James Geoghegan (Dublin Bay South, Fine Gael)
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588. To ask the Minister for Employment Affairs and Social Protection further to Parliamentary Question No. 496 of 18 February 2025, if he can detail the specified medical criteria referred or provide a copy of the criteria upon which the assessment is made; if he can confirm that it is a medical assessor in his Department who determines whether the medical criteria is met in the first instance; if he can confirm where an application is the subject of an appeal, if a medical assessor is responsible for determining that appeal where it relates to medical criteria; and if he will make a statement on the matter. [7488/25]

Dara Calleary (Mayo, Fianna Fail)
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The criteria for medical eligibility for Domiciliary Care Allowance (DCA) are that a child aged under 16 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 without their disability and the child must be likely to require this level of care for at least 12 consecutive months.

Applications for DCA are referred to my Department’s Medical Assessors for consideration in the first instance. The Medical Assessor will consider the medical information, care reports and any supporting documentation submitted in support of the application. They will examine all of this information and evidence for consistency, credibility and consensus in order to form a medical opinion as to whether the applicant meets the medical conditionality for the scheme.

It is important to note that eligibility for DCA is established primarily by reference to the impact of the child’s disability or diagnosis and the degree of resulting additional care and attention required by the child. In that regard, Departmental Medical Assessors use their clinical judgement and experience to form an opinion, based on the documentary and medical evidence provided by the applicant, as to whether the child meets the medical criteria for eligibility for DCA.

The Department’s Medical Assessors are fully qualified and experienced doctors who have been specially trained. They provide a second opinion to that of the person's own doctor for the guidance of the Department's Deciding Officers. It should be noted that the role of the Medical Assessor differs fundamentally from that of the traditional treating physician, GP or Specialist. The treating physician's role is to investigate, diagnose, treat and give advice to patients regarding their medical condition. The Medical Assessor's role is to assess how the medical condition or disability adversely affects the child with reference to their activities of daily living and resultant care needs. The Medical Assessor considers the severity of the condition, its expected duration and resultant care needs and gives an opinion as to whether the child satisfies the medical criteria of eligibility for DCA.

In determining the medical eligibility criteria for a scheme, a Deciding Officer will make decisions in accordance with the legislative provisions, taking account of all information and documentation provided by the applicant and having regard to the medical opinion of the Medical Assessor.

Where an application is subject to an appeal, the independent social welfare appeals officer is responsible for determining that appeal. Where further medical evidence is received in the appeals office, an appeals officer can request a medical opinion on that new medical evidence from the Medical Review and Assessment Section (MRAS).

Hope this clarifies matters for the Deputy.