I move: "That the Bill be now read a Second Time."
I am pleased to present the Redress for Women Resident in Certain Institutions Bill 2014, the purpose of which is to provide for health services to be made available without charge to women who were resident in Magdalen laundries and similar institutions. The Bill provides that these women will not be required to pay the statutory charge for public acute hospital inpatient services and that the ex gratia payments being made, including top-up pension payments, will not be included in the financial assessment of means under the Nursing Homes Support Scheme Act 2009. As Deputies will be aware, this Bill is one part of a wider package of supports for these women.
Before I go into detail about this legislation, I will briefly give the background to it and to the other supports the Government is providing to the women concerned. Deputies will be very familiar with the details of this background, including the establishment in June 2011 of an inquiry to establish the facts of the State's involvement with the Magdalen laundries. The inquiry in question, which was chaired by the then Senator Martin McAleese, published a 1,000-page report in 2013. This clear, detailed and objective exposition of the facts regarding the ten Magdalen laundries found that just over 10,000 women had spent time in Magdalen laundries since the founding of the State. The way that women found themselves in these laundries varied considerably. Many referrals were made by the women themselves. Other referrals were made by families, priests or clergy. Some referrals were also made by the Society of St. Vincent de Paul, the Red Cross and the Samaritans. Approximately 27% of referrals were made by or facilitated by the State.
The McAleese report makes the point that in today's world, it is difficult to understand the circumstances which in the past led to daughters, sisters and mothers being placed in these laundries. It may be equally difficult to understand the apparent acceptance by families of instructions from people in positions of authority, such as the clergy, in relation to family matters. The report goes on to say it would be unfair to judge these cases or the people concerned by applying today's standards and societal norms. The report points out that because of the general life expectancy in society at the time, it was common for one or both parents of the girls or women in question to be deceased. It needs to be emphasised that many girls or women ended up in these institutions because they did not have anyone in a position to look after them. In many cases, referrals to Magdalen laundries were used as temporary measures in the absence of more appropriate services which simply did not exist at the time. The Magdalen laundries were described by the McAleese report as often the only door open to these women. Many women and girls worked in the laundries for long periods. Approximately half of the women were in the laundries for periods of more than three years.
The referrals from State agencies came about in a variety of ways: from industrial and reform schools; from the health and social services, including the then existing county homes; and from psychiatric hospitals. There were also referrals from the criminal justice system including referrals of people on remand, referrals as a condition of probation, other less formalised referrals facilitated by the courts, referrals from prison and referrals by An Garda Síochána. As a result of the lack of more appropriate services, many case studies clearly demonstrate widespread acceptance of practices that would be repugnant to us today. The McAleese report makes it clear that "many of these case-studies and patterns are accordingly of their own times and [unfortunately] demonstrate some of the prevailing attitudes in Ireland across the years since 1922". Of course the new commission will take up many of the issues in relation to the experience of women in vulnerable circumstances in Ireland in the period from 1922 to a later time. The case studies illustrate that alternative social care arrangements for these women were often not available at the time.
The report refers to the mistaken public perception that the women who were referred to these institutions were predominately unmarried mothers, or lone parents as we would call them today. This perception does not reflect the reality in most cases. The report found that placements of girls or women in Magdalen laundries were made for a wide variety of reasons. It is hard to credit nowadays that in some cases, referrals were seen as a means of disciplining young girls. In other cases, referrals were made to provide for girls or women with physical disabilities or with mental or psychiatric illnesses. Some of them had intellectual disabilities and special needs, while others were referred because of advanced age. In other cases, girls or women were placed in Magdalen laundries by their families following family disputes, or as a result of abuse or neglect in the home. Only in a minority of cases did referrals relate to girls or women rejected by their families for having a child outside marriage. Everybody here will agree that the case studies are sad and harrowing accounts of a traumatic time in the lives of these girls and women. At the most vulnerable time in their lives, these women experienced a very traumatic removal from their homes and communities, often followed by a prolonged and extreme level of societal exclusion and ostracisation.
I thank Martin McAleese for the work he did. As a result of his report, the Government decided that a non-adversarial scheme for women who worked in Magdalen laundries or similar institutions should be introduced. Mr. Justice Quirke was asked by the Government to make recommendations. He reported in May 2013. All of his recommendations were accepted in principle by the Government in June of that year. My Department started work immediately on setting up a scheme and publicised the scheme widely in this country and abroad.
When I met the advocacy group some months ago, it suggested that we use our embassies and particular magazines to advertise the scheme's continued existence. I have since taken up that suggestion so as to ensure that more women know about the scheme.
The primary support that we have given comprises ex gratia payments to women who were in these institutions. Under the scheme, applicants do not need to prove that they suffered any abuse or damage. The manner of their referral - I have outlined the various ways - is also not considered relevant. All that has to be established is that a woman was admitted to and worked in a relevant institution. For this reason, it should be recognised that the scheme represents an appropriate and caring provision by the State to the women in respect of what was inevitably a traumatic experience in their lives.
Under the scheme, a woman is eligible for a payment of between €11,500 and €100,000, depending on the length of stay. As recommended by Mr. Justice Quirke, the balance of lump sums in excess of €50,000 is being paid by weekly instalments in order to provide an income spread over a longer period. To date, my Department has made decisions on 86% of the 776 applications received so far, and a total of €18 million has been paid out to the women. Many members of the public will be pleased to see that, even at this point when many of the women in question are older, this money has been paid to them in recompense for the trauma they underwent. The remaining applications are at various stages of the process. Some have only been received recently and some require further information, further investigation or verification. We are progressing work on all of these cases as quickly as possible.
One of the points the advocacy group made to me concerned the positive feedback it had received from the women regarding how they were dealt with by the staff of the Department of Justice and Equality. The team working on their cases has been extremely proactive and responsive when engaging on the issues that have been raised. The scheme remains open and I anticipate that a small number of further applications will be received.
The processing of all applications starts on the premise that the testimony of the applicant is correct and the officers processing the application then seek to verify it by checking appropriate records. Where the records of an institution are incomplete, as they are in a small number of cases, we have agreed to set up an interview process with the applicant and are making every effort to corroborate the women's information with other documentation or information held by other elements of the State - for example, the Department of Social Protection, work records, etc.
The Quirke report also recommended that the ex gratia payments should include top-up pension payments of up to €100 for women under the age of 66 years and up to €230.30 for those aged 66 years or over. These payments are being made by the Department of Social Protection. I thank the Tánaiste and Minister for Social Protection for her assistance in that regard.
Mr. Justice Quirke recommended that legislation be introduced to give effect to his recommendation on the provision of health services. Before outlining that, it is worth noting that Mr. Justice Quirke reported that 91% of the women surveyed during the course of his work already held a medical or general practitioner visit card. In his report, he was of the opinion that Magdalen women should be provided with access to a comprehensive suite of health services. He specified GP services; prescribed drugs; medicines; aids and appliances; dental, ophthalmic and aural services; home support; home nursing; counselling; and chiropody and physiotherapy services. He also advised that this entitlement should operate in a statutory manner. His recommendation that the women receive medical services equivalent to those provided to the holder of a Health (Amendment) Act 1996, HAA, card is being given effect in this Bill. As set out in his report, he also advised that not all of the services described in the hepatitis C guide might be directly relevant to the Magdalen women, and any comparable guide for the Magdalen women would require suitable adaptation.
I thank the Minister for Health, with whose Department we have had significant engagement, for his assistance in regard to the provision of medical services. The health services set out in section 2 of the Bill provide entitlements to benefits that are comprehensive and greater than those of a straightforward medical card. Deputies will note that the range of health services being made available without charge are those services listed in section 2 of the Health (Amendment) Act 1996, which provides for persons affected by hepatitis C. This comprehensive list of services includes all of the health services identified by Mr. Justice Quirke: GP, medical and surgical services; drugs, medicines and surgical appliances; nursing services; home help services; dental, ophthalmic and aural services; counselling services; chiropody services; and physiotherapy services. The Bill will exempt the women from charges for acute inpatient services. It will also provide that ex gratia payments made to these women under the scheme will not be included in any financial assessment of means under the Nursing Homes Support Scheme Act 2009. Some NGOs have incorrectly stated that the Bill will not provide for these services. The only service that is not included in the Bill relates to "alternative therapies". Deputies will be aware of recent investigations into spending on alternative therapies by the support group for hepatitis C, which has been the subject of comment in recent times. The Bill does not make any provision for the therapies of homoeopathy, angel healing and aromatherapy, as they have no proven medical benefits.
The focus is firmly on the health needs of the women, and some of the services provided will be accessible through referral by a doctor or nurse. Referral will ensure that the health care provided will be co-ordinated will be the most appropriate for each participant. Importantly, there is no means test to access these services and they will be provided without charge to relevant participants in the ex gratia scheme.
All health systems around the world vary in arrangements, and each system is unique. Therefore, the Minister for Health has agreed that, given the wide variation in the organisation of countries' health systems, access to equivalent health services for participants living abroad is best dealt with on an administrative basis by the HSE. The HSE will deal with a woman residing overseas as appropriate to her specific circumstances and the health system of her country of residence. I will take this opportunity to reassure those living abroad that they will be able to access equivalent services as though they were resident in the State. Recently, I visited women in the UK. They were benefitting from the support they were receiving from the relevant organisation there and the range of services that were available to them. I am aware that the procedure for accessing services in other countries will be different. Those women living abroad will be supported in sourcing and paying for services and securing refunds to the extent that they would be entitled to under the scheme if resident in the State. There will be circumstances in which a service similar to or aligned with what they would receive in the State may not be available. The HSE will have a variety of different arrangements with such participants. A specific contact will be established in the HSE with whom the overseas participants can liaise in terms of arranging access to services and recouping costs. This dedicated point of contact will provide clarity on what exactly the participant is entitled to in line with what is available in her country of residence.
I understand there has been some comment about the lack of explicit reference in the Bill to a so-called enhanced card. I will take the opportunity to explain. It is important to clarify that neither the standard medical card nor any new card is explicitly set out in the legislation of the Health Act 1970 or this Bill. This is normal legislative practice.
It will be a matter for the HSE to decide on the practical arrangements, such as a type of card, to be put in place in order to ensure that the women can easily demonstrate their eligibility for services under this legislation. I want to make it easy for women to do so. One operational possibility, for example, is that an RWRCI card, based on the name of the legislation, would be issued to the qualifying women. It is not practice to name the type of card in the legislation. We will make provision for an enhanced card and on an administrative basis the HSE will issue the card. The type of card is clearly spelled out in the legislation but the practical details - what it looks like and what name will be on it - are for the HSE to decide.
There has been some comment suggesting that no provision is being made for women entitled to these supports who do not have the capacity to make the necessary applications or arrangements. This is simply incorrect. The women are already covered by section 21 - concerning the appointment of a care representative - under the Nursing Homes Support Scheme Act 2009. Separate legislation, which I have already brought before the Dáil, will cater for cases in which the applicant is found to lack capacity but has not been made a ward of court or where there is no enduring power of attorney. The Assisted Decision Making (Capacity) Bill 2013 provides for the appointment of a person by a court to act on behalf of the applicant in regard to his or her financial affairs, and this will include applications for ex gratia payments under the scheme. The Bill is already awaiting Committee Stage in the Dáil and I expect it to be enacted in the first half of this year.
I do understand the role of advocacy groups. I have met those working with the women who were resident in the Magdalen laundries and I want to recognise their work. I have laid out clearly today, however, how in fact the Government is meeting Mr. Justice Quirke's recommendations in full. I hope this is now clear and that no further misunderstandings will be created on this important issue for the women concerned.
There is broad support in this House for all the measures that the Government has decided to put in place for these women. In drafting the Bill the Government has been fully aware of points made by Deputies, both in their representations to me - I have met with Deputy McDonald and others - and in parliamentary questions tabled in this House.
I commend the Bill to the House. I will very much welcome the discussion with Deputies in regard to the Bill as we progress it through the House. I hope the points I have made about the card will be clearly understood, including the practical administrative arrangements for women resident in this country, and the arrangements agreed with the Department of Health for women living overseas. The latter group's entitlements will be equivalent to those of women resident here.
