Blame underfunding for gaps in services for our most vulnerable

Fergus Finlay's claims that St John of God Community Services has been 'run into the ground' are incorrect and offensive, writes Claire Dempsey
Blame underfunding for gaps in services for our most vulnerable

Since as far back as 2008, the State, through the HSE, has systematically failed to adequately fund the services it contracts for vulnerable people. 

A recent column by Fergus Finlay ( Irish Examiner,  October 6) is both wrong and offensive, in its accusation that St John of God Community Services has been "run into the ground" by its senior management.

As a member of the board of the HSE, Mr Finlay should understand the systemic underfunding endured by the disability sector. 

On March 27, Mr Finlay and the HSE board received an extensive briefing on the sector. Therefore, he ought to be aware of the lack of resources since 2008 and also be aware of the acknowledgement by the HSE that the statutory funding model is unsustainable and not working. 

Equally, he ought to be aware of the need for multi-annual investment and the HSE's acknowledgement  that the increased regulatory burden caused  extra non-pay and capital outlay (in circumstances where the State never carried out a regulatory impact assessment) prior to implementation.

Fergus Finlay: Column 'offensive. Picture: Patrick Bolger
Fergus Finlay: Column 'offensive. Picture: Patrick Bolger

Mr Finlay incorrectly speaks of a top-heavy structure within our service. The majority of the people he refers to are clinicians, earning HSE-approved salaries,  in line with consolidated HSE pay scales. 

These people are also delivering vital services. He is wrong, also, in suggesting past financial and governance issues as the principal cause of the crisis facing the organisation. There is  an underlying implication of financial mismanagement, in respect of the use of current allocations, which we reject in the strongest possible terms. 

Our expenditure has been independently validated on behalf of the HSE. This is not only a flawed commentary, it sullies the good names, and the dedication, of a great number of people who have worked tirelessly to keep our service operational over many, very difficult years. 

In order to counter this misrepresentation, I wish to clarify the facts, as follows:

  • In respect of 33 people earning over €100,000 in 2018: These were primarily clinical directors, consultant psychiatrists, and principal psychologists, working  mainly in our mental-health services on salaries set by the State and not by St John of God Community Services. That figure has since reduced and now stands at 28; 

  • All salaries are in line with HSE consolidated pay scales and appropriate to the position held, and fully approved by the HSE; 

  • Five senior managers, including the CEO, are on a salary in excess of €100,000, the highest of which is the CEO of St John of God Community Services, at €124,000 per year (as specifically approved on the Department of Health consolidated salary scales; 

  • All of the above are in line with the sectoral norm; 

  •  St John of God Mental Health Services is currently funded at circa 50% of the staffing levels recommended in Vision for Change/Sharing the Vision; 

  •  It delivers one of the most efficient mental-health services in the country and has the lowest hospital admission rates; 

  • The HSE allocates just 60% of the funding required for inpatient care of adults with acute mental illness annually, with the balance provided on a piecemeal basis, when the service advises the HSE that it will cease the admission of patients to a psychiatric hospital and refer those requiring admission to the Emergency Department of the acute hospital; 
  •  Intellectual Disability:  Funding for each residential place at St John of God Community Services averages just over €100,000 per year, whereas the benchmarked cost across the sector is between €189,000 and €284,000; 

  • All costs have been  validated and the HSE acknowledges that the service is underfunded. 

Mr Finlay also highlights lapses in the former governance and management structures of the organisation. This we do acknowledge, without equivocation. 

We have apologised publicly for the mistakes of the past and there has been significant reform across the organisation. The issues  that arose in 2016 were addressed and while they should never be forgotten, they should not eclipse the more fundamental issue at the root of this current crisis.

As far back as 2008, the State, through the HSE, has systematically failed to adequately fund the services it contracts for these vulnerable people. That is not just the St John of God Community Services experience — it is the story of providers across the sector. 

This year, the National Federation of Voluntary Services Providers  submitted to government a requirement for additional multi-annual funding of €211m, for the period 2020-24. It has repeatedly highlighted the fact that people with disabilities, and their families, are experiencing an unprecedented crisis,  because of severe underfunding.

In respect of St John of God properties, we are providing services from all our existing locations. As we develop services in community settings, properties may become vacant. 

The order has already committed the proceeds of the sale of one property, for the redevelopment of residential and day services. It is a policy of the order that the proceeds of any sale of assets, such as properties or lands, will be used to support new capital projects for existing and new services. The order also provided €16m to subsidise the funding gap in recent years and has exhausted its resources.

Regardless, selling capital assets is not a sustainable solution for the recurring funding requirements of services to persons with a disability or mental-health issue in Ireland. An increased and sustained, multi-annual commitment is needed by the State, rather than a quick-fix cash injection arising from the sale of a building. 

That is just plastering over the cracks. These are vital frontline health services; demand is growing, requiring recurring annual funding, which cannot be met with one-off property sales.

Criticisms are justified about failings, as highlighted by HIQA, that occurred previously in our residential services for people with an intellectual disability.  However, many of those are directly linked to the systemic funding gaps that we are now highlighting. Our compliance rate with HIQA has improved and stood at 87% for 2019 across our residential services.

Mr Finlay, who sits on the board of the HSE, has chosen to heap false and inaccurate criticism on this organisation and, in doing so, he denigrates the significant contribution made by management, staff, and the Order of St John of God in the provision of disability and mental-health services in this country. 

That is deeply regrettable, given that our shared goal is the protection, care, and advancement of the most vulnerable people in our society.

  • Claire Dempsey, chief executive, St John of God Community Services

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