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Wednesday October 22nd 2014

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Mulcahy Seeks Clarification On Domiciliary Care Allowance Applications

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Clare Fine Gael Senator Tony Mulcahy has expressed his disappointment in relation to delays being experienced in the processing of Domiciliary Care Allowance applications.

Speaking in Seanad Éireann, Senator Mulcahy has also asked the Minister for Social Protection Joan Burton, T.D., to clarify the necessary qualifications of the Department of Health officials who assess the applications.

The 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 scheme was administered by the Health Service Executive before it was transferred to the Department of Social Protection.

Speaking in the Seanad about what he described as “unnecessary delays in relation to the processing of applications”, Senator Mulcahy said: “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,” commented Senator Mulcahy.

Responding to Senator Mulcahy’s queries on behalf of Minister Joan Burton, Deputy Dinny McGinley noted that the Department has 22 medical assessors including the chief medical advisor and the acting deputy chief medical advisor. He added that a further 3 medical assessors have recently been appointed by the Public Appointments Service and are have already commenced work.

He continued: “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.

In response Senator Mulcahy stated: “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”

Senator Mulcahy concluded by saying that he would reserve his opinion until he has received the additional information. Deputy McGinley confirmed he convey the Shannon-based Senator’s request to Minister Burton.