The Minister for Health and Children, Deputy Cowen, fully understands the Deputy's concerns. He fully appreciates the demanding role facing parents and guardians of children of all ages with a disability, and he is very conscious of the dedication and commitment demonstrated by these carers. 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, a dependant of such a person, or a person who, but for the provision of a service for him under the section, would require to be maintained otherwise than at home. 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 rate of the allowance is £111.20 per month. More than £12 million was paid out under the scheme in 1998 in respect of 9,108 children.
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 another year. The necessary medical assessment is carried out by health board medical personnel. In some cases, depending on the medical condition, eligibility is reviewed at regular intervals. Following such a review, if a child's condition has improved, 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, to the extent possible, the needs of the recipient on an ongoing basis. 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". However, there is a view that children under two years who have a severe disability need a greater level of care than a healthy baby. The Deputy will appreciate that any decision to extend the domiciliary care allowance to children under two years of age who are severely disabled will impact not only on 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. This examination involved consultation with the health boards, concerned groups and other Departments. The review concluded that best international practice recognises the additional care required for children under two years of age with a disability. The Minister accepts that very often it is not simply a matter of care but the kind and intensity of the care required. While the international experience var ies in the type of and eligibility for schemes, the underlying trend is to offer some support to children under two years of age. Having examined the findings of the review, the Minister remains sympathetic to the principle of extending coverage of the scheme. Consequently, he has instructed officials within the Department to consider the possibility of granting such an extension sooner rather than later. In this context, these officials are discussing the possibility of funding being sourced in the Estimates for the year 2000. I take on board what the Deputy said in regard to the forthcoming budget and consideration will be given in the Estimates.
The Dáil adjourned at 9.10 p.m. until 10.30 a.m. on Wednesday, 13 October 1999.
