Dara Calleary (Mayo, Fianna Fail)

The transfer of the domiciliary care allowance scheme from the HSE to the Department of Social and Family Affairs arises from a Government decision on 28 February 2006 to reallocate certain functions between Departments and agencies as part of the health service reform programme. The domiciliary care allowance scheme, since its transfer to the Department, has been placed on a statutory basis with primary legislation provided for in the Social Welfare and Pensions Act 2008. Prior to the transfer, the eligibility criteria for the scheme were set out in a circular from the Department of Health and Children. The medical criteria set out in the Department of Health and Children circular states that children who have a severe disability requiring continual or continuous care and attention which is substantially in excess of that normally required by a child of the same age may qualify for the domiciliary care allowance scheme. The medical criteria set out in Social Welfare and Pensions Act 2008 require that "the child has a severe disability requiring continual or continuous care and attention substantially in excess of the care and attention normally required by a child of the same age".

As there were no agreed national medical guidelines for the scheme while it was administered by the HSE, an expert medical group was established in advance of the transfer of functions to examine this issue. This group was chaired by the Department's chief medical adviser and comprised senior medical personnel from the HSE as well as eminent professionals in the areas of physical disabilities that affect children and child psychiatry and psychology. The primary purpose of this group was to agree a set of consistent and objective guidelines for use nationally in determining eligibility of children for the scheme. The report of the group was reviewed independently by external medical experts.

The expert medical group considered that the most appropriate way for the Department to assess medical eligibility was by assessing evidence submitted by the claimant rather than by individual examination by the Department's medical assessors as they are not involved in advice or treatment of the child. Since 1 April 2009 the Department has accepted new claims for domiciliary care allowance. The new process operating in the Department involves submission of a detailed statement by the parent or guardian of the child, a detailed statement by the child's GP and any other relevant evidence from qualified experts who have examined the child. This evidence is assessed by designated departmental medical assessors who have received special training.

Eligibility for domiciliary care allowance is not based primarily on the medical or psychological condition but on the resulting lack of function of body or mind necessitating the degree of extra care and attention required. Each application is assessed on an individual basis taking account of the evidence submitted. In the case of an application refused on medical grounds, the applicant may submit additional information and/or ask for the case to be reviewed by a different medical assessor designated for this task. Where a person is not satisfied with the decision of a deciding officer he or she may appeal the decision to the social welfare appeals office.

I recognise the comments of the Deputies regarding the specific condition and I will contact the Minister in respect of autism and revert to the Deputies with a response.

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