Joan Burton (Dublin West, Labour)

The domiciliary care allowance, DCA, is a monthly payment to the parent or guardian of a child with a disability so severe that the child requires care and attention and-or supervision substantially in excess of another child of the same age. This care and attention must be provided to allow the child to deal with the activities of daily living, and she or he must be likely to require this level of care and attention for at least 12 months. Responsibility for the administration of new claims to the allowance transferred to the Department from 1 April 2009, with the existing customer base transferring on 1 September 2009.

The allowance is currently paid to over 24,000 parents or guardians in respect of 26,000 children at a cost of approximately €100 million in 2011, with the accompanying respite care grant costing a further €45 million, a total of €145 million. The respite care grant is an annual payment of €1,700 automatically paid to DCA parents in respect of each qualified child, provided it is in payment at the beginning of June in the particular year.

The application process for the allowance is exactly the same for children with autism as for those with any other disability and involves the completion of a claim form which includes details of the medical condition of the child and the level of care and attention the child needs to deal with normal day to day activity. This information can be provided by the parent or guardian of the child, the child's general practitioner and any other professionals who have dealt with the child. There is a section on the application form which allows for the detail of referrals to any of nine professional services to be listed and reports relating to these referrals can be included with the application.

Applicants are also free to submit any other information they feel will inform the Department's deciding officer in making his or her decision. All the information submitted is assessed by designated departmental medical assessors. Decisions are made by doctors, not departmental administrative officials. Medical assessors are qualified and experienced people who meet regularly to ensure best practice and consistency of approach. As the medical diagnosis is not in dispute, it is considered that the medical assessor is in a position to perform the role of assessing the additional care required for the child by way of desk assessment using the detailed information supplied.

Based on the information available, the Department's medical assessors give their opinion to the deciding officer as to whether the child's disability is such, as Deputy Harris said, that it requires him or her to need continual or continuous care and attention substantially in excess of that required by a child of the same age. They also advise as to whether the disability is likely to last for at least 12 consecutive months.

The range of disabilities that could qualify a child for the allowance is not prescriptive and, as such, each case is decided on its merits, taking account of all the available information. The current application form allows for the applicant to submit as much information as he or she may wish and from as diverse a group of professionals as possible. This ensures that the medical assessor has all the relevant information available before giving his or her professional opinion in each case.

The decision as to whether a child satisfies the qualifying conditions for DCA is made by the deciding officer, having considered all the circumstances including the opinion of the Department's medical assessor. In this context, the Deputy should note that the percentage of children on the autism spectrum that are refused DCA is in line with the overall refusal rate. DCA cases are reviewed to ensure that the conditions for receipt of the payment continue to be met. Scheduled reviews, on the recommendation of the medical assessor, are based on the prognosis of the child's disability and how his or her condition may or may not improve over time.

Parents and guardians are involved in the review process as reviews are initiated with the completion a review of medical criteria form by the parent, which also requires medical input from the child's doctor. The parent returns this form, together with any additional recent reports of medical or therapeutic services the child may be receiving. This information is then sent for review by one of the Department's medical assessors who will provide an opinion to the deciding officer on whether the child still meets the medical criteria for receipt of the payment. DCA remains in payment during the review process until a revised decision is made.

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