Is there any place for religion in modern healthcare?

Pragmatism

Pragmatism

Practical determinants of religion range from national regulations to devolved Trust policy to everyday hospital considerations. Those discussed in this paper are not an exhaustive list and do not mention handling bovine/ pig material, alcohol hand wash, among others.

The national policy must be concordant with legal requirement of Employment Equality (Religion or Belief) Regulations of 2003, Article 9 of the Human Rights Act of 1998, Part 2 of The Equality Act of 2006 and The Racial and Religious Hatred Act of 2006. Though this religious tolerant policy is in place to protect the right to practice religion in the workplace, the practical execution is complacent (or ignorant). When we first look at religion within the populace in 2019, 49% irreligious, 42% Christian (all denominations), 5% Muslims, 4% other, (2, 14) while religion in 2018 NHS personnel 44% Christian, 16% Atheist, 3% Muslims, 4% other, 2% Hindus, 1% Sikhs, 1% Buddhist, while 29% refused to disclose (42, 15) with variations according to location, e.g. Kernow (43). The statistics suggest our public service aren’t wholly representative of the general populace.

Nonetheless, the proportions of religions suggest faith has a place in NHS staff to an extent, where Christians even overshoot their population statistics, possibly attributed to their recruitment campaigns. The discrepancies amongst the others may be ascribed to the small number of participants at 998 or perhaps the 29% who refused to disclose may equilibrate the under-representations of religions. This 29%, however, tells us something more. I would argue that a third of the population do not believe there is a place for religion in healthcare, and the reasons should be explored. Comparing these employment statistics to the job applicants, 2017, is similarly in favour of suggesting there is an underlying problem; 40% were Christian, 12% Muslim and 17% Atheist, while 13.3% refused to disclose. What happens to that 14.7% that chose not to disclose their religion when they joined the workforce - did they too notice the positive selection for Christians, the alarming negative selection for Muslims and to a degree Atheists? (2, 14-16, 21)

Another discrepancy is the organisational and societal support network. For example, the Christian Medical Fellowship (CMF) (^19, 20? 24), British Islamic Medical Association (BIMA) (22), Jewish Medical Association (25) are available for respective personnel, however currently no such society exists to represent Sikhism, Hinduism or Buddhism. This may convey a wide-spread ignorance concerning these religions in healthcare, and it shows that there is lack of support for around 40,000 NHS employees. Similarly, religious distribution by local authority and NHS Trusts have not been explored, nor clinical -support networks refined. Regardless, that religion has a place in NHS staff is arguably untenable.

It’s true to say that everyone works on a different time schedule in life, and it is the same with calendars in many religions (Islam, Sikhism, and Hinduism). Article 9 of the Humans Right Act permits the practice of ones’ religion in the workplace (17). However, this is commonly breached when requests for leave are being denied in work or medical schools. The exemption in the article conveniently encompasses the demands of the job, such as in the NHS, meaning this right cannot be guaranteed, which if applied to other human rights, such as the right to life or slavery, would be amoral. Understandably, difficulties arise when coordination leave, as festivals can depend on lunar events (Eid-al-fitr, Eid-al-adha, Hola Mohalla), however, the multi-faith calendar depicts how the religious festivals (e.g. Sabbath  (20, 23) Diwali, Vesak, Christmas, Guru Nanak, Vaisakhi, etc) do not coincide. Moreover, the brilliance of a workforce consisting of colleagues of different faiths means that, theoretically, with some communication, emendations to timetables and consideration by colleagues and employers, that adequate leave is feasible within Trusts.

Considering the stresses in healthcare, religious facilities are important and can positively impact mental health – a sort of ‘personalised medicine for staff’ (17, 18, 27, 41). Many trusts honour this with appropriately furnished prayer rooms, such as in Whiston hospital. When considering other healthcare environments, such as GP practices, pharmacies, medical laboratories, dental surgeries, nursing homes, research facilities, administration areas, there may be some difficulty. However, religion is often respected via a private area or store cupboard, though discontent could be avoided via greater input.

Palliative and bereavement services have made headway in appreciating the religious needs in a patient, with greater research papers, ongoing studies and readily accessible documents for self-education (27, 28, 29). ‘Palliative care is the … early identification and treatment of pain and other problems (physical, psychosocial and spiritual) (27)’ to maximize their comfort when dying. However, research studies do recognise how they could ‘further enhance their practical interventions by being sensitive and supportive to cultural diversity. (29)’ Without religious education, infractions of a patient’s religious beliefs are commonplace, such as with the Sikh Panj Kakka (5 Ks e.g. hair should not be cut), which may distress the patient, and further displays ignorance of religious practices.

It is requirement that all health-care personnel keep up-to-date and attend teaching sessions on current practice. Clatterbridge’s Religion or Belief: A Practical Guide for the NHS, discusses religion, its impact and suggests the everyday changes that personnel can make to help both patients and staff, consolidating how the place for religion in healthcare is ethical and attainable, but as of yet, tenuous. I will openly admit  I had to research the practices of the religions, even my own, in the construction of this review, which may convey the lack of education given concerning religion and its dire need. Currently, there are religious education sessions given to nurses (evidence!), however extending this to all NHS staff and providing regular (obligatory) sessions from representatives of all faiths in a manner applicable to healthcare, could proselytize religious tolerance and combat ignorance. After all, ‘it is vital that staff involved are aware on some level of the patient’s religious attitudes towards disease, suffering, dying, death, religious practices and rites, as well as their views on familial responsibilities and traditions, in order to ensure sensitivity and respect when administering care to the patient (27).’

Dietary requirements can heavily impact the everyday experience of religion. The NHS officially provides patients and staff with food tailored to all dietary requirements and preferences, however, it seems that before the writing could become reality, someone skipped off to lunch. The menu in UHS, Great Ormond Street, UHW and UHL (Cardiff Trusts), Queen Elizabeth’s (Scotland), Aintree (Liverpool), are comprehensive in providing for many dietary requirements and respect the religious differences (Halal meat, vegan, vegetarian, gluten-free, Kosher) (32-39). In DGHs and care-homes, though, facilities can be more limited, where Muslims are compelled to become a pescatarian/ vegetarian. While this may be beneficial to health, it is restrictive and many Muslims find this dissatisfying and aberrant. There are companies that meet NHS standards, such as Cater food (40), suggesting it is feasible.

The recidivist topic in the media, infection control, is notorious in the public eye due to the medical severity and sequaele. As a pertinent issue, the Trust policy and National guidelines have found ways of being religiously inclusive, however practically manifestations aren’t as positive (5-9).

Wedding bands, a Christian symbol of union which has transferred into Western society, has been permitted despite the hand-hygiene policy detailing that all other rings should be removed as they ‘become contaminated during work activities’ (4, 9, 26). In addition to this, the University Hospital Southampton (UHS) Trust also permits the Sikh Kara (5, 6, 8) and in many trusts, headwear (hijab, kippah, turbans, bindi,) are permissible/acceptable in a clinical environment, in faith that it is not the bearer of bad NEWS i.e. they are tucked in and are not a source of infection (4, 5, 27, 31). However, the Kara is not mentioned in all Trust policies nationwide, though surely it should be the responsibility of each trust to ensure that all religions are considered before an incident occurs?

The situation of headwear becomes somewhat more tenuous when approaching theatre and scrubbing in, where sterility is a concern and enforced. In recent years, there has been improvement in including headwear exemptions in policy, however this has not pervaded through all trusts and health personnel, which may cause indirect discrimination. Recent research has uncovered that 52% of female hijab-wearing Muslims reported difficulty wearing a headscarf in theatre, with 36.5% bullied, 37.1% anxious and 23.4% embarrassed via BIMA (British Islamic Medical Association) in 2017 (10-13). BIMA has called for more research regarding infection control and hijabs in theatre amongst other things, lobbying that it be confronted nationally.

Interestingly, the Department of Health (DH) and the World Health Organisation (WHO) recommend that long-sleeves are avoided in the clinical environment, however it is not yet a stipulation due to the lack of evidence-base despite Thames Valley University literature review and UCLH Trust’s empirical research in 2007. TG Magee’s ‘light-hearted dig’ at the BBE scheme in difficle times for the health secretary, may inadvertently explain the magnitude and speed of implementation (political motivations) despite insufficient evidence and no solution simultaneously applied to resolve it’s conflict with the Islamic custom of covering one’s body (5-9). The BBE policy is tackled with disposable sleeves for modesty, however this is not a well-known nor provided amongst healthcare personnel.