Alice-Mary Higgins (Independent) | Oireachtas source

I move amendment No. 33:

In page 14, between lines 13 and 14, to insert the following: “Report on adequacy of payment for health services to relevant persons not ordinarily resident in the State

19. The Minister shall, within 6 months of the passing of this Act, lay a report before both Houses of the Oireachtas on the adequacy of the payment to relevant persons referred to in section 18(5) who are not ordinarily resident in the State, and options for expanding entitlements under section 18(5) to ensure that the costs of certain health services incurred by such relevant persons outside the State do not exceed the value of their entitlements under this Act.”.

Amendment No. 33 calls for a report on the adequacy of the payment to relevant persons referred to in section 18(5) who are not ordinarily resident in the State, which would also look at the options for expanding entitlements under section 18(5) to ensure that the costs of certain health services incurred by such relevant persons outside the State do not exceed the value of their entitlements under the Bill. This is about expanding entitlement to certain health services for relevant persons outside the State and the adequacy of that payment.

The provisions of the scheme in respect of medical entitlements for those residing outside the State are, in general, deeply inadequate. Some of those residing within the State may have access to an enhanced medical card, allowing them to receive many services without charge. Persons outside the State will receive a once-off payment of only €3,000. We know the very severe psychological and physical trauma that was inflicted on survivors in the institutions. In many cases, this trauma has had a lifelong impact on health. In his engagement with survivors, the Minister will have seen and heard about the long-term impact the experience of the institutions and of giving birth within them has had on many survivors' health. This is partially acknowledged in the scheme but many of those who were deeply distressed and hurt by their time in the institutions and by their treatment within them chose to leave Ireland and travelled abroad. It is a very sad indictment of our State that they no longer regarded Ireland as a place where they could feel safe and where they could continue their lives. It is unfortunate that the maximum allowance for those who were so hurt by their time and experience within the institutions that they left Ireland is only €3,000.

For people who need to receive lifelong counselling, therapy or physical therapy or who need daily medication, €3,000 may not even cover a single year of their health expenses, depending on the part of the world they are living in. This once-off payment of €3,000 could be replaced by a system whereby survivors residing outside the State could provide proof of particular health services obtained and the State could then contribute at least a portion of the value of those services, up to a reasonable upper limit. An appropriate upper limit could be €30,000 or €50,000. This two-tier system whereby the value of health services that can be accessed by those resident outside of the State is drastically reduced in comparison with the provision for those residing inside Ireland is difficult when we look to the trauma.

The Minister will be aware that I have highlighted another aspect of the issue of health payments and inequity, which I will speak to again. It is a very serious concern of mine. I refer to the fact that the enhanced medical card is not being made available to women who gave birth in the institutions but who spent less than a certain amount of time there. I have previously highlighted and read into the record some of what was heard in the confidential committee with regard to the incredibly difficult experience of childbirth for many of those in the institutions. They were intentionally denied pain relief and, in many cases, they were told that this was effectively punishment for having been pregnant. We know the deep trauma and difficulty for women that can result from childbirth in such circumstances. The fact that women who gave birth in the institutions but who did not happen to spend the required number of days there subsequently are to be denied an enhanced medical card when they went through the most serious and potentially damaging health experience they have ever had, one of the most difficult any woman may have in her lifetime, within that institution is another issue.However, that is not the subject of amendment No. 33, which specifically relates to medical entitlements for those living abroad.

Amendment No. 34 calls for a report "on the potential to make provision for supplementary payments ... to relevant persons who experienced forced family separation". This is the core trauma for many and we know this because of the extensive work on psychological trauma that has been done. The impact of forced family separation is well known internationally. We see it around the world where forced family separation is happening, for example in Ukraine and on the Mexico-US border. We know the damage of forced family separation and how difficult and traumatic it is for people. It is a known fact.

Here in Ireland, following consultation with the survivors, the OAK report found that 64% of survivors agreed that forced family separation should be among the key criteria determining the amount of redress received while 61% indicated that the psychological trauma related to that should be a factor. This is in notable contrast to the fact that only 28% of the survivors who were consulted thought that the unit of time spent in an institution was an appropriate way to determine the amount of redress. Very clearly for survivors in Ireland, forced family separation is a major issue. When we all read the commission report and were discussing it, one of the things that gave rise to a wave of distress that went across Ireland, not just for those affected but among the public, was the core denial of the issue of forced family separation. It is not acceptable that the scheme should pass without any provision for forms of redress for forced family separation, which is clearly identified as deeply traumatic. On Second Stage I highlighted some of the harrowing stories, including the story of Carmel Larkin who was born in a mother and baby home and who learned that her mother had spent a dozen years in a psychiatric hospital not far from where she was raised but had never had a visitor in that time.

The Irish Human Rights and Equality Commission, IHREC, has recommended a two-track approach to the scheme. Track one would be a modified version of the time-based approach while track two would look to the individualised assessment of harm. The commission has suggested that there is the potential to look at individualised assessment. To say that the only way we can avoid an adversarial process is to simply use the unit of time is not an argument that I can accept. Under that argument, one could have no unit of time or one could have only one day or one hour as the unit of time. The idea being put forward is that the unit of time would avoid an adversarial approach but there is an important issue here. A basic payment should be given to everybody, regardless of the time involved but there is also the issue of specific experiences, people's own individual stories about what happened to them in their lives and these being recognised. IHREC has suggested that it is important, even if there is a basic payment, that there would be an option for an application for an additional award, even if that involves an additional process, that recognises specific traumas and ill treatment, including the impact of forced family separation.

I hope when the Minister responds to this group of amendments he will be bringing information back to the House on this. There is a concern at the moment that the scheme is a basic scheme based on time and that there is no space in it currently for an acknowledgement of the impact of forced family separation, among other issues. In that context, there is a need for clarity in relation to the waiver. It should not be the case - and I hope the Minister will assure me of this - that somebody who accesses the scheme based purely on a period of time spent in an institution would be expected to forego his or her individual right to seek redress or to take action in respect of a specific experience such as forced family separation if that is not covered by the scheme.

There are two options here. One option is to include things like forced family separation in the scheme and recognise them within it, either within the core scheme or as a second level that can be applied to within the scheme, as suggested by IHREC. The other option is to ensure that individuals are clearly informed that they retain the right to take action in respect of experiences and circumstances which the scheme does not address and which their application for payment does not recognise in any way. Anything other than one of those approaches puts the State in a position of being adversarial and effectively using the fact that people may need to access the basic payment as a reason to tie their hands behind their backs in respect of other areas where they may seek justice. Many survivors, because of the impact of their time in institutions, are in economic distress and they should not be put in the position of having to choose between their basic need to address their economic distress and the right to justice. They deserve both redress and justice.

Amendment No. 35 calls for a report "on the potential to provide for supplementary payments for relevant persons ... who had previously received an award from a court or settlement in respect of an action arising out of any circumstances relating to a period of residence in a relevant institution, where the value of the award or settlement was less than the value of their entitlement to a general payment or work-related payment under this Act". I may revise this amendment and reintroduce it on Report Stage because it should be clearer. Effectively, any compensation that people may have received previously should not cancel out this basic redress scheme, particularly if that compensation is in relation to specific circumstances which are not addressed by the scheme. Some survivors have historically, and heroically in many cases, taken proceedings against the State around their time spent in an institution, which was their right to do. It was a burden they should not have had to undertake but was a result of the failure of the State to provide avenues for meaningful redress. Those who took such cases took on a huge emotional, financial and psychological burden in doing so. They forged the way for many others and did the State a service by shining a light on these issues. The scheme currently excludes those who have previously successfully taken cases and I am concerned that there may be a gap there. We do not know, and cannot know in some cases, what the amount of these private settlements may have been but there may be circumstances where the amounts received are less than the amounts these people would be entitled to under the scheme. These individuals should not be punished for the fact that they led the way in demanding that the State would take responsibility and step up. I ask the Minister to clarify whether there is information available on this and how this intersection would work. There are gaps in the knowledge that is publicly available in respect of this and in that context we are happy to consider how we might nuance this amendment further on Report Stage.

Amendment No. 36 calls for a report "on the potential to make provision for a support fund for persons who developed additional needs as a direct or indirect result of time spent in a relevant institution". It also asks that the report would consider how relevant parties would contribute to this fund. We have defined relevant parties in this amendment as "persons, organisations, the estates of persons, or other entities involved at any time in the operation, management, administration or ownership of relevant institutions, or in the operation or administration of illegal vaccine trials or any other medical experimentation on relevant persons".We may bring versions of these amendments again, because the phrase "relevant person" will be changed within the Bill at a certain point so we will look to where that comes in. This comes back to the idea of the length of stay criterion being woefully inadequate and that it does not reflect the many-layered harms that resulted from time spent in the institutions, which in some cases included lifelong disabilities or additional needs as a result. If the Minister will not accept the amendments relating to the additional payments, at the very least we should explore the idea of creating a fund to which religious orders and pharmaceutical companies will be required to contribute and which could be drawn on for survivors with additional needs.

I note the announcement today in respect of a new negotiator. The fact we are still in a position where we are negotiating endlessly with religious orders and others in respect of their contribution or their recognition is disgraceful. It is disgraceful in a couple of ways. First, because the State still seems to be in a position of asking, rather than moving to requirements, levies or harder measures in terms of ensuring that those who played a systemic role in these institutional abuses are required to contribute. It is also a disgrace, and should be recognised in respect of certain religious orders, that the abuse is not historical. If we are still in a situation where over the past decade they have been creating complicated company structures to move money and resources around in order that they are less reachable, where they are in hardball negotiations with the State and where they require the State to send in negotiators to them, let us not pretend that this is historical in terms of the abuse that is being visited on women in Ireland. The failure to step up, contribute and recognise responsibility on the part of those actors, both religious orders and large pharmaceutical companies, is a continued abuse. It is an abuse of a position of power, a position of financial comfort and a position whereby they can afford all the lawyers they want. They will not be signing a waiver against anything for a couple of thousand euro. They are abusing that position of power to avoid their responsibilities. Those are actions that are happening now, in 2023. That still needs to be recognised. The State needs to have a much harder and strong line on these issues and proper pressure, rather than a "Do the right thing" plea needs to be applied.

Lastly, I refer to the provision regarding illegal vaccine trials in amendment No. 36. This is another example of an issue that is not addressed in the scheme. No additional compensation or redress payment is provided in respect of the experience of illegal vaccine trials. In that context, it certainly should not be the case that actions should not be allowed to be taken in respect of such trials. I know there will be issues around the Statute of Limitations in terms of individuals taking cases against some private companies. As for the complicity of the State in respect of such trials, that is an issue whereby any individual, whether or not they avail of this redress scheme, should be able to take a separate action because they clearly are not being recognised in respect of that experience in the redress scheme. It should not be covered and must not be covered by the waiver and I seek clarity on that.