Seanad debates

Tuesday, 23 October 2012

Adjournment Matters

Domiciliary Care Allowance

6:35 pm

Photo of Tony MulcahyTony Mulcahy (Fine Gael)
Link to this: Individually | In context | Oireachtas source

The best way of setting the tone in terms of this issue is by way of example. I have recently come across a number of cases involving applications for domiciliary care allowance, in respect, primarily, of young children with intellectual disabilities. One case involves a young child of four and a half years who is in nappies, cannot talk and struggles to walk and has been clinical diagnosed by a qualified clinical psychologist-occupational therapist as having autism, among a number of other challenges.

An application form with the full clinical diagnosis is sent to the Department on behalf of the child who has been assessed by all of these highly-qualified and highly-trained medical professionals in the HSE. However, a medical assessor in the Department makes a decision, without ever seeing the child or consulting with the therapists or the child's parents, that the child does not qualify or meet the criteria for domiciliary care allowance.

I ask the Minister of State to convey my concerns about this matter. We are all aware of the lengthy delays in dealing with the applications. I question the qualifications of many of the assessors. It is important and only fair to the citizens of the country that applications are assessed by somebody appropriately qualified. I wonder whether sometimes assessments are not carried out at all by a medical practitioner of any description, but are decided upon by somebody in the Department without being forwarded for clinical assessment. It baffles me how somebody can make an adjudication on whether a child qualifies for domiciliary care allowance without actually seeing him or her. I will ask a supplementary question after I hear the Minister of State's reply.

6:45 pm

Photo of Dinny McGinleyDinny McGinley (Donegal South West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

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, attention and supervision substantially in excess of another child of the same age. The 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.

The Department has 22 medical assessors including the chief medical advisor and the acting deputy chief medical advisor. A further three medical assessors have recently been appointed by the Public Appointments Service and are due to commence work in the first week of November 2012, which is in a fortnight's time.

The Department's medical assessors are fully qualified and experienced practitioners who provide a second opinion to that of the person's own doctor for the guidance of deciding officers. Their assessments conform to the ethical conduct and behavioural guidelines of the Medical Council. Medical assessors are required to be medical practitioners who are on the general register of medical practitioners while holding an appointment. They must have at least six years' satisfactory experience in the practice of medicine since registration. Many of the medical assessors have specialist postgraduate qualifications. They also have special training in eligibility assessment and disability evaluation. The medical assessors are committed to continuing medical education to ensure standards are maintained and enhanced. On-going medical education is provided by national and international experts in the evaluation of disability. There are also regular meetings and seminars under the direction of the chief medical adviser where a range of medical issues and developments in the occupational medicine field are discussed.

Medical assessors are not specifically assigned to any one particular scheme and all deal with domiciliary care allowance applications. All of the medical assessors have access to the medical review and assessment case management system where they complete desk assessments of medical evidence submitted with regard to customer claims, appeals and reviews on all of the Department's disability and illness related schemes.

Photo of Tony MulcahyTony Mulcahy (Fine Gael)
Link to this: Individually | In context | Oireachtas source

The answer is there - desk reviews are completed, which means one sits at a desk and decides. Given we have so few medical assessors I ask the Minister of State to ask the Minister for Social Protection to list the actual qualifications of each of the 25 assessors without naming them. I will reserve my opinion until I receive this information.

Photo of Dinny McGinleyDinny McGinley (Donegal South West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

As the Senator acknowledged, a further three assessors have been appointed and are due to commence work in the next week or two and this is a step forward. I will convey to the Minister for her consideration the Senator's request for the actual qualifications of the assessors.