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Investigation Report on Domiciliary Care Allowance *

Date released: 05.06.2008

The Ombudsman, Ms Emily O'Reilly, has today published her Report of an investigation into three complaints that she received regarding the refusal of Domiciliary Care Allowance (DCA) by the Health Service Executive (HSE).

* Domiciliary Care Allowance is a monthly allowance administered by the Health Service Executive which may be paid in respect of 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 first case involved an application for DCA in respect of a girl who has Sickle Cell Disease (SCD) which had been refused on the grounds that she did not require care and attention considerably in excess of that normally required by a child of  the same age. In this case, the girl's sister, who also has SCD, had been granted DCA. The medical evidence was identical for both girls. The Ombudsman considered that the decision to award DCA in respect of one of the girls and refusing it in respect of the other, was improperly discriminatory and contrary to fair or sound administration.

-   In the second case, DCA was refused in respect of a boy who has Attention-Deficit Hyperactivity Disorder (ADHD) because the HSE considered this condition to be a behavioural disorder, and not a disability.  However, the examination of other cases by the Ombudsman's had revealed that DCA has been awarded in respect of other children with ADHD. The Ombudsman considered that the decision to refuse DCA was improperly discriminatory and contrary to fair or sound administration.

-   The third case related to a boy who has cerebral palsy. The first application for DCA had been refused in 1995 and a second, made in 2001, was also refused. The Ombudsman considered the decision in respect of the boy's entitlement did not take into account all of the relevant medical and other  evidence and that the manner in which this case was handled was contrary to fair or sound administration.  She recommended that the case be reviewed by a Senior Area Medical Officer of the HSE, who had not previously been involved in the case, taking all of the evidence available from clinicians who had treated the boy, and from teachers in his school and that the HSE communicate the outcome of this review to her within two months.

In addition to the recommendations which are specific to these cases, the Ombudsman also recommended that the HSE undertake a review of DCA applications in respect of children diagnosed with ADHD, in the Community Care area, to determine the extent to which similar applications may have been refused.

In addition, because the Ombudsman had found that there is a lack of consistency in the administration of the DCA scheme throughout the HSE nationally, she recommended that the HSE provide her with a detailed report setting out the measures it proposes to take in order to bring about consistency and understanding in the interpretation, among Senior Area Medical  Officers nation-wide, of the DCA scheme.  

The full report, which has been anonymised to protect the parents' and childrens' privacy, may be viewed on the Ombudsman website, http://www.ombudsman.gov.ie/en/Publications/InvestigationReports/, and gives details of the background to the three complaints and the investigation carried out by the Ombudsman. The report also contains the Ombudsman's findings and recommendations which were accepted in full by the HSE. The HSE has informed the Ombudsman that in two of the cases, in which she had recommended the award of DCA, arrears in excess of Euro18,000 and Euro13,000 are to be paid in addition to ongoing monthly payments of Euro299.60 each. In the third case, the HSE has arranged for a Senior Area Medical Officer, who was not previously involved in the case, to undertake a review of the DCA entitlement.

For further information contact:

Brendan O'Neill,
Office of the Ombudsman,
18 Lower Leeson Street,
Dublin 2.
Tel:- (01) 6395655,
e-mail: brendan_o'neill@ombudsman.gov.ie

or

Patsy Fitzsimons,
Office of the Ombudsman,
18 Lower Leeson Street,
Dublin 2.
Tel: -(01) 6395637,
e-mail: patsy_fitzsimons@ombudsman.gov.ie.

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