Q&A: What is happening at St John of Gods?

For the second time in recent years one of the largest providers of disability and mental health services, St John of God Community Services, has indicated it is to close, with the Health Service Executive (HSE) asked to step in and take over.

What is happening?

St John of God Community Services is the arm of the wider St John of God Hospitaller group that provides services to 2,500 people with intellectual disabilities and 5,500 mental health patients in the community.

The voluntary organisation is funded by the HSE to provide care on behalf of the State, but for several years has been involved in a dispute over funding. It has argued that annual grants from the HSE have not been sufficient to cover the cost of providing care, leading St John of God to run up a significant financial deficit.

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As a result the organisation has now taken the nuclear option of informing the HSE it can no longer carry on, asking the health service to step in and take over the running of its services by August 15th this year.

The HSE has responded forcefully by stating the voluntary provider has “more than enough money” to stay afloat in the short-term, and encouraged it to come back to the table and continue to talk.

Has this happened before?

St John of God previously told the HSE it would be walking away in late 2020. However following an appeal the provider paused its decision and entered into negotiations around future funding.

The organisation has said it is facing a built-up financial deficit in the order of €28 million due to underfunding going back several years. In a make-or-break letter sent last month, Clare Dempsey, its chief executive, told the HSE it would need €32.5 million in funding to continue to provide services. In the absence of any breakthrough on what would be a significant bailout St John of God this week served notice to the HSE that it would be stepping away from providing community health services.

What St John of God services will this affect?

The decision will not affect the wider St John of God group’s 180-bed psychiatric hospital in Stillorgan, Dublin, or its dementia care facility Saint Joseph’s Shankill.

It will affect those availing of the provider’s mental health services in the community, concentrated in the Dublin southeast area, and its five clinics for children and teenagers in south Dublin and Wicklow. It will also impact St John of God’s community services currently caring for 2,500 people with intellectual disabilities.

What will happen to those services?

St John of God has said the organisation will work with the HSE to ensure there is as little disruption as possible to people and patients currently using its services. If the provider follows through and hands over responsibility to the State this August, the HSE will either have to run the services directly or find another voluntary organisation, or multiple providers, to fund to take over the services.

For someone with a relative living in a residential centre for people with intellectual disabilities run by St John of God, the best scenario would likely be that they remain in the same location with the same care staff.

Will that be the case?

The 3,000 employees currently working for St John of God Community Services would be transferred over along with formal responsibility for the services, which would be the easy part. The more complicated question is what happens to the 300 properties where those services are currently being delivered.

The property portfolio ranges from large congregated settings to numerous small residential care homes. The St John of God religious order behind the healthcare group is understood to own much of the property. This could lead to the prospect of messy negotiations before the HSE or another voluntary provider could take over the facilities.

There is also the chance that some last minute funding deal is agreed with the HSE to see St John of God continue to operate the services. However, sources within the provider said after several years of talks no such offer of extra funds on the scale St John of God felt would be needed to continue to provide the required level of care had been forthcoming.

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