Dáil debates

Thursday, 26 January 2012

5:00 pm

Photo of Pat DeeringPat Deering (Carlow-Kilkenny, Fine Gael)
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Question 6: To ask the Minister for Social Protection the reason there is no review system in place that involves medical and parental input regarding the suspension of payment of domiciliary care allowance; the reason this process goes straight to appeal which can take up to 14 months with no payments; and if she will consider introducing a new system which will work more effectively for all those involved. [4357/12]

Photo of Joan BurtonJoan Burton (Dublin West, Labour)
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Domiciliary care allowance is 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, approximately €2 billion was paid out in respect of 1.36 million children on child benefit. In addition, qualified child increases were also paid to people on social welfare payments in respect of 495,000 children, with 369,000 at full rate and 126,000 at half rate.

Domiciliary care allowance 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 the child must be likely to require this level of care and attention for at least 12 months.

Domiciliary care allowance cases are reviewed to ensure the conditions for receipt of the payment continue to be met. Cases are reviewed based on either a scheduled review based on the recommendation of the medical assessor when the claim is initially processed, or on the basis of information received about a change of circumstances which potentially affects the continued entitlement of a case already in payment. As with the carer's allowance, this is a medically based assessment.

Scheduled reviews, on the recommendation of one of the medical assessors, are based on the prognosis of the child's disability and how his or her condition may improve over time.

Additional information not given on the floor of the House.

The review interval will vary from 12 months in cases where the child's disability is likely to improve significantly in the short term, to a five or ten year review date if the child's condition is likely to remain unchanged for the foreseeable future. In circumstances where a child has a life-long disability that is unlikely to improve by any significant degree, a "do not review again" status may be used.

It is not accurate to say that parental or medical evidence is not sought or taken into account in the review process. Domiciliary care allowance 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.

The decision of the deciding officer is communicated to the customer in writing and they are given the option to appeal the decision to the social welfare appeals office within 21 days. The average processing time for an appeal dealt with on a summary basis is just under six months for appeals and just over a year for appeals where an oral hearing is requested.

Photo of Pat DeeringPat Deering (Carlow-Kilkenny, Fine Gael)
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I thank the Minister for her reply. The reason I tabled this question is a number of my constituents have had their cases reviewed even though their circumstances have not changed. In one case a child with Down's syndrome - circumstances which unfortunately are not going to change - had been assessed two years previously and payment was going to be reduced from 31 January. An appeal process would have taken 14 months. My point is that no review process exists between an application being turned down and an appeal process and potentially there could be a wait of 14 months for payment although the circumstances would not have changed. This seems very unfair.

A number of cases have come to light in recent weeks and a review process should be put in place for circumstances which will not change. I agree with reviewing cases where circumstances can change and improve but payments for children assessed two years previously whose circumstances will not change for a considerable period of time or perhaps never should not be cut.

Photo of Joan BurtonJoan Burton (Dublin West, Labour)
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This scheme came to the Department from HSE and the Department of Health in 2009 and its payment and structures need to be reviewed. As stated about carers, it is also subject to modernisation in terms of processing. Review dates are most often set by the medical reviewer suggesting a child may be looked at again after a particular interval. I am happy to speak to the chief medical officer in the Department. Again there are variations whereby some children have a condition which is likely to be life-long and in other cases - it is hoped - children make a full recovery or make such progress that a domiciliary care allowance may no longer be appropriate. As we improve the processing of claims we can then turn our attention to this area.

Photo of Pat DeeringPat Deering (Carlow-Kilkenny, Fine Gael)
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I thank the Minister for her very positive response. The issue is medical evidence. These cases are dismissed without medical evidence, after which new medical evidence is submitted. They are dismissed with the stroke of a pen or the push of a computer button. People want an opportunity to produce medical evidence in a review rather than having to wait a long period of time.

Photo of Aengus Ó SnodaighAengus Ó Snodaigh (Dublin South Central, Sinn Fein)
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In the review being suggested, will the Minister deal with stakeholders and organisations which represent families who have gone through this? There is a sense that a consultant's letter rather than a GP's letter is all that is accepted. This is an insult to GPs and I would not say their representative bodies are too happy. Will the Minister confirm whether this is the case? Another aspect is the long waiting lists to see consultants, after which is a waiting list for the typing pool and yet another waiting list when the application is made. An undue amount of time is spent waiting.

Photo of Éamon Ó CuívÉamon Ó Cuív (Galway West, Fianna Fail)
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Has the Minister carried out analysis on medical evidence given in the first instance? I get the impression that sometimes the medical people providing certification have not read the terms of the scheme. They state a condition exists but they do not read the terms of the scheme which require information on a level of support. Is this a problem? What steps is the Minister taking to ensure medical practitioners are made more aware of the terms of the scheme prior to providing certification?

Photo of Joan BurtonJoan Burton (Dublin West, Labour)
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One of the reasons for the refusal of an application which is subsequently awarded is the required medical evidence is not presented in the required format. The medical people in the Department have much contact with various medical organisations with a view to improving communication. As the various schemes we have been speaking about today are modernised and the new technology is settled down, we should examine being very clear to the applicants and their medical advisers on the minimum acceptable standard. If an application does not meet this standard at the initial stage before refusal is offered, as happens with regard to other applications, people are advised the application is incomplete and asked to complete it.