Background

The Domiciliary Care Allowance (DCA) scheme was first introduced in 1973. The Allowance is payable under Section 61 of the Health Act 1970. The operation of the scheme is carried out in accordance with guidelines which are issued by the Department of Health and Children and updated periodically.

Under the heading "Criteria and Eligibility", the guidelines, (issued 1 July 2002), state:

"Domiciliary Care Allowance is a monthly allowance administered by [the Health Service Executive (HSE)] and may be paid in respect of eligible children from birth to the age of 16 who have a severe disability requiring continual or continuous care and attention which is substantially in excess of that normally required by a child of the same age. The condition must be likely to last for at least one year. Where medical confirmation is supplied which predates the actual date of application and the [HSE's] Senior Area Medical Officer is satisfied that the child required continual or continuous care and attention which is substantially in excess of that normally required by a child of the same age, then payment may be made from the date the Senior Area Medical Officer is satisfied that such care and attention was required."

The guidelines also state that DCA

"... is intended as a recognition of the additional burden involved in caring for children with severe disabilities in the child's home..."

and that

"It is a matter for the Senior Area Medical Officer or other designated medical Officer in the relevant Community Care Area to decide whether or not a child qualifies for Domiciliary Care Allowance on medical grounds."

The guidelines further state:

"Eligibility is determined primarily by reference to the degree of additional care and attention required by the child rather than to the type of disability involved, subject to the means test. While no condition is debarred, conditions such as Asthma, Diabetes or Epilepsy are not normally considered unless there is a very high degree of additional care and attention required."

Under the guidelines, the HSE is required to formally notify unsuccessful applicants of the decision and also to inform them of their right of appeal. Where an individual exercises this right of appeal, the procedures in HSE Dublin Mid-Leinster are that the appeal letter is passed on to the Senior Area Medical Officer (SAMO) who arranges for an Area Medical Officer (AMO) who was not involved in the original decision to carry out another medical assessment of the child. The case is then reviewed by the SAMO who may either change the original decision and award DCA, or uphold the decision to refuse the allowance. If the SAMO upholds the original decision, he/she then forwards the case to be considered by the Medical Review Committee, which is made up of SAMOs not involved in the original decision.