The purpose of this study was to identify and compare key features of spiritual care provision in hospices and acute hospitals within England and Wales. A survey by postal questionnaire was carried out on the perceptions of senior chaplains in 151 hospices and 194 hospital trusts. The overall response rate was 76%. The findings of the survey suggest (a) a trend away from establishing chapels as the spiritual focal point within hospitals and hospices, (b) the development of broader roles for chaplains, (c) a different level of service provision between hospices with funded chaplaincies and hospices with voluntary chaplaincies, (d) a wide range of non-religious spiritual care requirements on the part of patients and (e) a more frequent requirement for religious care in hospitals rather than hospices.