Rev. Ray Bloomfield on New Zealand Chaplaincy

Healthcare Chaplaincy in New Zealand

New Zealand has a public health System. This means that all New Zealand citizens and residents have free medical and surgical care through government hospitals. Over the last 30 years there has been an increase in the number of private medical insurers on the market, as well as larger numbers of private hospitals. Every medium-sized city has at least one or two private hospitals. The private hospitals do elective surgery that is paid for by the patient’s medical insurance. While we have a free public health system, there are long waiting lists for surgery, and some procedures simply won’t get done in the public health system.

The Government contracts with the Interchurch Council for Hospital Chaplaincy (ICHC) to provide chaplaincy services in all government-funded hospitals in New Zealand. Chaplains are employed by the ICHC and are seen as honorary staff members and members of the multidisciplinary teams. Currently there are 58 full-time equivalent chaplains working across 48 hospitals in New Zealand. The chaplains are assisted in their work by 300 chaplaincy assistants who, are mainly trained lay people, although some chaplaincy assistants are ordained clergy.

With the reduction in the number of chaplains, it has become essential to have chaplaincy assistants to fill the gap. The assistants are highly trained and many of them assist as locums as required.

A person has five years to be accredited after being appointed to a chaplaincy position. Accreditation is compulsory, and failure to obtain accreditation will result in contract termination. The accreditation is given by New Zealand Healthcare Chaplains Association, and I am currently in my third term as president. Chaplains must be re-accredited every five years.

Last year a common stipend was approved for all chaplains, and funding for chaplains comes from a number of sources. The government (through the Ministry of Health) contributes approximately 35 percent of the cost of a chaplain, and the chaplain’s hospital contributes 15 percent. This brings the government contribution up to a total of 50 percent, agreed to by the government in 1972. The remainder of the funding comes from local churches and public fundraising through charitable trusts.

Funding continues to be a source of concern, as many of the churches that have been traditional supporters are reducing in size due to more and more members who are on pensions. More and more chaplaincy is being funded from sources outside of the church.

There are only two private hospitals that I am aware of that have a part-time chaplain. The Mercy Hospice in Auckland (previously Catholic – now private) has a chaplain, as does the Mary Potter Hospice in Wellington. Rest homes, with the exception of church-run rest homes, do not employ chaplains – they rely on clergy or lay people visiting as volunteers.

Some chaplains receive patient ward lists, and details often include patient’s religion. All chaplains in the public health system are Christian, and they work ecumenically. They also provide appropriate pastoral and spiritual care to patients of non-Christian faiths and refer to the appropriate faith groups as requested. Those who do so will visit patients as they come into the hospital, so an assessment and follow-through are required. All chaplains, whether or not they receive patient lists, do regular ward rounds and “try” to ensure that everyone is seen. Chaplains receive referrals from doctors, nurses, clergy, and family.

They are often involved in family meetings and, in some instances, in ethical meetings. Decisions regarding DNR are generally made by physicians within 48 hours of a patient being admitted to hospital. The physician decides if a patient is not suitable for resuscitation based on what quality of life the patient would have if resuscitated. Doctors in New Zealand have no obligation to continue treatment if it is considered futile. At Rotorua Hospital where I work, there is a “Do not attempt Resuscitation form” but no “DNR Form”. It is very uncommon for a patient to request a DNR. Doctors and chaplains are involved in talking with families whose relatives are on life support about when it may be appropriate to turn the machines off.

In hospitals where there is only one chaplain we provide care from the cradle to the grave and cover the whole hospital.

It is becoming more common for people to want to die in their own home, and the hospital facilitates this with support services and hospice services when possible.

Some of our hospices have chaplains, but not all. The hospice chaplains are not necessarily ordained, and their level of training varies. Not all of our hospices are residential. There is a conflict in some places with hospice management – some feel that nurses can provide spiritual care, though I disagree with this. Chaplains in New Zealand, both in hospital and hospice, do not have to do spiritual assessments as is required in the U.S., although most chaplains do an informal assessment. The practice of writing in patient charts is not as frequent as in the U.S. either.

For more information on the New Zealand Healthcare Chaplains Association, please visit our Web site: http://www.nzhealthcarechaplains.org.nz/

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