I am pleased to come before the House today to represent the Minister for Justice and Equality, Deputy Frances Fitzgerald, and present the Redress for Women Resident in Certain Institutions Bill 2014. The purpose of the Bill 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 also provides that the women concerned 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 Senators will be aware, the Bill is just one part of a wider package of supports for the women concerned. Before I go into detail about the Bill, I will outline the background to the legislation and other supports the Government is providing for the women concerned. In June 2011 it decided to set up an inquiry to establish the facts of State involvement with the Magdalen laundries. Former Senator Martin McAleese chaired the inquiry. His report of over 1,000 pages was published in February 2013. It is a very detailed, clear and objective exposition of the facts in regard to the ten Magdalen laundries. It found that just over 10,000 women had spent time in a Magdalen laundry since the founding of the State.
The manner in which the women concerned found themselves in Magdalen laundries varied greatly. There were a large number of referrals by the women themselves. There were also many referrals to Magdalen laundries made by families, priests or clergy, as well as the Society of St. Vincent de Paul, the Red Cross and Samaritans. In addition, 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 could in the past have led to daughters, sisters and mothers being placed in the laundries. It may be equally difficult to understand the apparent acceptance by families of instructions from people in positions of authority, particularly priests, in family matters.
The report further states it would be unfair to judge these cases or the people concerned by applying today's standards and societal norms. It points out that, because of the general life expectancy in society at the time, it was common for one or more parents of the girls or women to be deceased. The point needs to be made that many of these girls or women ended up in these institutions simply because they did not have any person in a position to look after them. The Magdalen laundries were, in many cases, used as a temporary measure in the absence of more appropriate services which simply were not available at the time. They were described in the McAleese report as “often the only door open to these women".
Many of the women and girls worked in the laundries for long periods. About half of the women were in the laundries for periods in excess of three years. The referrals made by State agencies came about in a variety of ways. There were referrals from industrial and reform schools, as well as health and social services, the then existing county homes and psychiatric hospitals. There were also referrals from the criminal justice system, including persons on remand; referrals as a condition of probation; other less formalised referrals facilitated by the courts; referrals from prison; and referrals made by An Garda Síochána. Owing to the lack of more appropriate services, many of the case studies demonstrate widespread acceptance of practices that would be unacceptable to us today. The case studies often illustrate the fact that alternative social care arrangements for the women concerned were often simply not available at the time.
The report also makes the point that there seems to be a mistaken public perception that women referred to these institutions were predominately lone parents. 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 range of reasons. It is hard to credit nowadays that some referrals were seen as a means of providing for girls or women with physical disabilities, or with a mental or psychiatric illness. Some 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 they relate to girls or women rejected by their families for having a child.
The case studies which are included in the report provide very sad and harrowing accounts of a traumatic time in the lives of the girls and women concerned. This is especially the case when we consider the fact that, at that most vulnerable time in their lives, they did not just experience a very traumatic removal from their homes and communities. In many cases, this was also followed by a prolonged and extreme level of social exclusion and ostracisation by society.
On the basis of the McAleese report and, in particular, based on the wishes of the women themselves, the Government decided that a non-adversarial scheme for women who had worked in Magdalen laundries or similar institutions should be introduced. Mr. Justice Quirke was then asked by the Government to make recommendations on an appropriate scheme. He reported in May 2013 and all of his recommendations were accepted in principle by the Government in June that year. The Department of Justice and Equality then started work immediately on setting up a scheme which was publicised widely both in this country and abroad.
The primary support being provided by the Government is the scheme of ex gratia payments to women who were in these institutions. Under the scheme, applicants do not have to prove that they suffered any abuse or damages. The manner of their referral to the institution 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 a very appropriate and caring provision by the Government and the State for the women concerned in respect of what was inevitably a very traumatic experience in their lives. Under the scheme’s provisions, they are 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 in weekly instalments to provide an income spread over a longer period. To date, decisions have been made on almost 90% of applications out of 776 received so far.
A total of €18 million has so far been paid out to the women.
The remaining applications are at various stages of the process - some have been received only recently, some require further information, investigation or verifications. Work is progressing on these cases as quickly as possible. For the purpose of clarity, applications for the scheme remain open and I anticipate that a small number of further applications will be received.
The processing of all applications starts off on the premise that the testimony of the applicant is correct and the officers processing the application then seek to verify the application by checking appropriate records. Where the records of institutions are incomplete, as they are in a small number of cases, the Department arranges to meet the applicants affected and the Department is generally able to verify the information provided by the applicant by corroborating the information with the institutions or third parties.
The Quirke report also recommended that the ex gratia payments should also include top-up pension payments of up to €100 for those under the age of 66 years and up to €230.30 for those aged 66 or over. These payments are being made by the Department of Social Protection and I would like to thank the Minister for Social Protection for her assistance in that regard.
Mr. Justice Quirke recommended that legislation be introduced to give effect to his recommendation with regard to the provision of health services. In his report, Mr. Justice Quirke was of the opinion that Magdalen women should be provided with access to a comprehensive suite of health services. Mr. Justice Quirke's recommendation that the women receive medical services equivalent to those provided to the holder of a HAA card is being given effect in this Bill. However he also stated "not all of the services described in the [Hepatitis C] Guide may be directly relevant to the Magdalen women and any comparable Guide for the Magdalen women would require suitable adaptation"
It should be noted that the services provided in section 2 of the Bill are precisely those recommended by Mr. Justice Quirke on Page 35 of his report. These are: GP services; prescribed drugs, medicines, aids and appliances; dental services; ophthalmic services; aural services; home support; home nursing; counselling services; and a range of other services, to include chiropody-podiatry and physiotherapy. All of these services are specified in section 2 of the Bill and will be made available free of charge to the women who were in Magdalen laundries.
There has been some incorrect comment in regard to the Bill which has suggested the Health (Amendment) Act 1996 also provides for alternative therapies such as massage, aromatherapy, reflexology or acupuncture; counselling services for immediate family members of persons with hepatitis C; provisions that the persons not have to wait more than two weeks for an appointment with a specialist, liaison officers; and personal advocacy services. There are no such provisions in the Health (Amendment) Act 1996. However, some additional services are available to persons with hepatitis C under the HAA card scheme on an administrative basis that are in addition to those provided for in the Health (Amendment) Act 1996. These include drug treatments for hepatitis that are not on the approved medicines list; counselling for immediate family members in regard to the effects of hepatitis C, and the need to avoid infection of other family members; and open access to specialist hospital treatment for hepatitis C.
These provisions are not contained in the Health (Amendment) Act 1996 and it would make no sense whatsoever to include these specific provisions in this Bill. The Magdalen women do not have this illness and would not need or benefit in any way from the specific treatments for hepatitis C.
With regard to the question of alternative therapies, the Minister for Health has reservations about such therapies being provided and funded through the health service and, for that reason, they were not included in the Bill, just as they are not included in the Health (Amendment) Act 1996, or in Mr. Justice Quirke's recommendations. However, the Minister for Justice and Equality is considering options for provision of such services on an administrative basis outside of legislation.
I thank the Minister for Health for his assistance in the provision of this very comprehensive suite of medical services, as recommended by Mr. Justice Quirke. Senators will note that the range of health services being made available, without charge, are also those services listed in section 2 of the Health (Amendment) Act 1996, which provides for persons affected by hepatitis C. This very comprehensive list of services includes all of the health services identified by Mr. Justice Quirke. The Bill also provides these women with exemption from charges for acute inpatient services. It also provides that payments made to these women arising from the scheme of ex gratia payments will not be included in any financial assessment of means under the Nursing Homes Support Scheme Act 2009.
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 and the most appropriate to each participant. 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 practically unique. Therefore, the Minister for Health has agreed, given the wide variation in the organisation of different countries' health systems, that 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 the specific circumstances of the individual, the country of residence and its health system. 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 if resident in the State. There will be circumstances where a service similar to or aligned with what they would receive in the State may not be available and the HSE will have a variety of 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 the 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. The HSE will also provide an information booklet to the women here and abroad setting out in detail the services to which they are entitled.
I understand there has been some comment about the lack of explicit reference in the Bill to a so-called enhanced card. It is important to clarify that neither the standard medical card nor any new card is explicitly set out in the Health Act 1970 or the Redress for Women Resident in Certain Institutions Bill 2014. 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. One operational possibility is that an RWRCI card, based on the name of the legislation, may be issued to the qualifying women.
There has also been some comment suggesting no provision is being made for women entitled to these supports who do not have capacity to make the necessary applications or arrangements but this is incorrect. The women are already covered by section 21 - appointment of a care representative - under the Nursing Homes Support Scheme Act 2009. Separate legislation which the Minister has already brought before the Dáil will cater for cases where 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 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. This Bill is already awaiting Committee Stage in the Dáil and I expect it to be enacted in the first half of this year. That Bill also provides for decision making assistants, co-decision makers, decision-making representatives and the public guardian, measures which are well suited to look after the best interests of the Magdalen women who have capacity issues. It would not make sense to introduce a special scheme for the women who lack capacity in the light of the Assisted Decision-Making (Capacity) Bill which has already passed Second Stage in the Dáil.
The Department of Justice and Equality is careful to ensure applicants have the necessary capacity and cross-check with other Departments to establish whether there are issues. A medical assessment is sought if there is any indication that an applicant under the scheme has capacity issues. Some 40 women in this category have been identified to date and payments to these women are being made once proper safeguards are in place. As we need to have regard to the mental capacity of a number of these women, section 2 of the Bill must allow for a situation where a woman does not have the capacity to make decisions in regard to these services. That is why the wording is slightly different from that of the Health (Amendment) Act 1996. In some cases a family member or a carer, rather than the woman herself, will have to make decisions about GP or other services. Again, we are trying to ensure that all care provided will be most appropriate to the needs of each participant.
I reiterate that the Government is committed to implementing all of the commitments we made to the Magdalen women. The Government will implement all of Mr. Justice Quirke's recommendations in full. I believe there is broad support in this House for all of the measures that the Government has decided to put in place for these women. In drafting the Bill the Government has had regard to points made by Senators and Deputies in representations. I commend the Bill to the House and will very much look forward to discussing it with the Senators.