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Drivers and Diabetes

Volume 531: debated on Tuesday 12 July 2011

I rise to raise the matter of type 2 driving licences for public service vehicles and large goods vehicles, particularly disqualification as a result of having insulin-dependent diabetes. I raise the matter primarily because a constituent, Mr Donald Campbell, has brought it to my attention, having had his licence removed in curious circumstances, which I will come to. However, I would like to say at the outset how grateful I am to Diabetes UK and other people who have been in touch to brief me on this debate.

May I say at the outset that I do not for one moment question that it is absolutely correct that, when medical conditions may cause a safety issue, they should be proscribed? A range of conditions are taken into account, and people who suffer from them, whether they hold group 1 or group 2 licences, may be prevented from driving. I do not for a moment question that. Having been a transport spokesman for my party two Parliaments ago, and having been a member of Standing Committees on various legislation, I am well aware of the importance of road safety and of this country’s extremely good track record. We obviously want to keep the number of deaths and injuries to an absolute minimum; we have a good track record compared with many other countries, and nothing should be done to prejudice that.

At the same time, although it is proper that people with some medical conditions should be prevented from driving, others—with proper supervision and consultation, perhaps with annual or periodic check-ups—should properly be permitted to drive. The other question is whether it is right to remove someone’s livelihood in the case of a group 2 licence when the example of other countries and, indeed, medical advice suggest that that is unnecessary.

I will give a rapid history, which I am sure the Minister is as well aware of as I am. The regulations precluding insulin-dependent diabetics from obtaining vocational licences were introduced in 1991, and annex III specifies that for drivers of LGVs and PCVs,

“driving licences shall not be granted or renewed for applicants or drivers who are diabetics needing insulin treatment”.

Since 1 April 1991, insulin-dependent diabetics have been barred by law from applying for such a licence, and indeed from renewal thereafter. A point in parenthesis is that those who held a licence under certain conditions had grandfather rights, and some people may still be driving with those rights. I will come to why that is important.

In August 2009, following reports from three medical working groups, the European Commission adopted an amending directive, 2009/113/EC, on the driving licence rules covering eyesight, epilepsy and diabetes. The change to the rules allows member states to issue group 2 licences to drivers with insulin-dependent diabetes when, in the opinion of a qualified medical practitioner, the condition is properly controlled and they pose no risk to themselves or other road users. That change should have been in force by August 2010, but the UK was unable to meet that deadline, and a consultation paper was eventually put out in February this year. The consultation has now closed, but I understand from a reply from the Minister to a parliamentary question that the Government are now saying that further input from some of those who have responded may be necessary. That is the situation at present.

My constituent, Donald Campbell, has type 2 diabetes. He was diagnosed in 2000, but was not treated with insulin until 2005, when he was advised by doctors to change his medication to slow-release insulin to protect his long-term health. Since then, his health has improved considerably, for which I am grateful, and at his annual check-ups his consultant tells him he is going from strength to strength. Mr Campbell notified the Driver and Vehicle Licensing Authority of his use of insulin in 2005, and his LGV licence was immediately withdrawn. However, two years later, in August 2007, the licence was reinstated. Mr Campbell was obviously extremely pleased about that, and returned to full-time driving with no problems. He renewed his licence in 2008 and 2009, so he had three years of driving. Not until last summer did the DVLA recognise that under the present regulations, it had reissued Mr Campbell’s group 2 licence wrongly. While Mr Campbell was driving, he experienced no problem whatever, and he has been driving alongside those with grandfather rights—hence their importance—and those from other EU countries who have already been given the right to drive on such licences. At the moment, his job is being held for him pending the possibility that the UK will catch up.

This is an opportunity for the Minister to right a long-standing wrong perpetrated by the EU. Had there been no original directive, undoubtedly the traditional elements of British fair play would have come into effect, and the sort of rules we are now contemplating would almost certainly have been those that Her Majesty’s Government adopted. It has come to pass that the EU, having seen the error of its ways, has put in place that which will allow the Minister to correct an obvious wrong—I know how much that will appeal to him. The change is open and available, and has been adopted by other EU countries, so it is peculiar that we are dragging our feet; perhaps the Minister will address the reason for that, and the safety aspect. Why are we content that drivers from all sorts of other countries enjoy that relaxation and are considered safe, but we do not extend that to our own people? Are there are any statistics showing whether insulin-dependent drivers are more likely than others to have an accident?

I congratulate my hon. Friend on securing this debate, which is not the first time in the last 15 years that the House has discussed the matter. I have had a similar debate. I suffer from diabetes, and I know people who can win gold medals, and others whom I would not trust to drive my lawn mower. The reality is that the decision should be based on an individual medical assessment, and I hope my hon. Friend agrees.

I entirely agree with my hon. Friend. The whole point of my case is that the medical profession can, with considerable accuracy, state when people should be taken off the road—I am sure that they apply a precautionary principle—and when they may be allowed to continue to drive. I am particularly concerned about group 2 licences—commercial licences—and my constituent. I received a recent e-mail from him which sums up the situation:

“I am sorry to be such a pain”—

he is no pain at all, I hasten to add, and has been extremely patient—

“but I am so exasperated with the whole issue—every time they take my licence away I am left trying to keep things going financially and this time they have wiped me out…Between the worry of keeping the bank off my shoulders and the boss needing to know when I’m coming back to work, I am drained.”

That shows the personal impact on my constituent. Given that the rules may be about to change and that the Government have put forward proposals that would permit him, subject to medical examination, to get back on the road and back to work, I suspect that he feels a little like a mouse that is being toyed with by a cat. The Government owe their citizens better than that. I throw myself at the feet of the Minister, whom I know is an honest and honourable man, and plead with him to lift that burden from my constituent.

It is a pleasure to serve under your chairmanship for the first time, Mrs Riordan, as either a Back Bencher or as a Minister of the Crown. I hope to provide a little good news for the hon. Member for Caithness, Sutherland and Easter Ross (John Thurso)—it is easier to say Hemel Hempstead, but I mean no slight on the hon. Gentleman’s constituency and congratulate him on securing this debate. I have been a Minister a little longer than some others who have held the post over the years—the average life expectancy of a Minister in my job is eight months, so a year and a bit is an exception. I have taken a particular interest in the case of Mr Campbell and, as I am sure the hon. Gentleman realises, in the involvement of the European Union in this great country of ours.

I will summarise the details of the case mentioned by the hon. Gentleman and endeavour to address some of the issues, particularly those relating to Mr Campbell. At the moment, the law is specific, which was not done on my watch—although it is my Department and the buck stops with me. When the Driver and Vehicle Licensing Agency gave the licence back to Mr Campbell, it messed up. I know that it wrote to him, and I have a copy of the letter, which could have been worded better and showed more empathy and understanding about the effect that the decision on his licence would have on Mr Campbell, his family and the company for which he worked. I apologise for that, and if Mr Campbell were present today, I would apologise to him personally. We need to address problems as we go forward. I cannot right the wrongs of the past, but we can try and ensure that they do not happen again. We must look at how best to address such situations, and avoid the foot-dragging to which the hon. Gentleman—probably quite rightly—has alluded.

The law in question concerns epileptic fits, diabetes and visual impairment. The consultation by the DVLA has been well taken up and a lot of work has been done. However, the situation is complicated, because the law includes those three areas. The areas of visual impairment and of fits are more complicated than that of diabetes, but all three issues have been rolled into one. The hon. Gentleman is right: ideally, we would have produced proposals to address all three areas by now, but, if I am honest, we will be unable to do that by the October deadline. As I have said to my officials, we will produce proposals on diabetes, which will be based on clinical advice. I will be subject to criticism from those involved in the other areas on which we are not yet ready to introduce proposals. My view, however, is that if we are ready to introduce proposals in one of those areas—by October, we should have a proposal on diabetes—we should go ahead and remove the blight that affects not only the hon. Gentleman’s constituent but many other people around the country.

It is imperative that we do that that without affecting road safety and, as the hon. Gentleman said in his opening remarks, that is the principle from which we start. The UK has a good record on road safety—indeed, we have the safest roads in the world. A new report on the number of people killed or seriously injured on the roads last year indicates that we are now doing even better. Over the years, we have struggled in some areas of road safety to get the right results, particularly concerning serious injuries for motorcyclists, but—as a biker, I declare an interest—we did particularly well in that area last year.

Of course, there are too many deaths, and we need to look at the core of the issue, which we are doing in the road safety strategy. It is, however, absolutely imperative that we do not use a sledgehammer to crack a nut. Medically, the treatment of type 2 diabetes has moved on in leaps and bounds to say the least. I was a shadow Health Minister for three and a half years and I took a particular interest in the public health side of things. Soon, we will be moving away from injections altogether, because there will be aspirators, and we can make it much easier for diabetic patients to get on with their lives and address their insulin issues.

The issue of hypos is important, as are other matters such as visual impairment. My point of view as a non-medically trained Minister is that a clinician must decide whether someone in the groups that we are talking about—particularly group 2—is fit to drive. Hopefully we will bring forward proposals on diabetes in October. We are further behind in the other two areas and, as the hon. Gentleman said in his remarks, we need more consultation on those issues, in particular on the control of epileptic fits.

There is some concern from the road safety lobby that we will be reliant on people addressing their need for insulin treatment themselves. Two members of my family are reliant on insulin—one is a type 1 diabetic; the other is a type 2 diabetic. They sometimes get it wrong, and everybody understands that. We must have full confidence that if diabetes is controlled by insulin, the condition is stable and the clinicians are happy with the situation. If that is the case, we should be able to agree in October that after medical assessment and agreement—which will be continually assessed as things progress—we will allow insulin-reliant diabetics in the classes mentioned by the hon. Gentleman, and particularly those in group 2, to drive. I said that there is some good news.

That will not, however, address the problems experienced by Mr Campbell. Under the present rules, the DVLA was right to take his licence away and fundamentally wrong to give it back and not to pick up the mistake sooner. Everybody makes mistakes, but it is crucial to ensure that such things happen as little as possible, because they have such dramatic effects on people’s lives.

The hon. Gentleman asked whether statistics are available to show whether diabetics who are reliant on insulin are more likely to be involved in an accident. As I understand it, we do not have such statistics and when the European Commission looked into the matter, it used the fact that there was no evidence available to change its mind. As hon. Members will realise, I am ever so slightly Eurosceptic, so it is great news that UK plc is again allowed to be in control of procedures and safety on our roads. Our borders are open to anybody from the European economic area or the EU who wishes to drive in this country, which is right and proper.

I fully accept that other countries have moved faster than us, but they do not have roads that are as safe as ours. Many of their Ministers and officials come to see me to see how we manage to have such safe roads. If they were slightly more vigilant in how they enforce road safety, the position might be different. In the area that we are debating today, they may have got things right a little more quickly than us. I fully accept that there is an anomaly between on the one hand drivers with grandfather rights and overseas drivers and on the other hand UK citizens who are being penalised. I think that we will be able to wipe that away very soon—in October, I hope.

I am extremely grateful for the reply that the Minister is making, in terms of both the tone—I am sure that my constituent will have noted his remarks and be grateful for them—and the good news in respect of diabetes. The Minister has mentioned October. Will that be when the Government promulgate the change to the regulations? Am I therefore accurate in saying to my constituent that he might look forward to being able to take the medical exam in October, permitting him to go back to work shortly thereafter?

I think that Mr Campbell should be at the front of the queue in October—I think that that is the least we can do for him. I hope that he sees that the Minister understands what went wrong and is trying to address the matter as soon as possible. Yes, we will move the relevant orders in October, when the House returns from recess. The process will start in October in relation to the particular area of diabetes, and more work is required in the other areas. I hope that people understand that I need more time on the other two medical conditions.

I want the Minister to be under no misunderstanding about this. It is critical that whatever change is brought in enables people with diabetes to be confident about declaring to the licensing authority that they have the condition, because we do not know how many people there are with the condition who, fearing the loss of their licence, do not declare it.

The hon. Gentleman has touched on an important point, which is one of the reasons why I have moved as quickly as I can on this issue. I want members of the public, after they have been diagnosed with diabetes and start treatment, to be confident about coming forward and saying that they have been diagnosed with type 2 diabetes—or whatever the condition is—and about being assessed fairly, so that either they can carry on driving in whatever categories they are designated as being able to drive in or they understand why, at that moment, their licence needs to be revoked and withheld from them. That will happen in some cases.

I can refer to my own experience with my father-in-law; I am sure that he will not mind my doing this. He was a complete scallywag about admitting that he was a type 2 diabetic in the first place, despite what all the doctors were telling him. He said that he could address the situation through his food intake or with tablets. Eventually, we convinced him that he had to go to insulin injections. In fact, it was not me; it was his daughters who eventually convinced him. They said, “You’re going to kill yourself if you’re not careful.” At the time, his medication had not been got right to the point where he could be allowed to drive. His diabetes was not controlled, so he had regular hypos.

People need to be able to have confidence that once their condition is addressed—if it can be—the independent medical practitioner assessing them will either allow them to drive or indicate to them what levels they need to be at to get their licence back. At the moment, there is a grey area. People think, “What do I need to do? Where do I need to be? Will I ever get my licence back?” The issue of fairness is fundamental. I think that that is what the hon. Member for Caithness, Sutherland and Easter Ross, who secured the debate, was saying. I will use an old-fashioned term—natural justice. I use it as much as I can as a Minister. There is an ex-Minister in the Chamber now for the next debate. I hope that all Ministers, when they look at the effect that they are having on a constituent anywhere in the country, look at whether justice is being seen to be done.

Licences are often taken away for the right reasons. I understand why they are taken away, but I do not think that we explain particularly well either the rationale for that or the likelihood of the situation changing. As I have said, the Government will produce new proposals in October. We want there to be an open, clean discussion in which things are explained. We want people to be told, “This is where we need you to be to get your licence back. You can’t have your licence back at the moment because you haven’t reached that point.” However, there is a link between visual impairment and diabetes, so in some circumstances people would be unlikely to get their licence back. My father-in-law is now registered blind, because of his diabetes. It was not treated early enough; he admits that that was his fault and nobody else’s. As a result, he will never get his licence back. We need to be honest with people, which is where natural justice and fairness come in.

I hope that I have been open and honest. We are proceeding as fast as we can. The representative groups for the other two medical conditions will criticise us for not moving as fast on those conditions as I have just announced that we are on diabetes. That is simply because I do not yet have the evidence base behind me to be confident enough from a road safety point of view—I am thinking of the driver as well as their loved ones and other road users—to move forward. As soon as I can move on the other categories as part of the review and the consultation, I will do so, but I hope that in October Mr Campbell will have some control over his future income and his life.