Dr. Nicky Scaramuzzi:

To add to that, it is interesting to point out that in the assessment process we would have a mindful routine that we work through when we meet appellants. We would introduce ourselves and try to keep the process similar for each person. We would always ask them if they understand what they are with us for and what they are applying for. It would not be an exaggeration to say that nine out of ten people at the appeal stage cannot tell us what they are with us for. They have been told it is a driving benefit they are entitled to. Some people think it is the parking sticker - they may have come all the way from Kerry, for example, for something they could have got through their GP. Occasionally, we encounter someone who is incredibly well informed, but the majority of people do not know about the primary medical certificate, its definition, the legalities or the criteria. We send out the information to them in writing and we explain the situation to them. Some of those people are a bit shocked because they thought they had come to us so they would be able to get a benefit to enable them to buy a car or get an adaptation. They do not realise that this is done via tax.

We walk people through the process and they are shocked when they realise they are not with us to get a sticker. Therefore, people are not really being informed of what they are applying for. The mechanic or the social worker may have told them they are entitled to a benefit and they have applied for it. This is a problem. There is a large gap in what is being understood as being offered and what is actually being offered. People are on the back foot from the beginning of the assessment. They will often have come all the way from places like Cork, Kerry or Clare to try to fight for something and it will then have been exposed that they do not know what they have come for. This whole process is about education. It involves telling people what they are applying for, explaining the criteria and going through a detailed examination. People are not told the outcome on the day, because the group of three must sit down and discuss applications to ensure there is consensus. There are occasions where two members agree and one does not. It is necessary to get through that. Generally, however, it is found that there is full agreement with what happened at the first level.

At that first, community, level, there is a great deal of pressure. It is easier in the cities, but in the country and rural areas we get situations where the doctors are under pressure. What they do is to advise the applicants to appeal. Many of the applicants therefore come into us and say they went through the first level, but they were told they would get it on appeal. That means they have an expectation. As Dr. McDonagh said, the people who get this certificate on appeal are those who have a progressive condition like Parkinson's disease. It may be six months later when they are seen by the DDMBA, their illnesses will have progressed and, sadly, those people will then qualify. That is, however, a small percentage of the appellants. The majority will be exactly as they were when they were seen at the first level.

There is a lot of confusion as a result and all that builds into the atmosphere of anger and frustration. People arrive sometimes accompanied by legal representation. We ask their legal, or sometimes political, representative about the situation and they are unable to tell us what the primary medical certificate is. Those individuals are there representing people, but they cannot tell us what they are representing them for. Therefore, there is great lack of understanding about what is offered in this context and this plays into the lack of people being heard. All people want is to be heard and to be helped, as appropriate, and not to be discriminated against.