Our response to DVLA call for evidence – Driver licensing for people with medical conditions

This consultation has aimed to identify areas where legislative and policy changes can be made to improve the outcomes of drivers and other road users. It is significant that any range of medical conditions, disabilities and treatments that can affect an individual's ability to control a vehicle are legally disclosed to DVLA. This is vital in ensuring that there is no increase in road accidents, cause of injury or death due to an individual's health concern.

Our response

1a) What are your views of the legal obligations or responsibilities placed on:

i. The Secretary of State for Transport and DVLA
ii. Drivers and applicants
iii. Healthcare professionals

The DVLA is presently responsible for legally determining a person’s fitness to drive with regard to vision and other health factors including neurological and cardiological, conducting investigations, and revoking driving licences when necessary. This function protects drivers, road users, pedestrians and the public at large. Drivers are required to notify the DVLA of any medical conditions that may affect their ability to drive safely, including eye conditions. 

As the DVLA is the Government agency that maintains the registration of drivers and licenser of vehicles, we see no persuasive reason for its public safety functions to change. In particular, it would be inappropriate and potentially cause unintended consequences were the DVLA to pass its obligations and responsibilities to any other forum, including healthcare settings.

At present, optometrists’ responsibilities in this field are to offer advice to patients who may need to notify the DVLA, either because they have a notifiable eye condition, or because their vision doesn’t appear to meet the required standard. Part of sight testing is to examine visual acuity necessary for safe driving. If an optometrist finds a patient’s vision is not suitable for driving, the optometrist advises the patient to inform the DVLA of this. By advising the patient in this way the optometrist has discharged their clinical responsibility.

We oppose any passing of existing DVLA and/or patient legal obligations or responsibilities to optometrists. We do not support mandatory reporting to the DVLA or any another intermediary function between the patient and DVLA as new legal obligations or responsibilities for optometrists for the following key reasons:

Clinical trust

There are well established concepts of confidentiality and trust between healthcare providers and patients. Any changes that may violate those concepts in the eyes of patients could undermine the basis of the practitioner patient relationship. This could result in patients being more reluctant to attend for sight tests, resulting in harm to patients and avoidable sight loss.

From our Don’t swerve a sight test campaign, we know it is already the case that two-thirds of people are currently putting off a sight test. This is likely to be particularly the case for the cohort of patients that fear that they will lose their license. Even if these patients did attend sight tests, they may hold back key information. The unintended consequence of additional reporting requirements being placed on optometrists could therefore be more, not fewer, unsuitable drivers on the roads. 

Administrative burden

Optometrists are not currently funded or resourced to provide an additional service to the DVLA. Any additional reporting requirements would therefore either require funding provided by the DVLA or require patients to self-fund.  

We are therefore opposed to any dissemination of present DVLA and patient legal obligations and responsibilities to optometrists. 

1b) Do you think any specific part of the law should be changed and can you provide evidence to support your views?

The UK currently has some of the laxest requirements for vision and driving in Europe. Most countries in Europe require visual checks to be carried out at regular intervals with an eye care professional. The AOP is of the opinion that there should be a change to the law that would require drivers to have a comprehensive vision check to prove their vision meets the legal standard when they first apply for the licence and then every 10 years thereafter, or more frequently after the age of 70.

There are other aspects of the law that could be changed to furnish the DVLA with a greater ability to keep roads safe. In our experience as the membership body that represents the majority of UK optometrists, standards for eye health in driving are not currently sufficiently enforced.

In our 2022 research and campaign programme Don’t swerve a sight test we found alarmingly that as many as one in ten drivers could be driving with vision that does not meet the legal standard. In addition nearly half of the 1033 optometrists surveyed said they had seen a patient in the last month who continued to drive despite being told that their vision was below the legal standard.  

To strengthen existing law, there could be scope for the DVLA to check:

• Mandate a minimum period between sight tests for drivers
• Where visual correction is required to meet the standard for driving, whether this correction is worn
• A vision-testing programme for drivers. We advocate that all drivers in the UK should be legally required to have their vision checked when they apply for or renew their licence - every three years for people over 70, and every 10 years for others – to protect themselves and other road users

Our main objection to mandatory reporting by optometrists, is the unintended consequence that drivers would avoid having their eyes checked for fear of losing their licence. If regular vision checks for drivers were introduced, it would however mitigate our objection to mandatory reporting by optometrists.

2a) If you have experience of medical driver licensing from another country, please tell us about it.

As above, the UK currently has some of the laxest requirements for vision and driving in Europe. Most countries in Europe require visual checks to be carried out at regular intervals with an eye care professional. The AOP is of the opinion that the law should require drivers to have a comprehensive vision check to prove their vision meets the legal standard when they first apply for the licence and then every 10 years thereafter, or more frequently after the age of 70.

2b) What are your views on Great Britain’s (GB) approach to driver licensing?

As per our answer to 2a.

Sight loss can often be gradual and people may not notice changes that affect their ability to drive. This is why regular sight tests are needed to ensure drivers have a suitable level of vision for safe driving.

2c) Do you think GB should consider adopting a different approach? Please explain your reasons and provide any evidence to support your views.

As above.

3a) If you have experience of having to prove medical fitness as a pilot, seafarer or in another situation, please tell us about it.

This is not something that our members have conveyed to us.

N/A.

4a) Are any changes needed to address the growing prevalence of drivers with multiple medical conditions?

Optometrists are well placed to advise patients on vision problems affecting driving suitability. However, they do not have comprehensive knowledge of patients’ full medical histories and still lack the IT access of patient medical records that GPs have. It is therefore important that all health professionals involved in a patient’s care have access to other related information to avoid siloed decision making.

As the DVLA’s chart at 1.19 showing the breakdown of medical conditions that the DVLA was investigating as of 25 January 2023 shows, many factors contribute to road safety challenges. These extend well beyond visual problems: the chart shows that vision was one of the lowest investigated medical condition segments at 10.25%. The largest at 33.12% was neurology, with other areas including cardiology and alcohol and drugs higher than neurology. 

In our view the best placed professional for this role would be a patient’s GP, with optometrists working with the GP as part of a multidisciplinary team (MDT) in the context of integrated care. This MDT could provide care asynchronously and remotely with relevant information from each professional added to an appropriate repository. However, any such service would need to properly scoped in partnership with professional bodies such as the AOP, properly commissioned and end-to-end funded. 

5a) Do you think that the cost associated with medical investigations should be paid by taxpayers and DVLA?

While question is somewhat outside of our scope, our main contention is that irrespective of future Governments deliberations on this point, there can be no question of the underfunded optometrist profession being expected to assume further nonfunded requirements. 

Notwithstanding the above, in our view, given that driving is not a human right, but a personal choice, and bearing in mind that vehicle insurance and maintenance costs are borne by drivers rather than the state, it would be consistent for individual drivers to meet the cost of their medical investigations rather than these costs be absorbed by taxpayers in their entirety.  

5b) Would it be appropriate for the individual customer to pay for medical investigations in relation to their fitness to drive?

Yes, as above.

5c) Do you have any knowledge of alternative arrangements for funding medical driver licensing requirements? If so, please describe.

No.

5d) Do you have any evidence relating to the success of or any problems with these arrangements?

No.

6a) Do you believe that the current medical standards will need to change to take into account advances in in-vehicle technologies? Please give the reason for your answer.

There is an insufficient evidence base on how safe and reliable AI cars can be and any potential impact on road safety.

6b) Is there any evidence you would like to provide on how driver licensing could be future-proofed to accommodate advanced in-vehicle technologies?

As above, there is an insufficient evidence base for concrete assertions. However, in the event that self-driving cars become viable and overcome the inevitable insurance and legislative barriers to adoption, one measure could be tiers of license, taking into account different types of vehicles on the road and the degree of automation. The questions around this are in our opinion for wider consideration with regards to regulation of automation, technology, and AI. 

6c) Do you believe that the use of automated decision-making would be beneficial for drivers medical casework? Please explain your reasoning.

It is our opinion that if automated decision making is used, that decisions and algorithms are open and transparent to avoid, or at least reduce the risk of bias, with a clear route of appeal. To not do so, risks loss of confidence in the system and potentially redirects anger towards the practitioners providing data to the decision-making process. 

6d) Do you think that a person should continue to make the decision on whether to issue or revoke a driving licence? Please explain your reasoning.

Yes, or at least the process during an appeal about a decision should be overseen by a person. Knowing that if escalated there will be human oversight is in our view essential to maintain confidence in the system.