Diabetics

HL Deb 13 March 1998 vol 587 cc437-50

1.9 p.m.

Lord Alderdice rose to ask Her Majesty's Government what steps they are taking to review the evidence and rationale behind the current policy banning insulin-dependent diabetics from driving large vehicles.

The noble Lord said: My Lords, the Question I put to your Lordships and to the Government today is specific. Of course it is the case that governments often regulate—and rightly so—who may and may not drive for public safety purposes. There have recently been arguments implying that employment opportunities may appropriately be limited for people with certain medical conditions and, on the other hand, that research may suggest that some of the limits being imposed are unnecessarily harsh.

Drivers with diabetes mellitus who are treated with insulin are commonly perceived to pose an increased threat on the roads, not only because of their susceptibility to hypoglycaemia, but also because of the long-term effects of diabetes, particularly the eye effects in terms of retinopathy. But there remains a good deal of uncertainty as to how severe the problem is.

This issue arose and was debated in another place last week. The Government outlined their rationale for introducing a ban on people treated with insulin for their diabetes. I propose therefore, rather than simply repeating that discussion, to try to move forward a little bit and make some progress on the matter.

In answering in the other place last week the Government outlined a number of issues lying behind the ban—the need for higher health standards to drive larger vehicles; the fact that the ban was introduced following medical advice; that the number and nature of collapses behind the wheel of diabetic drivers warrants a complete ban; but also a suggestion from the Minister that the ban was perhaps a little over-cautious in the interests of road safety and some indication that the rules would be kept under review, which I particularly welcome.

Given that those were the prime concerns indicated by the Government so recently, I should like to take a few minutes to address those issues. First. in relation to the higher health standards required for larger vehicles, it is entirely appropriate that we should be particularly stringent in regard to larger vehicles and vehicles which carry more goods or more people. Last week the Minister in another place outlined the rationale behind the introduction of the higher health standards for licences. They circulated and approved a document setting out the medical aspects of fitness to drive, and that document highlights a higher fatality rate of accidents involving buses and LGVs. But there are no statistics showing a higher fatality rate of the smaller categories of CI and Dl vehicles—those weighing 3.5 to 7.5 tonnes and minibuses with nine to 16 seats.

The question is whether the Government should impose a blanket ban on all insulin-dependent diabetic people forbidding them from driving larger vehicles. It is a little like some of the other blanket bans in relation to health issues that have recently been imposed by the Government in the light of medical advice—to which I shall turn in a moment—but nevertheless not taking into account that a degree of flexibility ought to be considered. Indeed. EU Directive 91/439, under which this was dealt with, allows member states a degree of licence in exceptional cases. Other member states seem to have interpreted that a great deal more flexibly than we have in this part of the world.

I am sure that the Government will say that the crucial matter is medical advice. As your Lordships know, I would be the last to suggest that the Government should ignore medical advice. But we should ensure that all the expert views and evidence are included in the assessment. There has been some contention over the matter. Indeed, some years ago a Swedish study showed that some diabetics were less likely to have accidents and other studies indicated that there may be no difference or only marginal differences. Independent studies have been commissioned. For example, the British Diabetic Association commissioned an independent study which concluded that, of course, maximising road safety is in everybody's interest but, cannot be justifiably achieved by restricting the driving privileges of those who have consistently been exonerated from claims that they pose a significantly greater risk than the general driving population".

I suspect that one of the problems may be a proportion of insulin-dependent diabetic patients whose diabetes is not well controlled. We know that for a range of reasons—not all physical—some diabetic patients suffer from a diabetes which is much more brittle and less controlled. That is not an unusual circumstance, because in the case of epilepsy we know that there are patients whose epilepsy is not so well controlled. That is recognised, yet we do not place a blanket ban on everyone who has epilepsy. We have a situation where, if there have been any epileptic episodes in the previous three years, the possibility of that person driving is removed. But there is no such regulation in respect of patients with diabetes. For example, there is no indication that if the diabetes has been perfectly controlled, even over a long period of time, there would be some flexibility. It is in that regard that we should give this matter consideration.

While instituting regulation—I agree that it is appropriate, particularly in cases where the diabetes is brittle—there may be other things that can be done to help diabetics better control their diabetes. Indeed, there is some impatience that some of the materials which would be helpful—for example, the innovative pen-injectable devices—are not yet available on prescription for diabetics. Perhaps, rather than depending solely on blanket bans, we could provide appropriate regulation and licensing, on the one hand, and some better and more modern facilitation under the National Health Service for insulin-dependent diabetics to control their diabetes, on the other.

The third matter which the Government cited was the fact that the potential for hypoglycaemic collapse behind the wheel warranted the introduction of the ban and they quoted significant percentages of accidents. However, in doing that the Government did not make a comparison with the situation with epilepsy. I do not make these remarks in order to increase restrictions on those suffering from epilepsy when it is well controlled, but rather to show that there is a degree of inconsistency which needs to be addressed.

I have mentioned already those who have brittle diabetes and those who do not maintain the kind of control that they could. There are also other ways in which one might identify those who may be more dangerous; for example, those who are not aware of the hypoglycaemia when it happens. Some diabetics are aware, in the run-up to hypoglycaemia, that that is what is happening and they can do something to deal with it. But there are others who do not seem to have that awareness. They would obviously create a greater danger. There are some who have few episodes of hypoglycaemia and others who experience it frequently. Of course, if anyone had a previous hypoglycaemic accident or injury, that would be an important consideration.

If we ask a doctor, as a scientist, "Is there any risk in this circumstance?", he or she will give the answer, "Yes, there is a risk". However, as a scientist the question is not just whether there is any risk, but of what size the risk is. One must balance the notion of doing away with any possibility of risk against the removal of the reasonable individual human rights of those who already have a degree of disability, both physical and otherwise, because of the nature of their disorder. It is a pity if those who suffer from diabetes also find themselves at the rough end of the stick when it comes to regulation, even when there is no indication that they as individuals are as much a danger as may be thought.

The Government clearly need to take the issue with some seriousness. There is an EU directive, and that is rightly the case. But I am a little encouraged by the indication of the Minister in another place that the Government may see the regulation as an over-cautious rather than as an appropriately cautious measure. Perhaps the Government therefore can reassure us that the matter will be kept under review in the ways to which I have already adverted: first, that a blanket ban may be amended to a more appropriate regulation setting down standards for those who should not be permitted to drive such vehicles and, on the other hand, allowing those who would pass the test to be able to continue. Secondly, there may be some question as to whether the older groupings to which the ban applies are appropriate for all the groupings that are currently included. Thirdly, rather than depending merely on regulation to remove those who might conceivably be at risk, I wonder whether the Government might balance up the see-saw a little by giving some slightly better facility to insulin-dependent diabetics to control their diabetes by enabling them to have on prescription some of the more innovative devices, particularly the pen syringe device.

1.20 p.m.

Lord Rea

My Lords, there is very little more to say following the presentation of the problem by the noble Lord, Lord Alderdice, in his usual eloquent manner. However, I thought it might be useful for a Member from these Benches who is also medically qualified to back up the noble Lord's arguments which are fully endorsed by the British Diabetic Association, which has both medical and lay membership. Of course it could be argued that the British Diabetic Association has an axe to grind and that it would take the side of diabetic drivers, would it not? But the noble Lord has shown that the BDA case is logically strong as well as being humanitarian. In fact the Government have said that there is no evidence that medical conditions play a significant role in road accidents.

As a practising doctor with five years' experience as a clinical assistant in a diabetes clinic at UCH and working in a group practice which, as my noble friend knows, ran its own diabetic clinic, I know that there are a small proportion of insulin-dependent diabetics whose diabetes is very difficult to control. They are rather quaintly known as "brittle" or "fragile" diabetics. It is possible that a high proportion of the small number of these collapses at the wheel—I think 27 is the figure for last year—where the diagnosis of insulin-dependent diabetes was present, according to government statistics, were in that category.

I suggest that it is possible to identify those who are more liable to hypoglycaemic attacks. It is worth mentioning that very few insulin-dependent diabetics collapse with hypoglycaemia without warning. Yes, it happens sometimes, but there are nearly always premonitory symptoms—hunger, sweating, tremor or faintness. Sudden collapse is rare, although it is not unknown and has to be reckoned with.

I back the noble Lord's suggestion, although I know it is not my noble friend's area, that it would help very much if the pen method of injecting was available on prescription on the National Health Service. That would not only help the heavy vehicle drivers we are discussing but could, at least theoretically, result in fewer episodes of sudden hypoglycaemia in all insulin-dependent diabetics, many of whom are car drivers and are now perfectly free to drive.

In conclusion, I ask my noble friend to consider carefully the case and the evidence which will be given next month by the British Diabetic Association's working group to her honorary advisory panel. This is not incompatible with proper management of insulin-dependent diabetes. Patients with this condition should attend their doctor at least annually and preferably every six months. So it will not be difficult for them to get a medical signature as to whether or not they are liable to have these sudden attacks and therefore should be precluded from having a licence.

I am fully aware that the Government have to consider the safety of the wider public, whether they be drivers, passengers or pedestrians. But I would suggest that, as a listening and caring government, they should also carefully consider the employment rights of this minority of otherwise perfectly fit and able citizens who have the misfortune to suffer from insulin-dependent diabetes.

1.25 p.m.

Lord Holmpatrick

My Lords, I should like to thank the noble Lord, Lord Alderdice, for giving me an opportunity to speak today. I have held an HGV 1 licence for 10 years. I have used it for categories C1 and limited use in DI, which is largely PSV.

I have lived with a diabetic in the family, diagnosed insulin-dependent age seven. Indeed, he has travelled often with me in various vehicles. I have always carried with me biscuits, largely left unused and crumbling in my pocket. Now 23, extremely healthy and leading a balanced and normal life, most people would not know about his medical condition. But most important, I have become aware that, under a ban introduced by the Government which came into force on 1st January 1998, my son and other insulin-dependent diabetics may not now take a test to allow them to drive categories C1 and D2.

Others will speak in more detail than I about the EC directive that brought about the ban. Suffice it to say that I have read Hansard of another place of 4th March 1998 which deals with the issues in great detail. I would ask the Minister to note that other countries have interpreted, or appear to have interpreted, the EC directive rather differently and are allowing group 2 licences to be issued subject to the usual stringent medical requirements.

The debate in another place was detailed and raised a number of points. I should like to read a few lines of what the Member for Torbay said: 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".—[Official Report, Commons, 4/3/98; col. 1027.] The Minister will note that I have left out mention of what amounts to, dare I say, civil disobedience. They would be breaking the law and would almost certainly be uninsured. That is not acceptable. I would also refer the Minister to the decisions taken by a panel largely made up of departmental officials, with little advice from organisations such as the British Diabetic Association and motoring organisations. Were the discussions based on statistical evidence, as the statistics, such as they are, show that there is little evidence that insulin dependent diabetics are causing more accidents than any other category of drivers?

I support any important measures that improve road safety but I cannot support this measure as I believe it sends a message to the public that diabetics have an incurable disease that makes them a danger to the public. I do not believe for one moment that the Minister or the department accept that diabetics should be discriminated against in this way. Too many short cuts have been taken. Can the Minister give me any hope, as the Minister for Transport in London in another place did in her closing remarks in the last paragraph of her reply?

I am very worried that the Government have shut the door rather firmly on a minority, with very little benefit for the majority in terms of safety but with a devastating effect on the former in terms of low future prospects and the loss of jobs.

1.29 p.m.

Lord Addington

My Lords, I was attracted to this debate for the simple reason that it deals with a blanket ban on a group of people in society, and for reasons which are no fault of theirs. There is nothing that they can react to. The ban strikes at someone who has a disability caused by disease. I therefore looked rather askance at a policy which means that, because of a disability, one falls into a category which restricts one from a certain area of activity.

When we deal with disability legislation across the board, generally speaking, we try to resist this type of approach. We try to remove such barriers that are put in front of people. All forms of discrimination tend to reflect the idea, "You are in a group which cannot do something or which is restricted in its activities". I thought that we were busily hacking away at that type of approach. Looking at this issue, I see that we are returning to it.

The matter becomes increasingly difficult because we are dealing with safety and the general public. If insulin-dependent diabetics were so dangerous behind the wheel of a car, I would suggest that this is a rather pathetic half measure. If one drives an ordinary car with three passengers and has a blackout, one could quite easily kill everyone in the car and also career into another vehicle. If one is that dangerous then we should ban everyone in that condition from driving. Evidently, the Government do not think so. They believe that there are greater risks involved with larger vehicles. That is probably the case, because greater skills are required.

The vast majority of those affected by this illness seem to have been handling the responsibility quite well. They certainly do not seem to be providing a very high death toll on the roads. It seems to be a small group with immense variation within it. I suggest that the Government's path should be to take a little bit of flexibility into account. Regular testing and individual licensing would seem to be the way forward because one is taking a very broad brush to very fine, detailed work. Very few of the people in this category will be a risk. Indeed, I have read some of the briefing. If one wants to take a broad brush approach, it would be much better to remove from the road males under the age of 25 because they are far more likely to have road accidents.

We are not proposing that approach. We are dealing with certain people who have one specific type of problem, which is controllable, and the risk can be assessed. The people involved should be treated as individuals. They should be tested individually. One would then probably end up with a group which is statistically safer than the general public. The use of a broad brush approach here simply catches far too many people and does not allow for the flexibility which would allow individuals to carry on law-abiding and commercial activities which they have been carrying out safely until this point.

1.33 p.m.

Lord Brabazon of Tara

My Lords, like other noble Lords I am most grateful to the noble Lord. Lord Alderdice, for having raised this Question in the House today. I am also grateful to the British Diabetic Association for the briefing material that it kindly sent to me on the issue. I gather that the issue has caused considerable interest in another place and a large volume of correspondence for the responsible Minister whom, I am glad to say, we have in this House and who is to answer the debate today. I also heard her on the "Today" programme this morning, so it is obviously an issue of great national concern.

The noble Lord, Lord Alderdice and Lord Rea, in particular, put the issue very clearly, as have other noble Lords, so there is not an enormous amount left for me to say. As has been said, the issue arises from the Government's requirement to bring into force EU Directive 91/439. I have become concerned over recent years about the issue known as "gold plating", whereby the Government have used the excuse of bringing in EU legislation to add measures that they wanted to introduce themselves but which actually went beyond the requirements of the directive. I hope that I never did that when I was in the noble Baroness's position, but one cannot always be certain.

My first question to the Minister is this: do the regulations implemented on 1st January this year go further than the EC directive? If they go only as far as the directive requires, then I shall be happy. I also believe that member states should also be allowed to use their own discretion as to whether to use any permitted exceptions. My second question, therefore, is whether the Government were right not to use the "only in very exceptional cases" provision allowed for in the directive, which has already been referred to by the noble Lord, Lord Alderdice. The Minister has no doubt taken expert medical advice and I look forward to her setting out the reasons for the Government's decision not to use that exception.

Reference has also been made to the granting of grandfather rights, as was done in the case of eyesight and epilepsy in the 1996 regulations. My final question, therefore, is this: are such grandfather rights available in this case?

The issue of road safety is a very important one. Our record in this country is second to none, I believe, in Europe. I pay tribute to some of the noble Baroness's predecessors, particularly my noble friend Lady Chalker and my honourable friend Mr. Peter Bottomley, who achieved an enormous amount during their time in office, particularly in the fields of seatbelts and drink-driving. I also pay tribute to vehicle manufacturers. I cannot let the opportunity go by without reminding the Minister that new roads and bypasses also make a considerable improvement to road safety. Therefore, I hope that the road programme is not going to be lost entirely next Tuesday. However, that is perhaps another matter.

I look forward to hearing the Minister's reply and in particular to what she has to say about reviewing the evidence available to her. No one wants to take away someone's livelihood or to see it taken away. Therefore, the Government must have a very good reason if they choose so to do.

1.36 p.m.

Baroness Hayman

My Lords, like others, I am extremely grateful to the noble Lord, Lord Alderdice, for having raised this important Question in the House today and to other noble Lords who have contributed to the debate with a great deal of individual personal or professional knowledge besides a great deal of concern. It is a concern which has been echoed nationally and of that I am extremely aware. There has been an enormous amount of correspondence on the subject. It means that I have not only listened to the points which have been made today with great care, but I have obviously spent a great deal of time over the past weeks studying this issue and looking at whether we have got the balance right between individual's rights and their livelihoods in some cases and the needs of the community as a whole in terms of road safety.

I am particularly well aware of how much concern the change in the law affecting the entitlement of those with certain medical conditions, particularly those with insulin-dependent diabetes, is causing to drivers and their families. I am, therefore, very glad to have the opportunity today to explain the Government's position. It may be helpful if I set out something of the background to the new requirements and exactly how the issue has arisen.

The Second Driving Licence Directive was adopted by EU governments in 1991, to come into effect across the EU in 1996. It was intended to take further the process of harmonisation begun by the first directive in 1980. It introduced, among other things, driving licence sub-categories for lorries between 3.5 and 7.5 tonnes (C1) and vehicles with nine to 16 passenger seats (D1). It required entitlements to these vehicles to be subject to separate driving tests and the more stringent medical requirements which in the UK already applied to drivers of large lorries over 7.5 tonnes, buses and coaches. In doing so, those higher health standards and higher driving test competences take into account not only the individual risk of an individual driver having an accident, but also the consequences of accidents involving such vehicles.

I must advise the noble Lord, Lord Alderdice, that serious issues arise because of the effect of accidents involving heavier vans or lorries as well as because of the number of people who might be involved if there was an accident involving the driver of a minibus which had, say, 10 or 12 passengers on board. It is because the consequences of accidents involving such larger vehicles are likely to be much more serious in terms of death and serious injury than accidents involving cars that it has been recognised across Europe that it is appropriate to impose higher standards on the drivers of such vehicles.

I am obviously aware of the concerns, to which the noble Lord, Lord Addington, referred, that those higher health standards might be extended to the driving of cars. I can assure noble Lords that there are no such plans either in Europe or in this country. There is always a question about where to draw the line, but it is agreed throughout Europe that there is an intermediate category between the heavy goods vehicles, buses and coaches (about which I do not think that there is a great deal of debate now although there was earlier) which have been subject to higher health regulations since 1991, and, at the other end of the spectrum, cars.

The application of the higher health standards to drivers of C1 and D1 vehicles had particular implications for the UK. Until the beginning of 1997 in this country those who passed a driving test in an ordinary car were automatically given entitlement to these vehicles—in the case of the passenger vehicles (D1) limited to not for hire or reward. This was a long-standing arrangement, and one which British drivers had come to expect and accept. It was out of step with the practice in the rest of Europe: most other member states already required higher health standards for driving lorries over 3.5 tonnes and vehicles with more than eight passenger seats. Unlike those member states, the UK had to consider how drivers holding C1 and D1 entitlements were to be brought within the requirements of the directive. We had to grapple with a situation which was different from those in other member states, and where we were dealing with the possibility of taking away entitlements from people as opposed to not giving them opportunities. That difference has to be borne in mind when international comparisons are made.

A consultation was undertaken in 1996 on implementation of the directive. This included the proposal that the drivers who already held C1 and D1 entitlements should have to meet the higher health standards when their licence expired if they wished to retain those entitlements. There was general agreement that the higher standards were appropriate for the driving of vehicles over 3.5 tonnes or with more than nine seats. There has not been a great deal of dispute about those standards applying to new drivers. For most drivers, the new requirement would come into force at the age of 70 when their driving licence expired.

However, drivers with medical conditions, who had for that reason been issued with short-period licences, valid for periods of up to three years and renewable only subject to satisfactory health checks, would necessarily become subject to the proposed regime at an earlier age. It was recognised that this could inconvenience many licence holders, and it was decided that the application of the new health requirements to these existing drivers should come into effect one year after it applied to new drivers, to give drivers affected some extra time to adjust to the change. The regulations implementing the directive, which were introduced on 1st January 1997, therefore provided that the new requirements would apply only to licences expiring from 1st January 1998.

The noble Lord, Lord Alderdice, asked whether we were being inconsistent in our treatment of diabetic drivers as against others. Out of over 30 million drivers, there are some 300,000 with short-term licences, only approximately 110,000 of whom are diabetics treated by insulin. It is not difficult to understand, however, how the change in the law must seem like discrimination to those drivers who have lost, or will lose, an entitlement to drive these vehicles because of a health condition. However, I hope that noble Lords will accept the assurance that the new requirement is not specifically targeted at diabetics or at any particular groups; there are another 200,000 drivers with various medical conditions—for example, epilepsy and heart conditions—who are also affected.

Reference has been made to a blanket ban. I believe that the noble Lord, Lord Alderdice, suggested that if we are looking at individual assessment for insulin-dependent diabetics, we should look at individual assessment also for those other categories of higher health risk. That is not possible within the terms of the directive. There is not even the very limited potential provision and exception which exists for insulin-dependent diabetics available for the others in those health risk groups. For them, the directive leaves no possibility of an exemption.

The point has been made that given that many of those affected have been driving safely for many years, it might be appropriate to provide "grandfather rights", to which the noble Lord, Lord Brabazon of Tara, referred. The directive does not provide for such rights. As I have said, it provides for no exceptions for the other categories but, in the case of diabetes, it states: Only in very exceptional cases may driving licences be issued to or renewed for applicants or drivers … suffering from diabetes … and requiring insulin treatment". I know that many of those who are concerned about the new requirements attach particular importance to the possibility of providing exceptions, as allowed for in that provision. Several noble Lords have made that point. It has been suggested that failure to do so on the part of the Government indicates an over-zealous approach to implementing the directive, or even "goldplating", to which the noble Lord, Lord Brabazon of Tara, referred. It has been suggested that as other member states permit exemptions and their insulin-treated licence holders may drive goods and passenger vehicles, our drivers are being discriminated against.

I turn now to the crucial points raised in this debate. On the question of exceptional cases, the Government had to consider whether it would be proper for the possibility allowed by the directive to be adopted in this country—that is, not to have the blanket ban to which the noble Lord, Lord Addington, referred. That decision must be based on informed medical opinion. We would be rightly criticised if we reacted to representations from a patient-based organisation or to the weight of correspondence that we receive simply because of the passion engendered rather than if we acted on objective medical advice.

As the noble Lord, Lord Brabazon of Tara, pointed out, our road safety record is an extremely good one—and that is partly attributable to the fact that we have a highly developed system of obtaining expert medical advice in relation to driver licensing. I refer to the Honorary Advisory Panels. It was to enable the Government to have access to the best possible advice on the road safety risk of certain medical conditions that the Secretary of State's Honorary Advisory Panels comprising experts in their fields were set up many years ago.

Perhaps I may reply to the point raised by the noble Lord, Lord HolmPatrick, which I know was raised in another place, about the membership of such panels and the advice given by them on this point. Membership is limited to medical specialists who are independent advisers to government in this area. It is not a matter of any officials being involved in the decision-making process or being responsible for the advice. The only people to participate are the independent members of the panel. Separate panels cover the main areas of health affecting fitness to drive: cardiac conditions, neurological diseases, alcohol abuse as well as diabetes. We are about to set up a panel on eyesight issues. The panels have a specific road safety remit that takes account of the interests of road users as a whole as well as their specialist knowledge of the conditions involved. Nominations for the panel chairmen are on the recommendation of the Royal College of Physicians and, for members of the panels, on recommendation through inquiry or by the Royal Colleges.

The Diabetes Panel has been for some time of the considered view that those who are insulin treated should not be allowed to drive the larger and heavier vehicles. There has been a ban on drivers of lorries of over 7.5 tonnes, buses and coaches since 1991. Nevertheless, in the light of the claim that modern treatment methods reduce the risks of hypoglycaemic attacks, the panel was specifically invited to advise the Government on whether there was scope when implementing this directive for exceptional cases. However, its view remains that despite improvements in modern methods of treating diabetes there are no individual cases that can be regarded as sufficiently exceptional for concessions to be allowed. That is the background to the legislation that has come into force.

I am aware that some member states apply the "very exceptional cases" provision. We do not know exactly what expert medical advice these members took before making such arrangements, although we understand that in most cases—obviously, the exception is not taken into account in all cases—those whom they treat separately as very exceptional drivers are not those who drive vehicles professionally for a living, which is the group that has occasioned most concern in this country because of the possibility of such individuals losing their livelihood. I believe that that analogy gives rise to a particular problem.

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 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 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.