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Mr John Buchan

Volume 931: debated on Thursday 12 May 1977

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Motion made, and Question proposed, That this House do now adjourn.—[ Mr. Snape.]

1.41 a.m.

I am very pleased, even at this late hour, that, after trying unsuccessfully for several weeks in the Ballot, I have finally succeeded in securing this debate to raise the case of my constituent, Mr. John Buchan, who lives at 12 West-haven Crescent, in the village of Cairnbulg, just outside Fraserburgh.

Mr. Buchan is an active and lively young man of 23 years of age, who has had one very strong ambition in life—to become a bus driver. He was delighted, therefore, when in May 1975 he passed the PSV—public service vehicle—driving test and was issued with his licence and badge.

No permanent jobs in the bus industry were available at the time, so he accepted temporary employment with the local bus company, part of the Scottish Transport Group, Alexander's (Northern) Ltd., a post which he held until October 1975, at which time, with the more restricted winter schedules in operation and as no permanent employment was available, he was paid off.

I want to emphasise at this stage that I have found no evidence that his service with Alexander's was other than completely satisfactory and that he, for his part, was extremely happy in that job.

There being no permanent work as a bus driver, Mr. Buchan decided that it would be valuable for him to have more than one string to his bow, so he enrolled for training as a lorry driver at the ARTIC training centre in Aberdeen. He was accepted and, after the requisite period of training, applied to take the test for a heavy goods vehicle licence in February 1976.

At this point the story becomes somewhat tragic, because he was astounded when he was informed that, on medical grounds, he could not be permitted to take the test, and, following an appeal, which he was not invited to attend and to which he was not privy, he was asked to return his public service vehicle licence and badge.

Having met Mr. Buchan, I can say that I can appreciate that he may well have been justified in thinking that the world that he had built up for himself had crashed about his ears, because the grounds on which his HGV test application was refused and on which he was asked to return his hard-won PSV licence and badge were that he had, as a child, suffered from epilepsy.

I want to make it clear at this stage that Mr. Buchan made a full disclosure of his medical history, both when he successfully applied for a PSV licence and when he applied to take the HGV test. On both occasions, he was medically examined and pronounced fit by his doctor.

After he returned his PSV licence and badge, I understand that he underwent a full medical examination, including EEG tests and X-rays at Aberdeen Royal Infirmary, and was adjudged to be in excellent health.

There is no history of epilepsy in his family. Why, then, was he refused leave to take the HGV test? Why did he have to surrender his PSV licence and badge?

We have to go back to Mr. Buchan's childhood—to 1963, when he was nine years of age—and consider what happened. On the night of Friday 24th May 1963, his parents were aroused by a low mumbling sound from his bedroom. They found him in bed, with a slight tremor in his limbs. For less than five minutes he was unable to speak, although he was able to comprehend and respond to what was said to him. For example, his mother said "Sit up" and he immediately sat up, although he was not able to answer.

His parents summoned the doctor from Fraserburgh, three or four miles away. When the doctor arrived the boy was behaving normally. The parents recollect that the doctor expressed the opinion that the boy had probably pressed his face against the pillow. He prescribed no treatment. The boy slept normally for the rest of the night and was out playing with his friends the following day, a Saturday.

Ten days later, on the night of Monday 3rd June 1963, a similar incident occurred and lasted for the same period. On this occasion, as on the previous occasion, the boy's bed was not unduly disturbed and the bedclothes were in place. The doctor was summoned from Fraserburgh. This time a partner of the previous doctor arrived. Apart from a slight shivering, the boy was behaving normally when he arrived. He again slept normally for the rest of the night and went to school the next morning.

The doctor referred the boy to the sick children's hospital in Aberdeen, where he had an EEG and an X-ray of the skull. I believe that no abnormality was detected, but that could be checked. When I spoke to the doctor on the telephone, he referred to a left-sided focus. I am no expert, but that could be checked.

A course of phenobarbitone was prescribed for two years. No further recurrences of these incidents took place. The treatment was therefore discontinued at the end of two years. Since then, I understand that, apart from normal minor ailments to which both children and adults are subjected, Mr. Buchan has enjoyed excellent health and progressed normally in his school work and career.

I have related his medical history from the recollections of Mr. Buchan, his parents and doctor. The events occurred 14 years ago. I spent time quizzing the family. They answered my questions as honestly and fairly as they could and related as best they could the events of those two occasions. For a busy general practitioner the events happened a long time ago. It is not for me to try to evaluate the medical evidence, but I respect the conscientiousness of the doctor.

It is worth quoting from a booklet on epilepsy and fits published by the British Medical Association. Having described the various forms of epilepsy, it states:
"At this point it is worth mentioning some conditions resembling epilepsy, but quite distinct from it, according to our definition of the electric outburst in the brain. It is possible for a neurotic person to seek refuge from an unpleasant situation by an hysterical attack."
It notes that such fits and hysteria were popular among Victorian ladies. It continues:
"In hysteria, the patient may lose awareness and throw himself about violently…. Similarly temper tantrums in children occasionally cause loss of consciousness and spasmodic movements."
I wish to stress that last sentence.
"There is no evidence, however, that temper tantrums are comparable in any way to epilepsy",
it states.

I introduce that aspect into the story of Mr. Buchan's life because it occurs to me that the fact that only two attacks took place some years ago and that no serious effects seem to have resulted from them indicates that it may be that in legal jargon there was a reasonable doubt about the incidence of epilepsy in this case. That is my first main point to the Minister. I should like him to say tonight whether he considers he has the power to order, construct or recommend a review of the situation in that sense. He will appreciate that the events of those two nights—24th May and 3rd June 1963—have never been repeated. They represent a watershed in the man's life and for his employment prospects. Has the Minister any powers to reopen this matter and look at it in a second light?

Secondly, why was Mr. Buchan found fit, on the basis of medical evidence, to hold a PSV licence and badge for several months, both of which he lost only when he took the HGV test? Mr. Buchan was driving a double-decker bus in Fraserburgh and he disclosed all the information that was necessary to get the PSV licence. It was only when he went to take the HGV test that he was ordered to turn in his PSV badge and hand back his licence. I am assured that the information provided for the PSV licence was the same as that provided for the HGV licence.

My third point is of wider application and interest than Mr. Buchan's case. Even if it were established that he had suffered from a minor form of epilepsy as a child, the question arises whether he should ever have been debarred from driving heavy goods or public service vehicles. Under the regulations he is, of course, eligible and free to hold a private vehicle licence, as are all epileptics who have passed the qualifying trouble-free period of three years. But he cannot hold a PSV or HGV licence if he is adjudged to have suffered from epilepsy after the age of three.

I understand that there are about 300,000 epileptics in Britain, which is about one in every 200 of the population. Almost 100,000 of them are children, and that suggests that many children grow out of the disabilities of the ailment. Many countries impose strict conditions on driving, and Britain's Department of Transport is relatively enlightened in terms of the allocation of ordinary driving licences. For HGV and PSV licences, most Governments adopt an approach similar to that of the United Kingdom. Luxembourg is prepared to consider individual cases on the basis of medical reports. Denmark is perhaps more liberal than Britain, since it will consider applications for HGV and PSV licences after a seizure-free period, depending on the individual case. That may range from five to 20 years.

The United Nations Economic Commission for Europe Agreement on minimum requirements for driving permits. reached on 1st April 1975, includes, for what it calls the heavier or group 2 vehicles—I concede that they are not in quite the same category as our heavier vehicles—provisions that, subject to competent medical opinion, permits may be granted to persons who have suffered from epilepsy in the past but who have been free from attacks for a long time. In fairness, it should be said that to date only Luxembourg has signed this agreement. The Minister may wish to comment on that aspect tonight.

I wish to record the fact that, for the assistance that I have had in obtaining this information, I am grateful to Mr. Peter Mitchell, who is the excellent and lively research assistant to the All-Party Disablement Group and, of course, to our splendid staff in the House of Commons Library.

I put it to the Minister that there is perhaps a case and a need for a programme of research on epilepsy and driving. What, for example, is so sacrosanct about the age of three as the dividing line in considering applications for PSV and HGV licences? When was it set, why was it chosen, and is it still valid? No one will disagree that the maximum care ought to be taken in issuing PSV and HGV licences. I am sure that the Minister does not think that I was arguing for any unnecessary relaxation in that respect tonight. However, nowadays restrictions on hours and conditions of service must surely play an increasing part in improving safety standards. It may be said that there are more stringent rules in connection with driving a bus or a lorry than with driving a motor car, because the driver of a private car can drive for any number of hours. There is no check or restraint on the period during which he can drive. In those circumstances, is there the same force in the argument for treating PSV and HGV licences so differently from private vehicle licences? My constituent, incidentally, has held a driving licence for six years without incident.

Then there is the question of comparing sufferers from epilepsy with sufferers from other disabilities, such as diabetes or coronary thrombosis. There is surely scope for comparative research here.

In summary, I ask the Minister whether he will examine the considerations that I have presented tonight and, in particular, whether he will look sympathetically at the case of my constituent, about whose medical background there is some doubt, and who views the permanent withdrawal of his PSV licence as in the nature of a life sentence. By way of analogy, can the Minister see his way to grant some reprieve, or at least a parole?

1.58 a.m.

I thank the hon. Member for Aberdeenshire, East (Mr. Henderson) for raising this matter. He has presented it in his customary eloquent and compassionate way. It might be helpful if I explained the background, with particular reference to driving and epilepsy.

First, I want to answer the more general point that the hon. Member raised. One of the objectives of the vocational driver licensing schemes is to ensure, as far as possible, that those who drive heavy lorries, buses and coaches in today's traffic conditions are physically fit to do so. Drivers of these vehicles usually drive under conditions which are very much more demanding than those to which the ordinary motorist is subjected. They drive for longer hours and it is not so easy for them to stop driving when they feel unwell. Furthermore, the risk of death or serious injury to other road users in collision with heavy lorries is very high on account of their bulk and because they need more distance in which to stop.

For recommendations on medical standards and driving we are indebted to the Medical Commission on Accident Prevention, which provides useful guidance to medical practitioners in its booklet "Medical Aspects of Fitness to Drive". This has been recommended to doctors generally in connection with the giving of advice to their patients about their fitness to drive. As well as providing guidance about fitness to drive under ordinary driving licences, the booklet also advises in particular on the higher standards needed—in the interests of road safety—in drivers of heavy goods vehicles and public service vehicles. This guidance is especially important in the case of doctors who are called upon to give the medical reports and certificates on applicants for drivers' licences to drive heavy goods vehicles, as the standards recommended by the commission are those accepted for the vocational driver licensing schemes. They are therefore the standards by which the statutorily independent licensing authorities are guided in exercising their discretion whether or not it would be appropriate to grant licences.

The commission advises on all the main disabilities which could affect a person's safety as a driver; cardiac conditions, diabetes, disorders of the nervous system, mental illness, inadequate vision, loco-motor disabilities, drugs and, last but by no means least, epilepsy.

Epilepsy is, in fact, in a unique category in relation to the vocational driver licensing schemes, as it is the only disability prescribed in the regulations for those schemes as a bar to the issue of a licence. I shall explain how this situation comes about.

First of all, however, in response to the hon. Member's question, I shall provide a definition of what constitutes an epileptic attack. This has been defined as a
"brief disturbance of brain function which may cause altered consciousness and which develops suddenly, ceases spontaneously, and exhibits an open-ended tendency to recur".
The risk of epileptic attacks in a driver is generally recognised by all countries as constituting a threat to road safety, and conditions relating to epilepsy feature in their driver licensing schemes. An analysis of cases notified by the police to the licensing centre of drivers collapsing at the wheel between January 1976 and February 1977 showed that epilepsy was diagnosed in 88 of the 229 cases—38 per cent. A further 38 drivers were said to have suffered "blackouts", and there is little doubt that epilepsy was the underlying cause in at least some of them.

Prior to 1970, epilepsy was a complete bar to the holding of any driving licence in Great Britain. I understand in the late 1960s a panel of eminent specialists, initially under the chairmanship of the late Lord Brain—and later of Dr. Denis Williams—recommended to the then Minister of Transport that the bar could be relaxed without significant risk so as to allow people whose epilepsy had been satisfactorily controlled to hold an ordinary driving licence. On the advice of the panel, which still exists, the regulations were amended in June 1970 to allow a person who had had at least three years free from wakeful attacks—or who had a history of attacks only while asleep, extending back for more than three years—to hold an ordinary licence.

In giving this advice, however, the panel was quite categoric that the bar should not be relaxed in the case of those who drive goods vehicles, buses, coaches and taxis. The reasons stem from the general ones that I have mentioned about the conditions under which professional drivers work. Many of these drivers, day in and day out, travel what to them are often monotonous miles at the wheel in comfortable ergonomically-designed cabs, often listening to music. Schedules are tight. Turn-and-turn-about shifts are worked, and insomnia is not uncommon, particularly when drivers have to stay away from home. I am told that these are ideal conditions for an attack of epilepsy in persons with an epileptic tendency.

As the liability to epileptic fits in a person who has had an attack since the age of three years is open-ended, the panel advised that the regulations for the vocational licensing schemes for drivers of heavy goods vehicles—that is, rigid goods vehicles with a permissible maximum weight over 7·5 metric tons and all articulated goods vehicles—and public service vehicles should bar from licensing those who had had an epileptic attack since the age of three years. The Department's medical adviser, who is also the medical adviser to the licensing authorities for vocational drivers' licences, tells me that in the course of discussing cases with many consultants he has never come across a challenge to the appropriateness of the regulations.

Our standards in this country in this matter are no more stringent than those of other states. The British Epilepsy Association has been kind enough to let us know the results of its research. The association found that no licences were granted to a driver of the larger vehicles by Belgium, Denmark, Eire, France, Italy, the Netherlands and West Germany. It may be that the hon. Gentlemen has different information from that which I have, but I understand that mine is correct. I am sure that the hon. Gentleman said what he said in good faith.

In an even wider field, the agreement concluded in Geneva in 1975 by the United Nations Economic Commission for Europe on minimum requirements for the issue and validity of driving permits provides that driving permits should neither be granted nor renewed for the driving of goods vehicles with a permissible maximum weight in excess of 3·5 tonnes, or with more than eight passenger seats, to anyone.
"who suffers or has suffered in the past from epilepsy".
I make these points to illustrate that internationally, as well as nationally, it is widely accepted that a history of epileptic attacks should continue to be a bar to the driving of large vehicles.

Expert opinion sees no breakthrough in the treatment of epilepsy or any change in conditions that would suggest that this complete bar should be in any way relaxed in the foreseeable future. That is a depressing message, but that is the case. The only slight possibility is that the three-year period for the ordinary motorist might at some stage be brought down to two years, but it would not help since it would increase the difference between the circumstances of the ordinary motorist and those of other drivers.

I now turn to the case of Mr. John Buchan. I can well appreciate the concern of the hon. Member for Aberdeenshire, East for his constituent. I hope that I have helped him to appreciate the reasons underlying the present regulations, which have led the staff of the licensing authority for the Scottish Traffic Area—which, as I have mentioned, is quite independent, statutorily, of my right hon. Friend—to advise Mr. Buchan that the epileptic attacks which he suffered in 1963 debar him from holding a heavy goods vehicle driver's licence.

I understand that, although Mr. Buchan attended at the public counter of the licensing authority's office in Aberdeen in February last year with a completed application for a heavy goods vehicle driver's licence, he did not actually lodge the application. He took it away with him when he was informed by the counter clerk—quite correctly—that the epileptic attacks in 1963 referred to in the medical certificate that accompanied his application disqualified him from applying for a licence.

It is common practice in such circumstances to give a would-be applicant for a licence every opportunity to establish that he does not have a disability that debars him. Although the Aberdeen office did not accept Mr. Buchan's application—which the licensing authority coud not have granted as it stood—it suggested that Mr. Buchan should take it back to the doctor who completed the medical certificate. The intention in so doing was that if the doctor had any doubt whether the attacks were truly epileptic, Mr. Buchan could authorise the release of the medical case papers so that they could be referred to the licensing authority's medical advisers.

When Mr. Buchan told the counter clerk that he was already the holder of a PSV driver's licence, it was discovered that when this licence had been issued the reference in the medical report to epileptic attacks in 1963 had been overlooked. The hon. Gentleman is right to suggest that there was no attempt to conceal anything by Mr. Buchan. He presented the facts in both cases.

Mr. Buchan was informed that if the further consideration of the medical evidence led to the conclusion that the attacks were indeed epileptic, the PSV driver's licence would have to be revoked.

As nothing further was heard from Mr. Buchan, the licensing authority's office wrote to him on 4th June 1976, confirming what Mr. Buchan had been told earlier in the year. The letter stated that it was assumed that Mr. Buchan did not wish to pursue his application for a provisional heavy goods vehicle driver's licence. On receiving this letter Mr. Buchan stated that he still considered that the 1963 attacks were not epileptic. His medical case papers were, therefore, referred to the licensing authority's medical adviser, who advised, however, that he was in no doubt that the attacks in question were epileptic.

All the evidence thus confirmed the nature of attacks suffered by Mr. Buchan: the medical certificate accompanying his application for a PSV driver's licence in 1975; the medical certificate accompanying his intended application for a heavy goods vehicle driver's licence in February 1976; and the opinion of the licensing authority's medical adviser, who has seen all the medical papers going back to 1963 immediately after the two attacks in question. There seems little room for doubt, therefore, that the licensing authority was thus correct in not accepting Mr. Buchan's application for a provisional heavy goods vehicle driver's licence. He would have had to refuse it if it had been lodged.

That is the problem. There does not appear to be evidence that would deny that there is a likelihood of these attacks being epileptic. Even Mr. Buchan's own doctor is not prepared to attest that they were not epileptic.

If Mr. Buchan had lodged the application, however, a right of appeal to the sheriff would have been created in the event of the refusal of the application. If Mr. Buchan wishes to pursue the matter further, the right course would be for him actually to lodge an application. If he did so and it were refused by the licensing authority, Mr. Buchan could take the matter on appeal to the sheriff. I have given the circumstances of the case. and it is clear on the medical evidence that this is not something that I would recommend Mr. Buchan to do. I think that he should try to think of another sort of job to pursue, recognising his wish to be a driver. None the less, it seems unfortunate that he has chosen the one profession that has debarred him by the nature of his condition.

I have looked at the matter sympathetically—

The Question having been proposed after Ten o'clock on Thursday evening and the debate having continued for half an hour, Mr. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at eleven minutes past Two o'clock.