Frances Fitzgerald (Dublin Mid West, Fine Gael) | Oireachtas source

I move amendment No. 1:

In page 3, to delete lines 26 and 27 and substitute the following:"(a) a general practitioner medical and surgical service,".

As I elaborated in detail on Committee Stage, the Government is committed to implementing in full and in good faith the recommendations of Mr. Justice Quirke. The arrangements put in place for the payment of monetary benefits show that we have consistently taken the most generous interpretation of those recommendations. For example, a woman who spent a weekend in an institution will receive a one-off payment of €11,500 and a top-up payment to ensure a weekly State benefit of up to €100 until she turns 66 years of age and then the equivalent of the State contributory pension of €230 per week for the rest of her life. Women who were in the institutions for ten years or longer will each receive a payment of €100,000. More than 70 women fall into this category. As I stated on Committee Stage, more than €18 million has been paid out and payments will continue to be made to the women for the rest of their lives. This is as a result of the Government's decision to do what was appropriate, given the women's suffering in the institutions.

The advocacy group has acknowledged the Department's work in assisting as many women as possible. It is generally agreed by the women concerned and their advocacy group that the Department's dedicated unit has provided the women with a supportive and positive service. I want the same attitude to apply in terms of the health benefits to which the women will be entitled once this legislation has been passed.

All Deputies share the objective of acting in the best interests of the women. A number of amendments have been tabled in good faith but, for technical reasons, have been ruled out of order. I reassure the House that the Quirke recommendations will be implemented in full.

I listened to contributions on Second Stage and addressed them on Committee Stage. A number of concerns were expressed to the effect that we were trying to restrict the choice of general practitioner for the women, but I made it clear that that had never been the intention. I needed to discuss the matter with my colleague, the Minister for Health.

I have decided to remove any doubt by eliminating the explicit link with the medical card GP service. This amendment to section 2(1)(a) will enable the HSE to make available a GP service through a private GP, if that is the woman's wish. Women will also be free to maintain their existing GP if they so wish, where their GP already provides care to medical cardholders. This amendment is making it absolutely clear that there is an unrestricted choice of GP for all the relevant women. The same is available to those who come within the scope of the Health (Amendment) Act 1996. They will also be free to change to a different GP at any particular time.

Mr. Justice Quirke pointed out in his report that the scheme introduced under the Health (Amendment) Act was aimed specifically at women who contracted hepatitis C as a result of contaminated blood transfusions and that some of the benefits that were applicable to women who had hepatitis C would require suitable adaptation in terms of the legislation in this arena for women who were in various institutions. The scheme proposed for the Magdalen women does not have those adaptations because people suffering from hepatitis C required some products outside the normal range of drugs available. That does not apply to the Magdalen women. To ensure that women get the best health care, however, provision is made in the scheme for a number of health services to be provided, by referral, by a medical practitioner or nurse. Obviously, that is not intended to restrict access in any way, as the focus is firmly on the woman's health needs. The referral will ensure that the health care provided will be co-ordinated and will enhance the continuity of care being provided through the GP who is the primary contact with the health service for any individual. In this way, referral will ensure that all care provided will be most appropriate to the needs of each participant.

Mr. Justice Quirke made a clear distinction in his report between what is put in legislation, that is, appendix E of his report, and the broader administration of the scheme. Deputies will be familiar with the fact that there are a range of areas concerning services for the women which are being dealt with outside legislation and on an administrative basis. The Government took that decision and the services are being supplied. I will say a little bit more about that later.

There is no reference in the Health (Amendment) Act 1996, or in the draft scheme put forward by Mr. Justice Quirke, to liaison officers or the issue of special cards. They are dealt with under the provisions of the scheme. I went into a lot of detail on Committee Stage about this special card that will be given to the women. It is an administrative issue as regards what the card will be called. It can be called the special card for women who are availing of this scheme, but it is an administrative issue - as it was under the hepatitis C proposals - to work out precisely what the card will look like physically. The services are clearly provided for under the legislation.

We have also included two additional services in this Bill - chiropody and physiotherapy - which were not in the hepatitis C legislation. They were not in the 1996 Act but they are provided to HHA cardholders, so I have put them in to avoid any doubt.

As regards some of the discussions we had on Second and Committee Stages, Mr. Justice Quirke, in paragraph 2.07 of his report, sets out a list of services that should be provided to the women. All these services are being provided under the Bill. I hope Deputies will be able to support the Bill, given that all the services recommended by Mr. Justice Quirke are clearly being provided under its terms.

Mr. Justice Quirke did not comment, one way or another, on complementary therapies. I have examined this issue and, for example, the Minister for Health would have reservations, as others have, about such therapies being provided and funded through the health service and medical card. I am not in a position to provide those services under the Bill. On a personal level, however, I am open to the benefits that could be brought to people through such complementary therapies. I have asked my officials to examine the desirability of providing some limited funding to the women concerned in order that they could avail of such complementary therapies. That would be a separate scheme run on an administrative basis rather than a statutory one. I am not in a position to put that on a statutory basis, but I will examine it in terms of the women's needs. The Department will bring in a scheme that will provide some funding. Funding is provided in the UK to the advocacy group there. It makes various services available to women it works with through funding it has been given. Some of that concerns advocacy for housing and some complementary therapies. Counselling is allowed for in the Bill.

I am in favour of the women having access to advocacy and I intend to implement Mr. Justice Quirke's recommendation on this matter in full. Mr. Justice Quirke makes a clear distinction between what is required for most women and what is required for those lacking full mental capacity. Mr. Justice Quirke recommended that arrangements similar to those provided for in section 21 of the Nursing Homes Support Scheme Act 2009 should be introduced, which allow the court to appoint a care representative to look after the interests of a person lacking full mental capacity, in the context of applications under the nursing homes support scheme.

As regards applications under the nursing homes support scheme, I want to put it on the record of this House that Magdalen women are already covered along with all other applicants, but there is a more general issue. The model recommended by Mr. Justice Quirke was the best available when he published his report in May 2013. However, he Assisted Decision-Making Capacity Bill, which is a better model, was published in July 2013. The range of options covered by this Bill include decision-making assistance, co-decision makers, decision-making representatives and the public guardian measures, which are well suited to look after the interests of the women we are speaking about, who have capacity issues. In light of the Assisted Decision-Making Capacity Bill, which has already passed Second Stage and will be completed in this Dáil term, it would not make sense to introduce a special scheme for women who lack capacity.

I want to make it clear that a medical assessment is sought if there is any indication that an applicant under our scheme has capacity issues. We have identified about 40 women who will need this kind of support and advocacy to help them because of difficulties with decision-making. We want to ensure that the best safeguards are in place for those women.

As we need to have regard to the mental capacity of a number of these women, my amendment to section 2(1) must allow for a situation where a woman does not have the capacity to make decisions about GP services. I am making that point because the other amendment which we will go on to discuss does not take note of that. That is why the wording is different from that of the Health (Amendment) Act 1996. It cannot be the same as in the Act because of those capacity issues. I must allow for that discretion in order that those women are included in this Bill. In some cases, a family member or carer, rather than the women herself, will have to make decisions concerning GP services. We are trying to ensure that all care provided will be most appropriate to the needs of each participant.

As regards women who do not lack capacity, I fully recognise the benefits of them having access to an advocacy service. Such a service already exists for those women who live in the UK because we have given funding to the Irish Women's Survivors Network in London.

I visited the latter in December and met Sally Mulready, Phyllis Morgan and many of the women who are benefiting from the services being provided. They are receiving very good practical support in the context of accessing housing etc. A number of advocacy groups act on behalf of Magdalen women who are resident in Ireland and, like other Deputies, I have met representatives from them.

In recommendation No. 6, Mr. Justice Quirke suggested the establishment of a dedicated unit which would have a variety of functions, including assisting women in obtaining their entitlements and advocating on their behalf. This does not require any legislative basis. I will be examining how to develop this idea now that the existing dedicated unit in the Department has almost completed its primary task of paying out the cash benefits. I will develop recommendation No. 6 and establish the kind of advocacy support that is suggested by Mr. Justice Quirke.

The various issues to which I refer were discussed on both Second Stage and Committee Stage and I stated that I would bring forward this amendment in response. I hope Deputies understand that it is designed to make it absolutely clear that women will have access to a wide range of services and that they will not be restricted in their choice of GP. What is proposed is exactly the same as the scheme established to deal with women who contracted hepatitis C. I ask Deputies to support the amendment.

See this speech in context