1. Assessing fitness to drive in Category B licence holders in 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 Patients General 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 advice the doctor should 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 & Prospective Disabilities Road Traffic Act 1988 S.92(2) 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.

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

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. Overall effectiveness of the process? 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

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