The Wardman Wire

The National Secular Society report on Hospital Chaplaincy uses at least 3 different figures for the “cost” of a nurse in different places, and gave different information to the Department of Health to that given in the related Press Release.

This article documents confusions in the methodology and interpretation of the data collected by the NSS, in the hope that they can be clarified.

[Update: I emailed the National Secular Society asking for clarification on the points listed at the end of this article on 8/4/2009 at 11am. To date I have received no reply.]

The National Secular Society report is titled An investigation into the cost of the National Health Service’s Chaplaincy provision (PDF). There has been a lot of Press Coverage, and a lot of different, and possibly contradictory, numbers appearing in different places.

The NSS states that :

Using the Freedom of Information Act, the NSS undertook its own research into the cost of chaplaincy services after the Government said it did not keep centralised figures on such spending.

…

The NSS has now sent the report to the Health Minister, Alan Johnson, calling on him to review chaplaincy services with a view to ending taxpayer funding for them.

I should state at the outset that I always adopt a sceptical approach to the NSS, due to considerable past experience of watching their claims and peculiar public relations strategy. In this case, I think there are some clarifications needed.

There are three documents on the National Secular Society website:

1. An “Overview” Press Release by Terry Sanderson: Religious demands costing NHS over £40 million a year
2. The Raw Data from a Survey of Medical Service Providers
3. The Report sent to the Department of Health

Questions for the NSS

After a fairly quick examination, there are three sets of questions that need to be answered, concerning:

1 – The integrity / accuracy of the research done. It is not clear where some of the plethora of different numbers quoted in different places to different audiences come from.

2 – The scope of the research, which is purely financial, and makes no comment on the medical value of Chaplaincy Services. I’d suggest that the NSS has a habit of shaping it’s research to fit its own assumptions and campaiging agenda. In this case the unwritten assumption is that Chaplaincy Services can have no medical value, I suggest as a result of NSS Doctrine. They are put across as only providing “religious services” as if such services existed in a sort of religous bubble; they don’t.

It is fascinating to compare the “research conclusion” (April 2009) with the “submission to the Shadow Health Minister’s Consultation on Hospital Chaplaincy” (September 2008) before the research project was finished. They are two peas in a pod, apart from the April 2009 proposal “that a large scale opinion poll be carried out by the Department”, as the NSS tried and found it difficult.

I’d support thorough research into the question, but it should be a survey of patients undergoing medical treatment rather than evalution of public opinion – since Health Policy should be based on medical evidence rather than popular prejudice. The results should be evaluated medically alongside other services.

3 – The way the NSS has used its traditional smoke and mirrors in the presentation of its case to the public.

The whole thing is presented as “Religious demands costing NHS over £40 million a year” – while the reality is that these are services which NHS policymakers have chosen to provide, rather than some sort of cosmic establishment-supported mugging of the public budget by extremists.

Questions about the Research

1 – How many nurses can we get for how much money today?

The one that jumps out in the first 5 seconds of looking at this research is that the headline claim – note from the authoritive Report sent to the Minister, not the Press Release – states that:

Salary cost of NHS chaplaincy services: 32,014,475 pounds. This figure is for “staff salary and associated on-costs only”. It does not include the provision and maintenance of chapels, churches, prayer rooms/centres etc.

The cost is equivalent to the cost of around 1,500 nurses or over 2,600 cleaners.

That cost for Chaplaincy Figures seems to involve all the personal on costs, while I’m not convinced that the figure for nurses does so. The claim is that a nurse costs the NHS 32 million pounds, divided by 1,500, which equals 21,300 pounds, looks more than dubious. A quick Google reveals an article from the BBC in 2007 which said:

Spending on the NHS has rocketed in recent years, and the average nurse’s salary is now 25,000 pounds – not megabucks, but certainly not peanuts either.

If the salary of an average nurse was 25,000 pounds 2 years ago, as reported, I’d be interested to know how the figure – which must involve on costs for the comparison, or at least break them out and provide a justification why comparable numbers have not been used – has somehow reduced from 25,000 plus perhaps 30% to 21,000 in 2 years. That 30% is my estimate of nursing “On Costs” – I have asked the Royal College of Nursing for the accurate numbers.

By the time the BBC was interviewing Terry Sanderson, somehow this:

“32 million for around 1500 nurses”

which was what they told the Government, had undergone a secularist divine intervention and morphed into:

“the £40m figure was equivalent to employing 1,300 nurses or 2,645 cleaners.”.

If the second figure is accurate, we need to hear that the National Secular Society has admitted to the Department of Health that it got it’s initial headline conclusion from its official report wrong. In any case the different assumptions need to be explained to the people to whom they have been they have briefed.

The 1500 number has also made its way into at least one newspaper .

Is the data in the Raw Data Table actually raw?

The document about Raw Data from a Survey of Medical Service Providers in England atates that it contains figures for “Salaries per annum – This figure represents staff salary and associated on-costs only” for Health Service Providers in England. For each Provider, it also includes “Staff – Whole time Equivalent” i.e., how many FTE are in there in Chaplaincy Service.

The NSS calculate three figures from this document:

1 – Total Spend in Trusts responding to the survey in England: 26,722,494

2 – Total FTE: 545.1

3 – Total spend per Chaplain (including salary and “on costs”): 48,953. This is the simple ratio of 1 and 2.

Elsewhere (in the Press Release) the NSS quote their £32m figure, and say:

“The headline figure only takes into account the salaries of the chaplains, it doesn’t take account of National Insurance contributions, pension payments, administration costs, office accommodation, training, the upkeep of chapels and prayer rooms,” said Terry Sanderson, president of the NSS. “We can conservatively add another 20% to the headline figure taking it up to 40 million.”

(Ironically the figure in the Headline on this Press Release is actually 40 million.)

Some of that sounds like “associated on costs” to me, as mentioned in the Raw Data document. The BBC report repeats this confusion:

“But the NSS said this (the 32 million figure) took into account only the salaries of the chaplains, and excluded national insurance contributions, pension payments, administration costs, office accommodation, training, and the upkeep of chapels and prayer rooms.”

That statement is not what the NSS in its own Raw Data document, which leaves more confusion. It is not clear what is included where.

I’m not going into questions such as broad brush assumptions being applied across all Chaplains, when it is far from clear that Part Time Chaplains have comparable “on costs” or “overheads”. For example, my current and past anecdotal soundings suggest that many Part Time Employed Chaplains don’t even bother with the NHS Pension Scheme. If they want to add these sort of numbers, and convince us that their work is anything like rigorous, the NSS needs to prove their assumptions to be justifiable – rather than just assume them and start shouting.

More Unexplained Numbers

In the Press Release, Terry Sanderson also comes up with a figure of 57,000 pounds per Chaplain from somewhere (not mentioning his own 48,953 figure above):

Terry Sanderson commented: “The average cost to the Health Service of a chaplain is 57,000 per annum. I’m sure if patients were asked where they wanted their money spent – two and a half nurses or more than four cleaners rather than one cleric – it is clear that nearly all would opt for the nursing or cleaning staff.

The 57k figure is not obviously related to anything else that is calculated anywhere, and the “two and a half nurses” gives a “cost per nurse” of 22.8, which is different from the 21k told to the Government, and also different from the £25k briefed to the BBC.

Perhaps it is significant that none of this “interpretative” calculation appears in the submission to the Government, as they might get confused as well.

It’s also worth a note that the “English” figures – which are the highest by some way among the different countries – somehow end up being used in most of the articles about the “National Health Service” without qualification.

Clarification Needed Please, Mr Sanderson

I have emailed enquiries@secularism.org.uk requesting clarification on several points:

1 – That the data in the raw data table is the raw data received from the trusts, i.e., that it does not include any adjustments to the numbers you received back from the Hospitals and Trusts. If the data is adjusted, what has been done?

2 – The source of the figure for the average cost of a nurse, and whether this is salary only or includes “on costs” such as National Insurance and Pensions, offices and training etc. The comparison with Chaplaincy costs including On costs (as documented in the data table) etc suggests that it is the latter.

3 – The extrapolation from 26.72 million from Trusts responding to 32 million overall. Where does it come from?

4 – Terry Sanderson stated: “The average cost to the Health Service of a chaplain is £57,000 per annum.” Where does this number come from?

5 – You would prefer Chaplaincy to be funded by Church Resources. Have you identified these resources, which would make for a stronger argument.

Wrapping Up

If I receive clarification, I will let you know.

There’s a debate to be had here, but it can’t be on the basis of questionable or ambiguous data.