In light of public controversy over the proposed movement of the National Maternity Hospital from Holles Street to the St Vincent's campus, Minister for Health Simon Harris has said he would like to see a debate about the possible divestment of health service assets held by religious congregations.
Hospital and disability services used by hundreds of thousands of Irish people every year, paid for by the State and by private health insurance, are owned by religious congregations motivated by their Catholic faith.
An examination by The Irish Times of the four largest providers of such services shows that they all have rules that require that their assets are transferred to other charitable bodies with a Catholic ethos in the event that the congregations decide to wind up the companies that run these services.
With many of the congregations now seriously reduced in numbers, and their remaining members elderly, the hospitals and other services controlled by these orders are likely to be transferred to trusts and other such charitable entities, with a stated Catholic ethos, over the coming years.
The value of the institutions involved is considerable as is their importance to the Irish health service. It is important to note that properties that were funded by the Health Service Executive (HSE) by way of capital grants are usually covered by legal obligations stipulating that they must be used for stated purposes and cannot be sold without the permission of the HSE.
The Catholic Church is the largest non-governmental provider of health services in the world and the question of what to do with the institutions owned by its religious congregations in the light of ageing and depleted memberships is a global one.
Despite the collapse in the number of people entering religious life, the sponsorship by the Catholic Church of hospitals and other health services is continuing by way of new, mostly lay-operated structures in many countries.
In the US, the number of Catholic-ethos hospitals has increased significantly in recent years.
Listed below are some of the larger congregation-owned health service organisations in the Republic, with details as to their size, value, and the age of the congregations’ surviving members.
Bon Secours
The Sisters of Bon Secours order owns hospitals in Dublin, Cork, Galway and Tralee, as well as the Care Village in Cork.
Bon Secours Health System Ltd had a turnover of €230 million in 2015, the latest year for which accounts are filed. The company had a value of €132 million and employed 2,700 people who worked with more than 350 consultants to provide care to more than 200,000 patients, the accounts show. The group relies hugely on private health insurance income.
The constitution of the company says that its main objective is to carry forward the healing ministry of Jesus Christ in the church through the ownership and governance of facilities for the health and well-being of the community in general and the sick and dying in particular, “all in a manner consistent with the teachings and laws of the Roman Catholic Church”.
The hospitals paid €3.99 million to the congregation in 2015 for buildings leased from it and on interest on loans, according to the accounts.
According to a report from the National Board for Safeguarding Children in the Catholic Church in Ireland (NBSCCCI), there were 112 sisters in Ireland in 2015 aged 53-101.
The constitution of the company provides that in the event of the dissolution of its assets will go to another charitable institution with similar objects.
Sisters of Mercy
The Religious Sisters of Mercy is not just the largest order of nuns in Ireland but also one of the biggest players in the hospital sector.
The congregation had 1,869 members in Ireland in 2015, according to a report from the NBSCCCI. According to a 2009 audit the average age was 74, with three quarters of the sisters over 65.
The nuns have handed their primary schools over to the local dioceses and their secondary schools to the Catholic Schools and Irish Schools Trust (Ceist), the board of which includes independent senator Rónán Mullan.
The order owns the Mater Misericordiae and Children’s University Hospitals Ltd (MMCUH) which is the owner of the Mater public hospital, the Temple Street Children’s Hospital and the Cappagh National Orthopaedic Hospital, all in Dublin.
The company owned land and buildings with a value of €637 million at the end of 2015. This figure did not include the land on which the orthopaedic hospital is situated, as that is owned by a separate trust.
The congregation also owns and operates the Mercy University Hospital Cork. The bulk of the group’s income comes from the State.
The MMCUH constitution states that if it is wound up that its surplus assets should go to the trustees of the South Central Province of the congregation or, if that province no longer exists, to the congregation in Ireland or then to the Catholic Archbishop of Dublin for the charitable purposes of the archdiocese, or then to a charity having the same objects as the company and, in default of that, to a charitable object consistent with the ethos of the Catholic Church.
Sisters of Charity
The Religious Sisters of Charity operate the St Vincent’s hospital complex in Dublin 4, and St Michael’s Hospital, in Dún Laoghaire, Co Dublin.
The sisters own St Vincent’s Healthcare Group (SVHG) which operates St Vincent’s University Hospital and St Vincent’s Private Hospital, as well as St Michael’s.
The proposed movement of the National Maternity Hospital from Holles Street to the St Vincent’s campus has created controversy. Under the current plan the €300 million hospital, to be funded by the State, would be independent but owned by SVHG.
The SVHG constitution says its main objectives are to provide medical and nursing services “through the continuance and furtherance of the ethos, aims and purposes of the congregation ”.
The mission of the hospitals is to “bring the healing love of Christ” to the sick and poor “in keeping with the mission of the Catholic Church”.
The group had an income of more than €400 million in 2015, with more than half of that coming from the HSE, and ended the year with a deficit of €7.7 million. It had a net value of approximately €110 million and employed more than 3,700 people. During the year the hospital group paid the congregation €1.2 million in rent and €1.1 million for the purchase of a leasehold.
The order had 213 members, with an average age of 76, in 2015. The SVHG constitution states that if the company is dissolved its property should be transferred to a charitable institution “having main objects similar to the main objects of” the SVHG.
Brothers of Charity
The Congregation of Brothers of Charity in Ireland (BCSI) is the largest provider of services to people in Ireland with intellectual disabilities.
Active since the late 1930s, the order has outlets in Clare, Galway, Roscommon, Limerick, Cork, Kerry, Waterford and Tipperary. The provision of the services by the group to thousands of adults and children is funded by the HSE.
The residential, respite, day, home-based and multi-disciplinary supports involved 2,854 employees in 2015, the latest year for which accounts were filed by the group.
The main objects of BCSI are fidelity to the mission of the congregation and the social teaching of the Catholic Church and to the support of people with intellectual disabilities who avail of the company’s services.
The accounts show a total income of €191.7 million, €178 million of which came from the HSE, and a deficit for the year of €296,644.
Property used by the company and its subsidiaries is leased to it by the Trustees of the Congregation of Brothers of Charity, for a nominal annual rent.
According to the 2009 audit conducted as part of the Redress Scheme, the congregation had property worth €170 million.
According to a NBSCCCI report from 2015, the congregation in Ireland is part of its UK region and there were a total of 12 brothers in the region. The average age was in the mid-70s and three required sustained care.
A further three brothers lived under supervision in another jurisdiction because of child abuse allegations made against them in Ireland.
The report noted the “significant and problematic safeguarding history” of the congregation and that it now has no input into the day-to-day running of its services “except to ensure that the ethos and values of the congregation are followed”.
There was, it said, an urgent requirement for the congregation to “actively address the question of succession planning”.
The BCSI’s constitution says that in the event of its dissolution, surplus assets should be transferred to another charitable institution having similar objects and which restricts the distribution of its assets in a similar way to the constitution of BCSI.
In so far as putting this provision into effect might not be possible, then the members of the congregation should give the assets to “some charitable object”. In the event the members are not able to, then this task should fall to the Commissioners for Charitable Donations and Bequests.
Order of St John of God
The Hospitaller Order of Saint John of God provides services in the areas of intellectual disability, mental health, and aging.
It operates the St John of God acute psychiatric hospital in Stillorgan, Co Dublin, the 60-bed St Joseph’s Dementia Centre, in Shankill, Co Dublin, as well as other services to children and adults with intellectual and learning disabilities.
The hospital and the dementia centre are run by Saint John of God Hospital Ltd. The hospital is dependant largely on income from private health insurers, while the centre receives the bulk of its income by way of the fair deal scheme.
According to the company’s 2015 accounts, the hospital supplied services to 1,172 inpatients that year while another 2,156 people received care on an outpatient/day care basis.
Total income was €33.3 million, while total expenditure was €34.5 million. During the year it had an average of 447 employees. The company’s costs included rent of €1.36 million which was paid to the congregation.
The accounts state that the company had the use of lands and buildings worth €28.7 million the legal title of which was held by St John of God Trust (Ireland). The 2009 audit run as part of the Redress Scheme said the order has assets with a value of €522 million.
Another company, St John of God Community Services Ltd, runs HSE-funded support for the intellectually disabled and those in need of adult mental health, and adult and child psychiatric services. Approximately 8,000 adults and children benefit from these services per annum.
According to the NBSCCCI, the order had 19 members in three religious communities in Ireland in 2015, with an average age of 72 years.
The constitution of St John of God Trust (Ireland) states that in the event of its dissolution, its surplus assets should go to the congregation and, if it is no longer in existence, then to a charitable body having similar objectives to the company, and similar restrictions on the distribution of its assets.
