Ms Geraldine Gleeson:

Deputy Jim Daly asked what lessons are being learned in respect of the medical cases. Many lessons are being learned and we feed these back. Often in my annual report I set out issues that have come before appeals officers of which we think the Department should be aware. Also we meet with the Department's decisions advice area and tell them about issues that are coming up at appeal and particularly where there are problems and what might solve them. That is fed into the guidelines given to appeals officers.

Having said that, this is not an easy issue to solve, in the medical schemes there simply is a difference. The case is looked at by a deciding officer, mainly based on a medical assessor's opinion. The medical assessor does not see the person. That was an agreed approach by experts in the field on the basis that they are not a treating physician, are not diagnosing, and this would be the best way to assess them. That is the way it is done. They get the best evidence they can. One could argue that they are looking at it more clinically. When it comes to appeal, we are concentrating a little more on the care that is actually given. In any particular case, the care that is given can fluctuate for any number of reasons, even socioeconomic reasons. If one looks at a case on paper, a child requires X attention. That same child in one house might need more than in another, depending on the make-up of the household. There are any number of reasons.

People have often asked whether a medical assessor should decide and whether a medical person should appeal. One can look at this in many ways. This is the system in place. I think the medical assessors would argue that the submissions they get cover the socioeconomic aspect of the case, or certainly they look for them to do so. I think our experience would be that they do not always and often do not. That is probably the aspect that is fed in at appeal. I do not think that is necessarily a bad thing. Certainly, we would feed back our experience of that as it is gleaned at appeal hearings. The system is not perfect but I do not think there is a perfect system for that kind of situation.

One of the assistant secretaries in the Department has met many Deputies and Senators twice or three times since the Government was formed, because there would have been many new Members, to explain to them what is available, whom they might contact and what is the best approach. One of the aspects she would be trying to drive home is the TD helplines. I do not know what the experience is unless it is bad. Certainly we have a TD helpline in the office. It is a dedicated resource. The number is given to Deputies. The experience within my office and in the Department is that every assistance possible is provided. I include in this the sessions provided by the particular assistant secretary who brought along information people to help. It is an issue about which everybody is conscious and they would be aware that if a Deputy is given good information, he or she can help the client and they are clearer on the issues involved.

In regard to the number of staff, in 2000 the number of appeals officers during all those years would have ranged between 15 and 18. I do not know what the number would have been for any particular year. Therefore, a jump to 40 is significant.

In regard to doctors' letters versus consultants' letters, the appeals officers would confirm that more weight would be given to a consultant's letter for the simple reason that he or she is the expert in the condition that is presenting whereas a general practitioner treats more generally. He or she may not be treating in the children's cases. Often a consultant is treating the child and the general practitioner may know the child. A consultant's letter is certainly given the weight it deserves in the appeals system.