Identity and Ministry in Healthcare Chaplaincy: The liminality of the Church of England priest who continues to sing the Lord’s song in the strange land of the National Health Service Submitted by Anthony Paul Richard Kyriakides-Yeldham to the University of Exeter as a thesis for the degree of Doctor of Philosophy in Theology in March 2017 This thesis is available for Library use on the understanding that it is copyright material and that no quotation from the thesis may be published without proper acknowledgement. I certify that all material in this thesis which is not my own work has been identified and that no material has previously been submitted and approved for the award of a degree by this or any other University. (Signature) _______________________________ 1 Abstract This thesis examines the dual identity of the Church of England priest employed as an NHS healthcare chaplain. In 1948, full-time NHS chaplains provided a Church of England ministry of liturgy and pastoral care. Their twenty-first century counterpart delivers existential spiritual or pastoral care. Though Church of England chaplains are licensed by the Church, their work is shaped by the NHS and the Trust which employs them. They are accountable to the Church and the NHS even though each promotes different values and serves different ends. Published literature alludes to the chaplain’s sense of marginalization from the Church and within the NHS. Interviews with twelve full-time NHS chaplains, who are Church of England priests, focused on how they interpreted their dual identity as priest and chaplain, and the impact the two institutions had on these identities. This I framed using the theoretical model, ‘communities of practice’. Analysis of these interviews confirmed that chaplains thought they were disconnected from the priorities and values of the Church. This they described as ‘marginalization’, a term which appears elsewhere in published literature sometimes interchangeable with ‘liminality’. I claim that liminality is not only conceptually different but makes a distinct contribution to understanding the work and identity of chaplain and priest. I argue the existence of liminal intelligence and its importance in the ministry of the chaplain. I maintain that ministerial priesthood needs to be faithful to its liminal credentials. These I trace back to the liminality of the cultic priesthood outlined in the Hebrew bible as well as the liminality of Jesus, his teaching and the communitas of the early Church. I propose that the role of the ministerial priest is not only about recalling the institutional Church to its liminal roots but that liminality is the essence of priesthood. 2 Acknowledgements Predictably, with a research project that has spanned seven years I owe a debt of gratitude to many people. Some have shared their own research, journal papers or academic contacts while others have formed part of an invaluable support network. There are too many to acknowledge individually although I hope they will understand how deeply appreciative I am of their help. Among those who I want to mention by name are my lead supervisor, Professor Christopher Southgate, who has been a source of enormous encouragement and reassurance, and my second supervisor, Dr Esther Reed, whose penetrating insights were crucially important and invariably challenging. Funding of the research has been provided by the Trustees of St Luke’s College Foundation Exeter, as well as by the Dean and Chapter of Westminster Abbey. To both I am most grateful. Equally, I am indebted to Marie Curie Hospice Hampstead, where I work as Spiritual and Religious Care Lead and Chaplain, for granting me study leave in order to complete the writing-up. If I were to dedicate this thesis to anyone, it would be to the twelve healthcare chaplains who generously agreed to be interviewed, imparting their experience, knowledge and practical wisdom. In addition, there have been those healthcare chaplains of all faiths and beliefs with whom I have had the privilege to work these past thirty years, and from whom I have learned so much. Finally, there is Denise my partner who has patiently, some might say stoically, stood by me through the highs and lows of an extended and extensive research project. No holiday would be complete without time set aside for ‘the thesis’. I remain grateful to Denise more than words can ever convey. 3 List of Contents Abstract 2 Acknowledgements 3 List of Abbreviations 10 Chapter 1: The Introduction 1.1 Introduction 11 1.2.1 The Research Objective 12 1.2.2 The Research Question 12 1.3.1 Practical Theology as the Preferred Framework 13 1.3.2 The Integration of a Framework of Practical Theology with Qualitative Methodology 15 1.4.1 Beginnings of NHS Chaplaincy 17 1.4.2 Challenges to NHS Chaplaincy: The National Secular Society 17 1.4.3 Challenges to NHS Chaplaincy: The British Humanist Association 19 1.5.1 The NHS: from the religious to the spiritual 22 1.5.2 Healthcare Chaplaincy: an encroaching professionalism 23 1.5.3 Healthcare Chaplaincy: Ideology and Spirituality 25 1.5.4 Healthcare Chaplaincy: national leadership and its professional agenda 28 1.5.5 Healthcare Chaplaincy: Agenda for Change and its impact on NHS chaplaincy 29 1.6.1 What is already known about priesthood and NHS chaplaincy 34 1.6.2 What this research adds 40 1.7 A Summary 42 1.8 Developing the thesis 43 Chapter 2: Theoretical Issues and the Development of Personal Identity 2.1 Introduction 45 2.2.1 Healthcare Chaplaincy: the identity of the chaplain 46 4 2.2.2 Healthcare Chaplaincy: identity and the spiritual care adviser 55 2.3.1 Identity and socialization 60 2.3.2 Socialization and the identity of the NHS priest-as-chaplain 62 2.3.3 Identity and Social Constructionism 64 2.3.4 Social constructionism and the identity of the NHS priest-as-chaplain 69 2.4.1 Identity and theological anthropology 71 2.4.2 Theological anthropology and the identity of the NHS priest-as-chaplain 80 2.5.1 Summary 84 2.5.2 Developing the Thesis 85 Chapter 3: Theological Issues and the Development of Priestly Identity 3.1 Introduction 87 3.2.1 Priesthood in the Hebrew Bible 88 3.2.2 Priesthood in the Synagogue 90 3.2.3 Priesthood in the early Church 92 3.2.4 Priesthood in the Patristic and Medieval Church 95 3.3.1 The emergence of the Church of England and the theology of priesthood 101 3.3.2 The Development of Ministerial Theology over the last 25 years 106 3.3.3 The Anglican Priest: Ontology, Function and Ecclesial Relationship 110 3.4.1 Summary 115 3.4.2 Developing the Thesis 116 Chapter 4: Theoretical Issues and the Development of Professional Identity 4.1 Introduction 117 4.2.1 Healthcare Chaplaincy: the professional identity of the chaplain 118 4.2.2 Healthcare Chaplaincy: professionalism or professionalization 123 4.3.1 The sociological analysis of professional work 124 4.3.2 The discourse of professionalism 129 4.3.3 Professional Scripts & Renegotiated Identities 131 5 4.4.1 NHS chaplaincy and the new professionalism 135 4.4.2 New professionalism: implications for the identity of the NHS priest-as-chaplain 140 4.5.1 Professionalism: a theological perspective 142 4.6.1 Summary 145 4.6.2 Developing the Thesis 145 Chapter 5: Methodology 5.1 Research Methodology 147 5.2.1 Practical Theology 148 5.2.2 Quantitative or Qualitative Methodology 153 5.3.1 Grounded Theory 155 5.3.2 Grounded Theory Method (GTM): a critique 155 5.3.3 GTM as an interpretative framework 156 5.4.1 Qualitative Data Collection: Intensive Interviewing 157 5.4.2 The Interview as the main mode of qualitative data collection: a critique 158 5.4.3 Transcribing the Interviews 158 5.4.4 Questionnaire Design 160 5.4.5 Stages of Data Analysis: immersion, review, abstraction and synthesis 162 5.4.6 Participant Selection and Recruitment 164 5.4.7 Participant Selection: epistemological foundations and assumptions 173 5.4.8 Churchmanship 177 5.5.1 Ethical Issues 179 5.5.2 Reflexivity 182 5.5.3 Sharing Interview Transcripts with Participants 184 5.6.1 Summary 189 5.6.2 Developing the Thesis 190 Chapter 6: Interrogating the Data 6.1.1 Introduction 192 6.2.1 A discourse of two narratives 193 6.2.2 Reappraisal: one discourse becomes two 195 6 6.2.3 Wenger’s theoretical model of community of practice 197 6.3.1 The vocational discourse: the narrative of the NHS healthcare chaplaincy 198 (a) Healthcare chaplaincy as a specialist ministry 198 (b) The professional status of the healthcare chaplain 199 (c) An expendable priesthood 202 (d) A summary of the narrative 203 6.3.2 The vocational discourse: the narrative of the Church of England priest 204 (a) The meaning of priesthood 204 (b) The authority of the priest 206 (c) The nature of priesthood 208 (d) Priesthood as ministry: being and doing 210 (e) The priest as sacramental minister 212 (f) The relationship of the priest to ministers of other Christian denominations 214 (g) A summary of the narrative 215 6.4.1 The institutional discourse: the narrative of the NHS 216 (a) The NHS context 217 (b) Integration and assimilation 218 (c) NHS values 219 (d) Ecclesial estrangement 220 (e) Dysfunctional relationships 222 (f) Mission 224 (g) Negative experience of parochial ministry 225 (h) A summary of the narrative 227 6.4.2 The institutional discourse: the narrative of the Church of England 227 (a) The Church within the NHS 227 (b) Episcopal support and a mission-based ecclesiology 229 (c) A summary of the narrative 231 6.5.1 Summary 231 6.5.2 Developing the thesis 232 7 Chapter 7: Discussion of the Research Findings 7.1 Introduction