Quality statement 6: Holistic support – spiritual and religious

Quality statement

People approaching the end of life are offered spiritual and religious support appropriate to their needs and preferences.

Quality measure

Structure:

a) Evidence of local access to a range of spiritual care providers for people approaching the end of life, either in-house or through referral to appropriate providers in the community.

b) Evidence of availability of local chaplaincy services in accordance with NHS chaplaincy: meeting the religious and spiritual needs of patients and staff (Department of Health 2003).

Process: Proportion of people identified as approaching the end of life who receive spiritual and religious support in accordance with their care plan.

Numerator – the number of people in the denominator receiving spiritual and religious support in accordance with their care plan.

Denominator – the number of people identified as approaching the end of life.

Outcome: People approaching the end of life feel satisfied with the spiritual and/or religious support they have been offered and/or received.

See the overview for overarching outcomes.

What the quality statement means for each audience

Service providers ensure that systems are in place to offer, facilitate and provide (including sign-posting and referral) spiritual and religious support to people approaching the end of life that is appropriate to the person's needs and preferences.

Health and social care workers offer, facilitate and provide (including sign-posting and referral) spiritual and religious support to people approaching the end of life that is appropriate to the person's needs and preferences.

Commissioners ensure they commission services with adequate provision for offering, facilitating and providing (including sign-posting and referral) spiritual and religious support to people approaching the end of life that is appropriate to person's needs and preferences.

People approaching the end of life are offered spiritual and/or religious support appropriate to their needs and preferences.

Source guidance

NHS National End of Life Care Programme draft Spiritual support and bereavement care quality markers and measures for end of life care: spiritual support 1, 2, 3, 4 and 6.

Data source

Structure:

a) Local data collection.

b) Local data collection.

c) Local data collection.

Process: Local data collection.

Outcome: Local data collection. Office for National Statistics (ONS) National bereavement survey (VOICES) includes a question on the level of spiritual support provided in the last 2 days of life.

Definitions

In the context of the draft Spiritual support and bereavement care quality markers, spirituality is defined as 'those beliefs, values and practices that relate to the human search for meaning in life. For some people, spirituality is expressed through adherence to an organised religion, while for others it may relate to their personal identities, relationships with others, secular ethical values or humanist philosophies'.

In Standards for NHS Scotland Chaplaincy Services 2007 spiritual and religious care are defined as follows: 'religious care is given in the context of shared religious beliefs, values, liturgies and lifestyle of a faith community. Spiritual care is usually given in a one to one relationship, is completely person centred and makes no assumptions about personal conviction of life orientation. Spiritual care is not necessarily religious. Religious care, at its best is always spiritual'.

Spiritual support helps people approaching the end of life and those close to them including their relatives, carers and friends, to:

  • explore how they might understand, make sense of or find meaning in what is happening to them

  • identify sources of strength they can draw on, and

  • decide whether those sources are helpful during this period in their lives.

Such support does not have to be structured, but the expectation is that it would also include assessment and provision of resources to support the person approaching the end of life and those close to them. Spiritual support is tailored to the needs, beliefs and values of the person approaching the end of life.

Within healthcare, chaplains are the main spiritual care providers. In some circumstances, health and social care professionals and workers may assist with spiritual care. Spiritual interventions that make up spiritual support can come in many forms, such as:

  • referral to a chaplain or dedicated spiritual care provider, counsellor, psychologist or therapist, or where appropriate a spiritual leader in the community

  • arranging transport so that a person can attend religious services in places of faith and worship

  • counselling someone who feels that life has lost all meaning, listening to them express doubts about their religious faith, or helping them make peace with their family or their own past.

Families and relationships tend to be an important influence on spiritual wellbeing, and much support can be provided from within the family or by close friends.

Personal beliefs and medical practice (General Medical Council 2013) provides detailed guidance for doctors on personal beliefs.

Further detail on auditing spiritual support is available from draft Spiritual support and bereavement care quality markers and measures for end of life care (NHS National End of Life Care Programme 2011).