Memorandum submitted by Lord Whitty, Parliamentary
Under Secretary of State, Department of the Environment, Transport
and the Regions
SCIENCE AND TECHNOLOGY COMMITTEE: DIABETES
AND DRIVING LICENCES: HC 206
Update on Progress made in relation to Committee's
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
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
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
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
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
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
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
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
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
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
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
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
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
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
We recommend that the scope and depth of
the Fitness to Drive Research Programme should be enhanced and
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
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
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.