Wednesday, 2 May 2012
Dáil Éireann Debate
Deputy Aengus Ó Snodaigh: The Minister of State will be aware of the domiciliary care allowance, DCA, system from her constituency and ministerial work. Last year, 403 reviews were carried out on individual DCA payments. Between September 2011 and March 2012, 213 reviews resulted in the withdrawal of the payment. DCA is a gateway payment and, therefore, its withdrawal quickly precipitates the loss of carer’s allowance and associated benefits. The review process can result in significant financial loss to families with special needs children. The withdrawal of DCA and, for instance, the respite care grant means an automatic loss of €5,408 per annum. In other cases, carer’s allowance is also lost and that can be the principal social welfare payment of a household. It is vital that the review process is fair and, currently, that is far from the case. I have debated this with the Minister for Social Protection on a number of occasions and some progress has been made.
Parents are not given sufficient notice of the review to gather supporting documentation from consultants, therapists etc, which is necessary to re-establish successfully their eligibility for the payment. They have received letters in a number of cases giving them only three weeks notice of a review. I suggested to the departmental officials responsible for information technology and the Minister at a joint committee meeting that an automatic notice of review should be sent six months in advance. Following my intervention, I was delighted the Minister said she would consider extending the notice period to two or three months. What is the updated position? Has that happened?
A desk review of documentation can result in the cessation of payment. When we debated this, I proposed to the Minister that no payment should be stopped without the Department first meeting the claimant and affording him or her the opportunity of an oral hearing, given the crisis that can result from the withdrawal of payment. Has that policy change been implemented?
Since the last time I debated the issue with the Minister, the position has worsened. It has come to my attention that due to a backlog of reviews in the Department, as opposed to in the social welfare appeals office, a number of DCA payments were cut off before the desk review had been conducted at all. For example, a parent has been written to and told a review would take place, has submitted the forms and all the supporting documents, all of which are on time. When the conclusion of the notice period arrives, however, their payment is cut off because no decision has been made. It seems to be an automatic cut-off, which is wrong in the extreme. Does the Minister of State agree this is of great concern and seems to suggest the overriding concern of the Department is cost saving rather than the needs of the disabled children?
At the very least, will the Minister ensure no payment is cut off in advance of the completion of the review? It is not good enough to say, “We will find in favour whenever we get around to the review and we will backdate it”. This causes hardship and the supplementary welfare allowance scheme does not cover the full loss. We must remember we are dealing with a child of significant needs in the first instance.
Deputy Kathleen Lynch: I thank the Deputy for raising the issue. He is correct that it is not just a relevant but a very pertinent issue that is being dealt with on an ongoing basis. Domiciliary care 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. In addition, the Department makes an extensive range of payments to support families with children. In 2011, some €2.08 billion was paid out in respect of 1.13 million children on child benefit. Qualified child increases were also paid to people on social welfare payments in respect of some 495,000 children — 369,000 at full rate and 126,000 at half rate.
Domiciliary care allowance can be paid in respect of children under 16 years of age 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. This care and attention must be given by another person, effectively full-time, so that the child can deal with the activities of daily living. The child must be likely to require this level of care and attention for at least 12 months.
A review policy is an integral part of all social welfare schemes and is necessary to ensure payments continue to be made only to those customers who meet the qualifying conditions. Domiciliary care allowance cases are routinely reviewed to ensure all the conditions for receipt of the payment continue to be met. Cases are reviewed based on either a scheduled review on the recommendation of the medical assessor when the claim is initially processed or on information received about a change of circumstances which potentially affects the continued entitlement of a case already in payment.
Scheduled reviews, on the recommendation of the medical assessor, are based on the prognosis of the child’s disability and how their care needs may change over time. Customers who are reviewed are asked to provide relevant up-to-date medical evidence and details of the additional care needs of their child. This information is assessed by a medical adviser and a decision is made based on the medical opinion he or she provides. Where payment is stopped as a result of a review, the customer is invited to submit any further information he or she may wish to have considered, and that information is further examined and-or he or she may appeal the decision directly to the social welfare appeals office.
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. No specific condition or disability rules a child in or out of qualifying for the allowance.
An expert medical group was established in advance of the transfer to this Department in 2009 and recommended that the most appropriate way for the Department to conduct assessments for medical eligibility was by way of desk assessment of the evidence submitted by the claimant, as provided by themselves and the medical staff who regularly see the child. It was considered that it was not necessary for the child to be physically examined by the Department’s medical assessors as the diagnosis of the child’s condition by their GP is accepted. What is being assessed is the level of additional care and attention the child requires as a result of that condition or disability and if this is substantially in excess of that required by a child of the same age without the condition.
The effective and efficient operation of the scheme is monitored regularly and any improvements to the delivery of service that are identified are implemented. I assure the Deputy that the Department is committed to ensuring those children who meet the conditions for the scheme will continue to receive payments.
Deputy Aengus Ó Snodaigh: I took the time to peruse the online discussion forums for parents of children with special needs. I strongly advise any Deputy but, in particular, the Ministers to look at sites such as www.magicmum.com or www.rollercoaster.ie as well as the various Facebook pages, which show a level of confusion and fear about the reviews. If anything, I ask the Minister of State to take the time to clarify, as she has in regard to some of this, what the reviews are about. The level of fear evident among some of the domiciliary care allowance recipients is somewhat out of synch with the scale of the review-based control system. Nonetheless, I am not opposed to the reviews once they are fair, notice is given and only on completion is a decision made to end or confirm payment.
The fear is in some degree led by the unfairness and lack of transparency, and I ask the Minister of State to end the confusion. A substantial group of 24,000 people are in receipt of this payment but we have sent out mail shots to many more. I ask that a letter would go to each recipient informing him or her whether a review was recommended in the first instance by the medical officer who decided his or her case, given there will not be a review in many cases. If there is a review, the recipient should be informed whether it is a three year or five year review, or otherwise, and when the next review is scheduled to take place, which will give enough notice. Recipients should also receive advice on what supporting documentation they need to keep on an ongoing basis and what to have ready, and they should be encouraged to write a diary of the extra care needs of their child so they can present the full position. This would also facilitate the Department.
Given the level of fear that exists and the concerns people are raising, will the Minister meet the parent and carer’s representatives so they can better articulate what I have tried to articulate today?
Deputy Kathleen Lynch: The Deputy’s suggestion is very helpful and I will also convey that. From my experience of children with disabilities, there are children who will not progress — we know that because it is obvious and we do not need to go into specifics. It is not even in one particular area. Children with autism can sometimes be on the very mild end of the scale and in other cases on the profound end, and there is a whole range of categories. However, as someone who is interested in ensuring people with disabilities progress in life in as independent a way as possible, I would expect there are certain children who would progress and that training and involvement in school and with their local community would ensure them the level of attention and detail they need. For example, the expectation is that when a three, four or five year old with certain needs reaches eight or nine years of age, the level of dependence would have diminished. The review process is about that more than anything else.
I regret there is confusion. I understand that when a letter such as this comes in the door, into circumstances where people felt secure in the past, it can lead to a certain amount of confusion, and not just of insecurity. I will convey the Deputy’s remarks to the Minister.
|Last Updated: 10/01/2013 12:32:19||Page of 143|