Léim ar aghaidh chuig an bpríomhábhar

Joint Committee on Children, Equality, Disability, Integration and Youth díospóireacht -
Tuesday, 24 May 2022

General Scheme of the Mother and Baby Institutions Payment Scheme Bill 2022

We have received apologies from Deputies Sean Sherlock and Holly Cairns. Senator McGreehan will be joining us online but she will not be on the Leinster House campus. Today's meeting is on the pre-legislative scrutiny of the general scheme of the mother and baby institutions payment scheme Bill. We have two sessions today. In the first session, we will be joined by officials from the Department of Children, Equality, Disability, Integration and Youth. In the second session, we will be joined by representatives from Oak Conflict Dynamics and the Tree House Practice.

I would like to welcome from the Department Ms Laura McGarrigle, assistant secretary general; Ms Caitríona O'Connor, principal officer; and Ms Joanne Byrne, assistant principal officer. I thank them very much for being here today.

I will advise on some housekeeping matters in relation to Covid-19. We ask that people take personal responsibility in relation to distancing, etc. The chat function on Microsoft Teams should only be used to make us aware of any technical issues or urgent matters that may arise. It should not be used to make general comments or statements during the meeting.

With regard to parliamentary privilege, witnesses who are participating from the committee room are reminded of the long-standing parliamentary practice to the effect that they should not criticise or make charges against any person or entity by name or in such a way as to make him, her or it identifiable or otherwise engage in speech that might be regarded as damaging to the good name of person or entity. Therefore, if their statements are potentially defamatory in relation to an identifiable person or entity, they will be directed to discontinue their remarks. It is imperative that they comply with any such direction.

I remind people of the constitutional requirement that members must be physically present within the confines of the Leinster House complex in order to participate in public meetings. Members will not be permitted to participate if they are not adhering to that constitutional requirement. Any member who attempts to participate from outside the precincts will be asked to leave the meeting. In this regard, I ask any member who is participating by Microsoft Teams, that prior to making their contribution that they confirm they are on the grounds of the Leinster House campus.

Ms Laura McGarrigle will now give her opening statement.

Ms Laura McGarrigle

I would like to thank the committee for inviting officials to the meeting today to discuss draft legislation for the mother and baby institutions payment scheme. The scheme is a key action in the Government's comprehensive action plan for survivors and former residents of the mother and baby and county home institutions. Following on from the State apology in January 2021, the action plan was developed to demonstrate the State's commitment to recognising and responding to the suffering experienced, and to support survivors who were so badly failed in these institutions.

Given the payment scheme's scale, the Government agreed that it should be grounded in statute. This legislation, therefore, aims to support a user-friendly, one-stop-shop approach for applicants, as well as providing for lawful access to records.

I will broadly and briefly set out what is covered by the proposed legislation. An applicant to the payment scheme is referred to as a "relevant person" in the heads of the Bill. The definition of a "relevant person" encompasses a person who was resident as a child or as a mother in one of the institutions listed in schedule 1 of the heads of the Bill. The scheme will be administered by an executive office established within the Department of Children, Equality, Disability, Integration and Youth. This arrangement provides the best opportunity to open the scheme to applications as quickly as possible, following the enactment of the legislation. This is because we can work on setting up the office in parallel with our work on the legislation. While the office of the chief deciding officer of the mother and baby institutions payment scheme will be part of the Department, the chief deciding officer will be statutorily independent in the performance of her or his functions. She or he will also have staff.

Heads 7 to 10 set out the general duties and powers of the chief deciding officer. He or she will make determinations on applicants' eligibility to the scheme, in accordance with criteria and processes that are set out later in the legislation. He or she will also advertise the scheme, prepare an annual report on its operation and have the power to delegate operations to the staff of the executive office to ensure efficient administration of the scheme.

A number of the heads between 11 and 24 concern the benefits available under the scheme, as well as the application and determination processes. The benefits include a general payment, a work-related payment, a form of enhanced medical card or, for those who live outside of Ireland, a once-off health support payment of €3,000 in lieu of the enhanced medical card.

It is the intention that payments will be disregarded for the purposes of income tax and means assessments and work is ongoing with the Departments of Health, Finance and Social Protection in this regard.

Staff of the executive office will have the power to search the commission’s database and related records so that they can assist an applicant in providing relevant information and to verify information. Staff will also have the authority to request relevant information from the bodies listed in schedule 2 of the heads of the Bill, where relevant.

The Department is currently preparing a data processing impact assessment in relation to the processing of personal data and special category personal data under the scheme and has engaged with the Data Protection Commission as required. The eligibility criteria for each of the scheme's benefits are included in heads 18, 19 and 21. A general payment may be made to an applicant who was resident as a child in a relevant institution for six months or more, and to an applicant who was resident as a mother in a relevant institution for at least one night. A work-related payment may be payable to any mother who was in the Tuam institution or a county home for at least three months, as well as to a mother who was resident in another relevant institution for a minimum of three months and who undertook commercial work without pay outside of that institution. The overarching rates for these payments are set out in schedule 3.

Applicants who were resident in a relevant institution for at least six months will be entitled to an enhanced medical card and those who live abroad can choose a health support payment in lieu of the card.

Head 22 provides that in order to receive a payment from the scheme, an applicant will be required to sign a waiver. The waiver would only be signed at the point where the applicant accepts an offer, so he or she will know precisely what they are being offered prior to signing. The waiver is not attached to the enhanced medical card or the health support payment.

A person can apply to the scheme on behalf of a "relevant person" where the "relevant person" does not have the capacity to apply or has died since the date of the State apology.

Heads 25 to 34 provide for a number of other matters related to the administration of the scheme, including rights of review and appeal, support for legal costs, the carrying out of independent reviews of the scheme's operation and the power to add additional institutions to schedule 1.

We thank the committee again for the invitation today and we are happy to take questions.

Thank you very much Ms McGarrigle. We will move on to questions.

I thank Ms McGarrigle for her opening statement. The mother and baby institutions are a really dark stain on the history of this State. Listening to the testimonies at the committee of those who were personally affected was heart-wrenching. I have met a number of survivors and it was absolutely traumatising for me, even though I did not have to go through that experience. Hearing their personal experiences was absolutely traumatising and it is really a dark stain on our society.

The exclusion from this redress scheme of infants who spent less than six months in a mother and baby home and of preventing them from accessing an enhanced medical card tells me that survivors have not been listened to. This was one of the things survivors called for. Infants were taken from their mothers, they were stolen and, in some cases, they were shipped overseas. The Government is effectively telling these children that their forced separation and suffering is not worthy of compensation and telling women that their suffering may only be worth €5,000. To me, that is an absolute scandal. Will Ms McGarrigle explain the rational as to why children will only receive a general payment if they were in an institution for six months or more?

Ms Laura McGarrigle

In terms of the rational for the six month requirement in respect of children who were formerly resident in one of these institutions, the first thing to mention is that the interdepartmental group that developed detailed proposals for the Minister and the Government would have very much understood this payment scheme to be just one measure in the broader action plan that seeks to respond through an array of different measures to the concerns and the needs of survivors and former residents.

This is only one remedy that is being proposed. In that regard, the importance of access to records and information was noted, particularly as an overriding concern for those who were resident as infants in mother and baby homes for less than six months. The overwhelming need that has been expressed is for access to records and the real trauma that has been expressed is caused by the denial of access to information from that period in their lives. The Birth Information and Tracing Bill is the key mechanism to respond to those concerns. Alongside it, the IDG has noted the paramount importance of the action plan providing for counselling support for every single survivor and former resident in a mother and baby and county home so that counselling support is there for everyone.

Did the Government get any expert opinion from, say, medical experts? We will hear witness testimonies during the second session of today's meeting. Trauma can be happening from day one and can impact people for the rest of their lives. Did the Government get any expert opinion on that issue when it was designing this redress scheme?

Ms Laura McGarrigle

As I mentioned, the IDG was cognisant that counselling support should be there for every survivor through the action plan. It is in place at the moment. Access is available on a prioritised basis for all survivors and former residents through the National Counselling Service.

I am aware of the counselling and it is important that people have access to it. However, I am asking specifically about redress and compensation for people who spent less than six months in a mother and baby homes.

Ms Laura McGarrigle

Within that frame of reference, the IDG was developing detailed proposals that were recognising unduly long periods of time spent in an institution and the harsh conditions that were experienced there, particularly, as the commission noted, the appalling conditions that prevailed in the Tuam institution or in a county home and the emotional abuse and mistreatment that many residents experienced. The development of the proposals for the payment scheme was seen as responding to the recognition of those unduly long periods of time spent in the institutions. In that regard, the IDG in undertaking its work looked at the commission's recommendations as a starting point but also built beyond them, designing a payment that recognises these unduly long stays in institutions.

Listening to people who have contacted me, one day in one of these facilities is an unduly long time for anybody to have to endure. We will hear from witnesses in the second session of today's meeting. They will say that anybody who has passed though mother and baby homes, irrespective of how long they were there, have been affected by these experiences and this will have shaped their lives and influenced their childhood and adult development. There must be a redress scheme for anybody who spent one day in these institutions.

I thank our guests for their presentations. I am also interested in the term "unduly long". It may be just a language issue. We talk about six months. What criteria suggest that six months was unduly long? How was that arrived at? It is an arbitrary number but we are saying that length of time and longer is considered unduly long. How did the IDG assess that six months was unduly long?

Ms Laura McGarrigle

I thank the Senator. As I mentioned, the starting point of the work of the IDG in its terms of reference was that it was to develop detailed and costed proposals for a repayment scheme that would take account of the commission's recommendations but not necessarily be limited by them. In looking at the starting point of the commission's recommendations, the commission made recommendations that recognised these unduly long lengths of stay and the commission had used the phrase "for example, in excess of six months" when referring to mothers who had unduly long lengths of stay. The reference to six months started in the commission's recommendations. It is important to say that the IDG did not just stick to the commission's recommendations. It made recommendations to the Minister and the Government that went beyond the commission's recommendations but that would have been the starting point.

There is a vote in the Seanad.

Senator Clonan is okay too. Sorry for interrupting.

The commission also mentioned the period of six months. It is a long time since I read the report and I did not read it page for page at the time because it was large. The commission would not have set some sort of assessment test that stated six months was an accurate number. We are taking an arbitrary number from the commission and using it without any sort of assessment of what is considered unduly long or what is considered trauma.

We will hear from witnesses in this afternoon's session. I have explored trauma for a long time. We know there are different types of trauma. There is big trauma caused by a one-off event. That can happen in the space of five minutes, not six months. There are also little traumas caused by the consistent, everyday chipping away at somebody's sense of safety and what that means in the world. The idea that it is in any way related to childhood trauma is premised on a shaky bed of accuracy. Trauma can be caused by a one-off event. One can witness an accident. A child could have witnessed violence against her mother in the first month or two of life and heard the mother wailing beside her every night. There are many things that can happen in a moment that have nothing to do with a point in time. I struggle with the six months and the designation as unduly long and that type of thing. It does not make sense when we consider the trauma piece.

We know many records have been falsified. What types of hoops are we going to put mothers through in terms of them proving they were in for six months? We know that not every piece of documentation we have is accurate. How do we know the information we have is true with regard to the six months?

Ms Laura McGarrigle

I thank the Senator. I have one point to come back on there. In the case of mothers, I will clarify that a mother who spent any period of time, even one night, in a mother and baby or county home institution will qualify for a financial payment under the scheme.

That mother's child bore witness to the mother's trauma rather than having it inflicted on himself or herself.

Ms Laura McGarrigle

Of course. With regard to the records, the intention behind this scheme is to create a scheme that is as non-adversarial as possible, does not retraumatise and has a very low burden of proof. The work of the IDG strongly recommended that approach. An awful lot of effort was put into that. Aligned with that is the idea that a person should be able to rely on qualifying for a payment solely based on residency. In the majority of cases, we consider records should be there and should give admission and discharge or departure dates for people. However, the scheme will also allow for people to submit sworn affidavits. There will be rights of review and independent appeals mechanisms within it where somebody has concerns that the records are inadequate or inaccurate.

I echo my colleagues' concerns about that six-month period. If an unborn child is in utero and the mother is in one of those settings, is that period counted? There is a lot of research that shows there will be effects if a mother is not properly nourished and stressed. I note that many of the women concerned carried out commercial work without pay. Another way of putting that would be that they were engaged in slave labour. If a woman is engaged in slave labour and is pregnant and stressed out, and knows there is going to be a negative outcome, that is going to have serious implications for the development of the child in utero. There is a long-established body of research that shows the negative consequences and outcomes.

Does that period of time apply to children? Does the legislation include that time or does it start to apply from the date of birth?

I wish to echo Deputy Ward's question and hope that Ms McGarrigle will answer this time. Did the Department or Government use expert advice to address these kinds of questions? This matter occurs to me as a parent without any qualifications in the area. In a previous life I was a primary schoolteacher, so I know that a lot of our major software as human beings is installed in utero or in the first 72 hours. If a mother experiences a trauma during that early period, it can have profound and life-altering or life-limiting consequences on the individual. I think that the six-month cut-off point is arbitrary and idiosyncratic. Is it based on evidence? If so, who supplied the evidence? Will the Department take into account whether the child was there with the mother while she was pregnant? Will that time be counted? Finally, what expert inputs were used to arrive at these arbitrary cut-off points?

Ms Laura McGarrigle

On the question about taking account of the period when the child was in utero, the policy proposals that were developed and the general scheme do not provide for that time to be taken into account in terms of the six months, including the period before the birth of the child.

On expert advice, the IDG considered whether there was a specific question that it could put to an expert in trauma in order to assist in its deliberations. At the same time, and it was a point that the IDG considered very carefully as part of its deliberations, the IDG listened to feedback from stakeholders and looked at national and international evidence that talked about a scheme that would be non-adversarial and kind in approach and would not be grounded in people having to relive their trauma and provide evidence of abuse. All of this caused the IDG to propose very strongly the general payment approach that would provide for a single common experience payment, grounded in the length of stay, as a way of recognising these harsh institutional experiences without requiring people to bring forward evidence of abuse. The IDG did not look to bring in experts that would speak to individual trauma at the level of designing an individualised approach. Again, it was very mindful not to disregard in any way the experience of children who were in a mother and baby home for fewer than six months, and instead to recognise counselling support and access to records as key measures that would respond to needs that the IDG understood had been raised as priority needs in that regard.

May I respond?

Time is tight but I may let the Senator back in after Deputy Murnane O'Connor.

Please forgive me for asking but this is my first time to be a member of a committee.

The Senator is very good.

My concerns are the same as previous speakers. We must remember that this process has been very painful for survivors. I feel strongly about the fact that survivors are getting older, so timing is of the utmost importance. The longer this matter goes on, the longer people will have to wait and the harder it is on them because they must constantly fight a battle, which is unfair to them. We must be very aware of our timing on this matter.

I, too, am concerned about the six-month period and feel that it is unfair. We must be very mindful that a day or a week is very hard for survivors. I ask that the committee considers this matter. The Minister has explained the matter and Ms McGarrigle has explained it just now. Like others, we have spoken to survivors. Nothing can repay the heartache that they have experienced. The Government has provided a good bit of money and we must be mindful of survivors.

At one stage an interim payment of €10,000 or €15,000 was spoken about. Perhaps that proposal should be examined again because survivors are getting older. The provision of an enhanced medical card to survivors is the most important thing we can do.

Earlier the assistant Secretary General mentioned counselling and I welcome that. I believe we should provide counselling to families because so many survivors and their survivors have been affected. I emphasise that families feel stress every day when they talk to their mothers. These experiences have been very hard on survivors and their families. I ask the Department to recognise the need to provide supports and counselling to families.

There is another issue that arose when we spoke about the redress scheme. People raised with me the need for the application process to be as simple, clear and transparent as possible. That is an important aspect for survivors too.

Another important issue that has been raised is the need to provide an advocate, social worker or adviser to assist survivors in liaising with the Department. Another area that arose when I met survivors, and I am involved with survivors in my own area, is regional and local accessibility. Both of these aspects must be addressed. I feel that issues have arisen that we can try to sort out. If survivors are watching this debate, I am sure it has not been easy for them. All of us have been really affected by the stories we have heard.

Ms Laura McGarrigle

My colleagues and I will do our best to answer all of the questions.

Ms Laura McGarrigle

I will start by answering the questions about getting the scheme up and running. Then I will explain how it runs, respond to the timing question and speak about having a scheme that is simple, clear and transparent. I will also answer the question on the interim payment.

It is the firm intention of the Minister to establish the scheme as quickly as possible but that depends on the passage of this legislation. That is one of the factors behind the IDG's recommendation that we establish an executive office where we can do an awful lot more work in parallel than if an agency were to be created, which would take a longer lead-in time to establish. It would take time to establish all of the ancillary infrastructure that an agency would need, which is not needed in a Department as it can start to leverage existing ICT, human resources, etc.

I confirm that there is a commitment to establish the scheme as quickly as possible. The Deputy mentioned the need for a firm commitment. That is something that came through strongly in the consultation with survivors and stakeholders, and it was a key concern of the IDG. The IDG recommended that the scheme be as clear, transparent, simple and user-friendly as possible so that entitlements would be very clear. Again, that is the idea - the general approach would be one where it is very clear to applicants that the payment is based on the length of time a person was a resident. One would know that if one were a resident, one would have a good degree of certainty in terms of applying to the scheme and qualifying for benefits versus having to bring forward a burden of proof. Obviously that is also a much more straightforward and efficient type of scheme to run than one that would require individual engagement with people having to bring forward evidence, which would have the potential to have a traumatising effect. There is also the question of the length of time such a process would take. These aspects are very much reflected in the intention of putting together this general scheme and in the work that the team is undertaking at the moment to prepare the infrastructure to deliver the scheme.

We appreciate that people are very keen for an interim payment to be made. Also, it is very important that the scheme is opened up as quickly as possible.

A practical challenge is that because the scheme is already designed to provide one payment, which is based as simply as possible on residence, it is not apparent how we would make an interim payment in any faster way, particularly because we require the same infrastructure to make the payment. Therefore, we need the IT system and the human resources in place to make the interim payment in the same way we would need it to make the full payment. The scale of this scheme is way in excess of any other of its kind the State has ever administered in terms of the anticipated 34,000 applicants at an estimated cost of €800 million. With the expected number of applicants, the scheme is the largest of its kind in the history of the State. We need a legislative basis for access to records and data sharing. For those reasons, unfortunately, we cannot see how we can move any faster because we need those core blocks to make any form of payment but we are committed to wanting to do this as quickly as possible in the interests of survivors.

The Deputy mentioned advocacy and support for people making applications. Action 1, which is a measure that sits within a much broader Government response and a suite of measures to respond to the needs and concerns of survivors and to recognise the wrong that was done and the suffering, is the creation of enhanced stakeholder engagement mechanisms. We are currently working on proposals for a new form of advocate model that would enhance the level of advocacy support provided in this space. That is something we hope to progress alongside progressing this scheme as well as ensuring existing mechanisms can be supported.

The Deputy mentioned the fact that nothing can repay what has happened to people. That point, absolutely, was very much recognised in the work of the IDG. It is so sad but, sadly, we cannot give back what was taken away. We cannot hope to compensate. Therefore, this scheme, as part of the broader action plan, is an attempt to acknowledge, recognise and make amends for the suffering and wrong but recognising that no money can compensate and it does not attempt to do so. It attempts to recognise and acknowledge.

The Deputy also mentioned counselling for families. The commitments made and the supports put in place to date for counselling services and prioritised access are for survivors and former residents. There is not anything specific that has been put in place for families.

Ms McGarrigle might consider that or talk to the Minister about it. It is important that families would have the option to go for counselling. It is very hard on all of them. Ms McGarrigle might look into that.

Ms Laura McGarrigle

We can certainly look at that and discuss it with the Minister.

Did Senator Clonan want to add a comment?

I would make a brief observation and it is in no way intended to be a personal one. It is just part of the discussion and the dialogue. I am just concerned about an aspect of this matter. The length of time spent at the site of the trauma does not correlate in any way with the outcomes of the trauma. Trauma is an inevitable organic and automatic consequence of being in the wrong place at the wrong time but there is no evidence whatsoever that its depth equates to the length of time spent at that place. There cannot be a quantitative measure of the manner in which trauma is inflicted. It is a qualitative, experiential phenomenological event in someone’s life. If one is exposed to those circumstances, one automatically qualifies irrespective of the length of time. That is evidence based.

The other thing I am concerned about is the arbitrary decision to disregard or exclude time spent in utero. Again, this is not evidence based. It is not an intellectual position. There has been an a priori assumption that we are just not going to consider that. I would reference those two factors taken together. I point to the absence of an evidence basis leading to an arbitrary, unnecessary and cruel distinction between categories of survivors based on six months, one day or three months in residence. Given that we will spend so much money on this scheme as a republic, is it possible at any stage in the process to reverse or remove that provision? I do not know if that can be done or if it is something we would have to revisit. I would be concerned about that.

Regarding the expert advice that was consulted, without naming those experts what were their disciplines or their professional formation? How could they be replied upon to have arrived at those conclusions when to me as a layperson it is quite clear? I have published on trauma as an academic but the approach being pursued in this instance seems very clearly not to be evidence based. I am curious to know what was discipline area or the professional formation of the experts the Department consulted in drafting these arbitrary timeframes of six months, one day etc.

Ms Laura McGarrigle

I apologise if my earlier answer was not clear. When I referenced national and international evidence earlier, it was not with respect to an individual psychiatrist or psychologist coming in and speaking to us. I was referring to evidence we gained from taking learnings from other schemes within this jurisdiction and in other jurisdictions. One example the IDG would have thought interesting in terms of learning, which is referenced in its published report, was the Australian stolen generation scheme. We would have examined it with respect to learnings from the perspective of the best way to construct a scheme that would deliver for survivors in a way that would not retraumatise and that would do no harm. The principle of "do no harm" was a key point put to us by the Irish Human Rights and Equality Commission, IHREC.

The stolen generation scheme would have started out with individualised payments that might have been set based on trauma and abuse. The individual assessor reported to the Australian Government and recommended moving away from that model to a common experience payment for a couple of reasons. First, he felt that he was being asked to make individualised judgments that were subjective in nature. He thought this could lead to unfair judgments as he was trying to gauge one person’s level of suffering and trauma vis-à-vis another in making these individualised assessments. He was also worried that it was deeply retraumatising for the individuals affected and it was causing them to feel let down by the process and feel retraumatised. There was a concern among advocates in Australia that it was also proving to be a more divisive approach. For that reason, the scheme in Australia moved to a common experience model instead.

When I referred to the evidence, it was evidence of that level that was informing the IDG when it recommended that in putting parameters around the scheme, the general approach of the scheme would be one that would be non-adversarial and grounded in a common experience payment based on residency. Within that, there is a length of residency scale. The rationale for that, which the IDG put forward, was that the longer the length of stay, the longer one endured the harsh conditions, particularly noting the harshest conditions were associated with longer lengths of stay in earlier decades of the State when conditions, particularly in county homes or in Tuam, were really appalling. It recognised that this is a scheme on an unprecedented scale that takes account of survivors coming from many different institutions over a span of many decades. If we look at the commission, we see that this was across eight decades. The age range of survivors spans quite a number of decades. It is quite a broad demographic as well. I hope that helps to answer the Senator's question and I apologise if my previous answer was not clear.

It does. It does not allay my concerns but it is very clear what the rationale was. I thank Ms McGarrigle for that.

Does Senator Ruane want to come back in?

I have two further technical questions about the heads of the Bill.

On heads 3 and 6, the role of the Minister for Public Expenditure and Reform seems to be dominant here given that decisions are primarily sanctioned by that Minister. While the role of the Minister for Public Expenditure and Reform is obviously relevant given the financial implications, there is a concern that the Department of Public Expenditure and Reform will essentially write off payments subject to budgetary availability. Is that accurate? I ask for clarity and assurances from the Department of Health in this regard. In regard to the enhanced medical card scheme and the €3,000 once-off payment in lieu for those living abroad, has a budget been allocated and ring-fenced for that scheme? If so, what is it?

Ms Laura McGarrigle

I will give an initial answer and my colleague will then respond if more detail can be provided. The interdepartmental group prepared detailed and costed proposals which the Minister brought forward to Government. In approving the proposals for the scheme the Government has approved the overall expenditure associated with the scheme, which is estimated at €800 million over its life-cycle. That has been approved by the Government and it is recognised that this funding has to be provided to deliver the scheme. Heads 3 and 6 are standard provisions which acknowledge that, in setting matters such as expenses and the annual allocations, the relevant Ministers would always have to consult, and obtain the agreement of, the Minister for Public Expenditure and Reform. They are standard legislative provisions, as is the intention here, that marry with our standard processes around the Estimates and budgetary process. There is upfront approval for the proposals and their cost. This includes the cost of a medical card for everyone who is entitled to one, which will have to be met through the scheme.

In regard to Schedule 1, which is subject to the consent of the Minister for Public Expenditure and Reform, we know from deliberations on both the Institutional Burials Bill 2022 and the Birth Information and Tracing Bill 2022 that the number of institutions confined in this Bill does not represent the real number of mother and baby homes. It is of concern that the Minister for Public Expenditure and Reform would have a say simply reflecting the prevalence of the institutions but also potentially hindering a victim's access to compensation and restorative justice. Ms McGarrigle's statement that this is a standard legislative provision answers my question to some extent. However, apart from the standard budgetary allocation, does the Minister for Public Expenditure and Reform have any say in terms of determining institutions and relevance?

Ms Laura McGarrigle

It would be for the relevant Minister, in this case, the Minister for Children, Equality, Disability, Integration and Youth, to bring forward a proposal that an institution should be added to the Schedule because it meets the criteria.

It is a matter of meeting the criteria and is not connected with the budget allocation.

Ms Laura McGarrigle

It would be that it meets the criteria. The heads of Bill provide that the Minister would obtain the consent of the Minister for Public Expenditure and Reform to add the institution. However, the Minister for Children, Equality, Disability, Integration and Youth should be able to make that case and obtain that consent by showing that the institution meets the criteria outlined in the head. As such, it would be comparable and equity would determine that.

I thank Ms McGarrigle.

Senator O'Sullivan is online. If he intends asking questions, will he confirm that he is in Leinster House?

I am in Leinster House but I do not have a question at this time.

I have a question or two. The enhanced medical card is one of the key features. The six-month cut-off point is a major issue but previous speakers raised that matter, so I will not do so again. What is actually covered by an enhanced medical card? A number of women have asked me that question. Some were left to give birth in horrific circumstances which resulted in lifelong medical conditions. That can be very personal for people. I hate that people have to tell that story in order to get any help. It is a very difficult thing to do. What is covered by the enhanced medical card? We all know how much pressure the health system is under. A medical card will only be of significant benefit if it enables people to access services or operations for which they may have been waiting for a number of years.

On the payment of €3,000 for those living abroad, how was that figure arrived at? Similarly, how were the other figures of €12,500 for those who were resident for up to six months and €5,000 for those who were resident for at least six months decided? How many people who were born in one of these institutions stayed for less than six months and how many stayed for more than six months? With all due respect, it seems to people who are following this process and those affected by it that it is coming down to numbers. Obviously, it appears that a larger number of people were born in institutions and stayed for less than six months. Is there information on that?

Ms Laura McGarrigle

I thank the Chair. In regard to the enhanced medical card and what it provides, head 20 sets out the legislative explanation of what it provides, namely, access to GP services and public acute hospital services, without charge in both cases, access to drugs, medicines, medical and surgical supplies, access to therapies, home help and nursing services, home nursing, and dental, ophthalmic and aural services. Counselling is included just to give it a statutory basis but acknowledging it is already provided outside of this legislation. Access to chiropody and physiotherapy is also provided. The Bill provides access to therapies, GP, acute inpatient services, without charge; access to drugs, medicines, aids and appliances, without charge; and access to dental, aural and ophthalmic services.

Separately, it is worth mentioning that another one of the actions in the action plan is a commitment to further health research to identify whether any further health needs exist in the population of survivors and former residents of mother and baby homes that would need to be captured in any future review or update of services provided to survivors or as part of this enhanced medical card. That commitment is also in place. I hope I have answered the Chairman question but I ask her to let me know if she needs more detail on any aspect.

In regard to the €3,000 payment, this was difficult for the interdepartmental group to grapple with because in January 2021 the Government agreed the commitment to an enhanced medical card for everyone with a length of stay of more than six months in a mother and baby or county home institution. Everybody qualifies for that enhanced medical card but of course it is of limited value to those living overseas unless they spend significant periods in Ireland or move back to Ireland. The €3,000 health support payment is an attempt to acknowledge that reality for the individuals affected. It acknowledges that the Irish State cannot legislate for the provision of health services in other jurisdictions. The reality is that health systems can be very different between jurisdictions and health needs can differ from survivor to survivor. It is accepted that there is no easy answer. The interdepartmental group grappled with this but the health support payment is an attempt to acknowledge the circumstances of those survivors.

In regard to payment rates, as mentioned, the interdepartmental group acknowledged that the payment scheme could not possibly compensate for what was lost and the suffering endured by people. It is just one in a range of measures designed to recognise and acknowledge the suffering but it cannot hope to compensate for it. The group recognised that.

It also decided that the recommended approach to the payment was this general, common experience payment grounded in the non-adversarial approach. In that regard, in terms of looking at something that might be in some way comparable, the IDG noted the payment approach and rates used in the Magdalen restorative justice scheme whereby a schedule of rates was recommended by Mr. Justice Quirke recognising periods of time in institutions with harsh conditions. The IDG would have had regard to that in setting the rates.

Ms Caitríona O'Connor

There was a question about numbers. The number of people with residency over six months is 19,000. There is an additional 15,000 mothers who have a period of time under six months and 24,000 children with a period of time under six months. The total number we estimate of those who are surviving and have spent time in one of these institutions is just over 58,000.

Ms Laura McGarrigle

It might be helpful to mention as well that the IDG wanted to give Government as much information as possible. In its published report it set out a range of costed options based on the numbers Ms O'Connor has just mentioned, namely the overall 58,000 estimated survivors and the 19,000 with a length of stay of more than six months, and various options in that space.

On the health aspect, that would mean people going on to the existing public list, I imagine. I am conscious that a lot of people really struggled to maintain employment because of their experiences and are in a situation now where they are really in need of certain medical treatments. If they are going on to an existing public system that we all know is creaking at the seams, it will be very difficult. Given that this is the prelegislative stage and we are probably hoping to make some changes, it might difficult to look at each case individually but I am thinking of people I know who are waiting for a hip operation or knee replacement, things like that. Would it be better to look at the individual needs rather than just providing this enhanced medical card? It sounds great but the reality is that they are going onto a system that could already have a three or four-year waiting list. They could even be on those waiting lists already.

Ms Laura McGarrigle

Absolutely. It is there in the report that the IDG was acknowledging the reality that the more the Government might expand access to services, potentially the flip side of that could be that those who need the services most could find themselves delayed. The IDG acknowledges that this could be a dynamic that has to be grappled with in policy terms. Given the scale of this scheme with 19,000 people with length of stay of over six months, and the fact that the commission had recommended that Government consider providing for those with health needs, it was considered that the enhanced medical card was a way of giving a level of assurance of guaranteed access to statutory services. The statutory entitlement would support a guarantee of access to therapy and home help services. Beyond that, going on an individual case basis would probably require that the public health system be able to triage access to acute hospital services based on need in terms of public lists.

I thank the witnesses for coming here and answering our questions. Is it agreed to publish the opening statements to the Oireachtas website? Agreed. I am going to suspend the meeting for five or ten minutes to allow the second set of witnesses to come in.

Sitting suspended at 3.55 p.m. and resumed at 4.08 p.m.

We will continue with our second session of pre-legislative scrutiny of the general scheme of the mother and baby institutions payments scheme Bill. In this session we are joined by representatives of Oak Conflict Dynamics, namely, Ms Mary Lou O'Kennedy, director; and Ms Estelle Varney, facilitator. From Concordia Consulting, we are joined by Mr. Ray Flaherty, facilitator and managing director; and from Treehouse Practice we are joined by: Dr. Sara O'Byrne, principal clinical psychologist; Ms Alanna Donnelly, psychologist in clinical training; and Dr. Yvonne Quinn, clinical psychologist, who is joining us online. The witnesses are all welcome and this will be a good session for us on this topic.

For witnesses who are appearing remotely via MS Teams, they are reminded that there is uncertainty if parliamentary privilege will apply to their evidence from a location outside the parliamentary precincts of Leinster House. Therefore, if a witness is directed by me to cease giving evidence in relation to a particular matter, it is imperative he or she complies with any such direction. For witnesses who are participating from the committee room, they are reminded of the long-standing parliamentary practice to the effect that they should not criticise or make charges against any person or entity by name or in such a way as to make him, her or it identifiable, or otherwise engage in speech that might be regarded as damaging to the good name of the person or entity.

Therefore, if their statements are potentially defamatory in relation to an identifiable person or entity, they will be directed to discontinue their remarks. It is imperative they comply with any such direction.

We will begin with our guests' opening statements, to be followed by a questions and answers session with members.

My apologies if I have to leave the room to attend the Seanad Chamber for ten minutes or 15 minutes. I do not want our guests to think I am rude if I leave during their contributions. I will come straight back afterwards.

For the information of all present, the Birth Information and Tracing Bill, which is relevant to the committee, is currently being debated in the Seanad. There is a bit of a clash and Senators are trying to attend both sessions. That is the nature of these Houses, unfortunately. I thank Senator Ruane for her explanation. I invite Ms O'Kennedy to make her opening statement.

Ms Mary Lou O'Kennedy

Oak welcomes the opportunity to appear before the committee to discuss the provisions of the general scheme of the Bill We are thankful to the committee for extending to us the invitation to attend. We do so very much from the perspective of the 561 survivors who participated in the consultation process undertaken by us with them in March 2021. We acknowledge and thank all those who took the time to participate in the consultation process, which, for many, reopened painful memories and feelings.

In considering the provisions of the Bill, the greatest disparity we discern between the provisions of the Bill and the views of the survivors relates to eligibility. Survivors overwhelmingly asked for a universal common experience scheme that recognised all survivors, regardless of duration of time spent by them in the homes. However, eligibility for financial redress is provided for in the Bill for all mothers regardless of duration of residence, but only for survivors who, as children, spent more than six months in the homes. The Bill also uses duration of stay as a determinant for eligibility for an enhanced medical card for both mothers and children and, similarly, it will be provided only to those who spent more than six months in a home.

The survivors described the nature of the harms they experienced for which reparation is needed. The Bill provides for a general payment of redress for unspecified harm, trauma, discrimination and stigma experienced by mothers and children while resident in the homes. The survivors, however, identified at least 17 different harms suffered by them, many of which have lifelong negative consequences. The primary harm described by them is the involuntary loss of the mother-child bond they suffered, but this is not recognised in the Bill.

Similarly, when considering financial recognition, survivors believed that a universal common experience payment was the most suitable form of redress, but with an additional 12 categories of claim identified, and that an initial interim payment of €15,000, on average, should be paid immediately. The Bill provides a general payment starting at €5,000 for mothers who were resident for up to three months and €12,500 for children resident for at least six months, with only two additional categories of claim, which are confined to lengths of stay in the homes and periods of work in excess of three months undertaken by mothers or pregnant women without pay.

The survivors stressed the importance of a human rights-based approach to the design of the scheme and, in particular, the need for accountability, truth-telling, identification of harm, participation, inclusion, equality, apology and restorative justice, all of which provide greater opportunity for healing. The eligibility and financial payments provisions of the Bill are, however, evidently based on a rights-based approach, operating within the current statutory framework of entitlements and, in particular, those applying to the residential institutions redress scheme and the Magdalen restorative justice ex gratia scheme, which, similar to what is recommended for this mother and baby home scheme, comprises a general payment based on length of stay and a work-type payment rather than on the particular human rights violations and common experience of harms particular to the mother and baby homes survivors, the main defining feature of which is the loss of the mother-child bond they suffered. Nowhere in the Bill or the general scheme is this recognised.

Other key concerns identified by the survivors that are not provided for in the Bill are listed in my written submission. In light of the time constraints, I emphasise in particular the option of financial payment by lump sum, periodic payments or enhanced pension payments and the provision of trauma-informed counselling or psychotherapy beyond that of the counselling services currently provided by the HSE national counselling service for survivors and their family members. There should be provision for a medical card equivalent to that granted under the Health (Amendment) Act 1996, as well as supports additional to those provided for in the Bill.

As regards the application, delivery of the scheme should be by trauma-trained and experienced staff. In terms of administration, a personal liaison advocate, social worker or adviser should be available to assist each individual with applications and to provide the necessary emotional and practical support they need. There should be no cut-off date or period for the duration of the scheme because many survivors do not have access to records and may not be aware of the circumstances of their birth. As such, it may take time for them to become aware of their eligibility for the scheme.

Our written submission provides summary tables of all of the key requests made by the survivors and the extent to which these are provided for in the Bill, with a commentary on each. Although our opening statement focuses on the issues not provided for within the Bill as it currently stands, that is not to ignore the amount of work and attention by the Department in the context of providing for the needs of the survivors. We make our observations with the intention of continuing to represent the needs of the survivors as expressed by them in a way that will enhance the scheme. I thank the committee for the opportunity to appear and for listening to my statement.

I thank Ms O'Kennedy. We will move to Dr. O'Byrne.

Dr. Sara O'Byrne

I thank the Chairman and members for the opportunity to meet with them today. I am a clinical psychologist working with young people who have experienced trauma and adversity, within a specialist setting. I welcome the opportunity to disseminate information in respect of research and best practice and to have this knowledge, in turn, shape and influence thinking in respect of the mother and baby home institutions payment scheme.

The committee may be aware that I was prompted to make contact with the Minister, Deputy O'Gorman, in respect of the scheme in November 2021. I, alongside co-signatories across disciplines working in the area of trauma, raised concerns regarding the current iteration of the scheme. These concerns stemmed from a knowledge base in respect of the impact of early trauma and its consequences throughout the lifespan, as well as the exclusion of certain cohorts of individuals from the scheme. In considering the impact from the perspective of early childhood trauma, this is not to negate the profound experience for the mother. We know it has been a profoundly harmful experience for many women to have given birth and resided in a mother and baby home. Indeed, we cannot separate maternal experiences from babies' experiences, given how important and intertwined the relationships are.

Donald Winnicott, one of the earliest proponents of developmental psychology in the early 1900s, stated, "There is no such thing as a baby. There is a baby and someone." Babies are born helpless and utterly dependent on another for survival. The context into which babies are born matters, as does the pre-birth context. Experiences are required to shape the potential of the child. The brain has a timetable for development, if you like, with different areas developing at different stages. Disruptions of experiences at different stages can lead to deficits in later development. For example, high maternal levels of cortisol, a stress hormone, during pregnancy will influence functions controlled by the brainstem for children, such as sensory processing, sleep, feeding and physiological functions such as cardiovascular and temperature regulation. When we reflect on pervasive experiences of shame, stress and trauma that are at the heart of the many stories women have told of their experiences in mother and baby home institutions, we would naturally expect higher levels of stress during pregnancy as a result.

Of course, their babies, who are now adults, will not be able to narrate their experiences, but many children born in mother and baby home institutions will experience sensory and physiological difficulties well into adulthood.

Apart from the impact of in utero and birth experiences, we must also consider what babies need after birth. Babies need to be rocked, held, soothed and comforted in predictable and safe ways for optimal relational growth to happen. They need caregivers who themselves are psychologically well and have a sense of safety to adequately care for and meet the needs of their babies. Infancy is a crucial period for attachment, in which the brain organises around expectations of safety and comfort within relationships. Daily experiences of caregiving shape the child’s later attachment system. Good enough caregiving, by which I mean attuned, present and responsive care, enables the baby to learn that the adults and the world are safe and predictable. The converse is also true. If babies are not responded to in a way that promotes safety and care, they learn to organise their own behaviour and emotions to respond to an unpredictable, unsafe or sometimes frightening environment. As such, they learn that others are not reliable and trustworthy to meet their needs. Institutional environments such as the mother and baby homes are suboptimal and indeed often harmful environments for relational growth. Thus, babies who have been raised in institutional settings are less likely to present with security of attachment and more likely to have developed strategies such as inhibition and suppression of emotional needs by withdrawing or exaggeration of emotional responses in order to have their needs met. Without intervention, these patterns tend to persist into childhood and, indeed, adulthood, and form the bedrock for all subsequent relationships.

It was only in the 1990s that we began to look at the impact of separation of mother and baby soon after birth on later development, something Nancy Verrier called the “primal wound”. She reflected that early separation can lead to profound experiences of loss, mistrust and difficulties in relationships with others later in life. Yet in many ways, the impact of this separation is often denied. The assumption is that babies do not remember, and therefore this does not matter. Of course, we know that the process of moving from one caregiver to another, such as through adoption, which was often an outcome for children born in these institutions, is a profoundly stressful one, even if the environment is ultimately an enriching and positive one. All of these experiences of separation and loss leave a lasting mark and shape how those who have experienced them navigate all future relationships.

To conclude, the message from research on childhood trauma is clear. The earlier the impact of trauma, the more pervasive and long-lasting the consequences. This is due to the rapid nature of brain growth and development at this time and the crucial nature of experiences to shape brain functioning and attachment. Impact is not time-dependent, but rather is related to the nature and quality of experiences and how these shaped later development. All who passed through mother and baby homes have been affected and these experiences will have shaped and influenced childhood and adult development. Indeed, we know that adults who experienced childhood trauma are much more predisposed to a range of both physical and mental health needs in adulthood, not to mention relational difficulties.

Recovery from early trauma is possible with the right ingredients. These are acknowledgement of harm, provision of tailored therapeutic supports, love and validation of experiences. We need to look towards the future while also orienting to the past, and recognise the harms caused by inadequate care to mothers and babies. Rupture and repair is at the heart of all good relationships. This Bill offers the potential to be a moment of repair in the lives of generations of families who were and continue to be impacted by the mother and baby homes. It can serve as an act of validation of people’s lived experiences and support genuine recovery, but revisions will be required to encapsulate all of those affected, not just some.

Both group’s contributions are invaluable in terms of our scrutiny of this Bill. We will move on to questions.

I thank the witnesses for their contributions. I have five minutes and I will split it between both groups. My first question is for Dr. O’Byrne and relates to a remark she made at the end of her opening statement:

All who passed through mother and baby homes have been affected and these experiences will have shaped and influenced childhood and adult development.

Could their lives be shaped by childhood trauma, irrespective of whether a child spent one day, six months or longer in an institution? In the last session we had, the Department used the term "unduly affected". Can "unduly affected" be put into a timeframe?

Dr. Sara O'Byrne

The simple answer is that we cannot break down experiences into a quantum of time. Regardless of whether we are talking about someone who spent a day or someone who spent six months in a mother and baby home, the impact is still relevant and applicable. It is not about the time which someone spent in one of these homes; it is about the quality and nature of the experiences there. Indeed, children who experienced this at six months or younger are arguably the most affected because of the experiences around brain development and growth at that time. It is not true to say that we can break it down in terms of timeframe being used as a measure of impact.

On the unduly influenced piece, it is important to recognise that experiences will manifest in different ways for different people. How do we measure that? For example, we will have people who will have physiological or sensory experiences which are hard to quantify. We will have others, who will be quite rare, who will be able to narrate and recall their experiences. Both are equally valid in terms of impact. That is important to note. It is not the quantum of time.

I apologise for interrupting. There is a vote in the Seanad, just so members know.

Dr. O’Byrne mentioned validation. Would she see access to redress as part of the validation that people need?

Dr. Sara O'Byrne

There are a few parts to it, including an acknowledgement of harm and an apology by way of acknowledging that harm. One of the most difficult things for some people who have come through this scheme and put forth their views is the sense that perhaps those experience have not been heard or validated in an adequate way. That is really important in terms of repair. It is a question of the acknowledgement that what happened was harmful and has had an impact.

I will rephrase that a bit. Would being rejected from the redress scheme impact somebody’s validations and their feelings of being heard? For example, if they are not in the scheme because they were in a home for less than six months, would that impact on validation?

Dr. Sara O'Byrne

I thank the Deputy for rephrasing that. Yes, absolutely. That is a very good point. If somebody is left out of this scheme, obviously that is not a validation of the experiences of that person or that group of people, and that has the potential to be harmful.

My second question is to Ms Mary Lou O’Kennedy. I like the name like the Mary Lou, so I will ask Mary Lou. The Government is effectively telling some children that their separation and suffering is not worthy of compensation and telling women that their suffering could be worth as little as €5,000. What would a universal common experience scheme look like? Can Ms O’Kennedy expand on her call for an additional 12 categories of claim to be considered?

Ms Mary Lou O'Kennedy

I can tell the Deputy what the survivors expressed to us. The overriding wish from them, as I said, was that it would be a common experience payment and there would not be a burden of proof on them to prove trauma or harms done. The kind of financial figure that was discussed for an interim payment - which would not be the totality of the payment, but an immediate interim payment - was estimated to be on average about €15,000. Other than that, there was much ambivalence by the survivors to put a figure on compensation because there was a sense that moneys would be seen as some form of compensation, and what they had experienced could not be compensated for. Figures went up to €200,000. People looked at what they could potentially seek as way of payment through the courts if they were to take a legal action around their experience. The amounts, I suppose, were not specific in the totality.

The kinds of harms that were referred to were extensive. There are 17 listed in the report: the loss of the mother-child relationship; the impact of psychological abuse that was suffered; the suffering inflicted as a consequence of a lack of proper vetting of family placements for children placed in the community; the damaging consequences of the withholding of personal information for mother and child survivors; the economic exploitation of work undertaken without payment, which was recognised; the suffering and harmful consequences of physical and-or sexual abuse in some of the placements and experiences of children; the impact of unspecified abuse or treatment; opportunities lost due to the lack of education, which has not been acknowledged; arbitrary detention and coercive control; the negative effects of stigma and discrimination, which have been recognised; greater harm experienced by those of mixed race; the suffering associated with the loss of the father, siblings and extended family relationships; the harm inflicted as a result of racial profiling and suppression of ethnic identity; health issues related to the lack of information or neglect; non-consensual participation in vaccine trials, which was a significant one; and the consequences of the loss of nationality and heritage.

There are so many impacts and harms experienced that the way it is set out in the Bill by comparison is so limited that it does not reflect the experience of the survivors.

I thank both sets of witnesses. That was very helpful.

I thank the witnesses. The following is for Dr. O'Byrne. I said at the earlier session that as a layperson I felt there was no correlation between length of time and significance of trauma. It must be disturbing for anybody with knowledge or expertise in the area that this rationale was in place. It seems a cruel and arbitrary time limit. I echo the question Deputy Ward put. I imagine that arbitrary distinction would have the potential to retraumatise somebody and cause further harm and hurt. In the previous session, they disregarded or refused to include the time for in utero people, all the evidence-based harm that can cause, including stress and everything, and the suboptimal lifelong outcomes associated with that. Does it have the capacity to retraumatise and cause harm?

Ms O'Kennedy's submission stated only four of the 17 harms identified by survivors were included. The involuntary separation of the mother and the removal of that bond was not included as a harm. Both of these things seem to fly in the face of expertise, evidence and even common sense. Will Ms O'Kennedy speak to what the motivation might have been? Is it an attempt to downplay or suppress what happened or, insofar as Ms O'Kennedy can answer such a question, is it about trying to save money? It seems to fly in the face of reason.

Ms Mary Lou O'Kennedy

It is not for me to interpret-----

Sorry, I should not have put her on the spot like that.

Ms Mary Lou O'Kennedy

It is not for me to interpret the will of those who designed the scheme, but I can refer to some references made in the proposals to the residential institutions redress scheme and the Magdalen laundries scheme. The latter scheme, in particular, used duration of stay and commercial work undertaken without payment as key criteria in assessing the claims. Those same criteria appear to be used in this scheme, so it appears the harms acknowledged are those for which precedent exists in previous schemes. That is my interpretation of why they are referenced in the proposals. For this to be a human rights-based and survivor-centred approach, which the Department was committed to ensuring, it would need to look at the specific harm inflicted on this group of survivors, which is different from the harms inflicted on Magdalen laundry survivors.

That is great. That makes sense. It is a deterministic, quantitative, paternalistic, measurable sort of thing. It is like they shy away from the qualitative, experiential element of being put in that awful situation and a mother knowing there will be negative consequences and seeing this happen to other people. It is unimaginable pain and torment. I thank Ms O'Kennedy.

Dr. Sara O'Byrne

What struck me into responding to the Bill was the lack of integration of research with policy. We know so much about brain development in utero and in early life that is absent from this Bill in terms of an understanding of the impact. That is important to state. For example, traumatic memories pre-verbally are encoded and stored differently from verbal memories. We need to know that and all these things in terms of design of treatments, interventions and knowing the likely impact. We may not see psychological needs in a clear way but we may see many physical symptoms. We may see people who really struggle with regulation of their sensory systems. That is a clear impact. It is an example of where the research needs to come in to inform policy and practice. That is what we hope to contribute.

It speaks to speaking the truth and naming the harm. I thank the witnesses.

I thank the witnesses. It has been hard for everyone, especially survivors. This seems to be going on and on and I have said it to the Department. Timing is crucial now. The survivors are not getting any younger. We as a committee have a duty of care. It is important we get this through as soon as possible and that there is a balance that survivors are happy with.

We spoke about enhanced medical cards. Ms O'Kennedy, who is only the second Mary Lou I know, spoke in her opening statement about having interviewed 561 survivors, for whom the enhanced medical card is a big issue. We need to make sure we work on this. Clarification of it is so important. What stood out for me in Ms O'Kennedy's opening statement was the reference to the primary harm of the loss of the mother-child bond. As a mother, I see where that statement is coming from. The witnesses will have heard all the stories, as we as a committee have, from the survivors, and we are all heartbroken. If Ms O'Kennedy had to pick two or three key messages or issues the Department should look at, what would they be?

We spoke about counselling for survivors but also I spoke about counselling for family members, and it is in Ms O'Kennedy's report. That will be important and we need to address it. I have gone through what Ms O'Kennedy wrote from her report and her work has been excellent. She spoke about survivors wanting assistance from an advocate or social worker, and these are things that should be developed. The Department said to us today it is an €800 million funding scheme. We have to make sure the scheme is there for survivors and families that have been really affected. Will Ms O'Kennedy come back to me on those?

Dr. O'Byrne, in her opening statement, stated that mother and baby homes have been "a profoundly harmful experience for many women ... Indeed, we cannot separate maternal experiences from babies’ experiences, given how important and intertwined the relationships are". That is so important. We can never make anything right but we can try. Dr. O'Byrne went on to say, "This Bill offers the potential to be a moment of repair in the lives of generations of families who were and continue to be impacted by the mother and baby homes."

This is very important. I thank the witnesses for their excellent work. This has been very touching for us. We know that what is in this is important and we need to do our best to see what we can do.

Ms Mary Lou O'Kennedy

With regard to the three things survivors would want to see, I will have to go back to what they have expressed. The overriding issue is the use of the duration of stay of children as a criterion for the medical card. Many of the medical issues that arose for women happened at the point of birth. As has been explained to us today, the impact on children starts prior to birth. This is the primary issue. The survivors also expressed the harm that would be done if different groups were identified groups over others. This would be divisive to their community. They took great solidarity from being together in the consultations. Solidarity among the survivor community is very important to them. This is another reason the six-month cut-off is very problematic. It is divisive and could be damaging in this way.

Trauma-informed counselling is another issue. It was referred to again and again as one of the overriding needs that survivors requested. The HSE counselling service was not designed to work with trauma at this level. The focus on having trauma-trained staff and an informed process in the administration was deemed to be equally as important in this respect.

The other item I would speak about is providing emotional support and administrative support to applicants by way of a personal advocate or personal case worker. Many of the survivors have simply expressed a need for this type of assistance in going through the bureaucratic application process. Although it will be simple, nonetheless they need emotional supports.

Paragraph 2.6 of the document submitted by Oak Conflict Dynamics states survivors stressed the importance of religious orders contributing financially.

Ms Mary Lou O'Kennedy

It comes back to accountability. Under a human rights approach it is very important that survivors are heard and once they are heard that accountability is given by those who are accountable. It would be a demonstration of the accountability of the religious orders.

Dr. Sara O'Byrne

We cannot press pause on people's development. The issues are live and happening as a result of earlier experiences. There is also intergenerational trauma and the impact of trauma across generations. This has been well-researched and it is known that if trauma is not repaired within a generation it has an opportunity to influence the next. It is certainly advisable and welcome that family members are included in this regard.

With regard to trauma-informed supports and interventions there are well-established principles on how to include survivors in the design of schemes. There should be a range of therapeutic options that fit the person's experience. Talking therapy will not be an option and will not be suitable for all survivors. In the scheme we will need approaches that are somatic or body-oriented in their approach. This is with regard to repairing the early trauma I spoke about. Having a range of options included in the schemes is advisable with regard to counselling.

I was also going to ask about trauma-informed supports. Part of the difficulty is that when people contact us as Deputies and Senators we direct them to the national helpline. I know there is no waiting time for those who are survivors of mother and baby institutions but often people will not engage in the process because they know it will not be of much benefit. It is a missed opportunity when people do want to reach out and go for counselling if this is the only service that is there. Do the witnesses want to say any more on this?

Will the representatives from Oak Conflict Dynamics speak about the consultations they have had on the medical card? We have spoken about this on a number of occasions. In the previous session I said many women, particularly because of how they were left to give birth in horrific circumstances, have had medical issues for their whole lives. I fear the enhanced medical card will not be what people think it will be if they are to join a public waiting system that is creaking at the seams. What feedback did the witnesses get on this? For many of the women I have come across it is a key issue.

Will Dr. Byrne speak more about the in utero experience? It is quite fascinating. Senator Clonan made the point in the first session that some of those in mother and baby institutions were sent there when they were three or four months pregnant. What are the potential impacts of this compared with somebody who was not in a mother and baby institution in utero? I find this quite interesting. It will be helpful for us if we are trying to look at changing the timeframes. We do not necessarily have the power to do this. We can make recommendations as a committee. It would be helpful for us to have heard some of the contributions.

Ms Mary Lou O'Kennedy

With regard to the enhanced medical card, the overwhelming issue is access and whether people would get access to healthcare. Medical card eligibility does not always mean access because there are waiting lists and all sorts of limitations at times. There were all sorts of suggestions around private healthcare being provided. The main card referenced by people was the Health (Amendment) Act medical card. This is the one they felt would be the most comprehensive. It would include many of the provisions already listed among those that have been put in place but with the addition of alternative therapies. Many of the women in particular are interested in alternative therapies, such as body work, and some of the other supports that would be available to them through that card but not through the one being recommended.

Extra practical supports were mentioned for fuel allowances and phone allowances. Things such as free genetic testing and health screening came up as a key issue because people do not know their family medical histories. There was also mention of services for genetic illnesses linked to ethnicity and addiction services. There is a range of needs. As comprehensive as possible health cover is what was asked for.

The need for trauma-informed counselling for the survivors and their family members cannot be overstated. It is not my field and I do not know how it would be put to the survivors in a way that would build trust in using the service and seeing it as something helpful to them. It would need to be designed specifically to their needs and not a generic counselling service. This is very much the feedback to us. The intergenerational aspect that has already been mentioned would also have to be considered under this.

Trauma-trained staff who would work with survivors in the administration and application process is something that was very much emphasised. It could probably go hand-in-hand with the advocate case worker support being put in place. They would feel that people providing support to them would understand their needs and could work with them with sensitivity. The word "kindness" has come up again and again in the consultation process. Kindness comes from understanding their needs and experience and being able to relate to it.

Dr. Sara O'Byrne

To address the question about the in utero experiences, what comes to mind is that we look at two aspects regardless of the developmental stage. These are the history of adversity and the history of relational health. If we consider these aspects in the context of pregnant women living in mother and baby home institutions, we would look at elements such as whether the mother was safe, was she harmed in any way and felt safe physically and psychologically. All those factors have an impact on the growing baby. Babies are tuned into their mothers' heartbeat rate. We know this from the type of beats that babies seek out after they are born. Babies are tuned into that heartbeat rate and it becomes soothing for them because they are used to it. Consideration must then be given to the impact of separation from an environment that has been familiar and soothing to the baby or that has been familiar post birth.

Turning to the history of relational health, this element would include consideration of whether the mother was shamed or isolated from family members or the community. All these relational health factors have an impact on the growth and development of the baby in turn, because that has been the environment in which the baby has been growing and developing. The baby's development will be impacted by that context. The parts of our brains developing in utero are the most impacted by such experiences. The brainstem is the oldest part of our brain, nearly fully formed when we are born, and that is what is responsible for our sensory and physiological regulation skills. This is where impacts will be observed in the cases of people who may be triggered by sensory experiences and who may have physical health needs down the line. Some of those needs can be traced back to in utero experiences and adversity outweighing relational health at those times.

This is fascinating and shows that, as has been said by many people, these experiences cannot be looked at in a set timeframe. It is necessary to consider these aspects in the context of the overall experience. So much research exists now in this area, even compared to when some of the Magdalen laundry schemes were designed. My next question is for Ms O'Kennedy. Are we potentially making a mistake by examining other schemes? This is not done intentionally, but sometimes existing schemes are examined to see if something similar might work. Obviously, however, this is a completely different set of circumstances. Perhaps this is an unfair question.

Ms Mary Lou O'Kennedy

Again, I will not answer this query from my personal perspective regarding whether such an endeavour might be a mistake. In the context of whether what is being proposed will meet the needs expressed by the survivors and address the harms they identified, it does not reflect those. The proposal does not reflect the harms particular to this group of survivors. This is a different group of people and they have had very different experiences from other groups of survivors of the Magdalen laundries or the residential institutions. This group of people has a different set of needs and a different set of harms to be addressed, and, therefore, this proposal does not reflect what the survivors told us were their experiences. There is a mismatch in this regard.

Additionally, when the Chair asked about health, there was an issue that was of concern for survivors living overseas. Significant numbers of these survivors live abroad. They asked that they be given access to health services overseas as well, at the equivalent level to that to be provided to survivors in Ireland. Sometimes, again, the solution to this request was seen to be covering the costs of those survivors' private health insurance overseas, because that would be the only way in which any sense of equivalency could be provided to them. This was another major concern expressed.

Does anyone else wish to contribute?

I have one question I meant to ask earlier but I did not get the time to do so. In the opening statement, it was mentioned that a key concern not provided for in this Bill is an independent board or panel to decide on claims. What would such a body look like and what concerns were raised in this regard by survivors?

Ms Mary Lou O'Kennedy

Concerns were raised regarding there being accountability and recognition and informed identification of harm. It was suggested that the panels should be made up of experts in the field who could make judgments. These could be people with trauma-informed knowledge and social policy experts with a range of expertise who would be able to assess claims in a fair and balanced way. Equally, concerns were expressed that such assessments be undertaken in a way that would allow testimonies to be part of the application process. People wanted a truth telling opportunity as an option, and not as a-----

Prerequisite. Okay.

Ms Mary Lou O'Kennedy

-----prerequisite to compensation. The survivors would like to be provided with that opportunity to testify, whether by oral, written or video-based means. That would allow the decision-making process to be one that would be accountable, transparent and informed.

Okay. I thank Ms O'Kennedy. I appreciate her response.

Does anyone else wish to add anything before we finish? This is the end of our questions.

Mr. Ray Flaherty

I have one comment. During one of our consultation sessions, one of the survivors said this group of people had been given a life sentence without parole. I cannot help but look at the six-month provision in that context and say this proposed legislation is actually suspending the first six months of the sentence. In effect, it is increasing the sentence by excluding people from the scheme. The comment struck me at the time it was uttered as being an extremely apt way of describing the situation. It is important to say this in the context of the six-month eligibility provision.

I thank Mr. Flaherty.

Ms Mary Lou O'Kennedy

I also wish to point out that a five-year duration was put on the scheme itself. It is important to remember that, as Mr. Flaherty told us that one survivor said, the consequences are lifelong. Provision in this regard should, therefore, be left open indefinitely for any survivors not aware of it during the period specified. I say that because many of the survivors are not part of networks and are not aware of the scheme. A great deal of outreach must be done, especially internationally, in a proactive way to ensure those survivors are made aware of this scheme. Before I came in here today, I spoke to someone in a different context entirely. He shared with me that his mother told him last year on her deathbed that she had had a baby in one of the mother and baby homes. Her son is now aged 50, and it is only now that he has become aware of what happened. Many of the survivors do not wish to talk about their experiences and have not shared accounts of what happened to them. For many of the survivors we spoke with, it was their first time sharing their stories and being in a group helped them. The solidarity we spoke about is so important. It is crucial, therefore, to remember that the legacy of these experiences continues to be felt by many people. There are impacts over lifetimes and intergenerationally. A five-year window does not seem to respond to that issue. This is something to be considered.

If no one else wishes to contribute, I thank all the witnesses sincerely for coming in and for their time. This has been very helpful to us before we draw up our report. I just need to get agreement from the members to publish the opening statements on the committee's website. Is that agreed? Agreed.

The joint committee adjourned at 4.58 p.m. sine die.