HL Deb 04 July 2000 vol 614 cc1459-74

7.13 p.m.

Lord Harrison rose to ask Her Majesty's Government whether the review of driving licence regulations, which currently prevent insulin-treated diabetics from driving vehicles over 3.5 tonnes and many passenger carrying vehicles, will examine the merits of individual assessment of fitness to drive, taking into account the practices of other European Union States.

The noble Lord said: My Lords, diabetes is a nasty, vicious and brutal disease which strikes indiscriminately and inopportunely. The recent loss of our good colleague in another place, Bernie Grant, testifies to that fact. It is also a disease which the majority of diabetics contend with well and go on to live long, useful and fulfilling lives.

In opening this debate I must declare myself a lifelong member of Diabetes UK (formerly the British Diabetic Association) whose recent successful publicity campaign highlighted the fact that as many as 1 million people in the United Kingdom are suffering from diabetes, although as yet they remain undiagnosed. However, the Question this evening concerns a great injustice against diagnosed diabetics, some of whom, through no fault of their own, find their livelihood threatened by a driving ban based on a misunderstanding about what it means to be a person with diabetes.

Since 1991, new applicants on insulin or existing drivers moving to insulin have been barred from driving large goods vehicles and large passenger-carrying vehicles, although so-called "grandfather rights" exist for those drivers licensed to drive such vehicles before that date. In 1998 the Government's stringent implementation of the second EC Driving Licence Directive, took away insulin users' entitlement to commercial licences to drive other vehicles such as mini-buses and smaller lorries weighing between 3.5 and 7.5 tonnes. Your Lordships may wish to be reminded that licences to drive those vehicles are known collectively as Group 2 licences.

The Science and Technology Select Committee of the other place examined this matter and published its report in March of this year. The committee cast doubt over the evidence used to justify the blanket ban and variously described current regulations as "illogical", "arbitrary" and "inconsistent". My noble friend Lord Whitty himself conceded in evidence to the committee that the UK's restrictive position on renewing driving licences for employment purposes for people with diabetes is based on "inaccurate" information.

It is unsurprising then that the said committee called for a review of the current regulations and a feasibility study on implementing individual assessment of fitness to drive. My hope is that the Government will act on those recommendations sooner rather than later because a large number of people face a threat to their livelihoods while the current system remains in place. For example, last month I met a council worker from Kilmarnock who lost his entitlement to drive his road sweeping vehicle, which is over 7.5 tonnes, despite the fact that it is driven at an average of five miles an hour and that his diabetes is acknowledged as being "well controlled". Many other examples of those whose jobs have been threatened or lost were given as evidence to the Select Committee. I understand that the Diabetes UK CareLine continues to take calls from worried drivers on a daily basis.

I said in my opening remarks that those policies are based on a poor understanding of diabetes. The misunderstanding at the root of the blanket ban appears to be that diabetes affects all people in the same way and therefore equally impairs their ability to drive. That is very wrong. Some people are not in good control of their diabetes. They may be unable to spot the warning signs of hypoglycaemia, which include hunger, sweating, tremor or faintness. Others may have poor eyesight or nerve damage as a result of their diabetes. Of course, many of those people should not be on the road at all. However, many insulin users are in good control of their diabetes; have never suffered a hypoglycaemic episode at the wheel and have an exemplary road safety record. Those people, too, are subject to the blanket restriction of Group 2 licences. Why are those low-risk cases treated the same as the high-risk cases?

The broad brush approach is unjust. It fails to take into account the individual. If it were a fair approach, it would be much better to remove licences from males under the age of 25 because statistically they are far more likely to have road accidents. Clearly that is absurd. But it reminds us of the general principle of human rights: that people should be treated as individuals and not discriminated against for being part of a group. People with insulin-treated diabetes should be tested individually and the decision to issue a licence should be based on an individual's ability to pass stringent annual health checks by a diabetes specialist. My own diabetes specialists feel that this is quite capable of being done.

Some of your Lordships may be aware that I served as a Member of the European Parliament for a number of years until 1999. During that time I engaged in a great deal of correspondence on this matter in which the United Kingdom Government claimed that their position was arrived at as a result of European legislation and that they were unable to make substantial changes to the current position because the UK is bound by European directives. My understanding was then, and is now, somewhat different. EC Directive 91/439 does indeed state that people with diabetes requiring insulin treatment can be issued Group 2 licences "only in very exceptional cases".

Beyond this, however, it is up to member states to decide how best to implement the directive. Several countries, including Germany, Denmark, the Netherlands and Belgium, have a case-by-case medical procedure in place. The UK imposes a blanket restriction, having decided that there were no individual cases that can be regarded as sufficiently exceptional for concessions to be allowed. I must say it seems rather absurd to decide that exceptional cases do not exist without even examining the individual cases.

I find it difficult to understand why the DETR continues to argue that individual assessment is unacceptable under the directive when the Commission appears to be unconcerned about the other countries taking this route. Of 20 infringement proceedings currently pending for various presumed infringements of that EC directive, I understand that none—I repeat none—relates to the diabetes clauses of the directive.

It appears that the Select Committee is unconvinced both by the Government's interpretation of European law and by the medical evidence which forms a basis for that law as it applies to people with diabetes. The most comprehensive independent review of the available evidence to date—an independent study made by Dr Ken McLeod of the University of Exeter—concluded that road safety, 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".

The Government must have a very good reason if they want to continue to endanger people's livelihoods and to compromise their driving rights. The reasons that I have heard Ministers give to date can be summarised in two parts: first, that a blanket approach is important for road safety; and, secondly, that the European Commission would prevent the United Kingdom from applying individual assessment, since this would in any event contradict European law. It now appears that both assertions are highly questionable. In the light of this, perhaps I may urge the Minister to look afresh at individual assessment as the basis of a safety-conscious licensing policy that replaces a discriminatory blanket ban.

I am very grateful to my noble friend Lord Whitty for being here today to answer the debate. I understand that a meeting has already been arranged with colleagues from Diabetes UK later this month. I am also grateful to my noble friend the Minister for his very helpful reply to my recent Starred Question in this House.

In all this, road safety for all our citizens is paramount, but in observing this desideratum let us not penalise the human rights of a small but important group of our people, through a lack of sense and sensibility.

7.24 p.m.

Lord Addington

My Lords, I am sure we should all thank the noble Lord, Lord Harrison, for drawing our attention to this important subject. Let me go immediately to what I think is the main thrust of his argument; namely, individual assessment. Every time we start to deal with something with a blanket ban, we must ask why we have a blanket ban and what it is trying to achieve. If it is trying to achieve greater road safety, why are we trying to single out one group which does not appear to represent a greater risk than other groups?

I was also rather confused by the idea that unless you know exactly who will be at risk within a certain group, you should not do anything except in a very individually focused way. The individuals in this group are so diverse as to make it virtually impossible for them to be called one section. That was the main thrust of what was said. As to the category involved, in my non-transport oriented, naive way, I thought that a vehicle of 3 tonnes might be every bit as dangerous as one of 3.6 tonnes. So there is an area on the borderline, and one is left wondering again what we are trying to achieve by this ban.

If people who have diabetes are thought to be dangerous drivers, why are we not paying attention to their driving licence as a whole? If an out-of-control car strikes a large lorry or a small truck it can cause the same amount of destruction on the road as a small truck striking a car. There does not seem to be any rhyme or reason in this situation.

Also, we have the restriction of "grandfather rights". I have never been terribly keen on those, as a matter of principle, but if they exist why take them away from somebody who has no record? However you look at this matter, it seems to come back to one question: do we consider the individual as the point of contact? If we are going to do this we need to have an assessment, and preferably an independent assessment.

A Member of your Lordships' House, who cannot be here tonight, pointed out that an elderly relative of his had damaged a number of cars recently and seemed to have various ailments. His doctor told a relative: "Oh, I have known him for years and I have many worse on my books". Surely we should have an independent assessment if an assessment is to take place, rather than one done by the family doctor. I hope that at the end of our debate the Minister will say that we will start to look at these cases on their individual merits with an assessment of individual risk. That is all we are asking for.

The noble Lord, Lord Harrison, pointed out that there are legal approaches to the problem. Certainly there is an argument to be made. Surely we can make sure that we have a coherent approach which pays attention to the rights, and liabilities, of the individual. We are not saying that a person who is at risk behind the wheel, or at least a potentially higher risk than other people, should be given any special treatment because they happen to come within a certain group. We are simply saying that they should have an assessment, which should be regularly updated. I think that is most advisable.

I can think of many drivers who do not have diabetes but who would not in any way suffer from updating their driving skills. If we could do this, surely we would not hurt anyone and we might expand the opportunity for employment to a slightly different group. We could also get rid of an anomaly.

7.28 p.m.

Lord Gladwin of Clee

My Lords, I too should like to thank my noble friend Lord Harrison for introducing this subject and allowing this discussion in your Lordships' House tonight. To begin with, I must declare an interest. I am a diabetic—sorry, I am not really supposed to say that! I am a person with diabetes. I am also a trustee of Diabetes UK, which is still probably better known as the British Diabetic Association, or BDA. I still have trouble with the new name so I hope your Lordships will forgive me if I lapse into calling it BDA.

Diabetes UK has about 200,000 members. It is the charity for people with diabetes and their carers. A major problem which concerns the association and its members is that under discussion tonight; namely, the arbitrary and discriminatory prohibition which prevents people whose diabetes is being treated with insulin from earning a living driving goods vehicles and some passenger carrying vehicles. This blanket ban—as has been said, that is what it is, particularly as regards people newly diagnosed with diabetes who require insulin treatment—is not based upon scientific evidence or upon any risk assessment. We have the ban because, according to the House of Commons Select Committee report, the Ministry incorrectly told the honorary advisory panel that other European Union member states were applying a ban. Fortunately the blanket ban, in effect, is being re-examined by the advisory panel.

That brings me to the main point that I wish to make tonight. Diabetes UK welcomed the announcement in May that there would be a review of licence regulations and has offered to help. It has access to much scientific and medical experience from highly qualified people.

I remind the House of some of the recommendations of the Commons Select Committee on Science and Technology. First, it recommended that the Government examine the merits of Diabetes UK's proposals for individual assessment. Secondly, it recommended that the Government and Diabetes UK jointly identify an insulin-treated diabetic—even the committee got the terminology wrong—to attend meetings of the advisory panel. Thirdly, it recommended that the advisory panel should meet annually with Diabetes UK.

The report states that, to enhance public confidence, the panel's proceedings need to 'De more open; and consultation with interested organisations like Diabetes UK needs to improve". Diabetes UK has much to offer the department in carrying forward the review. My noble friend the Minister undertook to meet officers of the charity following the Government's response to the Select Committee report, which was published two months ago. My notes inform me that I should seek an assurance from the Minister that he will meet them before the Summer Recess. However, I am delighted to say that yesterday he agreed to meet them on 27th July.

As my noble friend has said, people's livelihoods, now and in the future, are being affected by this arbitrary and discriminatory blanket ban. I welcome the review but let us get it right. In his evidence to the Commons Select Committee my noble friend conceded that mistakes have been made in the past. I fear that if DETR officials take forward this review in isolation from the views and expertise of those affected by this matter, any revised regulations may turn out to be as arbitrary and unfair as the current regime.

I cannot overstate the urgency of this issue. Today in hospital outpatient clinics up and down the country diabetologists are telling professional drivers either that they have diabetes which needs to be treated with insulin injections, or that the current method of treating their diabetes through diet and tablets is not working and therefore they must resort to insulin injections. If drivers follow that advice—they would be wise to do so—they automatically lose their licence to drive heavy goods vehicles and usually their employment. This is why individual assessment is so vital.

In conclusion, I ask my noble friend when he anticipates that the review will be completed and when—we hope—revised regulations will be introduced.

7.34 p.m.

Lord Blease

My Lords, at noon today I missed by a few moments the deadline for adding my name to the list of speakers for the debate. I was involved in other business in the House at the time.

I compliment and support the noble Lord, Lord Harrison, on the informed and constructive way in which he has presented the urgent need for a review of the regulations in regard to insulin dependent diabetic drivers driving vehicles of over 3.5 tonnes. I draw to the attention of the House the fact that, while the vehicle licensing agency in Northern Ireland constitutes a separate organisation, the regulations are the same as for the rest of the United Kingdom. I thank noble Lords for giving me the opportunity to make that point.

7.35 p.m.

Baroness Thomas of Walliswood

My Lords, I apologise to the House and to the noble Lord, Lord Harrison, for being absent during the first couple of minutes of his speech. I was in the Princes Chamber and had not realised that the business of the House had changed. I am sorry not to have been present and to have been rude to Members of this House.

This is a difficult subject but an important one for those affected by it. The noble Lord, Lord Harrison, pointed out the different relevant characteristics of different diabetes sufferers. As a mother of two young women with a mild seizure condition I understand the range of disability which can be covered by any one condition. I support the noble Lord's views on that matter. He is right to emphasise that some people are being prohibited from earning a living through the approach that is currently taken in this country to the issuing of drivers' licences.

My noble friend Lord Addington rightly emphasised the human rights aspect of this matter. That is important. I sympathise with the points the noble Lord, Lord Gladwin of Clee, made with regard to the correct terminology. As one gets older, one has to revise one's terminology in almost every context. I hope that I shall not fall into any trap today in that regard.

I believe that there is a general feeling that something should be done to change the present situation. On the other hand, one must still bear in mind safety considerations, both as regards people with diabetes and other road users. The case for modifying the UK interpretation of the European regulations seems clear. Prior to 1991, insulin-treated diabetics were not prevented from driving heavier vehicles. However, after 1991, those people were barred from driving HGVs but, as my noble friend Lord Addington said, existing licence holders were allowed to retain that right under so-called "grandfather rights".

Since 1997, on the other hand, the directive on the scope of Group II licences has been interpreted in a way that has resulted in a large number of potential drivers losing the right to drive any vehicle over 3.5 tonnes. Yet it seems that there is no statistical basis for saying that drivers with insulin-treated diabetes are more accident-prone than others. The Science and Technology Committee agreed that the driving licence regulations are illogical and inconsistent and that there is little evidence to support the current policy. On the other hand, some persons with diabetes who held a commercial Group II licence prior to 1997 may still be able to get such licences renewed for vehicles between 3.5 and 7.5 tonnes. Diabetes UK provides the information diabetics need to get through that process.

People with diabetes, unlike those with other conditions, are not individually assessed, although it is said that EU regulations provide for that. The noble Lord, Lord Harrison, gave us chapter and verse on that subject. On the other hand, diabetics, like other people with a licence to drive vehicles of up to 3.5 tonnes, can drive a minibus of under that weight with 16 people aboard so long as it is not a paid activity. This seems inconsistent with other regulations on heavy vehicles and safety on the road and all the other matters that are brought into this argument.

This curious jumble of prohibitions and permissions seems to justify the Science and Technology Committee's strictures about illogicality and the lack of statistical justification for the present situation. The case for a change of approach seems clear and the Government's willingness to reconsider the current position is most welcome.

A problem for all of us is the lack of evidence of risk. My first question to the Minister is whether he has any statistical evidence which shows either that people with diabetes are more likely to be involved in an accident or which shows that they are not any more likely to be involved in an accident.

The case in justification of the present situation has not been heard today. However, I know that some people with experience of diabetes in their family would oppose any extension of access to a driving licence. They justify that approach on the basis of the ever present danger of a hypoglycaemic attack and the degenerative effect of the condition upon eyesight and muscular and nervous control.

One can understand the force of that approach—which is based on knowledge of the condition and of those who suffer from it, and upon the concern for safety—but the existing criteria by which some insulin-treated diabetics can get licences for driving vehicles from 3.5 tonnes to 7.5 tonnes already include an absence of serious attacks while driving over a 12 months' period; regular self-monitoring of sugar levels; and an examination by a specialist hospital consultant, who will want blood glucose records for the past 12 months. My second question therefore is: why cannot all sufferers from diabetes who apply for a driver's licence be subject to that process? The licence could then be given or withheld according to how the process comes out.

The Government are reviewing this whole matter following the report of the Science and Technology Committee in another place, but the points made by other noble Lords are well worth re-emphasising. First, will the review involve people who are themselves suffering from diabetes or their representatives? The possibility of it coming to a conclusion after a period of months and then coming slap up against the views and experience of people who are suffering from the condition or of their representative is serious; it would damage the good impression that has been made by the Government's willingness to review the whole situation.

There is also the issue of the advisory panel and the fact that no persons with diabetes attend the panel, even as observers. My last question to the Minister concerns those two points. In particular, will he take up the recommendation of the committee that observer status on the advisory panel should be awarded to persons with diabetes?

7.43 p.m.

Earl Attlee

My Lords, I thank the noble Lord, Lord Harrison, for introducing this timely debate. The noble Lord has described the problem lucidly and accurately; I shall not repeat his arguments. I do not disagree with anything that noble Lords have said tonight; I hope that the Minister will not change that situation.

The noble Lord, Lord Harrison, raised this subject on 3rd May by way of a Starred Question. The Minister said encouraging things on that occasion, but I accused him of allowing for the gold plating of EU regulations. I say that because I recall a very similar problem with EU eyesight regulations. EU regulations on eyesight were naturally tightened up, but, as a result of the changes, UK drivers would lose their existing entitlements to vocational driving licences but other EU drivers would not. During that campaign I raised an argument by means of PQs which suggested that a Dutchman with a standard of eyesight that would disqualify him from a UK licence could still drive in the UK.

We face exactly the same problem here. A Dutchman could pass a Dutch medical assessment and then drive in the UK; but a UK driver with exactly the same medical condition would not be able to have a UK. driving licence at all. During the debate on the Starred Question, the Minister pointed out that the Dutch driver would have had to pass the medical assessment programme. That is exactly what we are asking for.

The noble Lord, Lord Addington, in his excellent speech, asked why it was okay to drive a 3 tonne vehicle but not a 3.6 tonne vehicle. I am sure that the Minister will point out from his brief that driving commercial vehicles involves hard work, an unpredictable work pattern and, in particular, an unpredictable eating pattern. However, if the Minister follows that line he will have forgotten that people with diabetes well understand their condition and will obviously avoid a driving job that is unsuitable. Surely a sales person with diabetes, working under considerable pressure, poses just as great a risk even if he is driving only a car.

Can the Minister confirm the assertion of his noble friend Lord Harrison that he will shortly have a meeting with the Diabetes Association?

Perhaps I, too, may take the opportunity to congratulate the select committee in another place on its useful, measured report, a matter referred to by other noble Lords. It has proved very useful in informing our debate. I am sure that the Minister will take careful note of its conclusions. The Minister has responded positively already to many of the select committee's observations.

We on these Benches believe that the safety of all road users must be paramount. I am certain that no noble Lord will disagree with that. However, it is important to remember that EU directives are not written in tablets of stone. If necessary—I emphasise "necessary"—Ministers should be prepared to ask the EU to look into a matter again. The noble Lord, Lord Harrison, raised some interesting issues that may give the Minister food for thought in regard to the point about going back to the EU. We must remember that the key point is the interpretation of the EU regulations. At the moment the Minister is applying a blanket ban, whereas other countries use a discretion.

We need to recognise the difference between being taken ill at the wheel—which would mean pulling over onto the hard shoulder or a safe place and recognising that one is in trouble with a diabetes condition—and actually having an accident. The House will be very interested to hear from the Minister how many accidents have been caused by a motorist coming to grief through diabetes; not a diabetic having an accident—I hate to use the word "diabetic".

We on these Benches believe that a blanket ban is unfair. We must have an independent medical assessment panel. Of course there are obvious dangers in using a GP's report in isolation, although information from a GP will be valuable. The noble Lord, Lord Addington, drew attention to the difficulties that the GP himself would have in making the final recommendation.

The Minister may point out that there is a slight but measurable risk in going down the route of the medical assessment programme—he may be right—but there are greater risks in driving; there are risks through drink, drugs and poor anger control, or road rage. Thinking out loud, perhaps we could offset any slight increase in risk of accident by requiring insulin-dependent diabetics to have an advanced driving certificate. We know that advanced drivers have fewer accidents after their training. Therefore they can enjoy preferential insurance rates. Perhaps I may suggest we could end up with a situation where an insulin-dependent diabetic could have the same overall risk by being an advanced driver. I appreciate that it might require EU agreement before implementation. What is the view of the Minister on reducing risk by increasing the standards of driving?

I appreciate that the Minister might not be able to give a full answer today, but of course I will have the opportunity to raise this matter in greater detail during the passage of the Transport Bill.

Finally, I turn to minibuses. Minibuses can he driven by volunteer non-professional drivers who are insulin-dependent. That matter was raised by the noble Baroness, Lady Thomas of Walliswood. It was raised in the select committee report. It is a serious problem because passengers in a minibus are frequently vulnerable passengers and may not be in a position to make an informed decision about the risk they are taking. They may be unaware that the driver of the minibus is an insulin-dependent diabetic. If we are to allow insulin-dependent diabetic drivers to volunteer to drive minibuses, perhaps we ought to take the precaution of insisting that the minibus is double-manned. Therefore if the driver feels the onset of a diabetic episode, someone could take over; otherwise he may be in the very difficult position of being 50 miles from home, late at night and unable to stop although he is feeling the onset of a diabetic episode.

Many excellent points have been made tonight. I hope the Minister will be positive in his response.

7.51 p.m.

The Parliamentary Under-Secretary of State, Department of the Environment, Transport and the Regions (Lord Whitty)

My Lords, I thank my noble friend Lord Harrison for raising this issue again. It is an ongoing concern, as was pointed out by the Select Committee of another place, and one which concerns many people up and down the country who suffer from diabetes. It is one which has therefore caused my department and the DVLA—and no doubt the DVLA in Northern Ireland—some concern as to whether the present regime is fair.

In practice we are moving along the lines, or very similar lines, that my noble friend suggests. We have started to work on the possibility of individual assessment of fitness to drive. However, we need more information on that. We are seeking information from other member states, from the European Union and the European Commission. Not all of that is as clear or in the single direction that my noble friend and others have implied. But it is clear that we need to examine the position in other member states and then look at our own regime in the light of that.

However, I think that one can be too simplistic about this because we are under a number of constraints. The noble Baroness, Lady Thomas, and my noble friend Lord Harrison have suggested that we are over-interpreting—that may also be behind the reference to gold-plating of the noble Earl, Lord Attlee—the European directive. The European directive, which in one sense, has stood for some time, refers explicitly to: Only in very exceptional cases may driving licences be issued to or renewed for drivers suffering from diabetes mellitus and requiring insulin treatment, and then only where justified by authorised medical opinion and subject to regular check ups". Regrettably there is no definition of "very exceptional cases" in this or other countries. We are in touch with the Commission to see whether a more common approach to this could be adopted. The Medical Advisory Panel in this country is also reconsidering its previous interpretation for this. Nevertheless, it is clear that "very exceptional cases" requires some definition and some understanding. It does not therefore allow a blanket restriction.

That does not apply to all people suffering from diabetes. Drivers whose diabetes is treated with tablets or diet only are allowed to hold a licence to drive large goods vehicles and passenger carrying vehicles in any case. The difference between them and insulin-dependent diabetics is the risk of a sudden disabling attack of hypoglycaemia, which can result in impaired awareness or unconsciousness. The noble Baroness, Lady Thomas, and the noble Earl, Lord Attlee, asked about the statistical basis for the assessment of higher risk. The statistical basis is not available. There is not an effective and robust analysis of the level of risk involved. However, there are a significant number of incidents reported over the years by the police and others attending accidents which indicate that there are accidents due to drivers losing control while suffering from hypoglycaemic attacks.

We recognise the inadequacy of the statistical base for that and the base that has been adopted across Europe and indeed many other countries. We have therefore initiated a programme of research recently which will help to establish the risks and to assess more accurately which drivers pose an unacceptable risk to road safety and which do not. At the moment there is not a robust base on which to make that judgment.

Earl Attlee

My Lords, I am grateful to the Minister for giving way. I am grateful, too, for his frankness. It would be helpful to noble Lords if he could give us some idea of the number of incidents, otherwise we cannot work out whether we are right or wrong.

Lord Whitty

My Lords, I cannot say. That information does not exist in the statistical form in which the noble Earl requests it. It is based on a number of accident reports. Accident reports, of course, are only extant if there has been an injury or there has been a serious incident. It is difficult to devise a methodology to achieve those statistics. However, the research programme that we have now initiated should help us down that road.

The main concern relates to light goods vehicles. There are around 100,000 insulin-treated drivers in Great Britain, and indeed a few more in Northern Ireland no doubt, as the noble Lord, Lord Blease, indicated. Most of those drivers are licensed to drive cars and motorcycles. Their licences are normally issued for three years, although in a few cases depending on the driver's health they may be issued for shorter periods. They need to satisfy the eyesight standard and to have good diabetes control. For the vast majority of drivers it is a relatively clear regime.

For drivers of larger vehicles, the situation is somewhat more complex. Because of the higher degree of risk to others involved in driving larger lorries and buses, the potentially serious threat to road safety has been recognised in effectively excluding new drivers in that category. The noble Baroness, Lady Thomas, referred to the statutory bar for a licence for large lorries and buses being in place since 1991 but not before that. Prior to that it had been recommended by the advisory panel that drivers with insulin-treated diabetes should not hold such licences. That did not have the force of law until that point. The change of law in 1991 institutionalised that recommendation. There were some who retained their rights through grandfather rights, but it was not the case that everyone was granted that licence prior to that point.

The key point where unfairness arises concerns those vehicles of more than 3.5 tonnes, as the noble Lord, Lord Addington, indicated. It is important to understand the complexity of this issue, because many of the reasons for the present regulatory position have little direct relationship to the situation with regard to diabetes. Before the introduction of a second EC directive in 1997, all car drivers were automatically granted entitlement to drive minibuses with up to 16 passenger seats and small lorries. From January 1998, drivers who already held entitlement to drive small lorries and minibuses would be required to reapply when their licence expired, demonstrating that they met the higher health standards required of drivers of larger vehicles.

For the majority of drivers, that meant that they could retain their entitlement without taking any further action until their licences expired at the age of 70, but for those drivers who, because of a medical condition, had been issued only with short period licences, that change in the law resulted in their loss of entitlement to drive minibuses or small lorries. Drivers with insulin-treated diabetes were among that group.

Those who drove for a living were understandably anxious that their livelihood would be threatened. In 1998, my predecessor, my noble friend Lady Hayman, in the light of representations, agreed, on advice from the Medical Advisory Panel, that exceptional arrangements should be made in respect of those employed to drive small lorries. That did not extend to the drivers of minibuses because the panel advised that no such easement should be made. But drivers of small lorries who wished to retain that entitlement have to fulfil certain criteria, including the requirement for the driver to have notified the DVLA by the end of 1997.

Inevitably, there were some insulin-treated drivers who could not meet the criteria and therefore lost their entitlement to drive small vehicles. In some cases that affected their employment. That is the area of unfairness, or apparent unfairness, but it affects a relatively small section of insulin-treated diabetes drivers on the road.

There have been applications for exemption on the basis of the employment rules. Around 12 per cent of drivers who apply are refused. Of those, about 75 per cent are refused because of other medical conditions. Therefore, there are relatively small numbers of refusals. That does not include those who look at the employment criteria and do not apply. There were around 1,100 requests for application forms and 500 were returned. At most, around 500 drivers looked at the employment criteria and decided not to apply.

We are talking about relatively small numbers of people. Nevertheless, it was quite right that the Science and Technology Committee should have identified the apparent inconsistency and illogicality in this matter and the poor statistical base for this action. We have accepted the vast majority of the committee's report. We have taken positive action on virtually all of the recommendations. We had discussions with Diabetes UK when the report was published. I can confirm that we will be meeting again. We have indicated that we are prepared to look at the possibility of introducing a system of individual assessment for fitness to drive. The Medical Advisory Panel has also indicated its willingness to look again at present arrangements. As a starting point, the panel will look at the practices in other member states. Action is already under way on the vast majority of the recommendations.

My noble friend Lord Harrison and others said that other countries use individual assessment. The information we have so far indicates that that is not entirely the case. In some senses the concession made in 1998 is a blanket concession whereas others have to go through an individual assessment in all cases to drive this class of vehicle. We have detailed information on Belgium, Norway, Sweden and Denmark. Drivers there are permitted to drive large lorries provided the condition is stable. In Sweden, buses are excluded but drivers are permitted to drive heavy goods vehicles. It is not clear precisely how the medical assessment operates. Although it may well be true that a Dutch driver could get through an individual medical assessment and drive in this country whereas a British driver might not, it is also true that, because of the general exemption, a British driver, going through the British system of being exempt or being allowed to have the licence because of the regular and recent employment criteria, might be able to drive whereas a similar driver in Holland might not.

That is the essence of national interpretation of European directives. It is that rather than an issue of gold plating. I notice that the noble Lord, Lord Pearson of Rannoch, has entered the Chamber at this point! It is by no means clear—I believe that Diabetes UK would accept this—that if we had a system of individual assessment, more people would be entitled to drive than under the present system. However, I accept the point made by the Select Committee and Diabetes UK that it would be a fairer system. We are looking at the possibility of adopting such a system. We are looking, too, at other EU countries' practice in that area.

The noble Earl, Lord Attlee, and the noble Baroness, Lady Thomas, referred to volunteer minibus drivers. There is no very direct relationship with diabetes but it raises an anomaly to which the Select Committee referred. During the negotiations on the directive in 1998–99 we successfully achieved a concession to protect the interests of the voluntary sector. The UK is the only member state to have introduced this exemption. The concession provides that all drivers who have held a category B licence far two years can still drive a minibus with up to 16 passengers provided that it is used solely for social purposes, there is no hire or reward and the vehicle weighs no more than 3.5 tonnes or 4.25 tonnes if inclusive of special equipment for disabled passengers. That leads to the anomaly that insulin-treated diabetics who no longer have a Dl minimum entitlement may nevertheless continue to drive minibuses under those conditions. If we were to correct that anomaly, it would not necessarily be to the benefit of insulin-treated diabetic drivers.

The noble Earl referred to the possibility of approaching the matter in an entirely different way. He proposed that those subject to an insulin-treated diabetes regime should take an advanced driving test. That is not quite the point. We need research to establish the risk. There is no indication that those people are worse drivers and therefore need to acquire higher driving skills. The point is: what is the risk element of an attack of hypoglycaemia?

Earl Attlee

My Lords, I was not suggesting that someone who is an insulin-dependent diabetic suffers from poor driving. My point is that we need to set against the increased risk of having a diabetic attack the lower risk of having an accident caused by the normal perils of the road.

Lord Whitty

My Lords, it is nevertheless an assessment of skill rather than an assessment of likelihood of a problem.I said that I will be meeting Diabetes UK shortly. I said that we are looking at the possibility of individual medical assessment. My officials will work closely with Diabetes UK. We will continue that process. We are also in contact with the advisory panel. The noble Baroness, Lady Thomas, referred to the membership of the panel. The suggestions of the Select Committee in that regard are being considered because, with regard to other advisory panels, it is more difficult to decide how lay members should be appointed. Indeed, we are looking at the totality of the membership of our medical panels.

Noble Lords may be assured that the Government are doing their utmost to try to ensure that a higher level of fairness is put into the system, compatible with observing the requirements of road safety. We wish also to ensure that better research is undertaken to underpin the regulations and that those regulations are seen by all concerned to be fairer than has been the case in the past.

House adjourned at ten minutes past eight o'clock.