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Fitness to drive

The Driver and Vehicle Licensing Agency and the College

Following a few high profile cases involving driving by people with both physical and mental disorders, the Driver and Vehicle Licensing Agency (DVLA) was asked by the Government of the time to review the procedures and standards to define fitness to drive. The new set of standards, as a result, was published in 1995 as the first issue of At a Glance (DVLA, 1995) and was sent to all practising doctors in the UK. Not surprisingly, the first issue covered controversial issues such as blanket withdrawal of the driving licence if someone had an episode of psychosis requiring in-patient hospital treatment. Justified or not, such restriction was in direct conflict with changes of policy, such as the emphasis on community care and closure of mental hospitals, thus placing more and more people with mental disorders in the community with an increased emphasis on social normalisation. Alongside this came changes to the benefit system that often influenced an individual's ability to afford to travel by public transport for social or clinical reasons. Such changes to the circumstances were occurring at a time of deregulation of buses, leading to a reduction of the level of service for remote and small communities.

The Public Policy Committee (PPC), from time to time, received notification of difficulties in patient care from College members as a result. It was clear that psychiatrists were representing individual cases directly to the DVLA, sometimes with satisfaction and sometimes not. Besides the perceived difficulties in clinical care some clinicians were concerned about a lack of clarity on whose responsibility it is to notify the DVLA regarding change to the physical and mental health of their patients.

With this background, the PPC agreed to explore the possibility of establishing a dialogue with the medical advisory department of the DVLA. The Honorary Secretary of the PPC visited the DVLA to attend the Secretary of State's advisory panel meeting and presented the College's concerns. During that visit it became very clear that:

1. there was limited room for manoeuvre because the regulations that govern driving are approved by Parliament
   
2. the DVLA's role is promulgation of these standards
   
3. since the original publication, the standards have been refined and continue to be refined in the light of the experience
   
4. such refinement was taking place through final approval by the Secretary of State upon receiving recommendations from the Advisory Panel.
   

The advisory panel on mental health matters was initially set up as a subgroup of the panel that dealt with drugs and alcohol related issues and held separate meetings. The psychiatric panel now stands alone. Currently, there exist six such advisory panels, which deal with the following areas:

1. cardiology
   
2. neurology
   
3. diabetes
   
4. vision
   
5. alcohol/substance misuse
   
6. psychiatry.
   

The psychiatric panel meets twice a year, including once in the autumn when the date for the next meeting is set.

The following documents outline the College's policy on driving related matters:

1. Psychiatric standards of fitness to drive large goods vehicles (LGVs) and passenger carrying vehicles (PCVs) were published in the Psychiatric Bulletin in October 1993 (Royal College of Psychiatrists).
   
2. PPC guidance on medical aspects of fitness to drive (Royal College of Psychiatrists, 1996).
   

Following receipt of a report on the above meeting with the DVLA, the PPC established a working group, the membership being as follows: Dr John Baird, Dr Ranjit Baruah (Chair), Dr David Thompson, Dr Daphne Wallace and Dr Mary Whalley.

Dr Jane Durston, senior medical adviser at the DVLA, attended the working group meeting on 7 September 2000. The following were agreed:

1. The current issue of the At a Glance document, which is issued to every doctor, specifies the current standards of fitness to drive.
   
2. Doctors should follow General Medical Council guidelines to notify the DVLA of a lack of fitness to drive of their patients.
   
3. Any concerns, current or future, that the College may have on driving related matters should be referred to the above DVLA working group for initial consideration who will then, if necessary, refer to the senior medical adviser for possible submission to the appropriate advisory panel.
   
4. The DVLA would appreciate any help that the College could offer that results in wider promotion of the At a Glance document and accepted the working group's suggestion for consideration that the proposed publicity drive to increase awareness of driving related standards should also be aimed at the general population as well as clinicians. It is the individual driver's responsibility to notify the DVLA of any changes to his/her physical and mental health that affects driving ability.
   

In the light of the above:

1. The College is in the process of submitting its policy documents to the Psychiatric Advisory Panel to ensure that these meet the statutory requirements. If amendments are called for these will be considered by the PPC. The outcome will be released through the Psychiatric Bulletin.
   
2. Any matter of concern relating to driving by psychiatric patients should be at first referred to the DVLA working group for consideration and further liaison with the medical department of the DVLA for advice and action, which may involve making recommendations to the Secretary of State. Such reports should be addressed to Christopher Walden, Parliamentary and Policy Officer at the College, for referral to the Chair of the DVLA working group. This arrangement does not prejudice individual members' ability to represent individual cases of concern.
   
3. The current basis of membership of the working group representing relevant faculties will continue and it is agreed that the Honorary Secretary to the PPC should act as the College link person with the DVLA.
   
4. The College could assist the DVLA in its promotion of the At a Glance document through the divisional structure, if presentation on the subject at divisional meetings is requested by the DVLA.
   

It is hoped that through these arrangements difficulties in patient care in the community will be minimised.

References

DVLA (1995) At a Glance. Swansea: HMSO.

ROYAL COLLEGE OF PSYCHIATRISTS (1993) Psychiatric standards of fitness to drive large goods vehicles (LGVs) and passenger carrying vehicles (PCVs). Psychiatric Bulletin, 17, 631 -632.[Free Full Text]

ROYAL COLLEGE OF PSYCHIATRISTS (1996) Public Policy Committee guidance on medical aspects of fitness to drive. Psychiatric Bulletin, 20, 631.[Free Full Text]

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