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Sleep Apnoea (Road Deaths)

Volume 492: debated on Tuesday 12 May 2009

Motion made, and Question proposed, That this House do now adjourn.—(Mr. Watts.)

On 8 August 2006, 25-year-old Toby Tweddell set off to work along the M62 near Liverpool. On the way, a lorry ploughed into his car, and as a result of the accident Toby died. The lives of his family and friends were devastated: his fiancée Jenny, parents Monica and Nic, his uncle, my constituent Seb Schmoller, and many others. It was a dreadful day, too, for Colin Wrighton, the lorry driver who killed Toby. He had fallen asleep at the wheel of his vehicle, which crashed into a line of cars. Colin Wrighton had seen his doctor just five months earlier complaining of tiredness. Tests to find out whether he was diabetic returned negative, and he was told he was probably suffering from stress. The medical profession’s failure to diagnose sleep apnoea and refer Colin Wrighton to a consultant in sleep medicine meant that he has had to come to terms with the awful result of the accident that he caused.

Toby Tweddell’s family were left asking questions, such as whether it was a freak accident or something more common. They asked questions about why drivers fall asleep at the wheel, about sleep apnoea and about why this relatively common condition is so poorly diagnosed, leaving road users at risk of injury and death. The family discovered that in the four months from October 2007, at least four cases came before UK courts of drivers of large goods vehicles accused of causing death by dangerous driving. The incidents killed nine people. All four LGV drivers were suffering from sleep apnoea, but that was diagnosed only after these terrible accidents. The family’s research has led them to conclude that there is a systemic failure to take sleep apnoea and its consequences seriously.

Sleep apnoea is a sleep disorder in which the upper airway repeatedly closes, causing people to wake up briefly in order to breathe. People with sleep apnoea wake many times an hour; their pattern of sleep is disrupted, leading to tiredness and sleepiness during the day. Research has shown that someone deprived of sleep has the same impairment of reaction time and judgment as someone who is over the drink-drive limit. One study calculated that people with severe sleep apnoea are between six and 15 times more likely to be involved in a road traffic accident.

Sleep apnoea is also highly correlated with being overweight. The lifestyle of lorry drivers means that many are significantly overweight—they lead a sedentary lifestyle, keep unsocial hours and have unhealthy diets. A study of lorry drivers showed that only 11 per cent. had a body mass index of less than 25, that just over 38 per cent. had body mass indexes of between 25 and 30, which is considered to be overweight, and that 50 per cent. had body mass indexes of more than 30, which is considered to be obese.

Britain’s leading sleep experts believe that nearly one in six lorry drivers may have sleep apnoea—that is nearly 80,000 of the nearly 500,000 LGV drivers. Sufferers from sleep apnoea tend to under-report difficulties when driving, perhaps for fear of losing their licence and livelihood. Identification of sleep apnoea is now relatively easy. Sufferers are provided with a continuous positive airway pressure machine, or CPAP. A mask that blows air into the airways is placed over the nose during sleep. Sufferers breathe normally, but the slightly higher pressure of air in the nose helps keep the upper airway open. Almost all drivers suffering from the condition can be back at work very soon after obtaining effective treatment. Successful treatment improves their quality of life as well as that of their families.

Following the inquest into the death of Toby Tweddell, Coroner Sumner took the unusual step of issuing a rule 43 report to the Lord Chancellor’s Department. It called for a toughening of the licensing regime for commercial drivers. Coroner Sumner stated that sleep apnoea is no respecter of age, and criticised the absence of any provision

“for a lorry driver to have to undergo any form of routine medical examination from the time of their qualification to drive until their 45th birthday”.

He went on to note that

“lorry driving involves little physical effort and there is evidence of obesity within the industry”,

and that

“apart from other medical complications arising from obesity, there is evidence to suggest that overweight people are more likely to suffer from sleep apnoea”.

The coroner’s rule 43 report called for the following: regular medical screening for all lorry drivers; amendment of the DVLA medical examination report form to improve identification of undiagnosed sufferers from sleep apnoea; fast-track medical assessment of commercial drivers involved in road traffic collisions; better education of all drivers on the dangers of tiredness when driving, in the same manner as drink-driving campaigns; and better education of commercial drivers to make them aware that a diagnosis of sleep apnoea is almost certainly not the end of their livelihood as a driver.

The Department for Transport responded to the coroner’s request in November 2008, arguing that current arrangements for the control of sleep apnoea are adequate. In his letter to Toby’s father, the coroner said:

“If I were honest, I would say it is a ‘fudge’. It is merely a recitation of the position today. If that were so perfect then you would not have lost your son.”

The response from the Department stated that no change is needed to the DVLA medical examination report form, which doctors complete with applicants for vocational driving licences, or to the frequency with which large goods vehicle drivers should undergo routine medical examination.

In the “information and useful notes” that the DVLA publishes for use with the medical examination report forms, there is no mention of obesity as being positively correlated with the incidence of sleep apnoea. The information currently online states, bizarrely, that

“at least three in every thousand men”

have sleep apnoea, yet among applicants or those renewing vocational licences the incidence is probably nearer to one in 15. All applicants and reapplicants for large goods vehicle and public service vehicle licences must complete a medical examination report with their general practitioner. That form contains the questions

“Does the applicant have sleep apnoea syndrome?”


“Is there any other medical condition causing excessive daytime sleepiness?”

Those questions do not adequately identify sleep apnoea sufferers. The DVLA should look again at how these forms can identify that there may be a possible diagnosis of sleep apnoea. One option would be a requirement that the driver’s body mass index be calculated and for the doctor’s attention be directed to the higher incidence of sleep apnoea among obese people.

While some major businesses in road and passenger transport take sleep apnoea seriously, I am not aware of any example of a company routinely testing its drivers. I have been working with my constituent, Seb Schmoller, and sleep disorder experts to set up a trial with a responsible employer to screen and test their employees. Discussions are at an advanced stage with the Co-operative Group. I am convinced that this process will demonstrate the value of screening.

The Department for Transport needs to tighten the requirements for identifying potential sufferers of sleep apnoea through requiring regular screening of public service vehicle and large goods vehicle drivers as part of the licensing process. Furthermore, it should be a requirement on road haulage and passenger transport operators for them to have screening processes in place. The Department for Work and Pensions, in dialogue with the Health and Safety Commission, has to ensure that the Health and Safety Executive plays a much more prominent role in relation to work-related fatal road traffic accidents and their prevention. It has responsibilities for minimising work-related death and injury, and powers to insist on action by employers to prevent risks to non-employees—that is, road users at risk from drivers suffering from sleep apnoea. In particular, the HSE should consider whether there is a need to introduce legislation, if necessary on a European basis, on compulsory testing of professional drivers for sleep apnoea.

Employers have duties to those other than their employees, as stated in the Health and Safety at Work, etc. Act 1974. Section 3(1) says:

“It shall be the duty of every employer to conduct his undertaking in such a way as to ensure, so far as is reasonably practicable, that persons not in his employment who may be affected thereby are not thereby exposed to risks to their health or safety.”

The Department of Health also needs to ensure that those involved in the diagnosis of sleep apnoea are well briefed about the problem, its symptoms, and its serious implications. Consideration should therefore be given to making it a responsibility of doctors to report their diagnosis to the DVLA, rather than that being solely the responsibility of the driver.

I know the Minister believes that the incidence of road traffic accidents caused by sleep apnoea is low. The Metropolitan police has told me that it believes that more accidents have been caused by sleep problems than have currently been identified. The introduction of post-accident assessment—a system of fast-tracking drivers involved in serious road traffic accidents to assessment of the possibility of their having sleep apnoea—would assist in getting more accurate data.

Before I finish, I pay tribute to all the people who are working hard to address this worrying situation: Toby’s fiancée Jenny, and his family, Nic, Monica and Seb; Professor Jim Horne and Louise Reyner from the sleep research centre at Loughborough University; Dr. John Shneerson, from Papworth hospital; Dr. Dev Banerjee from Birmingham Heartlands hospital; Dr. Stephen Bianchi from the Royal Hallamshire hospital in Sheffield; and Commander Shabir Hussain and Detective Superintendent Glyn Jones from the Metropolitan police.

I am sure that my hon. Friend the Minister recognises the importance of continuing to improve the UK’s good record on road safety. Unfortunately, the response to the coroner reads like a list of reasons why things cannot change, rather than showing willingness to consider necessary change. However, my hon. Friend did say that the Government keep under constant consideration the various practical ways in which they can ensure that road safety is not compromised by people who are not fit to drive.

Today, there are people driving large vehicles who are suffering from undiagnosed sleep apnoea. Will my hon. Friend commit to addressing the issues that I have raised? In particular, will he agree to meet me and key people to discuss the matter? Will he commit his Department to work with the DVLA on improving screening for sleep apnoea of all applicants for large goods vehicle and public service vehicle licences? Will he contact the Health and Safety Executive to improve the understanding of the responsibility of road haulage employers in relation to sleep apnoea? Finally, will he work with the Department of Health to achieve improved briefing of medical practitioners involved in the diagnosis of sleep apnoea?

This is an important discussion tonight, when we are all feeling somewhat sleep-deprived. I hope that my hon. Friend the Minister will be able to respond positively to my suggestions.

I congratulate my hon. Friend the Member for Sheffield, Heeley (Meg Munn), who is a good friend, on securing the debate. I begin on an immediate constructive note by saying that I am happy to meet her and others as she has requested.

This issue is of particular concern to my hon. Friend’s constituents, following the tragic death of Toby Tweddell, which she described, in a crash on the M62 in July 2007 involving a lorry driver who was subsequently found to be suffering from obstructive sleep apnoea. Many hon. Members on both sides of the House have written to me about the matter, and I sympathise very much with the family and their friends for their sad loss.

We at the Department for Transport are very concerned about the contribution of driver tiredness to casualties on our roads. Our research suggests that up to one fifth of crashes on motorways and other main roads may be caused by drivers falling asleep at the wheel. Driver sleepiness could be caused by modern lifestyles preventing people from getting enough rest, and aggravated by shift working, especially when combined with monotonous types of driving. Besides a lack of adequate rest, some medical conditions may cause drowsiness and increase any normal tendency to sleepiness.

The usual medical cause for excessive sleepiness, however, is obstructive sleep apnoea syndrome, which occurs most commonly, but not exclusively, in overweight individuals. It can be associated with diabetes and other medical disorders. Sufferers rarely wake from overnight sleep feeling fully refreshed, and they tend to fall asleep easily when relaxing. They might not understand how chronically sleepy they are.

Drivers with undiagnosed or untreated OSA are a significant risk to themselves and others on the roads. All drivers must, by law, inform the DVLA if they develop a medical condition, including a sleep disorder, which may affect their ability to drive safely. Medical inquiries are then undertaken to establish whether those drivers should retain their licences. If the condition is diagnosed, effective treatment is available, as described by my hon. Friend.

Drivers should be reassured that they will normally be allowed to continue driving, once satisfactory control of the condition is achieved. I emphasise that, generally, satisfactory control can be achieved very quickly. In only a week or two of treatment, most people comment on how much better and more refreshed they feel.

In response to my hon. Friend’s specific question, I assure her that the DVLA is looking at making its guidance notes for doctors more explicit to highlight the importance of sleep apnoea. However, the DVLA must have reasonable grounds for believing that somebody is suffering from a relevant disability. It cannot initiate medical investigations of fitness to drive unless there are reasonable grounds for believing that there is a relevant disability. The DVLA cannot screen for undiagnosed conditions.

Investigation of symptoms, diagnosis and treatment are matters for a doctor. As in the case that we are considering, there are, unfortunately, individuals whose symptoms have not been recognised, and have therefore not been treated. Some drivers also press on when they feel tired and unwell. We aim to manage the problem by improving the range of information to drivers, and especially to the medical profession.

There are circumstances in which doctors can inform the DVLA of any concerns, and they have a professional obligation to report a driver who is still driving against medical advice. The DVLA publication, “At a Glance Guide to the Current Medical Standards of Fitness to Drive”, includes a section on sleep disorders, specifically mentioning sleep apnoea. The Department’s publication, “Fitness to Drive: a guide for health professionals”, also includes a chapter on sleep disorders.

Articles and reminders about the condition have been placed on medical information e-mails for medical professionals. In response to my hon. Friend’s question, the Department also attends the Health and Safety Executive’s road distribution action group’s sub-group on fatigue. We are working with the HSE, unions and employers on the extent of fatigue generally among commercial vehicle drivers, and on how to address it with employers and drivers. That includes writing articles for industry journals.

In addition, the Department is preparing to consult the haulage industry on the UK domestic drivers hours rules. That consultation will include discussion of driver fatigue and possible means to manage it. A leaflet—“Think! Tiredness can kill”—has been distributed to clinics treating sleep disorders. Copies are included in the Smart Tachograph packs issued by the DVLA to lorry drivers, and in operator packs issued by the Vehicle and Operator Services Agency. Banner adverts about the condition have been placed on the DirectGov motoring page and an animated message runs at DVLA local offices that are used by the public.

Our “Think!” campaign has produced a range of materials on driver tiredness, including radio adverts broadcast last year to reach a working driver audience. By September 2014, all group 2 drivers will have to complete 35 hours of training every five years for their certificate of professional competence. Part of the syllabus addresses physical fitness and healthy lifestyle, and includes the effects of fatigue.

To answer my hon. Friend’s final specific question, the DVLA already engages with the medical profession in several ways to heighten awareness of OSA. It has provided an e-mail transmission message that was issued directly to GPs on the subject. It provides an “At a Glance Guide”, which is aimed at medical professionals but is also available to the general public. The DVLA’s animated message in its local offices specifically suggests that individuals mention OSA when seeking medical advice. The DVLA’s senior medical adviser is in close contact with the British Sleep Society about OSA and other sleep disorders and driving.

There is already a system whereby the police can notify the DVLA when they suspect that a medical condition of any kind is relevant to a driving-related incident. Some 3,500 such reports are made annually, covering a range of medical conditions. Those reports are treated as a high priority and are always investigated. Most relate to ordinary and not commercial licence holders. The Department is trying to improve the police notification system further.

In conclusion, I appreciate the Tweddell family’s concern that their son was tragically lost in spite of all the measures that we have in place and the fact that they would want to improve them. I can assure the House that we keep under constant consideration the various practical ways in which we can ensure that road safety is not compromised by people who are not fit to drive. The House knows that reducing the casualty toll on our roads is a priority. Our current strategy has improved road safety significantly, reducing the numbers of deaths and serious injuries by 36 per cent. over the past decade.

But eight deaths a day is still appalling. It is too many and we need to make our roads safer still. “A Safer Way”, the consultation document that was launched last month, proposes a new approach to road safety, ambitious new casualty reduction targets and a number of new measures to assist in achieving those targets. It also proposes a long-term vision to make Britain’s roads the safest in the world once again. I encourage all those who are interested in road safety to read the document and to join in the debate. I also look forward to meeting my hon. Friend and her colleagues in due course.

Question put and agreed to.

House adjourned.