Lynn Ruane (Independent)
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I move amendment No. 2:

In page 4, between lines 2 and 3, to insert the following:

“4.The Principal Act is amended by the insertion of the following new section after section 6—

“Review of operation of Act

7.The Minister shall—

(a) not later than 3 months after the enactment of the Redress for Women Resident in Certain Institutions (Amendment) Act 2019, review relevant participants’ access to health and social care services in accordance with the Principal Act and any differences between the entitlements to services as compared with the entitlements to services of holders of a Health (Amendment) Act 1996 card, ensuring relevant participants’ involvement in the review,

(b) assess any difference in entitlement to services in the context of the first recommendation of the 2013 Magdalen Commission Report, and

(c) not later than 3 months after its commencement, make a report to each House of the Oireachtas of the findings made on the review and of the conclusions drawn from its findings.”.”.

I welcome the Bill and the Minister to the House. The scheme providing medical and social support to the Magdalen women is being expanded and more women will soon be able to avail of it. I welcome the amendment to the Nursing Homes Support Scheme Act to ensure moneys received through the scheme are not included in a needs assessment for the supports. These are welcome measures but, unfortunately, they are inadequate and that is why amendments have been tabled today.

The Bill is short and mainly technical in nature. It represents part of the ongoing and never-ending work by the State that is required to support the cohort of women who survived the unimaginable experiences of the Magdalen laundries and the mistreatment in which the State was often complicit and for which we, as legislators, can never do enough to atone. However, we must continue to try.The scheme that we are discussing and the original 2015 legislation are part of the legislative enactment of the recommendations of the 2013 Magdalen commission report from Mr. Justice John Quirke. That report recommended the terms of an ex gratiarestorative justice scheme for Magdalen survivors and the recommendations were accepted by the then Government in full. A key recommendation made by Mr. Justice Quirke was the entitlement of the women to a Health (Amendment) Act or HAA card, not the standard medical card. This specific card was created in 1996 for those who contracted hepatitis C through State blood products. This specific and clear recommendation was first made in Mr. Justice Quirke's report and is a key part of the package of supports, which is broad, diverse and of a high standard, and is entirely justifiable in the context of the experiences of these women. However, the scheme available to the Magdalen women contains a number of restrictions on their medical and social care that are not limited to holders of the HAA card, the standard to which Mr. Justice Quirke specifically recommended that they be entitled. These include restrictions on dental and oral services as well as counselling and access to psychotherapy for family members, and a range of complementary therapy such as reflexology, acupuncture and hydrotherapy. These are exactly the kinds of services that Mr. Justice Quirke envisaged would be available to the women as part of this scheme, yet they are not able to access them. This is why I have tabled my amendment.

The Quirke report represents the contract made between the State and these women as part of the attempt to provide some form of reparation for their experiences. The women signed away their ability to take cases against the State on the understanding that the Quirke recommendations would be implemented in full. The fact that the State is withholding some of what was promised to these women is wholly unacceptable. I will not dwell on the indefensibility of this but it has to end.

The Minister knows that the Opposition is unable to introduce amendments that would impose a cost on the State. While I would have preferred an approach similar to that taken by Sinn Féin in amendment No. 1, that amendment was ruled out of order. The Seanad cannot, therefore, expand the scheme to include the kinds of therapies and treatments that we are talking about. That option would be entirely open to the Minister in the Dáil, however, and I urge him to take it. A Sinn Féin amendment that would have this desired effect has already been written. As we cannot control that process, we have tabled this amendment. It would require the Minister for Justice and Equality to review the health and social care supports available to the Magdalen women under this Act and to compare their entitlements with services available to those who hold a card entitling them to services under the Health (Amendment) Act 1996. Mr. Justice Quirke recommended that that card, which was specifically introduced for those who contracted hepatitis C, be made available to the Magdalen women and that relevant participants, namely, the Magdalen women themselves, be consulted in this review. The results of the review and the comparison would then be assessed in light of the first recommendation of the 2013 Magdalen report by Mr. Justice Quirke. This is the recommendation that specifically provides that Magdalen women should be entitled to this higher, broader set of benefits with the HAA card. The results of this process and the conclusions drawn from it were to be delivered to the Houses of the Oireachtas within six months.

This is not the course of action that I would have chosen first. I would prefer to introduce the Sinn Féin amendment to provide that these urgent changes would be made for the women affected or, better still, that the Minister would introduce them on behalf of the Government. In light of the constraints placed on us by Standing Orders, this is the option we have chosen. We cannot force the Minister's hand but we can require his Department to look at the inequality that exists between the HAA card's entitlements and those available to the Magdalen women. It should look at the inequality in the context of the exact recommendation from the Quirke report, which states that the inequality should not exist and that the Magdalen women should be entitled to the higher standard of care and services. We can require that the result of this process be delivered to the House within six months. I hope that being legislatively mandated to look at this issue through the lens that I have set out in this amendment would cause the Minister to move to make the legislative changes required to fully enact the Quirke report. We are talking about women who should be enjoying their lives with the full support of the State. They should not have to email Deputies and Senators to ask for what they were promised by the State and Government. I thank the Minister and look forward to his response.

Niall Ó Donnghaile (Sinn Fein)
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In light of what has happened to the amendment I tabled, while I do not want to over-egg the point, I am disappointed that, having come to the House to address the amendment, I was to be told that it had been ruled out of order. That is disappointing, not just for me but for the people who we are trying to assist with the amendment. Regardless, I support Senator Ruane's amendment, what it seeks to do, and the balance that it tries to strike in assisting and empowering the women who have sought redress and more specific, bespoke support services as required and necessary. Like Senator Ruane, my colleagues in the other House will table amendments, since they are not as hindered or restricted as we unfortunately are in this House by Standing Orders, to try to ensure that this legislation is strengthened, as our amendment sought to do. Its purpose was to assist, support and help the qualifying survivors in a practical and tangible way. It was an important but, in the greater scheme of things, modest proposal. Unfortunately, our amendment will not be moved today but we will support amendment No. 2 in Senator Ruane's name.

Charles Flanagan (Laois, Fine Gael)
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It is with reluctance that I will not accept Senator Ruane's amendment. I wish to highlight to the House that during the Second Stage debate earlier this week, I indicated that the Bill arose from the Government decision of May 2018 that the Magdalen restorative justice ex gratiascheme should apply to those women who were resident in one of 14 adjoining institutions and who worked in the laundry in a Magdalen institution. The Government decision was taken to give effect to a recommendation of the Ombudsman. From a technical perspective, the Government decision extended the scheme to a new cohort of persons. As part of that decision, the Government decided to extend to this new cohort all the benefits, including health benefits, which apply to the original cohort of women who were covered by the scheme.

I note that Senator Ruane's proposed amendment makes specific reference to health benefits, as the Senator mentioned in her contribution. This proposal to undertake a review falls outside the scope of the Bill to my mind. I reiterate a point I made on Second Stage. This is a short, technical Bill which deals only with extending the provision of health services to this new cohort of women. It is separate from the Quirke report. The Act provides for a range of primary community health services. The service provided in the context of the principal Act in respect of women who qualify under the scheme addresses the health circumstances that are typical of the over 60 age cohort. Three quarters of the Magdalen cohort were reported as being 60 years or over.

Separate from this circumstance, men, women and children who contracted hepatitis C through the administration within the State of contaminated blood and blood products are entitled to healthcare services under the terms of the Health (Amendment) Act 1996. There are certain eligibility criteria which a person must meet before being awarded the HAA card, including confirmation that the applicant has hepatitis C as a result of having received contaminated blood and-or blood products. The arrangements in respect of the HAA are clearly based on a person having been infected with hepatitis C and, consequently, hepatitis C-specific medicines and treatments are covered by that card.The health and social care services being provided in these respective circumstances are for specifically designated purposes. They are also individually focused to meet the health needs of what I might describe as somewhat or indeed very different cohorts of persons requiring access to packages of targeted health supports. On the matter of the setting up of the ex gratiascheme, Mr. Justice Quirke pointed out that the scheme introduced under the 1996 Act was aimed specifically at those who contracted hepatitis C as a result of contaminated blood transfusions. Some of the benefits were not directly applicable and the scheme would require suitable adaptation. The scheme proposed for the Magdalen women does have such adaptations. People suffering from hepatitis C required some products outside of the normal range of drugs available. In this scheme, provision is being made for a number of health services to be provided by referral by a medical practitioner or nurse. I wish to emphasise that the rationale for this measure is not intended in any way to restrict access, as the focus is firmly on the health needs of the women. Rather, the objective of such referral is to ensure that the healthcare provided will be appropriate and will be co-ordinated so as to enhance continuity of care through the general practitioner, 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 need of each participant.

The effect of the amendment is to seek to oblige me to carry out a review of entitlements to services provided under two distinct pieces of governing legislation, and to make a report to each House of the Oireachtas on the findings of such a review. It is important to note that the Department of Health has already developed separate packages of targeted health supports specifically designed to meet the respective needs of each particular circumstance, with each then underpinned by the appropriate legislation. As the health supports and the necessary legislative basis to underpin them have already been identified and clearly established, it is unclear what purpose a review in the manner proposed could usefully serve at this time.

Furthermore, the amendment would almost certainly have cost implications on the health service over a period of time. It seems clear that the amendment extends beyond the discrete purpose of this specific legislation; therefore, I am not minded to accept it as submitted. As far as I am concerned and having discussed the issue with some of the women directly involved, the object of this legislation is to give effect to the recommendations of the Ombudsman. That is what the Bill is all about. Having regard to the focus of the Bill, discussions I have had with the Ombudsman, and the need to work through the recommendations of the Ombudsman in a progressive manner, to ensure the women are paid and to ensure the State accepts a measure of responsibility in view of the Ombudsman's recommendations, I do not intend to depart from the fundamental goal of the Bill.

Martin Conway (Fine Gael)
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We can take it now.

Charles Flanagan (Laois, Fine Gael)
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Is the Acting Chairman sure that we are disbarred by Standing Orders from taking Report Stage now?

Martin Conway (Fine Gael)
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I think most people would like to take it now if it was possible.

Niall Ó Donnghaile (Sinn Fein)
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There would be concern about railroading this given what has happened to my amendment today. I would like to revisit it.

Charles Flanagan (Laois, Fine Gael)
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I accept that. There is absolutely no question of railroading. I resent the language of the Senator in that regard.

Niall Ó Donnghaile (Sinn Fein)
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I certainly did not mean to offend the Minister in that regard. The point I am making is that it is an important Bill, as we have all conceded.