Tuesday, 1 June 2021
Saincheisteanna Tráthúla - Topical Issue Debate
As the Minister of State knows, the primary medical certificate is issued by the HSE and is a declaration to say the holder is severely disabled and-or a permanently disabled person. This certificate is required for the purposes of the Disabled Drivers and Disabled Passengers (Tax Concessions) Regulations 1994. A primary medical certificate is only awarded to people with a very high level of disability. Holders of the certificate automatically qualify for a disabled parking permit. The primary medical certificate also provides a tax relief or fuel rebate for disabled drivers and passengers. Reliefs may also be used to help disabled drivers adapt their vehicles.
Qualification for the primary medical certificate is subject to one of several conditions, for example, being wholly or almost wholly without the use of both legs, or being wholly without the use of one leg and almost wholly without the use of the other leg. The conditions go on like that and it shows us how archaic the system is at this stage, that these are the criteria which are still used regarding qualification.
I am led to believe the HSE is considering the matter of primary medical certificate assessments in the context of its revision of the HSE recovery and restoration plan. In reply to a recent parliamentary question, the Minister for Finance stated:
Following approval of the Finance Act 2020, which provides for the medical criteria for the Disabled Drivers Scheme in primary legislation, a comprehensive review of the scheme, to include a broader review of mobility supports for persons with disabilities and the criteria for qualification for the Scheme, will be conducted this year. On foot of that review new proposals will be brought forward for consideration.
I have many examples of people who are discommoded by the scheme. This scheme has been frozen for quite some time and it is hoped this review will come forward, but I have my doubts. For example, one gentleman, who has just turned 50, suffers from idiopathic Parkinson’s disease, dystonia, which is severe cramping, and dyskinesia, which is an involuntary movement.
He applied for the certificate in June 2018. The medical officer assessed him at home and told him on the day that he would not qualify under the criteria. He received the refusal letter on 27 November 2018. He was told he would not qualify until the criteria change. This gentleman had to get a loan to buy an automatic car as he was no longer able to drive a manual vehicle. No supports were available for this man and his family even though he had a registered carer.
Another example is a woman in her late 40s who is registered with the Irish Wheelchair Association and was refused a primary medical certificate. She had an accident in 2007 and has had multiple back surgeries to allow her to be able to walk. She has bolts and screws all over her back. If she was to lie down on a floor, she would not be able to get back up. She is in chronic pain, unable to work and finds walking a challenge. The last operation she had was in 2015. She lost the use of her left leg for over a year but movement has partially returned. She is unable to use public transport. This is a scheme she would benefit from but she does not satisfy the criteria. She has applied many times and been refused.
There is no review process for these applications. An applicant can appeal but will have to travel to the Disabled Driver Medical Board of Appeal in Dún Laoghaire for a hearing. Before Covid, it was taking a year for appeals to be heard and at that stage, when people are in chronic pain, they cannot travel what is a long distance in some cases. A review system should be set up and made accessible in each county, similar to the social welfare appeals that are called for oral hearings.
In September 2019, the Minister for Finance stated that he had no intention of reviewing the criteria that allowed people to qualify for the scheme. A new functional scheme needs to be put in place without delay because there are many people who would benefit. As a society, we should make sure people benefit from this scheme and contribute to our society by being able to purchase vehicles and secure transport for themselves.
I thank the Deputy for raising this matter. He has outlined some difficult cases he is aware of and there are many such cases throughout the country.
The disabled drivers and passengers scheme provides relief from vehicle registration tax and VAT on the purchase and use of an adapted car, as well as an exemption from motor tax and an annual fuel grant. The cost of the scheme in 2020, excluding motor tax, was €67 million. The scheme is open to severely and permanently disabled persons, as drivers or passengers, and also to certain charitable organisations. In order to qualify for relief, the applicant must hold a primary medical certificate issued by the relevant senior medical officer or a board medical certificate issued by the Disabled Driver Medical Board of Appeal. Certain other qualifying criteria apply in relation to the vehicle, in particular that it must be specifically constructed or adapted for use by the applicant.
To qualify for a primary medical certificate, an applicant must be permanently and severely disabled with a physical disability. The terms of the Disabled Drivers and Disabled Passengers (Tax Concessions) Regulations 1994 set out the following medical criteria, at least one of which is required to be satisfied in order to obtain a primary medical certificate: be wholly or almost wholly without the use of both legs; be wholly without the use of one leg and almost wholly without the use of the other leg; be without both hands or without both arms; be without one or both legs; be wholly or almost wholly without the use of both hands or arms and wholly or almost wholly without the use of one leg; or have the medical condition of dwarfism and have serious difficulties of movement of the lower limbs. I think everyone would agree that is language from a different era. None of us would write medical criteria like that in this day and age but that was in the legislation, which is now subject to the recent Supreme Court decision.
The medical criteria for the tax concessions available under the scheme have changed over time. When the scheme was first introduced in 1968, the legislation only allowed for one medical ground. In 1989, four medical grounds were added. In 1994, one additional medical ground was added. The Supreme Court decision of 18 June 2020 found in favour of two appellants against the Disabled Driver Medical Board of Appeal's refusal to grant them a primary medical certificate. The judgment found that the medical criteria set out in the regulations did not align with the regulation-making mandate given in the primary legislation to further define criteria for severely and permanently disabled persons.
On foot of legal advice, it became clear that it was appropriate to revisit the six medical criteria set out in regulation No. 3 of SI 353 of 1994. In such circumstances, primary medical certificate assessments were discontinued until a revised basis for such assessments could be established. The medical officers who are responsible for conducting the assessments need to have assurance that the decisions they make are based on clear criteria set out in legislation.
In order to allow for assessments to recommence, the Minister for Finance brought forward an amendment to the Finance Bill to provide for the existing medical criteria in primary legislation. Following approval of the Finance Act 2020, the HSE has been informed that medical assessments can recommence from 1 January 2021.
The scheme is still in operation. All persons or charitable organisations can currently access the scheme. While some assessments have taken place this year, some of the key medical officers involved are tied up with the roll-out of Covid vaccines and that has led to a delay. The HSE has confirmed that the community medical doctors and their teams are predominantly deployed on Covid at the moment.
I thank the Minister of State for his response. I am glad he acknowledged the archaic language used in the scheme and the fact it bears no relation to the difficulties people live with now and for which they need support. The Minister for Finance has opened up the scheme because of a court action. He was forced into it, basically. I am wary that we might not see changes coming forward for this. It is vital that we do and that we make sure it happens.
The Minister referred to significant tax expenditure in a reply we received to a parliamentary question. The Government ratified the UN Convention on the Rights of Persons with Disabilities but not the optional protocol. Furthermore, it does not provide the necessary resources to give disabled people rights. That is what this is about. Disabled people are often an afterthought for governments. We talk about encouraging disabled people to participate in society but then put barriers in their way. It is not good enough any more and we need to address it.
The examples I highlighted are just some stories of many. I am sure every Member of the House has more stories. It shows the draconian rules implemented by government. Donegal is a rural and isolated county and has among the highest forced car ownership in the country. Given that the county is so badly served by public transport, what are disabled people supposed to do? If they are not granted relief to purchase a vehicle, how will they get those supports?
It is urgent that this scheme be reviewed and a proper system put in place to ensure disabled people can access what should be theirs as of right. I believe there would be a return to the State from that. The Minister referred in his answer to the costs of doing this. There will be a return because people will be able to go out and participate in our society.
Again, I thank the Deputy for his comments. All Deputies have encountered this issue in their constituencies over many years. We are all familiar with it.
Given the Supreme Court decision, the temporary measure the Minister put in place to put the medical criteria in primary legislation was, to some extent, a swift move within a couple of months and the scheme got up and running, narrow as it was. At least the scheme was not suspended ad infinitumafter the Supreme Court decision. It was good the Minister moved as quickly as possible but everybody recognises that there is need for review of the scheme.
The Department is carrying out preliminary work, including the examination of the main issues which will frame the scope of the review. Officials have been engaging with other Departments in the context of other ongoing work in mobility supports. It is envisaged the review group will be established shortly and will include stakeholders from other Departments, the medical board of appeal and other representative groups.
One of the first questions I asked before coming in today was how many people are involved in the scheme. Last year, the scheme supported the purchase of 5,500 new vehicles. Many of the people availing of the scheme have done so for a long time and are getting new cars. We need to know how many people would like to be in the scheme but are not.
The best indication we have is that there are at least approximately 17,000 people in the scheme because that is how many fuel grant scheme payments were made in 2020. There are 17,000 in the system as we speak, based on the fuel grant applications, and they are the most serious issue. I will urge my Department to move as quickly as possible with other Departments to complete the review.