Select Committee on Science and Technology Appendices to the Minutes of Evidence


Memorandum submitted by Lord Whitty, Parliamentary Under Secretary of State, Department of the Environment, Transport and the Regions


Update on Progress made in relation to Committee's Recommendations


  The UK's position on exceptional cases for renewing existing professional insulin-treated drivers' entitlements was to some extent based on the view of the Honorary Advisory Panel. The Panel's view, however, was influenced by DETR advice that other member states were applying a ban. The DETR now concedes that "information turned out not to be accurate". We recommend that the Government refers this matter back to the Honorary Medical Advisory Panel for further consideration based on an understanding of practice in other EU countries.

  The Government accepted the Committee's recommendation. The Panel would re-examine its advice in the light of practices across the EU.

  1. The Committee's recommendation has been met in full.

  2. Information from other member states was obtained and considered by the Honorary Medical Advisory Panel on Diabetes and Driving. In the light of this, changes for drivers of category CI vehicles (between 3.5 and 7.5 tonnes) are to be introduced from early April. The revised conditions, which have been welcomed by Diabetes UK, will mean the introduction of individual assessment relating solely to medical issues. The need to be employed to drive category C1 vehicles and to have had a minimum period of driving experience will be discontinued. New applicants, and not just those who held C1 entitlement before 1 January 1997, will be able to apply for the entitlement. The specific criteria for a C1 licence will be:

    —  no hypoglycaemic episodes requiring the assistance of another person in the last 12 months whilst driving;

    —  attendance at an examination by a hospital consultant specialising in the treatment of diabetes at intervals of not more than 12 months and to provide a report from such a consultant in support of the application which confirms a history of responsible diabetic control with a minimal risk of incapacity due to hypoglycaemia;

    —  evidence to be provided of at least twice daily blood glucose monitoring at times when C1 vehicles are being driven;

    —  to have no other condition which would render the driver a danger when driving C1 vehicles, and

    —  to have been on insulin for at least one month.

  3. The Advisory Panel felt unable to recommend changes for drivers of minibuses, large buses and lorries. Their view was that further hard data was needed before changes could be considered. The Panel undertook to look again at the situation in the light of the results of a recently initiated research programme on the effects of insulin treated diabetes on driving. These are expected in 2-3 years. The European Commission is also undertaking research relating to diabetes which will help to inform future European policies.


  We find the rules for medium-sized vehicles as they apply to insulin-treated drivers illogical and inconsistent. We see no reason why the exception for voluntary drivers of minibuses should be extended to those who do not meet the required medical standards for driving larger vehicles.

  The Government accepted the Committee's comments and undertook to regularise the situation in consultation with the voluntary sector.

  4. Work has begun on meeting this recommendation.

  5. The anomaly concerning volunteer drivers of minibuses cannot be tackled in isolation as there are implications for other minibus entitlements to consider.

  6. Discussions with the voluntary sector have taken place. It is clear that the application of higher health standards to all volunteer drivers of minibuses will have a significant effect on voluntary operations.

  7. In addition, the draft third EC Directive on driver licensing, expected to be published in the next month or so, is likely to propose changes to the sub-categories, including medium sized vehicles and minibuses, and to the application of health standards. It would be unwise to progress plans for changes to minibus entitlement until the draft Directive has been received and considered.


  We consider that the exception for insulin treated professional drivers of small lorries had been applied in an unacceptably arbitrary manner. We recommend that the overriding criterion which should be applied in determining whether or not any diabetic driver should obtain a Group II licence should be the risk of the driver being aware of the onset of hypoglycaemia.

  The Government noted the Committee's views but refuted the opinion that the "exception" was applied in an arbitrary manner. The judgement on whether awareness of the onset of hypoglycaemia should be the basis for driver licensing would be considered by the Advisory Panel.

  8. This recommendation has been met in so far as the criteria have been reconsidered.

  9. The Advisory Panel has re-examined its advice on what constitutes a "very exceptional case"; it also considered the suggestion that hypoglycaemia unawareness should be the overriding criterion. It was agreed that a more robust method for identifying hypoglycaemic problems was needed. The new arrangements for C1 drivers to be introduced shortly will require applicants to check blood sugar levels at least twice a day at times appropriate to C1 driving. Records must be produced to the consultant conducting the annual examination. The Panel will provide advice to consultants on completion of the forms used in the validation of blood glucose records.


  We welcome the planned compaign to raise awareness of the need to declare medical conditions which may affect driving.

  The Government welcomed the Committee's endorsement.

  10. The campaign began on 1 February 2001.


  We recommend that clear terms of reference be drawn up for the Honorary Advisory Panel, setting out precisely its role in advisng Ministers, the limits on the areas it should advise upon and the split between Panel, official and Ministerial responsibility.

  A review of the Panel's terms of references was already underway at the time of the Committee's report.

  11. All existing and newly appointed Advisory Panel members and Chairs have been issued with terms of reference.


  The current members of the Honorary Advisiory Panel have the necessary expertise and experience in diabetes and insulin-induced hypoglycaemia.

  The Government welcomed the Committee's acknowledgement of the Panel's expertise.

  12. No action necessary.


  We recommend that the Government appoints an expert on road traffic accident statistics to the Honorary Advisory Panel on Driving and Diabetes Mellitus and considers similar appointments to the other Honorary Medical Advisory Panels.

  The Government accepted the recommendation.

  13. Work on implementing this recommendation has been taken forward.

  14. Each of the Advisory Panels has considered how the expertise of a statistician or epidemiologist might be used. It has been concluded relevant expertise would be invited as and when required. A statistician will sit on the diabetes research steering group to ensure that the results are statistically relevant.


  The absence of lay membership on the Honorary Advisory Panel is unsatisfactory. We recommend that the Government appoint two lay members to this Panel and consider similar action in respect of the other Honorary Medical Advisory Panels.

  In principle, the Government favoured the introduction of a lay element in the formulation of advice on medical aspects of driver licensing. It undertook to consider how best to give effect to the Committee's recommendation.

  15. The introduction of lay members to the Advisory Panels is well under way.

  16. All Advisory Panels have agreed to the introduction of lay members. DVLA has begun the process of canvassing for suitable nominations. Diabetes UK has been involved in this process and has suggested several candidates. It is expected that lay members will be appointed to the Diabetes Panel by April 2001 with appointments to the remaining Panels following on shortly.


  We recommend that the Government and the British Diabetic Association jointly identify an insulin-treated diabetic to attend meetings of the Honorary Advisory Panelas a non-voting member. While such an individual should not be as a formal member of the panel, he or she should have full access to panel papers and be invited to participate fully in discussions.

  As with recommendation (h) the Government agreed to consider, in conjuction with each Panel, how best to give effect to this recommendation.

  17. Action has been taken to introduce a lay member who has insulin treated diabetes to the Diabetes Advisory Panel.

  18. In conjuction with Diabetes UK, several persons with insulin treated diabetes have been identified as potential members of the Advisory Panel. It has been decided to give full membership, rather than non-voting membership as the Committee recommended. Access to all Panel papers and participation in discussion will be permitted.


  The arrangements for appointment of members to Honorary Medical Advisory Panels are unsatisfactory. We recommend that the Government establish a fixed term of appointment of no longer than five years, which should be renewable only once. Such a policy although necessary to comply with the rules of the Commissioner for Public Appointments, should be implemented gradually so that continuity is maintained and to ensure that there is no large change in the Panel's membership at any one time.

  The Government agreed with this recommendation.

  19. This recommendation has been adopted.

  20. All Advisory Panel members are appointed for five years with a single renewal where appropriate. All existing Panel members have been made aware of this condition and notice of this requirement is included in the letter inviting new members to serve on the Panels.


  We recommend that the Honorary Panel publishes an annual report and, shortly afterwards, holds an annual meeting with the British Diabetic Association and other interested parties to discuss matters of common interest and to explain any complex recommendations made.

  The Government accepted this suggestion.

  21. An annual report will be published on the Internet shortly. Comments will be invited and a meeting held with Diabetes UK and other interested parties as required.


  We recommend that the Honorary Advisory Panel's agendas are published in advance of meetings and that minutes be published shortly after meetings, with the privacy of any individuals discussed protected.

  The Government accepted this recommendation.

  22. This recommendation has been implemented.

  23. Panel meeting agendas and minutes are now published on the Internet.


  We recommend that the Government makes explicit the risk basis for road safety policy in respect of licensing of individuals with medical conditions which potentially affect fitness to drive.

  The Government accepted this recommendation in principle.

  24. Action has been taken to obtain data that would enable risk assessment to be evaluated.

  25. An extensive programme of research has been initiated which will cover diabetes and driving, vision and driving and the DVLA database. A paper has also been commissioned on the risk assessment of driving and medical conditions. Further work will begin later in the year on commissioning work in the areas cardiology, neurology and psychiatry.


  The DETR states that independent UK evidence is necessary because the present policy and practices are derived from obligations to adhere to European legislation based on "long-standing expert assessment of the dangers associated with the driving of larger vehicles by insulin-treated diabetics". This assessment does not appear to be supported by any evidence. We recommend that the evidence basis for such expert assessment should be made publicly available.

  The Government noted the Committee's views and undertook, in conjunction with the European Commission, to obtain and make available such evidence, where possible.

  26. Action has been taken to fulfil this undertaking.

  27. From discussions with the European Commission, it is clear that the need for evidence based policies has been accepted.


  We recommend that the scope and depth of the Fitness to Drive Research Programme should be enhanced and adequately funded.

  The Government welcomed the Committee's endorsement of the proposed research.

  28. This recommendation has been met in full.

  29. There are three key areas of research currently underway: diabetes and driving; vision and driving; and an analysis of DVLA's medical database. In addition to providing the basis for risk analysis in the UK, the research will be used to inform European opinion.


  We recommend that the Government reviews policy in the area of licensing procedures for insulin-treated diabetic drivers of Group II vehicles including an analysis of the feasibility of implementing the British Diabetic Association proposals for individual assessments.

  The Government agreed to view the arrangements as recommended.

  30. This recommendation has been met in full.

  31. The policy for Group two drivers who have insulin treated diabetes has been reviewed. Changes have been proposed as outlined in the answer to point (a). The Advisory Panel examined Diabetes UK's proposal for individual assessment and agreed that they were in line with its own recommendations for changes to the C1 criteria but did not go far enough to satisfy concerns about blood glucose monitoring.

March 2001

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