The Minister fully understands and appreciates the Deputy's concern. He is very aware of the problems and the difficulties facing parents and carers of children with severe disabilities. Their unstinting commitment to care for these children must be and is acknowledged by the Minister. For many, this commitment is a life long dedication and is not only confined to the childhood years.
It is worthwhile however to explain the nature and background to the scheme. The domiciliary care allowance is paid by health boards in respect of children between the ages of two and 16 years who are so severely physically or mentally disabled that they require care and attention which is considerably in excess of that normally required by a child of the same age.
The scheme operates under section 61 of the 1970 Health Act. This section empowers a health board to make arrangements to assist in the maintenance, at home, of a sick or infirm person or a dependant of such a person or a person, who, but for the provision of a service for him under this section would require to be maintained otherwise than at home.
The scheme applies to children aged between two and 16 years of age. Eligibility is subject to a means test but only the means of the child are taken into account. For example, a child who receives a payment of compensation resulting in an income in excess of the allowance does not qualify. The current rate of the allowance is £106.70 per month. In 1997 just over 8,800 allowances were paid.
The criteria under which the scheme operates state that the handicap must be present at the time of the application, have been present for at least six months prior to that date and be likely to continue to last for at least a year. The necessary medical assessment is carried out by health board medical personnel. In some cases, depending on medical condition, eligibility is reviewed at regular intervals because should a child's condition improve, he or she may no longer meet the criteria for eligibility. These reviews also provide an opportunity to ensure that the services available and the care plan in place meet the needs of the recipient on an ongoing basis to the extent possible.
The allowance is not paid in respect of children maintained in institutions. However, where a child is at home for a continuous period of more than two months, for example, summer holidays, the allowance may be granted for that period.
The Minister is conscious of the many requests made by concerned individuals and representative organisations urging that the scheme be extended to cover severely disabled children under two years of age. The guidelines state that "children below the age of two are not regarded as eligible as such children normally require constant care and attention in any event", as was pointed out by the Deputy. However, there is a view that children under two years who have a severe disability need a much greater level of care than a healthy baby.
However, we must recognise the demands made on parents and guardians in relation to the care required for disabled children of all ages. As the Deputy is aware, there are many demands on the scarce resources available to support the care of the ill and needy. Priorities have to be agreed between a number of Departments to target resources as effectively as possible towards supporting the fullest spectrum of carers.
Therefore, one recent initiative is the agreement that the carer's allowance, administered by my colleague, the Minister for Social, Community and Family Affairs, Deputy Dermot Ahern, is to be extended to include eligible carers of children currently in receipt of the domiciliary care allowance. This initiative will be introduced in August this year. Eligibility will be subject to a means test.
I mentioned earlier the life long commitment of carers through the childhood years into adulthood. In many cases the care needs and requirements are quite often the same between child and adult, and the same quality of care can arise in both cases. In addition, the same problems of income can arise in both cases. The extension of the carer's allowance means that eligible carers providing full-time care and attention to a child in receipt of the domiciliary care allowance will benefit from this additional income. The Deputy will appreciate that any decision to extend the domiciliary care allowance to children under two years of age and who are severely disabled will impact not only the scheme itself but on the provision of other assistance provided by the state in the sphere of care and income support. Issues such as means testing and appropriate medical criteria require also to be addressed in this context.
As indicated in replies to recent parliamentary questions, the Minister, arranged for the issue of an extension of the domiciliary care allowance to be examined within the Department. This examination has involved consultation with the health boards, concerned groups and other Departments. The evidence gathered and initial outcome of that examination leads me to being sympathetic towards the principle of extending coverage of the scheme.
The Minister is, however, for the reasons stated keeping matters under review in relation to the future possible extension of the domiciliary care allowance to children under two years of age.
