Kathleen Lynch (Cork North Central, Labour)

I thank the Deputy for raising the issue. He is correct that it is not just a relevant but a very pertinent issue that is being dealt with on an ongoing basis. Domiciliary care allowance is currently paid to more than 24,000 parents and 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. In addition, the Department makes an extensive range of payments to support families with children. In 2011, some €2.08 billion was paid out in respect of 1.13 million children on child benefit. Qualified child increases were also paid to people on social welfare payments in respect of some 495,000 children - 369,000 at full rate and 126,000 at half rate.

Domiciliary care allowance can be paid in respect of children under 16 years of age who have a disability so severe that it requires the child needing care and attention and-or supervision substantially in excess of another child of the same age. This care and attention must be given by another person, effectively full-time, so that the child can deal with the activities of daily living. The child must be likely to require this level of care and attention for at least 12 months.

A review policy is an integral part of all social welfare schemes and is necessary to ensure payments continue to be made only to those customers who meet the qualifying conditions. Domiciliary care allowance cases are routinely reviewed to ensure all the conditions for receipt of the payment continue to be met. Cases are reviewed based on either a scheduled review on the recommendation of the medical assessor when the claim is initially processed or on information received about a change of circumstances which potentially affects the continued entitlement of a case already in payment.

Scheduled reviews, on the recommendation of the medical assessor, are based on the prognosis of the child's disability and how their care needs may change over time. Customers who are reviewed are asked to provide relevant up-to-date medical evidence and details of the additional care needs of their child. This information is assessed by a medical adviser and a decision is made based on the medical opinion he or she provides. Where payment is stopped as a result of a review, the customer is invited to submit any further information he or she may wish to have considered, and that information is further examined and-or he or she may appeal the decision directly to the social welfare appeals office.

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. No specific condition or disability rules a child in or out of qualifying for the allowance.

An expert medical group was established in advance of the transfer to this Department in 2009 and recommended that the most appropriate way for the Department to conduct assessments for medical eligibility was by way of desk assessment of the evidence submitted by the claimant, as provided by themselves and the medical staff who regularly see the child. It was considered that it was not necessary for the child to be physically examined by the Department's medical assessors as the diagnosis of the child's condition by their GP is accepted. What is being assessed is the level of additional care and attention the child requires as a result of that condition or disability and if this is substantially in excess of that required by a child of the same age without the condition.

The effective and efficient operation of the scheme is monitored regularly and any improvements to the delivery of service that are identified are implemented. I assure the Deputy that the Department is committed to ensuring those children who meet the conditions for the scheme will continue to receive payments.

See this speech in context