Maureen O'Sullivan (Dublin Central, Independent)
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I want to express my appreciation that this matter was accepted for Topical Issues. I have debated the subject a number of times in the House, with the Taoiseach during Leaders' Questions and several times with the Minister for Justice and Equality. Each time, it was in the hope it would be the last time and that all the issues would be resolved and systems put in place for the survivors.

When the Taoiseach made the apology in this House, he also expressed his intention, as he said, to establish a process "by which we can determine how best to help and support the women in their remaining years." That was on 19 February 2013. Over two years later some of the ladies are still waiting on that help and support.While I acknowledge that progress has been made in a number of areas, today's debate is about the outstanding health and medical concerns, especially for those ladies who are living outside Ireland.

I have a couple of specific questions which may be answered in the course of the Minister of State's reply. One concerns medical cards under the ex gratia scheme. There are concerns that the services provided may be means tested. Some of the Magdalen ladies have regular medical cards and the question is, will they use those cards in addition to the new card, or will the scheme operate as one single medical card? In the event that both cards are being used, will those with the regular medical card be at a greater advantage than those who have just the one, new card?

For those living abroad, how exactly will the scheme operate? What are the practical arrangements for the health needs of those ladies? We know there are a number living in Britain and America but the question is whether the Department has information on the number of ladies who are living in other parts of the world.

When I was discussing this on one occasion with the Minister for Justice and Equality, I made the point that there is a need for a guide to services for the survivors, including a comprehensive guide to the health services which are accessible that is written in language which is easy to understand for those ladies who will have the cards. The Minister was very receptive of that idea so I would like to know where that guide is. Services such as reflexology and acupuncture were also discussed during the debate and there were concerns these would not be covered by the health services. I am sure many of us in the House have used both reflexology and acupuncture at times as alternative health therapies.

I am in regular contact with the unit in the Department that is going through the issues on the justice side, and I know there have been delays from the Department of Health. The time issue is vital. Some of the ladies have passed away, some are ill and many are in very advanced years. Regardless of the time they spent in the laundries, I think anyone who ever spent any time in a laundry has been deeply affected. They have been waiting a long time for that abuse and suffering to be addressed.

Some ten days ago an article in The Irish Timesreported the Minister for Justice and Equality announced that the medical card and the other supports, such as home help and counselling, would start from 1 July, when the redress Act comes into force. However, that is for those who remain resident in Ireland. The article states the women can receive all the medical services recommended by Mr. Justice Quirke, which is positive. However, for those women living abroad, who were the subject of my specific question today, access to equivalent medical services will be dealt with on an administrative basis by the HSE due to the "wide variation of different health systems". I would like to know exactly what that means.

I ask that we would start with Britain and America because we know there are many women living in both of those jurisdictions. We should start with those ladies of the most advanced years who have medical issues.

Ann Phelan (Carlow-Kilkenny, Labour)
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I am taking this matter on behalf of the Minister for Health. I thank Deputy O'Sullivan for her interest in this issue.

The Deputy will be aware the Government decided that a non-adversarial scheme for women who had worked in Magdalen laundries or similar institutions should be introduced and it asked Mr. Justice Quirke to make recommendations on an appropriate scheme. The Government accepted all the recommendations of the Quirke report and established an ex gratiarestorative justice scheme. In that context, the Government set up a range of payments and supports for the women who worked in these institutions. Payments of up to €100,000 are made to these women, depending on their length of stay in the laundries. In addition, the Department of Social Protection is making pension-type payments to these women. I understand the Department of Justice and Equality has processed 90% of applications received and that 541 applicants have received lump sum payments at a cost of just under €20 million to date.

Mr. Justice Quirke also recommended that legislation be introduced regarding the provision of health services to Magdalen women. To that end, the Minister for Justice and Equality brought the Redress for Women Resident in Certain Institutions Act 2015 through the Oireachtas. The Act sets out the primary and community health services that will be made available in Ireland, free of charge, from 1 July 2015. Those services are as follows: GP services; prescribed drugs, medicines, aids and appliances; dental, ophthalmic and aural services; home nursing; home support; chiropody; physiotherapy; and counselling services.

A woman qualifies for these services where the Minister for Justice and Equality has determined that she is eligible under the restorative justice scheme and the woman has accepted a formal offer made to her under that scheme. The HSE will contact the qualifying women directly in order to issue them with an "RWRCI card". The HSE will also provide information to the women about the health services. In addition, the Government decided that the ex gratiapayments received from the Minister for Justice and Equality will not be included by the HSE in the assessment of means for a medical card or for the fair deal scheme.

As I stated, the primary and community health services are available only in Ireland to RWRCI cardholders. Women who currently reside outside of Ireland can access the health services when they visit Ireland. However, the Redress for Women Resident in Certain Institutions Act does not provide them with health services outside of Ireland. While the Quirke report did not make a recommendation that health services should be provided to women residing overseas, the Government has decided that some practical administrative arrangements should be put in place to support women residing overseas for the same services. While the Department of Health and the HSE have been focused on implementing the Act for the majority of women living in Ireland, they are also exploring the practical arrangements to be put in place for the overseas women. This is an important but complex matter, and it is taking longer than anticipated. I am sure that the Deputy recognises that all health systems around the world vary in organisation and that each system is practically unique and equally complex. When practical arrangements are in place, the HSE will contact those participants living abroad in this regard, which I hope will be as soon as possible.

Maureen O'Sullivan (Dublin Central, Independent)
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When this Topical Issue was selected, I was not aware the Minister was not taking it. I mean absolutely no disrespect to the Minister of State, Deputy Phelan, who I know has a personal interest in this. None the less, if I had realised this, I would have waited until the Minister was available.

There are outstanding issues. For many of the ladies, the remit of the McAleese report was too narrow and there is a lot of dissatisfaction with that. There are outstanding issues regarding An Grianán and the memorial, on which there is a wide diversity of views. I met somebody recently who had been in an industrial school rather than a Magdalen laundry, and his view was there should be a day of remembrance for everybody who suffered abuse in this way.

From the Minister of State's reply, there will be outstanding issues for those ladies who live outside the country. I will put this in the context of one person in particular who I met, because she is like so many of the other ladies. She lives in the United States and came to Ireland some 18 months ago. When she was in Dublin, she came to Leinster House and I had lunch with her. She is an amazing woman, with a great character, great strength and resilience - a feisty lady. Her story was one of horror, hurt and disappointment. She now has health needs, so much so that she cannot come to Ireland this year.

I apply her case to the answer I have received and I find that she can either travel here to address whatever health needs she has, I presume at her own expense or, otherwise, she is just going to waste away. As I said, she is over 80 and has health needs. There is nothing for her in this reply, which talks of "exploring the practical arrangements to be put in place", and "When practical arrangements are in place, the HSE will contact those participants living abroad". That is not a practical solution to her situation. I know she has been watching the post to see whether she will be told of these administrative arrangements. From this reply, I can only express the frustration, disappointment and despair she is going to feel at this. We know of certain women in America and Britain, including the woman I have just mentioned. She should be a priority.

Ann Phelan (Carlow-Kilkenny, Labour)
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I know the Deputy has acknowledged that progress has been made in this area. However, I understand her frustrations about the particular woman whose case she raised. To be helpful, it might be wise for the Deputy to contact the Minister for Health directly about this woman to see if she could be made a priority. I think the Minister would be quite willing to work with the Deputy on that.

I have a great personal interest in this issue and the debate on it in this House stands out in my memory as an example of where the Government and the Opposition worked together, in this case to find a solution for the women who had suffered so much in the Magdalen laundries. I advise the Deputy to take up the case to which she referred with the Minister.