In his book, “Hospital Chaplaincy in the Twenty-first Century.” Christopher Swift brings his substantial experience in chaplaincy to bear on the primary issues concerning the history and placement of the chaplain profession. Swift’s background includes ordination in the Church of England, Head of Chaplaincy Services in Leeds hospitals in the NHS, Director of Chaplaincy and Spirituality for Methodist Homes, and in 2019 he became a Visiting Professor at Staffordshire University.

The purpose of this review is to evaluate the effectiveness of Swift’s central thesis that the role of the chaplain must continually communicate the value of their service via practical metrics and positive measured outcomes. Swift provides an extensive history of the role of chaplaincy from the perspective of English history, including political, social, and religious changes. The active part of the chaplain and their place in patient care receives thorough analysis in ethnographic case studies, the impact of secularization in healthcare, and the effectiveness of spiritual care in the modern materialistic world.


            Swift’s overall emphasis is to establish the necessity of providing metrics for the effectiveness and utility of the chaplain. Swift engages his extensive experience as a chaplain in the NHS to provide a clear definition of the chaplain’s current role in the hospital setting, along with chaplaincy’s perceived effectiveness by the managing institution. The author does not merely describe the situation, but also uses the philosophical and social sciences to practically respond. How can the chaplain remain relevant and prove their positive patient impact where spiritual and subjective care is challenging to measure?

            The continuing challenge of the chaplain is to provide a distinctive spiritual service that is in crisis when faced with the modern cost-conscious budgeting of hospitals. An increasingly secular society further complicates the problem of relevancy. In this multi-faceted challenge, Swift begins the review of chaplaincy’s progression through history. How did the role of a chaplain evolve from necessity to potential irrelevance? Swift’s consideration of the historical context addresses the theme that secular hospitals reflect their period’s social and political trends.

            Swift traces the church’s role in providing historical reference to the medieval period when church and hospital were the same. These historically sick/poor houses initially had the mandate to rehabilitate the infirmed and marginalized through physical and moral improvement. The politics of governing were the church’s edict, where the primary treatments were food and spiritual care. In the sixteenth century, the politics changed to God and King. Swift shows how changing politics and priorities once had the chaplain/hospitaller as primary coordinator to subservience to the increasing importance of the Word.

            Swift contrasts the chaplain/hospitaller’s role from primary caregiver in the medieval period to the creation of the NHS, which changes accountability to the government. Since the government provides care for citizens of all faiths, the chaplain’s role changes again. Throughout these changes, the changing role of chaplaincy made accountability challenging, since assigned roles were dynamic. What should the primary function of spiritual care have on patients and staff? The author provides examples of policies and voluntary reports necessary to “articulate a stronger case for their presence in health care if they are to survive.”


            To the primary thesis of the need for the chaplain to show value, the author makes his argument. It is self-evident that accountability from all facets of hospital departmental administration that value is assessed. The subjective nature of spiritual support challenges science-minded administrators and physicians to measure outcomes, but the data supports the chaplain’s role even in the secular environment. Their ecclesiastical churches no longer support chaplains in the NHS in their duties, so it becomes vital for chaplains to coordinate their efforts with the medical staff.

            Swift provides ethnographic examples to measure effective outcomes, which give an excellent qualitative tool to measure lived experience. With ethnography, they can document events to analyze relationships. For the chaplain to establish and measure relationships, they become more relevant in their responsibilities. The result is the easing of tensions between the materialistic science of medicine and the spiritual guidance many patients require.

            Swift effectively addresses other tensions in how the chaplain should address practical theology. The role of theology is to be tread lightly, as it can easily overflow into competing disciplines of psychology, sociology, and philosophy. The author continually centers on narrowing the focus of the chaplain by this argument. By consistently approaching all components of spiritual care within patient care and outcomes, the chaplain proves valuable to the hospital environment and justifies their presence. By “staying in their lane,” the chaplain shows respect for other disciplines and safeguards against exposing their efforts to accusations of practicing another profession while unlicensed.

            An example of a weakness in Swift’s book is that he cannot emphasize the personal encounters that chaplains face as a nominal basis of their role in a secular society. What practical methods can contribute to a positive qualitative analysis of the chaplain’s duties? While all professions encounter institutional politics, which specific objective criteria are inclusive of a positive patient report? Swift’s central thesis is toward increasing accountability for the chaplain’s existence, and recommendations for cautious diagnosis, treatment, and academic knowledge would be a welcome addition to that goal.

            Along with the creation of the NHS, the church saw a decreasing influence on healthcare in the UK. Since hospitals were no longer charities that relied on church support and donations, government oversight met the accountability to cost. The result of the organization of the NHS resulted in fewer personnel necessary for fundraising, which also called into review all non-medical administrative and supportive staff. Once more, we encounter the author’s theme of the chaplain having to account for their presence amidst close financial scrutiny.

            The NHS receives public funding, which led to the question of the appropriateness of only providing Christian chaplains for patient care. Swift effectively follows the primary goals set for chaplaincy from the medieval period to modernity. The chaplain’s medieval role was aligned with moral improvement and increasing the social utility of indigent persons. Individual outcomes in providing spiritual care are the focus of the modern utility of chaplaincy. The resulting spiritual care and improved positive results are current metrics to show the chaplain’s effectiveness.


            Swift makes a case for his thesis of increasing metrics and accountability via metrics and individual outcomes. From their history of responsibility to the church to justify their presence to materialistic administrative staff, the struggle and effectiveness of the chaplain’s duties are well covered. Including other western metrics such as American, Canadian, or European outcomes would have contributed to his thesis, but they are lacking. Swift makes his case from the English perspective, but the allusion would enhance the book’s applicability to other countries’ metrics. In the end, society and hospital administration cannot judge the chaplain’s effectiveness and utility. Swift’s book thoroughly reviews chaplaincy in England and covers the impact of the NHS. Swift provides the perspective of the fluid role of the chaplain, and his book is helpful for students and practitioners of chaplaincy in a post-modern world.

see also: Book Review – Family to Family