Joan Burton (Dublin West, Labour)

Parents who receive domiciliary care allowance also qualify for carer's allowance and household benefits, subject to fulfilling certain criteria. Some 40% of those on the scheme receive these payments. Those who receive the carer's allowance and household benefits package, in addition to the DCA and respite care grant, receive a total of €16,742 per annum from the Department. It is a very significant and important expenditure and the Department has been very happy to administer it. Many thousands of additional awards have been made since the Department took over the scheme. It is necessary for Deputies to be fair to some of the staff of the Department.

I reiterate, the number of claims in payment has increased steadily over the years, from 11,000 in 2001 to over 23,000 in early 2009 at around the time the Department of Social Protection took over the administration of the scheme. Now the figure is 26,000 children. When they are aged 16 years children leave the scheme and many go on to receive disability benefit. The number, therefore, is a net 3,000 but an additional 6,000 children were awarded the grant.

In 2009, the average number of applications received under the scheme was 92 per week. This compares with 105 per week in 2010, 106 per week in 2011 and 83 per week to date in 2012. This year, it is expected that applications will average out at about 100 per week. More generally, it is also worth pointing out that 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. In addition, qualified child increases were also paid to people on social welfare payments in respect of some 495,000 children, with 369,000 at the full rate and 126,000 at the half rate.

I refer to the qualifying conditions for the scheme, or how applications are assessed and reviews conducted. To qualify for the domiciliary care allowance, the child must be under 16 years of age and have a disability requiring care and attention and/or supervision substantially in excess of another child of the same age. The care and attention must be given by another person, effectively full-time. Eligibility for the domiciliary care allowance is not based primarily on the medical or psychological condition but on the degree of extra care and attention the child needs. 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. Applications for children with autism and other intellectual disabilities are treated in exactly the same manner as applications for children with other types of disability.

To apply for the scheme, parents or guardians submit their detailed statement as well as a statement by the child's general practitioner and any other relevant evidence from qualified experts who have seen the child. Parents and guardians choose the GPs and specialists. it is important that the child is treated by his or her doctor or specialist. It would be very strange to do otherwise. Following this, the Department's medical assessor reviews the history of the case, considers all medical reports received and considers the description of the care and attention required by the child, as set out by the parent or guardian. Overall, the award and refusal rates have remained broadly the same over the three-year period in which the Department has been processing claims, with 46% of claims being awarded and 54% refused the allowance.

The review interval recommended by the medical assessor will vary from 12 months in cases where the child's disability is likely to improve significantly because the child is undergoing treatment, to a five or ten-year review date if the child's condition is likely to remain unchanged for the foreseeable future. If a child has a lifelong disability that is unlikely to improve by any significant degree, the Department does not review the case. Reviews form an integral part of all social welfare schemes and are necessary to ensure payments continue to be made only to those who meet the qualifying conditions. We are required to ensure that by the Comptroller and Auditor General. This may be different if it was in the HSE, as some Deputies suggests, but moving this scheme to the Department of Social Protection was generally welcomed as a positive move because it is an income support measure and concerns the care and attention required rather than the medical condition. Cases are reviewed based on either a scheduled review on the recommendation of the medical assessor 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 care needs may change over time.

Where claims are reviewed, parents or guardians are asked to provide relevant, up-to-date medical evidence and details of the additional care needs of their child. I extended the time allowed for the return of the review form and up-to-date medical evidence from 21 days, as it was under the previous Minister, to 60 days. That addressed the concern of parents who found the shorter timeframe caused difficulty. When the claim is initially awarded, parents are now advised when it will be reviewed. The Department gets in contact with parents three months in advance of the review date to provide a five-month period in which to put together a statement or claim. The information provided by the parent or guardian for review is assessed by a medical assessor and a decision is made based on the medical opinion provided. Where payment is stopped as a result of a review, the parent or guardian is invited to submit any further information to be considered and the information is further examined. The parent or guardian may also appeal the decision directly to the social welfare appeals office.

Positive changes were made to the scheme on its transfer to the Department in 2009. It now operates on a statutory basis with the primary legislation provided for in the Social Welfare and Pensions Act 2008. Prior to the transfer, the eligibility criteria for the scheme was set out by way of a circular from the then Department of Health and Children. The medical criteria - as set out in that circular - stated 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 DCA". The operation of the scheme on a statutory basis ensures consistency of approach to all claims. It would be a retrograde step for the scheme to return to its previous operational basis. Another significant improvement is that eligibility to the allowance is no longer subject to a means test as was the case under the HSE. I ask Deputies to think about that. The numbers of children awarded benefit under the scheme since its transfer to the Department of Social Protection speak for themselves.

The medical criteria, as set out in the Social Welfare and Pensions Act 2008, is almost identical, requiring 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". However, prior to taking over responsibility for the scheme in 2009, the then Minister convened an expert medical group to draw up a set of consistent and objective guidelines for use in determining the medical eligibility of children for the scheme. The group was chaired by the Department's chief medical advisor and comprised senior medical personnel from the HSE and eminent professionals in the areas of physical disabilities that affect children and experts in child psychiatry and psychology.

The group considered that the most appropriate way for the Department to conduct assessments for medical eligibility was by assessing evidence submitted by the parent or guardian rather than by individual examination by the Department's medical assessors, who are not involved in the ongoing treatment of the child. The experts in the area recommended this system of assessment. Departmental medical assessors received special training in human disability evaluation.

I listened with great attention to a number of Deputies. Every Deputy referred to the shortage of services. Traditionally, income support has been assessed and delivered separately to services. Deputies referred to the importance of speech and language therapy to some children with autism and autism spectrum difficulties. During the years of a lot of money in this country, there was much emphasis on paying income in cash directly. Perhaps the emphasis in those years should have been on developing and employing speech therapists. It is of great importance to the children about which Deputies spoke. An integrated assessment of need would take account of the need for various health, personal care and educational services and the need, if any, for income support.

Deputies referred to the assessment of need under the Disability Act. My colleague, the Minister for Health, who will be speaking in this debate tomorrow night, is making progress with regard to the assessment of needs of those with a disability.

The advisory group on tax and social welfare is currently examining a number of the issues relating to the operation of the disability allowance and the age threshold. I said before in the House that in my view the parents should be paid the allowance for anyone under 18 years. This is my personal view. I also asked my officials to liaise with their colleagues in the Department of Health, the Department of Children and Youth Affairs, and the Department of Education and Skills, who have a role in providing supports and services to children with disabilities in order to map the availability of services and to ascertain if an opportunity exists for greater connection and consistency in the assessment for such supports and services. It is an issue of income but also it is an issue of services. The Department of Social Protection does not provide services, rather it provides income support.

The Department is also undertaking an urgent review of the allowance policy. I am undertaking this review in order to clarify its objectives, to consider whether legislative change is required and to consider whether the current administrative and medical processes need further refinement in light of the review. As part of this review, the question of the duration of review periods for the allowance will be considered, based on the medical condition of the children involved, while taking account of other priority demands on the medical resources of the Department.

I am aware of the heroic efforts of parents to support their children. I wish to assure the House that I am well aware of the vital role played by the income supports paid by the Department of Social Protection in enabling people to live with dignity and to support their children. The Department does not directly supply services and for many of the parents the services are a critical issue for aiding the progress of their children.

Many of the matters raised in the motion are within the remit of the HSE and the services it provides. I wish to assure the House that the staff of my Department, which works on this scheme, understand the concerns of parents and the pressures they feel in dealing with the challenges in their lives. All claims are dealt with in a professional manner and all cases are dealt with on an individual basis and decided on merit, according to the eligibility criteria set out in the scheme. There have been no cutbacks in this area. There have been no policy of cutbacks initiatives by staff on their own behest or at the behest of anyone else. The fact that more than 6,000 extra children have been awarded the domiciliary care allowance should be acknowledged, considering the comments about the staff and officials in my Department. There have been no instructions issued by anyone in Government to cut back in this area.

See this speech in context