Assessing fitness to drive in Category B licence holders in Great Britain

1. Assessing fitness to drive in Category B licence holdersin Great Britain Dr Heather Major Senior Medical Adviser DVLA Swansea heather.major@dvla.gsi.gov.uk

2. Drivers Medical Group DVLA

3. Total UK Licence Holders

4. Assessment process Category B licence • (Minimum age 16 - mobility allowance) • Usual minimum age 17 • Expiry at 70 • Three-yearly renewal after 70 • Eyesight checked at first driving test • Medical self declaration throughout

5. A driver’s duty The driver has a legal duty* to notify DVLA of a relevant or prospective disability, stating the nature & extent of the disability: • on application for a licence and • during the period for which the licence remains in force *(1988 Road Traffic Act)

6. A Doctor’s Duty To PatientsGeneral Medical Council guidance If a patient has a relevant medical condition the doctor should: • Advise the patient not to drive • Make sure the patient understands that the condition may impair their ability to drive • Explain to patients their legal obligation to notify DVLA • If the patient continues to drive against advicethe doctorshould follow GMC guidance to notify DVLA directly • Doctors do not have a legal requirement to notify DVLA

7. Authority arising from The Road Traffic Act • Requires drivers / applicants to notify / declare to DVLA any medical condition that may affect driving • Gives DVLA powers to investigate • Gives the power to DVLA to issue, refuse or revoke licences (not to the examining doctors) • Duration of licences • Gives licence holders and applicants the legal right of appeal

8. Relevant disability: The prescribed disabilities Any other disability likely to be a source of danger to the public when driving Prospective disability: Any condition which by virtue of its progressive or intermittent nature or otherwise may become a relevant disability in the course of time. Relevant & Prospective Disabilities Road Traffic Act 1988 S.92(2)

9. Prescribed Disabilities Group 1 • Epilepsy • Severe Mental Disorder • Inability to meet the Prescribed Eyesight regulation - “number plate test” • Liability to sudden attacks of disabling giddiness or fainting • Liability to sudden attacks of disabling giddiness caused by any disorder / defect of the heart such as require correction by an implanted device (eg. pacemaker/ICD) • Persistent misuse of drugs or alcohol

10. Epilepsy Neurosurgical conditions Neurological disorders Diabetes Cardiac conditions Visual acuity/field Psychiatric conditions Alcohol, Drug & substance misuse Respiratory and Sleep Disorders Limb disabilities Self-declaration questions on :

11. Investigation procedure* at DVLA • Specific medical questionnaire and consent form sent to licence holder / applicant • Request for medical report from GP or consultant + / - • Independent medical / optometry assessment • referral for alcohol and/or drugs screen • referral for specialist Consultant opinion • referral to Disabled Drivers Assessment centre • (Free Driving test) *DVLA pays

12. Licence outcomes after medical assessment • Licence application refused • Existing licence revoked • Licence retained (till 70 or for 3 years over 70) * with/without vehicle restriction • Licence re-issued for 1, 2 or 3 year duration * with/without vehicle restriction (and thereafter subject to repeat medical review) *Licence restricted to certain types of vehicle / vehicle adaptation codes

13. Drivers’ Appeal rights Legal right to appeal • to Magistrates Courts (England and Wales) within 6 months of decision to refuse, revoke or restrict a licence • Same right of appeal but is limited under Scottish law to 21 days from date of decision, for appeal to be lodged • Also informal reconsideration / “new information” process within DVLA

14. Appeals data 2000-2004 801 693 108 100 8

15. Sources of notification • Licence holder (patient) • Medical - usually consultant/GP • Police • Courts • Family / friends • other “3rd party”

16. Transparency of the current process • Clear on licence application - all application forms require full medical self-declaration • Ongoing liability for licence holders to notify. Elements of under-reporting • variable, perhaps limited, awareness by both drivers and doctors • information on DVLA website and leaflets

17. Effectiveness of the process? • Thorough and fair for those entering the system, but liable to delays and rising costs • concerns over risk of under-reporting with some conditions (eg. alcohol problems) but others (eg. diabetes) have high notification rates • No data on direct impact of medical licensing process on road accidents • Average cost per case approx. €40

18. Medical acceptability of the process? • Removes some of patient/doctor conflict over driving (especially for older drivers) • doctors find our process cumbersome • psychiatrists (especially) and alcohol/drug treatment workers find medical process and standards conflict with patient’s rehabilitation • some doctors feel driving issues not their responsibility

19. For impartial consistency places onus on driver free to drivers right of appeal Against risk of under-reporting seen as remote / no local “discretion” process can be slow and cumbersome Medically focussed -case for functional approach Overall effectiveness of the process?

20. Category B medical caseload 2004 365,119 total cases

21. Examples of cat. B caseload(2004) by medical condition

22. Review of DVLA medical process • Developed when local licensing centralised under one authority (DVLC) in 1974 • Currently undergoing major independent review of the whole process. • Reasons for review include: • Ageing population • co-morbidity • rising costs ( approx. € 20m 2004) • balance between road safety & mobility