David Stanton (Cork East, Fine Gael)
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Responsibility for the domiciliary care allowance was transferred from the HSE to the Department of Social and Family Affairs on 1 April 2009. Since the transfer took place, many children who previously would have received the allowance - without question - are being refused it. This is particularly the case with regard to children suffering from autism and mental disabilities. Deputy Creed and I are extremely concerned about that fact and that is why we have raised this matter.

In reply to a parliamentary question I tabled yesterday, I was informed that from 1 April to 22 May some 445 applications were received within the Department. Some 249 have been processed and of these 149 were refused. The refusal rate is, therefore, almost 60%, which is extremely high. From the information we have received, this represents a major change.

When it was administered by the HSE, there were no agreed medical guidelines for the scheme. These guidelines were only introduced recently and the application form places an emphasis on physical rather than mental or intellectual disabilities. If one does not tick the box which indicates that a person has a physical disability, one will probably not be awarded the allowance. Is the change that has occurred evident to everyone? I want to ensure that it is brought to the Minister's attention and that she and her Department will reconsider the position. I am sure she would agree with me that a child with autism who might, physically and in every other way, be fine may need full-time care because he or she may not realise what he or she is doing at all times and could be a huge danger to himself or herself.

As far as I am aware, an announcement was not made with regard to the change to which I refer or the new medical criteria which apply. In addition, a debate has not taken place in respect of these developments. I would be disappointed to think that the new criteria are being used as some form of money-saving measure or as another cutback.

This is an extremely important matter. It relates to children who are extremely vulnerable and their parents, who are already under a great deal of pressure. If the criteria have been changed in order to restrict the payment of the allowance, I would like the Minister to make a statement to that effect so that people might be informed as to the position. If they have not been changed, then we must examine how the allowance is being administered. The information available to us indicates that a change has taken place and that the allowance is more difficult to obtain. In addition, it is no longer being paid in respect of children who previously received it. I request that consideration again be given to this important issue.

Michael Creed (Cork North West, Fine Gael)
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I suspect that having a child diagnosed with a disability is probably one of the more traumatic experiences for parents. At my constituency office, I have met the parents of young children who were recently diagnosed with autism. Subsequent to the assessment of disability, these people were informed with regard to their entitlements. They can avail of the incapacitated child tax credit, an entitlement to certain medical facilities and, with regard to autism, there is the domiciliary care allowance and home tuition. Every step of the way, these parents are being obliged to fight against the system in order to access the services to which they are supposed to be entitled.

In recent weeks, it has come to my attention and that of Deputy Stanton that there has been a change in the manner in which people's entitlement to domiciliary care allowance is adjudicated upon. The relevant figures give some cause for concern. For example, some 60% of the 249 applications reviewed under the new criteria were rejected. That is an extraordinarily high refusal rate. I am similarly concerned with regard to the relevant tax credit.

I hope that there has not been a change in Government policy. I also hope that restrictions have not been put in place with regard to people's entitlement to domiciliary care allowance. However, I am extremely concerned with regard to the way in which the new regime is being administered. I do not know, for example, whether this is purely an administrative issue which has not yet been brought to the attention of the Minister.

I implore the Government to reconsider the position with regard to the allowance in a generous manner. Those who need it are vulnerable people who are trying to survive in difficult times and they deserve our support in every possible and tangible way. Domiciliary care allowance is but one way in which we can provide them with practical assistance.

Dara Calleary (Mayo, Fianna Fail)
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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.

Michael Creed (Cork North West, Fine Gael)
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There is no mention of autism in the reply.