"Decongregation" in Ireland

The "Time to Move on from Congregated Settings - A Strategy for Community Inclusion" report and policy is Ireland's version of the international drive for Deinstitutionalization and Community Inclusion. For an international perspective, see here.

The Report was initiated by the HSE Primary, Community and Community Care Directorate in 2007 to develop a national plan and associated change programme for moving people from congregated settings to the community in line with Government policy. It was published in 2011.

HSE and government documents 

  • Time to Move on from Congregated Settings - A Strategy for Community Inclusion, HSE, June 2011
  • Press Release 26th June 2016 - Minister Finian McGrath announces significant investment to support people with a disability to move into more suitable accommodation; €100m funding for Programme for Government commitment from 2016-2021, including €20m in 2016
  • Above press release contains "Table 1: 2016 facilities prioritised for capital funding to move residents to community living | St. John of God - Beaufort Campus , Co Kerry | 4
  • HSE 2016 Transforming Lives Progress Report 2016
    • This contains an acknowledgement that community living is not for everyone
    • Page 33: "Proposed Review of Congregated Settings
      A proposal has been developed and forwarded to the Head of Programme for Health Service Improvement to commence a review in 2017 that will examine the configuration of services under the Time to Move On policy. The purpose of this review will be to agree how the policy will be applied in certain specific services, groups of services or for specific residents within a setting. The key principle of this review will be to address the concern that transitioning people into the community in line with the policy recommendations may not be in the best interest of certain individuals or in line with personal wishes or individual choice."
    • It is not clear if the proposed review was undertaken or not and what the conclusions were.
  • HSE 2017 National Service Plan 
    • Facilitate the movement of people from congregated to community settings
    • target 223 people in 2017, page 33 (160 plus 63 that were planned but not completed in 2016)
    • 20 million Euro in 2017 for: 47 units at varying stages of purchase and refurbishment to meet housing requirements for 165 people transitioning from congregated settings, page 73)
  • HSE 2018 National Service Plan
    • "There is a significant opportunity to shift care out of acute and congregated institutions and into community and home settings. This is more convenient for patients and supports them to self-manage and live more independently, offers better value for money, and facilitates greater service integration and proactive delivery of care. Over time, the aim is to meet the vast majority of the population’s health and social care needs in local settings, with institutional and hospital-based care being reserved for only those individuals requiring complex, specialised and emergency care, and even then only for the shortest period possible.
    • Target was to move 223 people in 2017, actually achieved were 161
    • Target for 2018 are 170 people 
  • HSE 2018 Cork Kerry Community Healthcare Operational Plan, page 72: Continue with implementation of National Policy on “Transforming Lives: A Time to Move On from Congregated Settings” in St. John of Gods’ Kerry Services:
    • Establish a group to work with SJOG to assist them with their preparation of a comprehensive plan for decongregation. [This is about St Mary of the Angels!]
    • Continue the communication and engagement process with SJOG and family group.
  • HSE 2019 National Service Plan
    • Enable people with disabilities to live ordinary lives, in ordinary places as independently as possible
    • Target was to move 170 people in 2018, this was achieved
    • Complete the move of 160 people from congregated settings to their own homes in the community
    • St Mary of the Angels is NOT mentioned in Capital Spending plans for 2019 (i.e purchase and refurbishment of houses)
  • HSE 2019 Cork Kerry Community Healthcare Operational Plan
    • "Decongregation" appears to have less urgency attached to it, if only for financial reasons
    • Page 70: "Decongregation of priority sites within Cork Kerry Community Healthcare will continue in 2019 within available resources."
    • Specifically in relation to St Mary of the Angels, page 75: SJOGs: Utilisation of Social Reform Funding received to assist with the following in 2019.
      − Community living plan to be prepared which should detail the resources available for debundling
      and what additional resources are required.
      − 2 Clients to move to Tullig community house in 2019.
  • HSE 2020 National Service Plan
    • Progress implementation of Time to Move on from Congregated Settings – A Strategy for Community Inclusion
    • Target was to move 160 people in 2019, actual figure is 118
    • Complete the move of a further 132 people with disabilities from congregated settings to transition to homes in the community in 2020
  • HSE 2021 National Service Plan
    • Commitments are made to providing 144 more people with a disability who are currently living in congregated settings with more person-centred homes in the community.
    • Target was to move 132 people in 2020, actual figure is 120

European study 

  • European Union Agency for Fundamental Rights: From institutions to community living: drivers and barriers of deinstitutionalisation, Case study report: Ireland 2018
    • Quote of how one unnamed service provider achieved "decongregation": “We would have pursued very much guerrilla tactics, seriously, we would say ‘these three or four people’ and then let’s move really fast and move faster than the unions you know, before they start ‘oh no we have to meet everybody and we have to’ you know you really have to be a kind of moving target, harder to hit, if you operate on the basis of ‘we need all the stakeholders in the room, we need to agree with all the families and all the unions and all around the table’, [forget] it.”

Re: HSE’s statement in Life Magazine interview (Sunday Independent 01/10/2017)

A spokesperson for the HSE says that the national decongregation policy is “based on giving residents choices and opportunities” and “in relation to St. Mary of the Angels, it is not correct to say that any resident will be forced out”.

The terms of the national policy clearly outlined in the HSE’s 2011 report ‘Time to Move on From Congregated Settings’ tell a different story:

  • “The policy should mandate that all those living in congregated settings will move to community settings” (See 7.2 p.14-15)
  • The policy should apply to all those living in congregated settings, no matter how severe or complex their disability. (See 7.2 p.92)

A mandate is the opposite of a choice. For something to be a choice, two or more options are required. For 4000 people living in 72 residential centres across Ireland, only ONE option has been presented to them. That is to move out of their long-term homes (where they receive specialist onsite care) to live in ‘an ordinary house, in an ordinary place’.

The true goal of this policy is to close all 72 residential centres. Minister Finian McGrath has said the goal is to “eliminate all congregated settings”. The 2011 report states:

  • No new congregated settings will be developed and there will be no new admissions to congregated settings. (See 7.2 p.15)
  • The move to community will be completed within seven years and minimum annual targets set for each year in order to reach that goal. (See 7.2 p.15)
  • An active transfer programme will be needed to secure closure of all congregated settings. Ending admissions will be a necessary but not a sufficient step to bring about closure. (See 10.2 p.192)

If the goal is to close all 'congregated settings', how can anyone have a choice to stay?

As each of the 72 residential sites become vacant, they will be sold by the state:
“Many current service providers have indicated their willingness to make available to the state, their current assets, when the facility is closed.” (See top of p.6)

St. Mary of the Angels is built on land that was donated by a local family to the children of Kerry with intellectual disabilities in the 1960s. Many of the chalets and facilities were made possible by local fundraising. The current service providers, St. John of Gods, were entrusted with the care of the residents at SMOA by the founding order of nuns in 2005. It is neither theirs, nor the states, to sell.

Although the government and HSE are behind in their target (the end date has been moved from 2018 to 2021), they are still pursuing aggressive annual targets to get every vulnerable resident out. This year 223 residents are to be moved out of designated centres – service providers are under pressure to meet these targets. The needs of residents cannot be to the fore while houses and sites are being purchased and must be filled.