Frances Fitzgerald (Dublin Mid West, Fine Gael)
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As I stated on the last occasion, the services provided for in section 2 of the Bill are precisely those recommended by Mr. Justice Quirke on page 35 of his report - GP services; prescribed drugs; medicines; aids and appliances; dental services; ophthalmic services; aural services; home support; home nursing; counselling services; chiropody; podiatry and physiotherapy. All of these services are specified in section 2 and will be made available free of charge to the women who were in Magdalen laundries.

It is incorrect to say, as has been said by some Deputies, that the Health (Amendment) Act 1996, HAA, provides for alternative therapies such as massage, aromatherapy, reflexology or acupuncture, counselling services for immediate family members of persons with hepatitis C, and that persons should not have to wait for more than two weeks for an appointment with a specialist, liaison officers or the personal advocacy service. There are no such provisions in the Act. However, some additional services were made available to HAA card holders - persons infected with hepatitis C - on an administrative basis, additional to those provided in the Act. These included drug treatments for hepatitis not on the approved medicines list, counselling for immediate family members in regard to the effects of hepatitis C and open access to hospital treatment in respect of hepatitis C. As I have said, these provisions are not contained in the Act and it would not make sense to include these specific provisions in the Bill as they are illness related.

On the question of alternative therapies, I have stated I am considering options for the provision of such services, on an administrative basis, outside legislation. As I indicated previously, the Minister for Health has serious reservations about such therapies being provided and funded through the health service. For that reason, they were not included in the Bill, just as they are not included in the Health (Amendment) Act or Mr. Justice Quirke's recommendations.

Niall Collins (Limerick, Fianna Fail)
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In our debate last week the Minister said none of the Deputies present in the House had been present on Committee Stage. I would like to correct her in that regard, as I was present in the committee room.

I sought clarification last week and now seek it again. If a holder of the medical card being granted to Magdalen women is referred for hospital treatment, will she receive a hospital appointment within two weeks? That is the entitlement of a person with the HAA card.

Maureen O'Sullivan (Dublin Central, Independent)
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I apologise for being unable to attend the debate last week.

We must take into consideration the age of some of the Magdalen women and the urgency attached to dealing with issues related to them. They must be dealt with as promptly as possible because the women concerned have been waiting a long time.

The Minister has said she is considering the issue of alternative therapies and I am anxious that she tease out the issue. We have highly qualified personnel working to provide reflexology, aromatherapy and acupuncture services, in particular, and the provision of these therapies needs to be considered.

For example, the Minister of State at the Department of Health, Deputy Kathleen Lynch, will next week launch Acupuncture Awareness Week, the theme of which will be the benefits of acupuncture in the treatment and management of stress. When we look at the ladies who were in the Magdalen laundries, we see examples of people who have been under stress for much of their lives. I would like to tease out that issue a little more with the Minister who has said she is considering the alternatives.

On liaison officers and advocacy services, there is no doubt that there were women who went into the institutions with mental health issues. There are also women who developed mental health issues because they had been institutionalised all of their lives. Therefore, there are women who lack the capacity to make decisions and need representation to ensure their best interests are served.

I ask the Minister to clarify the position for those women who are resident outside Ireland and the provisions related to their health care.

Mary Lou McDonald (Dublin Central, Sinn Fein)
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When we addressed these issues last week, I raised my concerns about the Minister's amendment and the fact that the formulation and form of the legislation strayed from that envisaged by Mr. Justice Quirke. That is most regrettable and also unnecessary. It has caused unnecessary confusion, unless, of course, it is deliberate in limiting the number of services and treatments to which the women concerned might be entitled. I draw the Minister's attention to the fact that amendments Nos. 2 to 5, inclusive, tabled by Deputies Joan Collins and Maureen O'Sullivan have been disallowed, but ironically, each of them fully and faithfully echoes the wording provided by Mr. Justice Quirke in Appendix E. We would have been better served if the Minister had stuck to that wording.

I share the concerns of other speakers about the range of therapies, including the alternative therapies, available to the women concerned. I asked the Minister during our exchange the other day to clarify whether she had been in contact since Second and Committee Stages with the women concerned and their advocacy groups. Even on Second Stage, the Minister conceded that there had been a level of confusion generated. I am wondering, in that context, what, if anything, the Minister or her officials have done to dispel that confusion.

Frances Fitzgerald (Dublin Mid West, Fine Gael)
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There is some confusion about the HAA card and the recommendation of Mr. Justice Quirke on the provisions he said should be applied. In that context, Deputy Niall Collins made reference to Appendix G of Mr. Justice Quirke's report. I also note the point made by Deputy Joan Collins, but the reference she made was to documentation relating to the HAA card, rather than to Mr. Justice Quirke's report. I also apologise to the Deputy about the committee.

The Health (Amendment) Act 1996 was the Act to which Mr. Justice Quirke made reference. What we are providing for and what I have clarified is that services can be private or public. I explained last week that both private and public services were to be included and that I was bringing forward an amendment to make this very clear. The Magdalen women and those who contracted hepatitis C are not identical and face different circumstances, as Mr. Justice Quirke recognised. He said the scheme needed to be adapted. When I spoke earlier, I highlighted the fact that particular services were made available to women with hepatitis C appropriate to that condition.

On the health status of the Magdalen women, Mr. Justice Quirke found that the main concerns were cancer, heart complaints, high blood pressure and diabetes, mental health illnesses, mobility problems, dementia, arthritic complaints, arterial difficulties and visual and hearing deficits. As Deputy Maureen O'Sullivan pointed out, many of these concerns are typically associated with the ageing population cohort, all of whom are over 50 years and many of whom are over 60. The services being provided, following on from Mr. Justice Quirke's recommendations, address the health circumstances typical of that age cohort. The women concerned will have access to all of the health services, nursing home services, GP services and prescribed drugs required. Anything they need is provided as part the services covered by the Bill. The only substantive services not included are alternative therapies. Deputies will be aware of recent difficulties related to HSE funding for alternative therapies. There was considerable public debate about the use of public money in that way. That is not to say, however, that some alternative therapies would not be helpful to some of the women concerned, as the Deputies argued. In that context, I will examine how we might go about including such therapies, but I will not do so under the legislation. It would be an administrative scheme and I need to examine the details of how we might provide for it. In principle, I am committed to finding a way to respond and set up a scheme under which we would provide some funding, albeit limited, to provide such therapies, but I am saying it cannot be done under the medical card scheme. That is the reality. I have said the same about advocacy services, an issue which will be discussed later.

In every other area that Mr. Justice Quirke recommended the women concerned receive medical services equivalent to those provided for holders of the HAA card such services are being provided. Deputies should note that he advised that not all of the services described in the guide to the HAA card would be directly relevant to the Magdalen women; therefore, any comparable guide for the Magdalen women would require suitable adaptation.

In terms of the health issues Mr. Justice Quirke identified, we are being very inclusive in the services being made available, free of charge, to the Magdalen women. By introducing this amendment, I am making it clear that all of these services are free, whether public or private. That deals with the issues raised by the Deputies.

The reference to a period of "two weeks" relates to urgent treatment for hepatitis C patients and does not apply in the same way to the women we are discussing who were in Magdalen homes.

Michael Kitt (Galway East, Fianna Fail)
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Amendments Nos. 2 to 11, inclusive, have been ruled out of order.

Ruth Coppinger (Dublin West, Socialist Party)
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I move amendment No. 12:

In page 4, to delete lines 16 and 17.

They should not have had to sign away their rights. The State owes them whatever they can claim in court. The obligation on them to sign waivers that they would not take legal action was not right.

A question about waivers was raised by advocacy groups for the women concerned in the light of what many saw as the scheme being less than that recommended by Mr. Justice Quirke. It has been argued that the waivers could be challenged by the women concerned or others on their behalf because the scheme falls short of what was recommended and of their understanding that they were getting everything recommended by Mr. Justice Quirke. I do not know if the Minister has a comment to make on it, but it is an issue. I have heard it being raised by the Justice for Magdalenes group and other women's groups. It is unjust from this point of view. Is the Minister satisfied that the women concerned are getting what they initially signed up to receive when they signed the waivers? We have had a debate about the limitations of the HAA card and what is not provided under the scheme. We have also debated the issue of pension entitlements. I am not sure if that issue has been ruled out.

Will the Minister clarify the following point? Mr. Justice Quirke recommended that the women be paid their full pension entitlements as if they had been paying into a pensions scheme, rather than incarcerated in the laundries. There were to receive backdated payments, which is not recommended under the current scheme. It seems that the waiver scheme might be in jeopardy.

Mary Lou McDonald (Dublin Central, Sinn Fein)
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I strongly support the amendment. When we look at the approach taken by the State in its totality, in so far as it concerns the Magdalen women, it has been limited, piecemeal and expressly and deliberately designed to achieve damage limitation, particularly in the payment of damages and financial compensation that might be awarded to the women concerned. The McAleese report remains fundamentally flawed, as I have said consistently. I say this not to impugn former Senator Martin McAleese but to recognise that the terms of reference and his task were deliberately limited in scope. The United Nations has been critical of the process and does not believe the women concerned had access to a full and proper inquiry, much less an adequate remedy. There is deep unease among many survivors and their advocates about the legislation and, as Deputy Ruth Coppinger said, about pension entitlements. This amounts to a massive question mark over the legitimacy of any waiver signed. In any case, there is a broader issue about asking a citizen, particularly women and girls who were placed in detention against their will, in unpaid labour and subjected to physical assaults and sexual abuse in these institutions, to sign away the right to pursue the State. That is wrong in and of itself, but it is doubly wrong because the procedures, process and remedy afforded by the State, or the lack thereof, are so grossly inadequate.

Frances Fitzgerald (Dublin Mid West, Fine Gael)
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To date, €18 million has been paid out. The amounts range from €11,000 to someone who spent a weekend in a Magdalen home to €100,000 to other women. The women concerned are in daily contact with the Department and I have already said in the House that the advocates representing them have talked positively about the service they have received. I reject the characterisation of Deputy Mary Lou McDonald of it as damage limitation and a piecemeal exercise. That is not an accurate description of the approach of the Government in developing the scheme, dealing with the medical needs of the women concerned or its day-to-day contact with them. A significant apology was given by the Government which very quickly made a commitment to set up the scheme and ensure the women concerned had access to these services.

Deputy Maureen O'Sullivan asked about services overseas. I commented on this issue in the debate on Second Stage, saying the HSE had agreed to provide equivalent services and make provision for them wherever the women in question were living. The services are available here and it is matter of the women in question being in contact and recognised and this fact being made known to the HSE.

The problem with the amendment is that the Quirke report recommends the introduction of this provision. A number of Deputies have been critical of this point, but it arises from the recommendations of Mr. Justice Quirke. He recommends, in section 2.12, that eligibility for ex gratiapayments and other benefits must be conditional on applicants accepting the offer of benefits and services. That is the essence of the approach taken. Deputies are correct to make the point that, if anyone in this position has assigned a waiver, there is always the possibility a person can go to the High Court or back to court. It is the right of an individual to do so, irrespective of whether they hold certain beliefs.

The health services and benefits set out in the Bill can only be provided for a person who has accepted a formal offer under the scheme. For example, the provisions in section 4 of the Bill provide that the ex gratiapayments are exempt from any assessment of means under the nursing home support scheme. That is very important for the women concerned, particularly the older age cohort. For the section to have effect, it can only apply to those who have received such ex gratiapayments. The amendment would be in conflict with the central approach recommended by Mr. Justice Quirke and the objective of the Bill, which is to provide a range of services as detailed in the earlier amendment for the women concerned.

The effect of the amendment would be to remove the requirement which restricts eligibility for benefits under the Bill to persons who accepted a formal offer made under the scheme. That is the essence of the approach recommended by Mr. Justice Quirke to address the needs of the women concerned. The response of many of the women in daily contact with the Department about the scheme has been very positive. The staff in the dedicated unit in the Department are dealing with all queries they receive on a daily basis. There was extensive contact at the beginning of the process, but it has lessened as issues were addressed satisfactorily.

Ruth Coppinger (Dublin West, Socialist Party)
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The women who are the Survivors of Symphysiotomy do not agree with the element of the Government's scheme which compels them to enter into a similar type of ex gratiaarrangement. It could also be argued by the women who signed up to the Magdalen redress scheme that they are not getting what they expected. If they go to the courts, however, the judgment may go against them. By signing this waiver, they may get less than they thought they would. When the rich and powerful go to court to sue the State, no boundaries are imposed on them, but the same does not apply when the poor, the exploited and victims seek redress. Nobody wants to see the State pay the entire bill, but the women concerned should not lose out because of penny pinching. The church should have been asked to cough up because none of the orders has given enough. People should not be forced to sign waivers before they join schemes, only to find that they are not getting what they expected after signing away their rights. I do not regard this as proper redress or restorative justice for victims of the Magdalen laundries.

Frances Fitzgerald (Dublin Mid West, Fine Gael)
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What was recommended by Mr. Justice Quirke is what the women concerned are getting. I do not think Deputy Ruth Coppinger is correct when she claims they are not getting what they expected. Many of the women who have been in contact with us believe the scheme has been extremely helpful to them. For many women, it is preferable for the Government to put in place a scheme of this nature compared to the alternative of going to court and facing a lengthy and stressful legal process. That is one of the reasons Mr. Justice Quirke recommended this approach. It is important that we do not cast doubt on a scheme which is working well for many women. I acknowledge that the Deputies are making their points about providing better services for the women concerned in good faith, but it is also important not to mislead people. The scheme is based on the Health (Amendment) Act 1996 and the same range of services are available, the only exceptions being those services included specifically in the earlier legislation for those with hepatitis C or family members who were at risk of contracting it. I have explained in detail why I cannot put the provision of alternative remedies on a statutory footing as part of the medical card provisions.

Michael Kitt (Galway East, Fianna Fail)
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Amendments Nos. 13 and 14 are out of order.

Maureen O'Sullivan (Dublin Central, Independent)
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I move amendment No. 15:

In page 5, between lines 7 and 8, to insert the following:"Provision of qualified personal advocates to relevant participants

5.The Minister shall lay a report before each House of the Oireachtas, within 1 month following the enactment of this legislation, setting out the options for the provision of qualified personal advocates to relevant participants.".

As I mentioned, we know particular ladies who went into the Magdalen laundries with mental health issues or, because of being there, developed mental health issues during their time there. I have met some of the ladies who were in the laundry on Sean MacDermott Street and there were mental health issues that were due to the institutionalisation as well as pre-existing issues. While there is much better living accommodation now, they need to be adequately and properly represented by qualified people. We have advocacy services for people with mental health issues and this is the purpose behind the amendment, that it would happen within a month.

Frances Fitzgerald (Dublin Mid West, Fine Gael)
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As I have already said, the provision of an advocacy service does not require legislation and is not part of the Bill. While I understand what the Deputy is doing, Judge Quirke's specific recommendation, on page 45 of the report, was that the State would fund, establish and accommodate a small, dedicated unit to provide a range of supports to the Magdalen women. We have established such a unit, which is focused on providing all assistance and obtaining the monetary benefits for the Magdalen women. Once the Bill has been enacted, the HSE will also make suitable arrangements with the women to provide the health service entitlements in the Bill. All the recommendations on the dedicated unit will be met, just as all Judge Quirke's 12 recommendations are being met.

Regarding Deputy Joan Collins's points, I refer back to the points I made about the Assisted Decision-making (Capacity) Bill and the advocates the women will have under it. When Judge Quirke made his report, the provisions in the Bill were not available and he suggested the best available. The Assisted Decision-making (Capacity) Bill 2013 covers a range of options including decision making assistance, co-decision makers, decision making representatives and the public guardian measures which are well suited to looking after the best interests of the Magdalen women who have capacity issues. The Bill will be very helpful for the women who fall under this category because they will have the benefits of what is outlined in it. Therefore, I cannot accept the amendment.

Maureen O'Sullivan (Dublin Central, Independent)
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Is the Minister satisfied that none of the women, particularly those who lack capacity, can be taken advantage of by anybody? Many of the women are living in the same orders that ran the laundries. While there is a different atmosphere, personnel and relationships today, it is ironic that the same orders which institutionalised them in the first place may end up advocating for them, and we must be 100% satisfied and content that the women cannot be taken advantage of.

Frances Fitzgerald (Dublin Mid West, Fine Gael)
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I appreciate the Deputy's point and it is critical in terms of residential care. HIQA would have a role to play and the Assisted Decision-making (Capacity) Bill will be very helpful. One or two issues were reported to us and they were fully investigated and if anybody has any information on the care and protection of these women, they will be fully investigated and the relevant authorities made aware of the issues.

Michael Kitt (Galway East, Fianna Fail)
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Amendments Nos. 17 to 19, inclusive, are related and will be discussed together.

Ruth Coppinger (Dublin West, Socialist Party)
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I move amendment No. 17:

In page 5, between lines 7 and 8, to insert the following:“Establishment of a Restorative Justice Scheme

5. The Restorative Justice Scheme proposed by the Magdalen Commission Report on the establishment of an ex-gratia Scheme and related matters for the benefit of those women who were admitted to and worked in Magdalen Laundries, authored by Mr Justice John Quirke and published in May 2013, shall be enacted.”.

Mary Lou McDonald (Dublin Central, Sinn Fein)
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I support amendments Nos. 17 and 18. Amendment No. 19 addresses the concerns expressed by Magdalen laundry survivors and their advocates, which are shared by Sinn Féin and other Deputies, that despite the Minister's insistence to the contrary, the legislation will not give full effect to Judge Quirke's recommendations. Despite the deficiencies in the legislation and discrepancies between the Quirke recommendations and the Minister's provisions, the Minister has not addressed them by way of amendment. We knew and said from the outset that Opposition amendments to give effect to the recommendations would be ruled out of order on Committee Stage because they would, by necessity, impose a charge on the State. That is precisely how it happened, and ten of the 11 proposed for Committee Stage debate were ruled out of order on this basis. They could not have been debated by the Deputies present, which rendered the debate on the Bill, to some extent, tokenism. For this reason, I urged the Minister to propose the amendments, as she had the power to do so. She did not take me up on it.

In light of this, and because I do not accept that the Minister's characterisation of her legislation is accurate, we should test those assertions by submitting the legislation to the independent scrutiny of the Irish Human Rights and Equality Commission, which has the power to advise on the human rights impact of legislative proposals in order to evaluate or, if possible, verify whether the legislation complies fully with Judge Quirke's recommendations.

My amendment proposes that a report to this effect should be laid before the Houses of the Oireachtas within one month of the enactment of this Bill. I accept it is not ideal but I was advised that had I attempted to table an amendment to block enactment pending the commission’s verification, as I had originally planned to do, that amendment would also have been ruled out of order. This is very much a compromise amendment. If it is the case that, as she claims, the legislation is completely ad idemwith the recommendations of the Quirke report I would imagine that the Minister, like the rest of us, would welcome the process I am proposing and the report and verification, and accept the amendment.

Maureen O'Sullivan (Dublin Central, Independent)
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We need to reconsider the limitations of the McAleese report. The remit was very narrow. We know there are criticisms of that. When we talk about what happened in the laundries it is important to hear the stories. It is important for the women that their stories are heard and believed. There was a great deal of disappointment because they felt the McAleese report did not give a true account of their experiences in the laundries. There is a debt owed on that aspect.

The mother and baby home inquiry is coming up. It will not be comprehensive enough because we know the crossover, the connections between mother and baby homes, industrial schools and Magdalen laundries and I hope that after the next commission of inquiry there will be a really comprehensive narrative but I am afraid there will be gaps again as there were in the McAleese report.

When this legislation comes in there will be a need for a comprehensive guide in simple language in order that all the survivors of the laundries can understand exactly what they are entitled to and there is no ambiguity for them.

Frances Fitzgerald (Dublin Mid West, Fine Gael)
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Deputy Joan Collins asked about the top-up pension payments. Judge Quirke’s recommendation on top-up pension type payments is being fully implemented. I have more detail on that if the Deputy would like me to give it to her.

Many of these amendments fall outside the scope of the Bill because the Bill deals specifically with the provision of health services. Many of the recommendations are being implemented outside legislation. The restorative justice ex gratiapayment scheme recommended in section 5.06 of the Quirke report already has been, and continues to be, implemented. It is not part of the Bill and it is not possible to provide that it shall be enacted by the Bill as amendment No. 17 suggests.

The recommendations on the State pension are already being implemented in full and are not part of this Bill. I addressed this issue on Second Stage and said that many of the issues being dealt with, and services being put in place, are being done outside legislation because that is the nature of the scheme. That is one of the benefits, that the scheme got up and running very quickly. Here, we are dealing with the health aspects which I hope can be enacted quickly so that the women can access these health services.

In response to Deputy Joan Collins’ point about the services available under the HAA card that are not available to the Magdalen women, those services arose because the women had hepatitis C. Judge Quirke, when he analysed this, said it would not be appropriate for many of them because the Magdalen women are not in the same category. The services were adapted under the HAA card for the women with hepatitis C. He said that in this scheme the services need to be adapted appropriately for the kind of health issues relevant to the Magdalens. I believe that is precisely what is being done by the range of health services we are covering.

I and the Department have given very full responses to any questions Members had on the detail of the payments being made or issues that have arisen. The Department and the unit dealing with the issues have been available to speak. That information can be given any time by way of parliamentary question or simply by requesting the information and I do not believe it is necessary to ask anybody else to report separately on these facts. They are already in the Official Report and will continue to be.

Mary Lou McDonald (Dublin Central, Sinn Fein)
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The difficulty is that not only Deputies here but people outside this Chamber have raised concerns about the robustness of this legislation and whether it fully captures the Quirke report. The best way to adjudicate on that is to ask the relevant and competent body to examine those matters and to report on them.

I am very disappointed that the Minister is not accepting my amendment or the others in the group. It is unwise and puts some of us in a position of considering whether to support this legislation, which is a very great pity. I do not see why the Minister could not support an amendment that envisages an analysis of the legislation and a verification of its implementation of Judge Quirke's recommendations. It would not prove a very costly or time-consuming exercise but it would have the merit of giving assurance, finality and peace of mind. I ask the Minister to reconsider her position on amendment No. 19.