Emmet Stagg (Kildare North, Labour)
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Question 84: To ask the Minister for Social and Family Affairs if the qualifying criteria for domiciliary care allowance have been altered since administration of the payment has been switched to his Department; the reason many children presenting with exceptional care needs are now being refused; and the details of the refusal rate both before and after the transfer of the function to his Department. [15393/10]

Éamon Ó Cuív (Galway West, Fianna Fail)
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Since 1 April 2009 this Department has been accepting new claims for Domiciliary Care Allowance (DCA). This follows the transfer of the scheme from the Health Service Executive on foot of a Government decision to reallocate certain functions between Departments and Agencies as part of the health service reform programme.

The main change to the qualifying conditions for the scheme is that the DCA scheme is now a statutory scheme 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 Department of Health and Children. The medical criteria as 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 DCA".

The medical criteria as 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 in the Health Service Executive, an Expert Medical Group was established in advance of the transfer of functions. This Group was chaired by this Department's Chief Medical Adviser and comprised senior medical personnel from the HSE as well as eminent professionals in the areas of physical disabilities which affect children and child psychiatry/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 conduct assessments for medical eligibility was by assessing evidence submitted by the claimant rather than by way of individual examination by the Department's Medical Assessors as they are not involved in advice or treatment of the child. The new process in operation in the Department involves the submission of a detailed statement by the parent or guardian of the child; a detailed statement by the child's General practitioner; 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.

DCA is payable in respect of children who have a disability so severe that it requires the child needing care and attention and/or supervision substantially in excess of another child of the same age. The care and attention received must be given by another person, effectively full-time so that the child can deal with the normal activities of daily life. The child must be likely to require this level of care and attention for at least 12 months.

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 by the applicant.

Since 1 April 2009 the Department has been accepting new claims for Domiciliary Care Allowance. In the period 1 April 2009 to 31 March 2010 a total of 4,575 applications have been received in the required format, of which 4,330 cases have been fully processed by the Department's Medical Assessors and 2,736 of these applications have been deemed not to satisfy the medical criteria.

The Deputy will appreciate that this Department does not have the information sought in relation to the scheme before the transfer on 1 April 2009. Where claims are deemed to be ineligible on medical grounds, it is because it is considered that the requirement of care and attention and/or supervision is not substantially in excess of another child of the same age who does not have a disability.

In the case of an application which is refused on medical grounds, the applicant may submit additional information and/or ask for the case to be reviewed by a different Medical Assessor specially designated for this task. Where a person is not satisfied with the decision of a Deciding Officer they may appeal the decision to the Social Welfare Appeals Office.