Considered in Grand Committee
My Lords, this is a short but important order that amends Section 94 of the Road Traffic Act 1988. It will allow a wider group of healthcare professionals to provide the important medical information that the Driver and Vehicle Licensing Agency needs to assess whether someone can meet the appropriate health standards for driving. This will reduce a burden that currently rests only with doctors.
This change will directly support the Department of Health and Social Care’s agenda to reduce bureaucracy in general practice. The Government recognise that we should be using the skills and expertise of other healthcare professionals, where appropriate. This in turn frees up time for doctors to focus on patient care.
The measure meets the tests set out in the Legislative and Regulatory Reform Act 2006 and has been approved by the Delegated Powers and Regulatory Reform Committee of your Lordships’ House, and the Business, Energy and Industrial Strategy Committee in the other place, as being appropriate for a legislative reform order with the affirmative procedure.
I will give a bit of background. The DVLA is responsible for deciding whether a driving licence holder or applicant meets the appropriate health standards for driving in Great Britain. The DVLA does this by assessing information about the individual’s health against medical criteria. This order does not change the DVLA’s responsibility for making driver licensing decisions.
All drivers and licence applicants have a legal obligation to notify the DVLA of a medical condition that may affect safe driving. In some cases, the DVLA can make a decision with the information provided by the driver. However, in many cases, additional information is required. By far the largest source of medical information is gathered from questionnaires that are completed by doctors from information held on the driver’s medical records. This service is provided outside NHS contracts; it is private work for which the DVLA pays doctors a standard fee.
Currently, the Road Traffic Act requires a driver to authorise a doctor who has previously given medical advice to them to provide information to the DVLA. In practical terms, this means that the DVLA can accept medical questionnaires only from a doctor. This is an unnecessary burden in this day and age, because not only doctors but many other qualified healthcare professionals are able to provide this information. Between 2016 and 2021, an average of 267,080 questionnaires were completed each year by doctors. It is estimated that each questionnaire takes 20 minutes, so I am sure noble Lords can appreciate that a substantial amount of time is taken up by those tasks.
I turn to the content of the order before your Lordships today. The current law was made in 1988 and does not really reflect current clinical practices. Often healthcare professionals other than a doctor may be primarily responsible for managing certain medical conditions. The term “registered healthcare professional” is used to describe a range of clinicians, including doctors and nurses. Changing the wording of the legislation from “registered medical practitioner” to “registered healthcare professional” will ensure that information can be provided directly by the most appropriate person.
The DVLA will take a phased approach and will initially ask for details of the driver’s doctor. The DVLA will write to the driver’s doctor, who will be able to pass the questionnaire to another healthcare professional for completion if they wish to do so. However, this change means that longer term, when a driver knows that their care is provided mainly by another healthcare professional, the driver will be able to authorise that healthcare professional to provide the information required by the DVLA. This will allow questionnaires to be sent directly to other healthcare professionals and will remove the need to include a doctor in the administration of the questionnaire. Before the DVLA begins to send questionnaires directly to other healthcare professionals, the department will write to the BEIS Committee with a review of the new process. This will provide reassurance to the committee that there are sufficient safeguards in place.
We have heard some concerns that healthcare professionals other than doctors may not have the knowledge to complete the DVLA’s medical questionnaires, but we are content that that is not the case. The DVLA recognises that a person’s medical history can be complex, but in many cases healthcare professionals other than doctors will be more than capable of providing the information needed. It is important to recognise that in this day and age many healthcare professionals are specialist practitioners—for example, diabetes nurse practitioners. Although some may feel that the GP’s overview of health is important, it should be noted that the DVLA’s questionnaire is about a specific medical condition and not about the person’s general health. It is about one condition and whether that may affect their driving. If that person has several conditions, there will be several questionnaires that will investigate whether that person is able to continue driving. The request is for the information, and then the DVLA makes that decision.
The order also removes the necessity for the person authorised to have personally given medical advice to the driver. This will address situations where the named doctor no longer has access to the information required, because the advice and attention was from many years ago, or the doctor has retired or moved to a different practice. We will amend the law to remove that requirement.
The DVLA consulted on this proposal. There were 411 responses to the consultation from the public, medical and healthcare professionals, and road safety groups. Almost 82% of those 411 people or groups who responded agreed with the proposal.
The aim of this measure is to update an outdated piece of legislation that does not reflect the way modern healthcare works today. We also see that it relieves a burden on doctors, which is why we have been able to use the legislative reform order route. Those doctors will be able to spend more time on patient care.
As I have noted, the measure will allow the most appropriate healthcare professional to provide the information, but I reiterate that it remains up to the DVLA and its doctors and medical experts, who will review that information, to make a decision about a driving licence application. I beg to move.
I thank the Minister for her very clear explanation. This seems a sensible streamlining of the legislation in accordance with the modernisation of clinical practice. It is welcome, because there are stories of drivers having to wait for excessively long periods for GPs to give their signature and hence their permission. That delay is undoubtedly largely because of the grave and worsening shortage of GPs in Britain. It is therefore really important that we use them in the most effective way.
I was pleased to see that the widespread response to the public consultation was overwhelmingly positive, and that the Secondary Legislation Scrutiny Committee agreed that the appropriate processes had been followed. However, I have two short questions for the Minister. First, what checks are there to ensure there are no abuses of this system? What will be done to review it? Whenever you introduce a new system, you need to look at it in the light of experience in case there is a weakness. Some respondents were concerned not just about abuse of the system but about the level of qualification of some of those healthcare professionals. That might be totally unjustified, but it is important that the review takes place.
Secondly, the DLVA is UK-wide, but healthcare is devolved. There are different approaches to the use of certain healthcare professionals across the nations of Britain. There are some areas where GPs are relied on more than in others, and the breadth of healthcare professionals used is greater in some nations. What consultation was there with the devolved Administrations about this to ensure that the legislation matches their approach to the use of a broader spectrum of healthcare professionals in the system?
My Lords, we will not oppose this instrument, which will allow a wide range of medical professionals to provide fitness to drive information to the DVLA. However, I hope the Minister can clarify five small points.
First, can the Minister explain why, according to the de minimis assessment, the net cost to business per year is £600,000? Secondly, has the department engaged with health workers’ representatives on this issue? Thirdly, the Explanatory Document notes that concerns have been raised that those other medical professionals might lack the required skills and knowledge. What monitoring will take place to ensure that this is not the case? Fourthly, the Explanatory Document refers to “professional indemnity”, which I could not fully understand. Could the Minister outline what the position will be when the instrument is approved?
Finally, the explanatory document, which is a significant step forward from what we have seen recently, tells me to contact one of the department’s civil servants, but sadly does not provide a telephone number. I know the Minister may find this trivial, but in the past— I have been doing these wretched EDs for decades—I have found that when you have a small point, it is most useful to pick up the phone to someone who is familiar with the document, and probably there will not even be five questions as a result.
I am grateful to both the noble Baroness, Lady Randerson, and the noble Lord, Lord Tunnicliffe, for their brief consideration of today’s order. Again, I apologise to the noble Lord, Lord Tunnicliffe, about the lack of a telephone number. My officials behind me have heard that, and I reassure him, and any noble Lord, that if ever they have any question about any legislation that I am doing, my door is always open and I will find an official who can answer their questions, big or small. However, obviously, it is not ideal not to have a telephone number in there, and we will do it in future.
The noble Baroness, Lady Randerson, talked about speed. Part of what we are trying to do here is to increase the amount of capacity within the healthcare system to allow the reports to come back more quickly. That will allow for quicker decisions for people who are waiting and hoping to get their driving licence back. Also, when a decision is made that, unfortunately, a driving licence needs to be revoked, that will also be done more quickly—so there is a road safety benefit element as well.
The noble Baroness picked up on the fact that this will be a phased introduction. In the first phase, things will still always go through the doctor before they go to any other healthcare professional. We will then ensure that we are not seeing any abuses and that the system is working well, and we will of course speak to doctors’ representatives—the British Medical Association and the Royal College of General Practitioners, the RCGP—to see how they feel it is going. We are not in a huge rush to move through the first phase, because the doctor is probably able to deal quite quickly with the decision, “Should I pass it on or do it myself?” So we will still be saving time, but I agree that we must make sure that this is working and that there are no gaps whatever in the system. When we are content that that is the case, we will write to the BEIS Committee, and I will be happy to share that with noble Lords so that they see the results of the review and the rationale behind us moving to a further phase—if indeed that is what we decide to do at that point.
The noble Baroness also mentioned that this statutory instrument is UK-wide—it is actually GB-wide, because Northern Ireland has a different licensing system—and that healthcare is devolved. I absolutely agree, and to a certain extent, this order links to however healthcare is organised in the devolved Administrations, because they can decide for themselves how they get the information back to the DVLA. Of course, we consulted with the devolved Administrations before we finalised the policy and there was broad support from them for the aim of removing a burden on the doctors by amending this law. We informed the devolved Administrations about the full public consultation, and we received supportive responses from officials, so I do not see any concern at this time that the devolved Administrations will find this difficult in any way.
There was a de minimis impact assessment, because it has very little impact on business per se. The businesses that it impacts are GPs’ surgeries, but they can choose whether they decide to put this into place. We think that a little familiarisation will need to be undertaken within GPs’ surgeries, but then it is up to them as to how they organise their business internally. The fees remain the same, so they will judge—certainly it remains a de minimis impact.
On engagement and consultation, we had some quite significant conversations with the British Medical Association and the Royal College of General Practitioners to put their minds at rest that in no way were we trying to force doctors to do anything at all. This is an optional proposal for them. They fully understood that we would never turn round and say, “No; we don’t want information from doctors any more”. We absolutely do—we want information from the right person, and that is absolutely behind what we are seeing here. DVLA officials have met with representatives from the BMA and the RCGP, and we will continue to have discussions with them as this rolls out.
Some people have raised a lack of skills and training. As I said in my opening remarks, we are content that the sorts of people who will be doing this are very skilled—in many circumstances we trust them with our lives, or at the very least with our health. There will be a definition of “healthcare professional”; so not just anybody who happens to work in a GP’s office will be able to do this. Anybody who does it will have to be, for example, a member of the General Optical Council, the General Osteopathic Council, or the Health and Care Professions Council; so they have to have professional membership. The other thing that the DVLA is very willing to do with regard to improving their skills and knowledge of this is to help develop the training. Often the training is provided by these professional organisations; the DVLA already works with some professional organisations to develop training, and although I do not believe that it would be particularly substantial, the DVLA stands ready to support them as they develop that.
I believe that I have answered all the questions, and if not, I will very happily write. No, I have not—I have just found the professional indemnity question from the noble Lord, Lord Tunnicliffe. This is a matter for the individual professional to discuss with the organisation that they work for, such as the GP practice or the NHS trust or board—or they may wish to seek advice from their professional organisation, for example the Nursing and Midwifery Council, for guidance on matters of indemnity cover. There is probably no one size fits all, therefore there will be lots of different ways to cover the professional indemnity. However, I point out, as I did in my opening remarks, that the DVLA remains responsible for the actual decision; the person is purely providing the information and the DVLA has its own panels of doctors and medical experts who then decide whether a licence should be revoked.