§ Mr. Adrian Sanders (Torbay)This is a debate about improving road safety in the United Kingdom and in Europe. The Department of the Environment, Transport and the Regions road strategy document, "Current Problems and Future Options", dated October 1997, states:
There is no evidence that medical unfitness plays a significant role in causing accidents; indeed, accidents with medical factors involved are too few to show up in any of the statistics that are collated.Nevertheless, there is a suspicion that people with a medical condition such as diabetes are less safe behind the wheel than others.That suspicion lies behind European Community directive 91/439, the origins of which are in discussions that took place in 1980. There have since been 18 years of medical advance and improvements to diabetic control that have dramatically reduced the complications of diabetes through the encouragement of better blood sugar control. The suspicion is outdated, and neither the European Union nor the United Kingdom Government can point to any statistical or actuarial evidence to support the concerns underlying the directive.
The Government's own assessment of the medical impact of drivers' medical conditions on the total road accident rates puts the issue into context. According to the Driver and Vehicle Licensing Agency, between April 1995 and March 1996 there were 163 notifications of collapse at the wheel, of which only 27 involved insulin-dependent diabetics.
Compare that with the 16,050 drink-driving accidents or the 31,050 accidents caused by driver fatigue. To follow the logic—if logic is the right word—should not we impose driving restrictions on anyone who drinks alcohol at any time or on everyone who at one time or another will suffer from fatigue?
I am not here to embarrass the Government or to score points. I want to help the Minister to find a way out that improves road safety while being fair to those individuals who are insulin-dependent diabetics and can prove their fitness to drive. I declare an interest, in that I am an insulin-dependent diabetic. The DVLA has yet to write to me to impose its ban for the vehicles that I shall mention in a minute, but I also have an interest on behalf of constituents and others who have written to me on the issue.
The Government have introduced a blanket ban, preventing people with diabetes who inject insulin from driving vehicles in category C1, which covers cars weighing between 3.5 and 7.5 tonnes, and category D1, which covers vehicles with between nine and 16 seats. Those vehicles come under group 2, which is the category referred to in the directive.
The ban was not even required by the original EC directive, which clearly states:
In very exceptional cases may driving licences be issued to, or renewed for, applicants or drivers in group 2 suffering from diabetes and requiring insulin treatment, and then only where duly justified by authorised medical opinion and subject to regular medical check-ups.1026 Sadly, the Government have gone much further than the directive and introduced a policy that is not applied in other EU member states.The Netherlands, for example, issues group 2 licences on an individual basis for one or three years, subject to independent medical examination. Finland and Sweden protect existing licence holders who use their licences as part of their employment, defining that as one of the directive's "exceptional circumstances".
According to the Danish Ministry of Transport executive order of March 1997, Denmark grants group 2 licences when a proper justified medical certificate is available, and provided that regular medical examination is carried out.
The Government have allowed discrepancies in the law in their interpretation of the directive. They allow people to drive vans, which are in category D1, on a voluntary basis but not professionally. That is surely proof that there was not sufficient evidence to introduce a complete ban. There was enough political pressure to protect voluntary drivers.
The Government have allowed the retention of licence rights to some drivers of even heavier vehicles, such as heavy goods vehicles, while preventing others from driving much lighter vehicles; they have allowed drivers from other EU states to come and drive over here in vehicles denied to United Kingdom drivers; and they have disregarded the rights of many drivers who have been driving for many years without any accidents or hypoglycaemic attacks at the wheel and who are now faced with unemployment without compensation.
People are already losing their jobs, and many more will follow as the DVLA notifies them of the ban. I have in my office a file of case studies from throughout the country. One concerns the BT engineer who will lose his job but will still be able to drive a minibus for cub scouts in his free time. Others concern employers who do not want to sack loyal, long-serving staff. I recently received a letter from an employer who asked:
Is there anything that can be done to help this very valuable, faithful, long-term friend and employee?The situation is ridiculous for a Government who promised to help people to move from welfare to work.
§ Mr. Conn Pickthall (West Lancashire)Many hundreds, if not thousands, of people will be grateful to the hon. Gentleman for raising this issue. Like him, I am an insulin-dependent diabetic. Tommy Wright, my constituent, is an HGV driver who became insulin dependent and lost his job. Because of his good record, the company kept him on to drive a minibus. Because of the blanket ban, he will now lose that job, even though he would be perfectly entitled to drive a minibus on a voluntary basis. Does the hon. Gentleman agree that that is totally unjust, and that the Government's blanket imposition of the ban is reprehensible?
§ Mr. SandersI agree entirely. I applaud the hon. Gentleman's work over the years on behalf of both insulin-dependent and non-insulin-dependent diabetics.
The situation is ridiculous. The Government promised to fight inequality in their new public health strategy and to tackle the problem of social exclusion, but this policy will have the opposite effect: it will drive people from 1027 work into welfare; encourage inequality; and lead to unemployment and further discrimination against, and social exclusion of, people with diabetes.
The Government say that they have taken the decision in the interests of road safety, on the advice of the honorary advisory panel on driving and diabetes, but that body is yet to reveal the sources of the information on which it based its decision; has not, to my knowledge, commissioned any review of the evidence; and did not even meet for four years, during the critical time when the previous Government were drafting the UK regulations.
In those years, new studies, from America and Denmark in particular, had not yet been published. The Federal Highway Administration evidence showed that the accident rate for diabetic drivers was lower than the United States national rate. In Denmark, a review of nearly 8,000 people with diabetes showed no increased risk of accidents, including road traffic accidents.
Surely the Government could consider more pressing and effective road safety measures rather than spending time discriminating against a small group that does not even figure in their own accident statistics and has been shown in some studies to be safer than other drivers on the road.
The new rules could compromise road safety rather than enhance it, because they will act as a disincentive to newly diagnosed diabetics to inform the DVLA of their condition. If the DVLA does not know about a person's diabetes, it cannot impose restrictions on his or her licence. The self-regulatory system has worked until now, with conditions being imposed on diabetic drivers of certain categories of vehicle, subject to medical tests. That regular assessment has undoubtedly led to poorly controlled diabetics being taken off the road. That may no longer be the case as a consequence of the legislation.
All we ask is that the Government listen to the medical evidence and instigate an urgent review. The insurance industry—not known for its altruism—has listened and does not impose higher premiums on insulin-dependent diabetic drivers. So, what would be the fairest way to protect the rights of drivers who are in complete control of their diabetic condition, while targeting the minority who are less well-controlled and who should be the target of legislation? It is possible to identify people with the highest risk of hypoglycaemia through three strong predictors: a history of unawareness; experience of frequent severe hypoglycaemia; and previous hypoglycaemic-related injury or accident.
The British Diabetic Association and I, along with the hon. Member for West Lancashire (Mr. Pickthall) and my hon. Friend the Member for Isle of Wight (Dr. Brand), recently presented a series of such proposals to the Minister. The association is also convening a group of medical experts to draft how a system of individual assessment might work, which will be presented to the Government and the honorary advisory panel on driving and diabetes. Its proposals already have the support of the Transport and General Workers Union, the United Road Transport Union, the Royal College of Nursing, the Employers Forum on Disability, the Drivers Action Movement, the Federation of Recruitment and Employment Services, Unison, the Road Haulage Association and the RAC.
That is by far the most sensible way forward. Can we have the Minister's assurance that individual assessment of fitness to drive is the fairest way forward and that the 1028 BDA's proposal will be seriously reviewed, in line with the evidence, by the Government in passing the law? Finally, will the Minister please say why individual assessment is not included in this legislation?
§ The Parliamentary Under-Secretary of State for the Environment, Transport and the Regions (Ms Glenda Jackson)I thank the hon. Member for Torbay (Mr. Sanders) for affording the House the opportunity to discuss this extremely important issue. As he said in his opening remarks, it is essentially about road safety, although the main thrust of the hon. Gentleman's arguments has been driving restrictions for insulin-dependent diabetics and, as chair of the all-party parliamentary group for diabetes, the House would expect nothing less from him.
The Government are well aware, from representations from hon. Members, individual drivers and bodies such as the British Diabetic Association, of the strength of feeling among those who stand to lose their entitlement to drive medium-sized lorries and minibuses, particularly when they drive such vehicles for a living. We do not underestimate the consequences for those drivers and have every sympathy with their situation.
Of course, it is the duty of the Government to listen to all concerns and to consider all the implications. As the hon. Member for Torbay said, on 12 February my noble Friend the Baroness Hayman met representatives of the British Diabetic Association with him, my hon. Friend the Member for West Lancashire (Mr. Pickthall) and the hon. Member for Isle of Wight (Dr. Brand). Indeed, in an intervention my hon. Friend the Member for West Lancashire raised the case of one of his constituents and how the restriction is impacting on his life.
However, it is also the duty of the Government to take account of the wider interests of road safety and to make clear decisions, even if those decisions may sometimes have unwelcome consequences for some. It has been said that the change in the law that prompted these concerns is not based on well-founded evidence and that British drivers are being discriminated against compared with drivers from other European Union member states. Although I am sure that there is now general awareness of the effect of the new law, it would perhaps be helpful to say a few words about the background to the new requirements and explain how the change in legislation, which has been portrayed as being specifically directed against drivers with diabetes treated by insulin, has come into being.
For many years, the United Kingdom differed from the rest of Europe in that we had long-standing arrangements that allowed a person who passed a driving test in a car of any size to drive a wide range of vehicles, including lorries weighing up to 7.5 tonnes, category C1, and non-commercial passenger vehicles with up to 16 seats, category DI. If we were devising a new driving licence scheme for modern road, vehicle and traffic conditions, it is unlikely—probably unthinkable—that we would give entitlement to drive such a wide range of vehicles on the strength of a driving test that could be taken in the smallest car.
The second driving licence directive, which was adopted in 1991 and whose provisions the UK fully supports, requires anyone wishing to drive 3.5 to 1029 7.5 tonne lorries or minibuses with 9 to 16 seats, to take separate driving tests and to meet the more stringent health requirements, which in the UK formerly applied only to drivers of large goods vehicles over 7.5 tonnes and buses and coaches. Given the size and weight of the vehicles in question, it is fair to say that those are sound and sensible requirements based on legitimate road safety interests. It is significant that during the consultations prior to implementation of the directive and in the period since it was implemented in the UK in January 1997, there have been almost no suggestions that anyone taking up driving for the first time should not have to comply with those requirements. Nor has the ban on people with certain medical conditions driving buses and lorries of over 7.5 tonnes and buses, which has applied for many years, been seriously questioned.
Also, if we were devising a driving licence scheme from the beginning, how would we decide which medical conditions should prevent a person from holding a licence or permit the driving of smaller vehicles yet preclude the driving of larger and heavier vehicles, bearing in mind the consequences if the person were involved in an accident? We would surely seek expert medical guidance on the risk associated with the particular medical condition. Assessment of medical evidence can be supported and supplemented by accident data, but lack of accident data should not invalidate the medical assessment.
The Secretary of State for the Environment, Transport and the Regions has a number of panels comprising experts in particular medical fields, which were set up to provide objective medical advice on the risk from driving by people with particular health conditions. One of those panels—the honorary advisory panel on driving and diabetes—has endorsed the decision that category C1 and D1 vehicles should be driven only by those who can meet the more stringent health requirements, which preclude among others insulin-treated diabetics. It would be irresponsible of the Government to ignore its advice.
§ Mr. SandersCan the Minister confirm that at the last meeting of the honorary advisory panel on driving and diabetes the majority of people on the panel were not medical experts but departmental officials?
§ Ms JacksonI cannot confirm or deny that, but I will certainly inquire into the matter and respond to the hon. Gentleman by letter. As I have argued, it is unlikely that the Government would have taken any decision that was not based on objective, informed and particular medical advice.
We do not have comprehensive accident data that could alone support the medical assessment that insulin-treated diabetics should not drive the heavier, larger vehicles. That is because information on the medical circumstances of those involved in accidents is not routinely collected, nor would it be practicable to do so. However, there have been individual studies. It has been found that insulin-treated diabetes was responsible for 17 per cent. of 1,605 police-reported accidents involving collapse at the wheel in which the driver survived and was minimally injured to the point that driving could subsequently be resumed. DVLA records also identified 23 hypoglycaemia-related serious accidents from November 1997 to mid-February 1998. The hon. Member 1030 for Torbay contrasted those figures with those involving drink driving and driver fatigue. However, both of those conditions can and should be avoided. Collapse at the wheel due to hypoglycaemia, however, comes without warning.
§ Mr. PickthallMay I point out to my hon. Friend that that is simply not true? Most diabetics get considerable warning of a hypoglycaemic attack. We are worried because the ban treats all insulin diabetics as if they were the same, which is not the case. Unlike other drivers, most of us have regular medicals, eye tests and check-ups. Insulin-dependent diabetics are often safer on the roads than other people.
§ Ms JacksonI am grateful to my hon. Friend for that intervention, but I understand that the detailed and specific health checks to which he referred take place over three years. I apologise to the House if I have done so, but I do not believe that I said that all hypoglycaemic attacks that cause collapse come without warning. Attacks that occur without warning when a driver is at the wheel are the greatest cause for concern.
§ Mr. Richard Allan (Sheffield, Hallam)What is the Minister's response to the telling point made by my hon. Friend the Member for Torbay (Mr. Sanders) about the actuarial position taken by insurers? Insurance companies are not known for doing people favours and are happy to load premiums when they believe that there is a risk. The Government must be aware that insurance companies do not believe that insulin-dependent diabetics pose a significant risk. Is not that one of the best indicators that insulin-dependent diabetics do not pose a genuine risk?
§ Ms JacksonIt is worth repeating that accident statistics alone, on which actuarial tables are based, cannot be the deciding factor. The point at issue is whether people with a known medical condition that carries the risk of collapse at the wheel without warning should be permitted to drive vehicles that are of such weight and size that there could be serious consequences if they were involved in an accident. That assessment can be made only by those with the detailed medical knowledge to understand the implications and to look at the issue with detachment and objectivity.
For those reasons, we support the medical standards prescribed in the directive and the requirement that they should apply to drivers of vehicles weighing more than 3.5 tonnes or with more than eight passenger seats. Understandable concern has been provoked by the issue of whether those requirements should extend to drivers who already hold entitlements to drive such vehicles on the strength of the less stringent testing and health regime which, until the directive was implemented, applied in the United Kingdom. Is it reasonable for the Government to remove entitlements which, in many cases, have been held for years and, in some cases, are being used by drivers in their jobs? As I said during the debate on road safety in the House in January, it is better to err on the side of what some might call overcaution than to increase the risk of death and injury on our roads.
It has been said that the UK has implemented the directive over-zealously, and that that is not reflected in the approach taken by other member states. The directive prohibits the issuing or renewing of licences for the 1031 vehicles in question to those with diabetes treated by insulin other than in "very exceptional cases". The advisory panel has advised that there are no exceptional cases that medical opinion would recognise as being lower risk than others, and that, while modern treatments have improved the control of diabetes, they have not eliminated the possibility of a hypoglycaemic attack.
On the basis of that advice, we have decided against individual assessment of drivers—a point that the hon. Member for Torbay asked me to address—other than for the purposes of holding a licence to drive a car. Some member states may have provided for exemptions from that requirement, but only to a limited extent in most cases, and only for non-professional drivers. We do not know what expert advice those states took in making such arrangements, but it is right that we should take our own counsel.
The United Kingdom's enviable road safety record has largely been achieved by taking firm decisions.
§ Mrs. Jackie Ballard (Taunton)The hon. Lady says that the United Kingdom has an enviable road safety record. She talked earlier about increased risk. Does she agree that there will be no increased risk if current licence holders are not restricted? How could not imposing restrictions make our enviable record worse? I hope that she follows my argument.
§ Ms JacksonI do, indeed, follow the argument, but our enviable road safety record is of no comfort to people who have lost children or family members in a road traffic accidents. Surely all Governments have the responsibility to try to improve our enviable road safety, and this Government are committed to doing so.
We do not underestimate the consequences for insulin-treated diabetics who drive these vehicles for a living, but the rules are based on medical advice that is generally accepted throughout the EU. I assure hon. Members that the rules will be kept under review, both by our medical advisers and through our representation on the EU committee set up to consider health requirements in the light of advances in scientific knowledge and treatment. Road safety will continue to underpin such consideration.