report and its recommendations. If it succeeds as I feel, it will put Scotland at the forefront of this work, but it will also achieve what it states, namely to ensure that it firmly establishes the role of spiritual care as an integral part of health and social care provision.

A few weeks ago, I went to visit the National Trust of Scotland property, the Weaver’s Cottage in Kilbarchan, Renfrewshire. It was truly fascinating and was an eye opener into both the significance and role of weaving in the Scottish economy both traditionally and still today. I found the weaving looms intriguing as they conjured up for me the memories of childhood when I can remember seeing smaller versions of traditional looms in the islands.

Weaving can be used as a metaphor for many things but as I read this report and reflected upon it the image of the weaving looms, I saw a few weeks ago came to mind. Someone who supports another through the art of delivering spiritual care takes the threads of living and loving, the fractures of memory and regret, the colours of joy and tear, into their hand and helps the person being supported blend them together into the rich and unique fabric of individual living. That might have an added poignancy in a life that is nearing its end, but it has value at all times.

Spiritual care if delivered well helps to integrate all the aspects of our identity into a unity of character and personhood; it leaves space for our growth and the discovery of new patterns and ways of being who we are both for ourselves and others. But having visited Kilbarchan I know how much hard work is involved in the art of weaving. If we are as individuals and as a society in Scotland to discover meaning, purpose and hope through person centred health and social care in all settings and places then the recommendations in this framework report can only be the start of all the hard, collective and shared work required to weave a cloth whose pattern is even today being created in the lives of those supported and cared for across Scotland.

Donald Macaskill

Last Updated on 13th July 2023 by donald.macaskill