The High Court president has described as a scandal the treatment of a young woman with intellectual disabilities who was left in the care of a foster family for 20 years despite physical abuse, gross neglect and possible sexual abuse.

Mr Justice Peter Kelly approved a settlement involving a package of measures worth €6.3m for the woman referred to as 'Grace', whose story was brought to public attention by the RTÉ Investigations Unit report Duty of Care.

The Health Service Executive apologised to the woman in court for the failings in her care.

The failings included inadequate monitoring and oversight of her care and inadequate action to remove her from the foster home after significant concerns had been raised.

In its apology the HSE said the care she received fell short of the compassionate, caring and personalised support that she was entitled to.

It said the HSE had taken steps locally and nationally for continued service improvements, standards and safe care.

Mr Justice Kelly said the reasons why 'Grace' was left in the foster care placement in 1996 despite recommendations from professionals and health board personnel that she be moved remained a mystery.

He said a decision to move her was reversed by a three-person health board committee, after representations were made by the foster parents to the then minister for health.

The Chief Executive of Barnardos has said that the state repeatedly failed Grace and he hoped today's settlement will provide for comfort and dignity for her.

Speaking on RTÉ's Six One, Fergus Finlay said he hopes the Commission of Inquiry will reveal exactly what happened in her case - both at an administrative and political level.

He said it is very unlikely that "we won't know everything at the end".

"This settlement today will not just I hope provide for comfort and dignity for Grace for the rest of her life, but also helps to undo some of the damage that was done to that organisation."

Mr Finlay said Grace is not alone, adding: "There are at least two other women who, although they didn't spend as long in the home as Grace did, were certainly as abused and I hope today's settlement is not the last settlement because other people need to have provision made too."

More from the RTÉ Investigations Unit

Health board abdicated responsibility for 'Grace'

The judge said this was a case that had arisen in relatively recent times - not 50 or 60 years ago.

He said it was a scandal when you considered how this young woman had been treated while in the care of the HSE and its predecessor.

The girl had profound intellectual disabilities from birth. Her mother had intended to have her adopted, but that did not happen because of her disability.

She had a number of foster placements before being eventually placed in the care of a couple in an isolated area in the southeast of the country in 1989. She remained there for 20 years.

She has very significant needs and was unable to speak.

Mr Justice Kelly said there was a suggestion that she had been sexually abused. He said she had certainly been physically abused.

Mr Justice Kelly said a decision had been made in 1996 to remove 'Grace' from the foster family but that decision had been reversed.

He said the decision was made in the teeth of recommendations from the professionals and health board personnel.

The judge said after that, the health board abdicated responsibility for 'Grace' once again.

He asked what extraordinary hold the foster family had over the health board officials who made the decision. He said if it was not for the fact that a commission of inquiry has been set up, he would have wanted answers to these questions.

Money would never be adequate for what she had suffered - judge

The settlement also includes a sum to repay 'Grace's' disability benefit which was signed for every week from the time she turned 18 but which she never received.

Mr Justice Kelly asked a representative of the HSE to give undertakings to the court, under oath, that they would comply with the conditions of the settlement.

The judge said documents in the case suggested there had been legal advice that 'Grace' should be made a ward of court and consideration was given to this over some years.

But that was not done for fear that if such an application was made in the High Court the court would want explanations about what had happened.

Rather than face that, he said the unfortunate 'Grace', was left where she was.

He said these proceedings were instituted to put right the wrongs done to her. Money was the only way the State could provide compensation he said although it would never be adequate for what she had suffered.

The judge said many questions required to be answered about the case and the decisions which were taken.

He said he was glad the commission of inquiry had been set up and he hoped it would be able to get answers in a more comprehensive way than would be possible in the High Court.

'Grace' unsuitable for foster care due to complex needs

Earlier, lawyers on behalf of 'Grace', told the court the HSE had abdicated its responsibility for an extremely vulnerable individual.

Senior Counsel, Sara Moorhead said there was very little interaction between the HSE and the foster family.

Ms Moorhead said she could find no professional rationale in any of the documentation disclosed to them for reversing the 1996 decision to remove 'Grace' from the foster home.

She said there appeared to have been some class of pressure, together with a financial imperative on the part of the family, which fed into the decision to keep her in the home.

Ms Moorhead said from the beginning, the professional opinion was that she was not a suitable person to be put into foster care because of her complex needs.

She said every time the question of moving her out of the home arose, it was resisted by the foster family and the HSE just stood back and allowed the family to take control.

Ms Moorhead said 'Grace' had only the HSE to look out for her as her family were not in contact with her.

She said 'Grace' lived in dreadful circumstances.

When she was eventually made a ward of court in 2009, she was very isolated, wearing ragged clothes, she had difficulties with food and significant dental problems.

Ms Moorhead said that even when the decision was finally made to remove her from the home, this was not done in a sensitive way but she was "spirited away" overnight.

She said this caused 'Grace' a lot of trauma.

She said she had no money when she was removed from the home, no clothes, and no belongings other than a small child's toy, which she still held on to for dear life.

Ms Moorhead said this case had not happened in the 1940s or 1950s when people could say they did not know any better.

The resources had been clearly available to allow 'Grace' to live a better life.

She was now receiving exceptional care, Ms Moorhead said, but as a result of her isolation for so long, she found it difficult to integrate with others.

She loved animals, particularly horses and loved going to the beach.