Memorandum from Roger Fell (RS 63)
SUMMARY
1. This response to the invitation by the
Committee to submit evidence is to identify an area of potential
in casualty reduction that is related to Medical Fitness to Drive.
2. This memorandum seeks to focus on a minority
sub-group of Insulin Dependent Diabetics who have reached medical
status levels which pose significant risks to other road users
contrary to the concept of public interest. (The lessons derived
in the research would suggest that other medical conditions affecting
fitness to drive may also pose unacceptable risks which are identifiable).
3. It seeks to quantify the size of that
minority sub-group and identify the cost to the nation using "official"
published data and research and demonstrates that the potential
saving in casualties is significant.
4. It seeks to identify areas of weakness
in the existing monitoring methodology laid down in the Road Traffic
Act 1988 and Health and Safety at Work Act 1974 and subsequent—and
how these have serious adverse consequences on legal challenges
following road traffic accidents.
5. During the writer's research the following
issues have arisen and are discussed below:
5.1 The failure of drivers to notify DVLA
of a medical condition as required by law.
5.2 The failure of the DVLA to prosecute
any driver for such failure.
5.3 The failure by DVLA to monitor drivers.
5.4 The lack of mandatory notification by
medical professionals despite DVLA, GMC and BMA guidelines.
5.5 The frequent portrayal of extreme resistance
by a diabetic patient to acknowledge the risk without regard to
self, family, friends and work colleagues.
5.6 The level of poor advice by medical professionals
to drivers.
5.7 The presence of "discretionary"
rather than "mandatory" advice by critical personnel.
5.8 The vague guidance in documentation such
as ACPO Road Investigation Manual (2007), HSE Driving at Work—Managing
Work Related Road Safety and DfT document Fitness to Drive—A
Guide for Professionals.
5.9 The dependency by DVLA on "self-notification"
despite warnings from research showing high levels of resistance
to notify mixed with a further dependency of information from
family, friends and work colleagues.
5.10 The tendency of most debate to focus
of the right to mobility by special interest groups at the expense
of accident risk and the consequences.
5.11 The poor level of solid research using
adequate sample sizes and avoiding biased samples leading to poor
conclusion.
5.12 The consequential complexity in law
due to the legal defence of "automatism" by an offending
driver following an accident caused by a medical condition such
as a hypoglycaemic episode which renders a driver incapable of
driving and where it can not be proven that adequate safeguards
were followed prior to driving.
NATURE AND
QUANTIFICATION OF
THE RISKS
6. The Memorandum addresses the particular
incidence of Diabetes & Driving Risk in the population. Appendix
1 and Appendix 2 set out the numerical data provided by "official"
sources. It is noted that data is "approximated" and
sometimes does not precisely tally in cross reference but generally
the values are without major discrepancy.
7. The focus of this evidence is on a specific
sub-group of Type 1 Insulin Dependent Diabetes patients who have
experienced hypoglycaemic episodes. From Appendix 2 Table (b)
it can be seen that the highest prevalence of Type 1 Diabetes
is within the 15-44 years age group with a rapid numerical population
fall-off in the older age groups. The problem is to identify those
in that population who are also drivers—thus there is no
immediate estimate possible except by interpolation from other
data sources of driver ratios in age groups.
8. Considerable research has been carried
out to identify whether a driving risk is present in the Type
1 group. From this there are repeated findings that within the
Type 1 group there is a higher risk where the patient experiences
hypoglycaemic episodes. There are 2 stages which may be identified—firstly
the range within which impairment occurs to the cognitive function
leading to erratic driving / poor judgment thus presenting a risk
to other road users, and secondly where the driver becomes unconscious
at the wheel with catastrophic consequences.
9. It is understood that an under-pinning
factor for the grant of licence to Type 1 Diabetic patients is
the assertion that there is time to note an onset of symptoms
leading to impairment thus permitting the driver to take suitable
action to cease driving. However I am advised by an expert Diabetician
with a specific interest in Driving Risk that this factor is not
a constant nor is it consistent between differing drivers: it
can happen very quickly and thus in many road driving scenarios
there may in fact be no safe option available—not least
high speed roads such as Motorways and dual `A' roads. This suggests
that driving licences are granted with a poor hypothesis unsupported
by robust positive evidence rather than adopt a pre-cautionary
principle—a principle more favoured in law where inconclusive
expert opinion exists.
10. Whilst Group 2 (essentially commercial
vehicle) drivers are automatically precluded from driving if Type
1 Diabetic (with exceptional circumstances) those driving Group
1 vehicles (cars and light vans) are permitted to drive subject
to certain notifications as required by law. One reason for the
refusal of licence for Group 2 vehicles is the assertion of greater
risk due to vehicle type and the time spent driving in commercial
environments. This division appears flawed as a hypothesis on
three grounds. Firstly a commercial driver has to comply with
rigorous driving time limits with enforced proper rest periods:
a car driver has no such regulatory control and in a work environment
will be placed under obligation to meet timescales for meetings/delivery
etc within traffic conditions which will often be stressful—a
factor in triggering hypoglycaemic episodes. There may well be
advice but there is no statutory obligation/control. Secondly
many accidents are caused by a car/light van driver fault which
subsequently collides with another vehicle—and on Motorway
and principle "A" class roads there is a very high commercial
vehicle content in the traffic mix. This therefore means there
is a high probability of one or more commercial vehicles being
part of the accident generating high impacts. This risk is a greatest
in any cross-over scenario whereby the commercial vehicle is caused
to pass into oncoming vehicles. Such collisions are likely to
have major injury implications. Thirdly there are numerically
greater numbers of Group 1 drivers—and there is no evidence
offered that the prevalence of Type 1 Diabetes is greater in Group
2 vehicle driver population than Group 1.
11. In Appendix 3 Table (B) and Appendix
4 Table (A) it can be seen that Road Type has a major influence
on accident rate and casualty level.
12. Limited research exists to break down
the specific medical condition which is presently recorded in
DfT Traffic Accident Data under the Heading "Contributory
Cause". This category specifically excludes Drink, Drugs,
Fatigue and Defective Eyesight. It thus includes Epilepsy that
is considered to be a contributory cause in some 50% of this category
of accident data. The DVLA currently states to the Secretary of
State's Advisory Medical Panel that it receives approximately
30 notifications from the police per month (having risen from
27 cases) where diabetes is recorded as a contributory cause to
a Road Traffic Accident (RTA). There appears no record of the
severity of these accidents—and it is considered there is
substantial under-reporting. This will particularly occur in the
case of Fatal Accident outcomes since the police do not report
where the driver at fault is the victim nor where a death occurs
after 30 days: that death passes into the Hospital reporting system.
There is evidence in research suggesting that 44% of fatal accidents
involve the driver at fault being the victim. There is further
concern that the police identification methods of injury severity
are not robust thus giving rise to further under-reporting. Finally
there is also evidence that lesser injury accidents are not all
reported to the police—thus the data in this memorandum
represent only data where the police attended the RTA.
13. By taking the 2006 value of 1846 RTAs
with Illness or Disability listed as Contributory Cause and the
360 annualised DVLA value for Diabetes related incidents it indicates
a 19.5% factor. This compares favourably with other research assessments
of 18%, 20% (police estimate) and more recently 17% for hypoglycaemia
(Dft "Fitness to Drive (2006)—Section 5 Sudden Incapacity").
For the purposes of this submission a value of 20-25% is considered
appropriate to take account of accepted under-reporting.
14. It is universally accepted that those
who suffer hypoglycaemic episodes do represent a significant risk
to other road users: the problem for legislators is that there
is no agreed method to identify the threshold value within the
overall Type 1 diabetic population thus it appears that rather
than blanket legislate for Group 1 vehicle drivers as per Group
2 the decision has been made to avoid similar controls.
15. Theoretically rules are in place—together
with guidance—to control this sub-group by a method of self-disclosure.
Unfortunately it is clear that an irresponsible attitude exists
amongst a significant cohort of this sub-group which ignores the
law and the advice of professionals. In this scenario—until
and accident happens—no-one is the wiser. The consequence
to victims and their families is one of catastrophic value.
16. Expert research (in North America and
Europe) has revealed in many studies that an unacceptably high
percentage of Type 1 Group 1 vehicle drivers admit to a hypoglycaemic
event whilst driving and significant numbers to having a driving
accident since starting insulin treatment. Worryingly there are
many reports indicating poor advice being passed to patients in
respect of driving risk by medical practitioners—this despite
substantive Guidance Documentation. It is accepted that there
are increased efforts in this area but it does appear to remain
one of deep confusion and inconsistency of advice.
17. Reports exist of deliberate fabrication
of testing results by drivers when driving or about to undergo
review or assessment by consultants.
18. The conclusion is that the current guidelines
and legal requirement fall well short of the desired position
to protect other road users. Most seriously—despite the
Statutory provision—the DVLA has admitted to never having
prosecuted a driver for failure to notify of a medical condition
likely to be a risk to others either exiting or developing. This
apparent " policy" expressed in correspondence from
DVLA to the writer is regrettable. It seems to contravene a basic
rule that the Executive should not become the Judiciary and effectively
negatives the wishes of Parliament. If there is no penalty for
failure then the system is fatally flawed. This is of no comfort
to victims and their dependants.
DVLA REQUIREMENT
TO NOTIFY
: THE STATUTORY
POWER
19. The underpinning statutory power is
given by the Road Traffic Act 1988. The DVLA acts on behalf of
the Secretary of State.
20. Part III of RTA88 under Physical Fitness
provides (section 92) that an application for the grant of a licence
must include a declaration by the applicant stating whether he
is suffering from or has at any time suffered from any relevant
disability or any prospective disability ("disability"
includes disease). Section 92(b) also states "any other disability
likely to cause the driving of a vehicle by him in pursuance of
a licence to be a source of danger to the public" Revocation
of a licence is provided by section 93(2) "If the Secretary
of State is at any time satisfied on inquiry that a licence holder
is suffering from a prospective disability the Secretary of State
may serve notice in writing on the licence holder revoking the
licence".
21. An important further provision exists
for the period between the first issue of licence and the 70th
anniversary of date of birth. This is the only limitation placed
on the first licence and unless a driver changes details such
as address no other application will be made until age 70. Under
section 94 Provision of Information the requirement is: 94(1)
If at any time during the period for which his licence remains
in force a licence holder becomes aware (a) that he is suffering
from a relevant or prospective disability which he has not previously
disclosed to the Secretary of State, or, (b) that a relevant or
prospective disability from which he has at any time suffered
(and which has been previously so disclosed) has become more acute
since the licence was granted the licence holder must forthwith
notify the Secretary of State in writing of the nature and the
extent of his disability.
22. Section 94(3) states "A person
who fails without reasonable excuse to notify the Secretary of
State is guilty of an offence".
23. Section 95 Notification of Refusal of
Insurance on Grounds of Health: (1) If an insurer refuses to issue
to any person such a policy of insurance as complies with the
requirements of Part VI of this Act on the ground that the state
of health of that person is not satisfactory the insurer shall
as soon as practical notify the Secretary of State of that refusal
and of the full name, address, sex and date of birth of that person
as disclosed by him to the insurer.
24. Section 99 Duration of Licence: provides
for provision to 70 years of age except for a driver suffering
from a relevant or prospective disability when duration may be
not more than three years and not less than one year.
ROLE OF
THE MEDICAL
PRACTITIONER
25. It is in this area that the major issue
appears to arise since there is an underlying consideration of
patient confidentiality. At the same time the Medical Practitioner
is also in a unique position of assessment of the Medical Condition
and the potential risks—and will be required by DVLA to
submit relevant appropriate information.
26. In AG -v- Guardian Newspaper Lord Keith
said: "The law has long recognised that an obligation of
confidence can arise out of particular relationships. Examples
are the relationships of doctor and patient, priest and penitent,
solicitor and client, banker and customer"
27. The present guidance by General Medical
Council (GMC) is to be found at:
http://www.gmc-uk.org/guidance/current/library/confidentiality.asp
28. This states that: "patients have
a right to expect that information about them will be held in
confidence by their doctors. Confidentiality is central to trust
between doctors and patients. Without assurances about confidentiality
patients may be reluctant to give doctors the information they
need in order to provide good care".
29. What, however, is the position when
it is apparent to the diagnosing Medical Practitioner that the
patient has a medical condition likely to cause risk to others?
30. The GMC Guidance is quite clear that
the first action by the Medical Practitioner is that there is
a Duty of Care to advise the patient of the risk which is considered
to pose a threat to either the patient or to others. It is advised
that the Medical Practitioner must further advise the patient
of the patient's obligation to notify the appropriate authority—eg
DVLA. Where the Medical Practitioner is not satisfied that his
patient has followed this advice to advise the DVLA as legally
required and continues to drive the GMC then advises that the
Medical Practitioner must act in the Public Interest even if this
means without the patient's consent. From the web based information
this section is poorly written and is inherently unclear. Previously
the advice (Blue Book) has been rather more robust that where
there are "exceptional circumstances" then disclosure
is required to the relevant person or Authority. In this matter
the definition of "exceptional circumstance" includes
situations where the health and/or safety of others would otherwise
be at serious risk.
31. In a further current GMC source (Confidentiality:
Protecting and Providing Information—2004) the position
is stated with greater clarity: "If you do not manage to
persuade patients to stop driving, or you are given or find evidence
that a patient is continuing to drive contrary to advice, you
should disclose relevant medical information immediately in confidence,
to the Medical Adviser at the DVLA".
32. The primary issue appears to be that
there is an absence of mandatory requirement under the present
terms of the RTA88 on the Medical Practitioner whereas it is placed
upon an Insurer (viz paragraph 23 above)—and that Insurer
equally relies on the Medical Practitioner to establish the detail
of the apparent risk posed by the patient after the patient has
informed the insurer. There appears some pressure on insurers
due to the Disability Discrimination Act not to disadvantage a
policyholder due to illness unless it can be proven there is a
risk requiring consideration. However this might have major implications
in the event of an accident when claims are made against the policyholder
and it is found material information has not been given.
33. The Medical Practitioner thus is placed
as custodian of his patient's medical treatment but also—without
legislation—is left to make a judgment as to the element
of Public Interest under the terms of a Duty of Care to the wider
public. It appears that legal opinion is that where the public
interest is greater than the interest of the individual the public
interest shall have primacy.
DFT GUIDANCE
DOCUMENT: FITNESS
TO DRIVE—A
GUIDE FOR
HEALTH PROFESSIONALS
(PUBLISHED 2006)
34. Loss of consciousness or an altered
state of awareness is a self-evident risk if it occurs while an
individual is driving and comes on too quickly to allow them to
stop the vehicle safely. The most important indicators of driving
risk are the speed of onset of incapacity from the event and whether
there are warning signs/symptoms which, if heeded, will enable
the driver to abort the event or to immobilise the vehicle safely.
35. In diabetes the most important safety-critical
impairment is hypoglycaemia—almost always as a complication
of insulin treatment, but occasionally from oral anti-diabetic
medications, especially sulphonylureas.
36. Cognitive impairments from hypoglycaemia
(prior to incapacity) are:- slower reaction time; slowed speed
of performance of complex tasks; difficulty in rapid decision-taking;
difficulty with sustained attention; difficulty with the analysis
of complex visual stimuli; impaired hand-eye co-ordination; impaired
contrast sensitivity; mood changes (including tenseness, tiredness,
increased anger and irritability and mental confusion.
37. Perceptions of early symptoms (awareness)
of a hypo may dimish over time. Early identification of a hypo
greatly reduces the risk of consequential crash damage, as either
oral carbohydrates can be taken to remedy the hypo or driving
ceased. The time course from first awareness to incapacity is
variable over a period of seconds to minutes.
38. There is some conflict between the evidence
that strict control of blood/glucose reduces the frequency of
complications but increases the frequency of hypos. There is a
view that tight medicinal management leads to less awareness and
thus greater risk.
39. Driving has its own metabolic demands
for glucose and measurement of blood glucose before driving is
recommended. This has been an important legal issue in a number
of recent court cases where major accidents have been attributed
to hypoglycaemia. Self recording meters have important advantages
in this situation.
ROLE OF
POLICE AND
HEALTH & SAFETY
EXECUTIVE
40. ACPO (in association with National Policing
Improvement Agency) has produced a revision of Road Death Investigation
Manual—2007 (RDIM).
41. The primacy of investigation at the
scene of a fatal RTA is held by the police but there does appear
to be a distinct need to consider the implications of the Health
and Safety at Work Act 1974 where it is found that the offending
driver is performing work on behalf of an employer—whatever
the vehicle classification. Whilst the monitoring of Group 2 HGV/Commercial
larger vehicle drivers is well recorded and monitored this appears
not the case for cars and light commercials in Group 1.
42. Page 120 of the RDIM discusses the relationship
of the HSE in respect of whether the HSE should be automatically
contacted where the offending driver is found to be driving in
connection with work related matters. If the driver is found to
have a medical condition affecting fitness to drive then there
appear implications on the role of the employer in monitoring.
43. An employer (under the Health and Safety
at Work Act 1974) has direct responsibility to ensure that all
drivers of all vehicles are fit to drive and not liable to put
themselves or others at risk. This is an extension of the principle
of duty of care. This appears to mean that all employers must
have in place robust monitoring processes to identify risks including
medical fitness to drive where it is a condition of employment
or a casual requirement. It is thus imperative that an employee
notifies his employee of material facts relating to medical fitness
to drive whether it be a temporary or permanent matter.
44. However the revised RDIM does not detail
this matter—it is vague and little better than the displaced
version which was lacking in advice to the Investigating Officer.
45. It is a fact that there are many occupations
which require regular (essential) use of a motor vehicle (whether
own provision by employee or provided by employer): furthermore
from the Accident Data shown in the Appendices the data showing
accidents by road type would suggest that many serious accidents
will have a very high probability of a driver being involved who
is performing a task on behalf of an employer. The question therefore
arises of how does the employer establish whether or not an employee
poses a risk due to a medical condition affecting fitness to drive—and
whether any driving role shall be adjusted to account for the
specific requirements of the employee. In theory a restricted
driving licence of either one, two or three years ought to be
able to offer a warning to an employer but this does not cover
the irresponsible driver who is the primary subject of this memorandum.
A recent simple freedom of Information request to a number of
Local Authorities (organisations employing many who require access
to Group 1 vehicles to carry out their role) revealed a major
area of concern in that none could offer full information on the
number of such drivers and whether or not they had any medical
conditions affecting fitness to drive. As expected there were
good and bad examples—including a County Authority which
had no access to the data in a readily accessible format and thus
declined to provide information.
ASPECTS OF
LAW AND
HYPOGLYCAEMIA
46. The legal position is that where a driver
suffers a hypoglycaemic episode which results in an RTA the plea
of "automatism" may be entered as the defence to any
charge laid.
47. Automatism is defined as "unconscious
involuntary conduct caused by external factor(s)" This can
be various causes and has included swarm of bees stinging the
driver and uncontrollable sneezing. The test is that the driver
has no control over the function of his limbs and thus can not
control the vehicle. It has also been held that it must be a sudden
event not progressive—where some control has been exercised
the defence of automatism will fail (Broom -v- Perkins). A person
is not criminally liable if he is found not to be aware of his
actions at the time of the accident. He must therefore be acquitted.
48. Similarly the defence will fail if the
automatism is "self-induced"—for example by taking
drink or drugs or the opposite by failing to take medicinal drugs
(such as insulin) which affect the ability to function correctly.
This implies that there is a fine balancing act controlled by
the patient/driver.
49. It is found that the proof of taking
steps prior to driving to ensure fitness to drive (following medical
advice/guidance) is fraught with problems of verification. It
can be readily fabricated post-accident since often it is merely
a written account in some form of diary. This is envisaged mainly
for use by the Medical Practitioner in ongoing assessments of
the patient's condition and treatment. Unless the Prosecution
can counter the claim based on such a record and prove that no
test was carried out and thus the "automatism" was self-induced
by neglect to follow medical guidance to control B/G levels the
driver will be acquitted—or more likely not charged with
any offence.
50. It is possible to consider whether a
person was reckless in continuing to drive despite having longterm
awareness of a poor condition leading to hypoglycaemic attacks
requiring 3rd party intervention or partial impairment whilst
driving. (Other research has shown how many drivers actually admit
to partial impairment yet have continued to drive). Case law exists
to the effect that if a person is reckless in ignoring the condition
likely to cause impairment then a charge of "Causing Death
by Dangerous Driving" is possible. Unfortunately there is
inconsistency of approach in this by Police and CPS across the
country.
CONCLUDING OPINION
AND IDENTIFICATION
OF AREAS
FOR CHANGE
TO REDUCE
RTA CASUALTIES
51. It is felt that the key requirement
in view of the level of inconclusive expert opinion is that a
precautionary approach should be considered to cover the sub-group
of Type 1 diabetics who have a record of hypoglycaemic episodes.
The evidence is that other countries have a more robust view in
comparison to the UK in this matter.
52. The key player in this must be the Medical
Practitioner since he has the first hand knowledge of a patient's
condition. With the evidence to hand it is clear that the level
of avoidance is far too high—and the consequences are represented
in the attached statistics of accidents where a medical condition
is a contributory factor.
53. The issue of patient confidentiality
and doctor/patient relationship is recognised and respected but
the matter is not one whereby the right of the patient exceeds
the right of the wider public. At worst the patient displays reckless
behaviour without regard to the risk to self, family or others:
this is a Public Interest decision based on the wider Duty of
Care to the public by the medical practitioner.
54. From various sources it is clear that
the official guidance is that where there is known to be a failure
to disclose voluntarily then there is a duty of care to advise
DVLA. However as it currently stands the Medical Practitioner
is likely to be accused of divulging confidential information
by the patient.
55. Thus the proposal must be that the law
is changed in such manner as to provide a mandatory requirement
on the Medical Practitioner to directly notify DVLA where a patient
exhibits a material condition affecting fitness to drive and is
likely to place others at risk of death or serious injury. It
would appear that the GMC would find little material change in
this position from their current (slightly obscure) guidance.
It is further considered that where the patient was clearly aware
that such notification was not discretionary on the Medical Practitioner
the choice would be whether the patient required medical support
or was willing to suffer from the condition thereby placing themselves—at
their own discretion—at serious risk. A patient does have
the right to decline medical intervention.
56. There should be immediate revocation
of the apparent unofficial DVLA policy of not prosecuting drivers
who fail to notify under the terms of the RTA88: this is giving
out the wrong message—it adversely affects the "honest"
and responsible patient/driver.
57. A more robust manner of digitally recording
testing must be mandatory: this is required to improve medical
assessments and to substantiate claims made in a court of law
where appropriate. Such equipment is understood to be readily
available at low cost.
58. The procedures between Police Investigation
and Health and Safety involvement to be urgently reviewed to ensure
that in every case where a driver is found to be working on behalf
of an employee the HSE is notified. Where a medical condition
is then suspected as a contributory cause the HSE can continue
to investigate the role of the employer under the terms of Health
and Safety at Work Act 1974.
59. Legal provision to be made to ensure
that all records of DVLA and Medical Practitioner are made available
to Police Investigator within 15 days of request and that this
shall be not more than seven days after the accident.
60. Robust information circulated with each
Road Fund licence reminder/renewal document.
March 2008
APPENDIX 1
PREVALENCE OF DIABETES—EUROPE (`000s)
| Rank | Prevalence
| Country | Population 20-79
| Diabetes 20-39 | Diabetes 40-59
| Diabetes 60-79 | Diabetes 20-79
|
| 1 | 10.2 | Germany
| 61,895 | 374.0 | 1,752.7
| 4,167.6 | 6,294.3 |
| 2 | 10.0 | Bulgaria
| 5,894 | 37.6 | 248.1
| 305.5 | 591.2 |
| 3 | 9.9 | Latvia
| 1,758 | 15.1 | 58.4
| 100.1 | 173.6 |
| 4 | 9.7 | Estonia
| 991 | 8.6 | 33.3
| 54.4 | 96.3 |
| 5 | 9.7 | Hungary
| 7,350 | 62.6 | 259.5
| 389.2 | 711.4 |
| 6 | 9.7 | Spain
| 30,329 | 838.4 | 973.2
| 1,192.6 | 3,004.3 |
| 7 | 9.6 | Austria
| 5,991 | 38.8 | 172.7
| 364.5 | 576.0 |
| 8 | 9.6 | Bosnia
| 3,074 | 24.5 | 141.0
| 129.9 | 295.4 |
| 9 | 9.6 | Slovenia
| 1,511 | 13.1 | 53.5
| 78.6 | 145.2 |
| 10 | 9.5 | Czech Republic
| 7,734 | 66.8 | 286.2
| 381.9 | 734.9 |
| 11 | 9.5 | Switzerland
| 5,310 | 35.3 | 166.6
| 303.1 | 504.9 |
| 12 | 9.4 | Lithuania
| 2,648 | 24.6 | 84.8
| 139.5 | 248.9 |
| 13 | 9.3 | Romania
| 16,392 | 154.7 | 519.0
| 845.6 | 1,519.2 |
| 14 | 9.0 | Poland
| 27,852 | 239 | 1,002.5
| 1,245.0 | 2,504.5 |
| 15 | 8.7 | Slovakia
| 3,903 | 35.9 | 135.6
| 167.2 | 338.7 |
| | (Quartile 1)
| 18,2632 | 1,969.0
| 5,887.1 | 9,864.7
| 17,738.8 |
| | % Total
| 43.4 | 66.7 |
63.4 | 55.7 | 55.9
|
| 16 | 7.8 | Portugal
| 7,471 | 14.9 | 170.9
| 398.7 | 584.5 |
| 17 | 7.3 | Sweden
| 6,290 | 36.3 | 140.1
| 280.5 | 456.9 |
| 18 | 7.2 | Finland
| 3,775 | 10.3 | 56.3
| 207.0 | 273.5 |
| 19 | 7.0 | Turkey
| 42,411 | 370.4 | 1,440.7
| 1,147.7 | 2,958.7 |
| 20 | 6.9 | Denmark
| 3,863 | 23.3 | 87.0
| 154.6 | 264.9 |
| | (Quartile 2)
| 63,810 | 455.2
| 1,895.0 | 2,188.5
| 4,538.5 |
| | % Total
| 15.2 | 15.5 |
20.4 | 12.4 | 14.3
|
| 21 | 6.7 | Norway
| 3,154 | 19.0 | 69.6
| 122.3 | 211.7 |
| 22 | 6.6 | Italy
| 43,925 | 185.7 | 1,009.4
| 1,684.9 | 2,880.1 |
| 23 | 6.2 | France
| 42,546 | 175.0 | 1,045.3
| 1,433.3 | 2,653.6 |
| 24 | 6.1 | Greece
| 8,069 | 12.9 | 129.0
| 351.0 | 493.0 |
| 25 | 5.8 | Croatia
| 3,142 | 5.3 | 56.8
| 137.1 | 199.1 |
| 26 | 5.6 | Serbia & Mont
| 7,542 | 11.8 | 127.1
| 283.2 | 422.1 |
| | (Quartile 3)
| 10,8648 | 409.7
| 2,437.2 | 4,011.8
| 6,859.6 |
| | % Total
| 25.8 | 13.9 |
26.3 | 22.7 | 21.6
|
| 27 | 4.9 | Macedonia
| 1,428 | 2.5 | 23.2
| 44.2 | 69.9 |
| 28 | 4.2 | Belgium
| 7,531 | 3.1 | 71.1
| 240.9 | 315.1 |
| 29 | 3.9 | United Kingdom
| 42,423 | 89.4 |
588.9 | 993.3 | 1,671.5
|
| 30 | 3.8 | Luxemburg
| 327 | 0.1 | 3.0
| 9.3 | 12.5 |
| 31 | 3.7 | Netherlands
| 11,678 | 5.3 | 118.3
| 308.5 | 432.2 |
| 32 | 3.4 | Rep. of Ireland
| 2,674 | 6.0 | 34.4
| 49.4 | 89.8 |
| Mean 7.5 | (Quartile 4)
| 66,061 | 106.4
| 767.8 | 1,645.6
| 2,591.0 |
| | % Total
| 15.7 | 3.6 |
8.3 | 9.3 | 8.2
|
| | Total
| 420,881 | 2,940.3
| 9,281.1 | 17,710.6
| 31,727.9 |
Diabetes & Driving in Europe : Second European Working
Group on Diabetes and Driving
APPENDIX 2
PREVALENCE OF DIABETES—UK : 2004 (A) ESTIMATED
DIAGNOSED DIABETES BY TYPE AND COUNTRY FOR THE UK
| Nation | Type 1
| Type 2 | Total
|
| England | 200,000 |
1,280,000 | 1,480,000 |
| Scotland | 18,000 | 130,000
| 148,000 |
| Wales | 12,000 | 80,000
| 92,000 |
| Northern Ireland | 7,000 |
40,000 | 47,000 |
| UK | 237,000 |
1,530,000 | 1,767,000
|
Source: Diabetes UK
(B) ESTIMATED DIAGNOSED DIABETES IN THE UK BY
AGE (BASED ON A TOTAL POPULATION OF 59,773,600)
| Age Group | Type 1
| Type 2 | Total
|
| 0-14 | 14,000 |
(Less than 1,000) | (Less than 15,000)
|
| 15-44 | 170,000 | 91,000
| 261,000 |
| 45-64 | 49.000 | 568,000
| 617,000 |
| 65-74 | 4,000 | 430,000
| 434,000 |
| 75+ | Less than 500 | 442,000
| (less than 442,500) |
| Total | 237,000
| 1,531,000 | 1,768,000
|
x
EXPLANATORY NOTES
FOR APPENDIX
2, TABLES (A) AND
(B)
(a) Based on Diabetes UK Update Prevalence Model the
total number of people in the UK with diabetes is now almost 1.8
million representing 3% of the population.
(b) This figure may be a conservative estimate.
(c) Of this, close to 250,000 people have Type 1 diabetes
and over 1.5 million have Type 2 diabetes.
(d) Figures for the number of people thought to have
undiagnosed Type 2 diabetes are estimated to be between 765,000
and 1 million (equal to a further 50% to 75% of diagnosed Type
2.
(e) The incidence of Type 1 diabetes in the UK has doubled
every 20 years since 1945.
(f) Half the people with Type 1 diabetes in the UK are
diagnosed under the age of 15 and 90% have been diagnosed by 30.
(g) The peak age range for diagnosis for Type 1 in the
UK is 10-14 years but is becoming younger with a steep rise in
under 5s.
(h) There are 20,000 children and young people under
15 with Type 1 diabetes in the UK (note the anomaly in Table (b)
above)
(i) Blindness is more prevalent in people who have Type
1 diabetes. 20 years after diagnosis nearly all people with Type
1 diabetes will have some form of retinopathy.
(j) 20 years after diagnosis 60% of people will have
some degree of retinopathy.
APPENDIX 3
CONTRIBUTORY FACTORS TO ACCIDENTS ATTENDED AND EPORTED
BY POLICE : GB 2006
(A) ACCIDENTS BY SEVERITY
| | Fatal
| Serious | Slight
| All Accidents
|
| Contributory Factor | No
| % | No | %
| No | % | No
| % |
| Impairment or Distraction (all types)
| 496 | 18 | 3,140
| 14 | 13,280 | 11
| 16,916 | 12 |
| Impaired by alcohol | 259 |
10 | 1,716 | 8 |
5,722 | 5 | 7,697 |
5 |
| Impaired by drugs (illicit or medicinal) |
51 | 2 | 174 | 1
| 410 | 0 | 635
| 0 |
| Fatigue | 69 | 3
| 385 | 2 | 1,511
| 1 | 1,965 | 1
|
| Uncorrected, defective eyesight | 4
| 0 | 47 | 0 |
158 | 0 | 209 |
0 |
| Illness or disability, mental or physical |
75 | 3 | 393 | 2
| 1,379 | 1 | 1,847
| 1 |
| Using mobile phone | 28 | 1
| 57 | 0 | 260 |
0 | 345 | 0 |
| TOTAL ALL ACCIDENTS | 2,703
| 100 | 22,111 |
100 | 120,984 | 100
| 145,798 | 100 |
Source: Department for Transport: Extract Table 4B
(B) ACCIDENTS BY ROAD TYPE
| | Motorways
| A roads | B roads
| Other roads
| All Roads
|
| Contributory Factor | No.
| % | No. | %
| No. | % | No.
| % | No. | %
|
| Impairment or Distraction (all types)
| 1,082 | 14 | 7,339
| 11 | 2,256 | 12
| 6,239 | 12 | 16,916
| 12 |
| Impaired by Alcohol | 279 |
4 | 2,975 | 4 |
1,115 | 6 | 3,328 |
6 | 7,697 | 5 |
| Impaired by drugs (Illicit or medicinal) |
31 | 0 | 243 | 0
| 93 | 1 | 268 |
1 | 635 | 0 |
| Fatigue | 436 | 6
| 1,012 | 2 | 196
| 1 | 321 | 1 |
1,965 | 1 |
| Uncorrected, Defective eyesight | 2
| 0 | 93 | 0 |
24 | 0 | 90 | 0
| 209 | 0 |
| Illness or Disability, mental/physical | 129
| 2 | 840 | 1 |
234 | 1 | 644 |
1 | 1,847 | 1 |
| Using mobile phone | 18 | 0
| 160 | 0 | 49 |
0 | 118 | 0 | 345
| 0 |
| TOTAL ALL ACCIDENTS | 7,489
| 100 | 66,371 |
100 | 18,552 | 100
| 53,386 | 100 |
145,768 | 100 |
Source: Department for Transport—Table 4F : Extract
APPENDIX 4
(A) FATAL AND SERIOUS INJURY ACCIDENTS AND NUMBER
OF CASUALTIES : 2004
| Severity | Fatal
| | Serious
|
| Killed | 5+ | 4
| 3 | 2 | 1 |
1 | 1 | 1 |
| | | |
|
| Seriously Injured | 0+ | 0+
| 0+ | 0+ | 2+ |
1 | 0 | 0 | 41+
| 3 | 2 | 1 |
1 |
| Slightly Injured | 0+ | 0+
| 0+ | 0+ | 0+ |
0+ | 1+ | 0 | 0+
| 0+ | 0+ | 1+ |
0 |
| Motorways | 0 | 0
| 2 | 11 | 13 |
22 | 34 | 67 | 6
| 20 | 105 | 303
| 464 |
| "A" Roads | 1 | 2
| 20 | 102 | 133
| 241 | 375 | 795
| 90 | 201 | 1008
| 2,858 | 8,229 |
| "B" Roads | 0 | 1
| 3 | 19 | 22 |
82 | 86 | 224 |
20 | 55 | 330 |
816 | 2,551 |
| Other Roads | 1 | 1
| 4 | 30 | 42 |
85 | 121 | 439 |
36 | 96 | 571 |
1,708 | 7,281 |
| TOTAL | 2 | 4
| 29 | 162 | 210
| 430 | 616 |
1525 | 152 | 372
| 2014 | 5,685 |
18,525 |
Source: Department for Transport
(B) REPORTED PERSONAL INJURY ROAD ACCIDENTS
: GB : 1997 TO 2006
| Year | Accident Severity
| Fatal | Serious
| Slight |
| Total | |
| | |
| 1995 | 3,286 | 38,501
| 188,757 | 230,544 |
| 1996 | 3,274 | 37,327
| 195,592 | 236,193 |
| 1997 | 3,298 | 36,330
| 200,659 | 240,287 |
| 1998 | 3,137 | 34,633
| 201,153 | 238,923 |
| 1999 | 3,138 | 33,267
| 198,643 | 235,048 |
| 2000 | 3,108 | 32,499
| 198,122 | 233,729 |
| 2001 | 3,176 | 31,588
| 194,250 | 229,014 |
| 2002 | 3,124 | 30,521
| 188,106 | 221,751 |
| 2003 | 3,247 | 28,913
| 181,870 | 214,030 |
| 2004 | 2,978 | 26,748
| 177,684 | 207,410 |
| 2005 | 2,913 | 25,029
| 170,793 | 198,735 |
| 2006 | 2,926 | 24,946
| 161,289 | 189,161 |
| Source: Department for Transport
| | |
| | | |
| |
|
