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Lord Rea: My Lords, I thank my noble friend for allowing me to intervene. My information is that Finland and Sweden protect existing licence holders who use their licences as part of their employment. Denmark grants group 2 licences when a proper medical certificate is available provided that regular medical examination is carried out. That is the kind of procedure that the noble Lord, Lord Alderdice, and I have advocated for this country.

Baroness Hayman: My Lords, I understand what my noble friend has said. It is difficult to obtain some of the detail, although I have asked for it. It appears that the majority of states who make exceptions do not do so for professional drivers. It is because I am concerned to understand what takes place in the rest of Europe that I have asked that when the expert group on the second directive, which the EU Commission chairs, next meets it should place the topic of diabetes on the agenda so that with other member states we can explore the question of their implementation of the directive and see how we are doing in comparison with them. I believe that some of the difficulties arise from the fact that we are dealing here with a group of people who already have an ability that may be taken away from them rather than simply setting in train a tighter definition for potential new drivers.

I return to the crucial issue of whether insulin-treated diabetics pose a danger on the road. It is viewed by some that improved treatment regimes have minimised the danger on the road, certainly that posed by the non-brittle diabetic. I heard the comment of the noble Lord, Lord Alderdice, about the possibility of improving NHS facilities for diabetics. I shall pass those comments to the Department of Health. We turned to the expert panel on the question of exceptional cases and asked whether with modern methods people who might well not have experienced hypoglycaemia could be categorised in a particular way that would effectively provide reassurance that they were not a risk on the road. The advice of the panel is that with modern methods the risks of hypoglycaemia are not eliminated and may even be increased rather than reduced.

I emphasise that the assessment of risk for those who suffer from medical conditions affecting fitness to drive is a medical matter. It is accepted that in medicine, as in any other field, there will be differences of opinion among experts. There is nevertheless a considerable body of literature on the effect of insulin treatment. It can lead to hypoglycaemia which in turn can result in

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a loss of consciousness without warning. Obviously, it is the latter that poses the greatest risk on the road. A number of studies have made clear that there is a link between road accidents and collapses at the wheel as a result of insulin treatment. I understand that for some years it has been the practice of certain employers, on the advice of their occupational health services, not to allow those treated by insulin to undertake driving duties even in vans and other small vehicles.

I very well understand the point made by the noble Lord, Lord Addington, about the desire to treat people with disabilities as individuals and not to over-categorise them and be too broad brush. However, in drawing up regulations and looking at fitness to drive, whether it is about eyesight or a whole number of other conditions, we must have standards and definitions into which people either fit or do not fit in order to administer the licensing process.

I hope that I can assure noble Lords that the Government have not been insensitive to the concerns of those who are worried about the effects of the directive. I have been ready to listen to those concerns. Recently, I met representatives of the British Diabetic Association together with the Chairman of the Commons All-Party Group on Diabetes. The association left with me written representations and an evidence review. The issue of assessment of risk and whether there is a way in which we can introduce an individual assessment programme is crucial to the Government's view.

I suggested that it would be sensible to have a special meeting of the advisory panel so that full consideration could be given to all of the arguments put forward. That meeting is to take place at the end of next month. It is part of the remit of the panel to keep scientific and medical advice under review and advise the department of any change to that advice which becomes necessary as a result.

One concern of the BDA and others has been the absence of evidence of the occurrence of accidents to support the new requirements. The Driver and Vehicle Licensing Agency receives reports from the police and others about accidents and road traffic incidents which may involve medical conditions. For example, over the past three months 40 accidents involving collapses at the wheel by insulin-treated diabetics have been identified. I informed the BDA that I wanted a more

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thorough examination of those records to see what statistics could be produced to supplement the assessment of risk provided by the medical experts. I also asked to meet, and met, the chairman of the advisory panel to learn at first hand the basis of the risk assessment that the panel had made. In addition to telling me his own experience of treating patients--the members of the panel are all practising physicians who deal with diabetic patients--he informed me that in the view of the panel there was a one in 10 chance per year of an insulin-treated diabetic having a severe hypoglycaemic attack.

In addition to speaking to the chairman of the panel, I have discussed this matter extensively both with the Chief Medical Adviser of the Department of the Environment, Transport and the Regions and the Senior Medical Adviser of the DVLA. A question was raised as to whether the department had been over-cautious in its attitude.

Faced with the clear advice that I have received from the professionals with the responsibility for providing objective advice to Ministers, it is difficult to see how the Government could responsibly have rejected that advice. Having said that, I say to my noble friend Lord Rea that I want to go back to the Commission and to the expert group, and to understand what is happening in the rest of Europe, and indeed whether there is a system of individual assessment that minimises risk that the expert panel would consider to be viable in this country.

I have no illusions about the strength of feeling among drivers who believe that their own condition is under control and that they do not represent a road safety danger. I understand their concerns. I have taken the opportunity to check and double check the medical advice that I have received. I have met those who have argued strongly against the Government's position. I shall ensure that the points that they make are considered fully by our expert advisers. I have to make it clear that at the moment the medical advice upon which current policies are based is clear and unequivocal. In those circumstances, I have to go back to test the medical advice again. It would not be correct for a lay Minister to intervene with his or her own assessment in those circumstances.

        House adjourned at one minute past two o'clock.


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