Thank you for giving me the opportunity to respond to your Editorial in
the April edition of Call Sign in which you discussed the subject of
diabetic drivers.
Firstly, I should perhaps correct the emphasis of your statement that the
PCO is "supposed to be looking after the interests of the licensed
taxi trade". Whilst it is true that the Licensing Authority has an
interest in London's taxi trade and seeks to maintain it's reputation as
regards quality and safety, you will recognise that his primary
responsibility is the protection of the public. The regulations and
policies presently in place are aimed at achieving this and, as a result,
I believe we can rightly claim that London's taxis and taxi drivers
provide a safe, immediately available, door-to-door service which is
second to none.
Part of the responsibility for maintaining safety is to ensure that those
who are licensed as taxi drivers are medically fit for the rigours of the
job. As neither the Licensing Authority nor officers of the PCO are
medically qualified, professional advice is taken as to the appropriate
guidelines to apply. The Medical Commission on Accident Prevention advises
that taxi drivers should be required to meet the standards applied to
vocational drivers, ie holders of DVLA Group 2 licences, as set out in
their publication 'Medical Aspects of Fitness to Drive' and these
guidelines have been applied since 1975.
I believe it is worth stating that the Commission comprises members of the
Secretary of State's Honorary Medical Advisory Panels on Driving, DVLA
Medical Advisers and other notable clinicians from the Commission's
Transport Committee. These are all experts in their respective fields of
medicine. Furthermore, the Commission's advice was supported (for taxi and
private hire drivers) by the Government in it's White Paper of 1995
responding to the recommendations of the House of Commons Transport
Committee on Taxi and Private Hire Vehicles.
Time Spent Driving
There can, I think, be no argument that professional drivers spend substantially longer at the wheel than do private motorists and as a consequence, the risk of sudden illness occurring while
driving is
greater. Unlike taxi drivers, those LGV and PSV drivers to whom Group 2
guidelines apply by law are subject to further controls governing their
working hours. With no such constraint, and in view of the busy urban
environment within which London taxi drivers work, the Licensing Authority
sees it as prudent to adopt Group 2 medical requirements.
On the specific subject of insulin dependent diabetes, the position of the
Licensing Authority has not changed. Since he began applying the Medical
Commission's guidelines in 1975, they have consistently stated that
insulin dependent diabetics should not be issued with a Group 2 licence.
This became law for Group 2 licence holders in 1991 (but remains advisory
in respect of taxi drivers) except where 'grandfather rights' apply, ie to
those who were insulin dependent and whose condition was known to the
licensing body prior to that date and subject to satisfactory annual
consultant's certification. The guidelines state that diabetes treated
with diet alone, or with diet and certain medication, carries no
hypoglycaemia risk and therefore, no significant driving risk.
Unfortunately, this is not the case with diabetes treated with insulin
which does present a risk of sudden incapacity which is seen as
unacceptable for drivers carrying fare-paying passengers. This is not an
arbitrary decision by the PCO, it is based on sound professional medical
advice.
Details of how the guidelines are applied in respect of the various
categories of diabetic are contained in PCO Notice 17/98 which you
published in January, so I will not repeat them now. However, it is
important to stress that the Licensing Authority is not bound by the
legislation and each case is considered on its individual merits. The
process is as follows:
If Refusal, Suspension or Revocation is indicated...?
When drivers advise the PCO (as they are required to do) of a change in their medical condition, their situation is measured against the guidelines contained in the booklet referred to above. If it appears that refusal, suspension or revocation is indicated, this is the course of action recommended to the Licensing Authority. If any aspect is unclear, further information may be sought from the driver's doctor/consultant before the recommendation is made. If the information available indicates that drivers do not meet the Group 2 standard, they are asked to surrender their badge and licences
while their case is considered in order to
protect them and the public. If the Licensing Authority agrees with the
recommendation to refuse, suspend or revoke the licence, the driver
concerned may ask for that decision to be reconsidered or he/she may
appeal to Horseferry Road Magistrates' Court. Individuals are free to
present specialist reports or other material which may indicate any
exceptional clinical reasons why the guidelines should not apply in their
particular case.
Responding to specific points in your editorial:
* The PCO takes note of EU Directives insofar as they are incorporated
into the Medical Commission's guidelines which we apply.
* You refer to an insulin dependent driver who you say would have been
permitted to drive had he been prescribed insulin "before the
beginning of 1998." 1 am not aware of 1998 having any significance:
'Grandfather rights' apply only to those being treated with insulin prior
to 1 April 1991.
* I confirm that a misleading letter was sent to some drivers and I
apologise to those affected. It was to correct this error that PCO Notice
17/98 was issued.
It is appreciated that the loss of a licence can have a profound effect on a driver and his/her family. This is particularly so in medical cases when a driver can lose his livelihood through no fault of his own. Unfortunately, the Licensing Authority has this responsibility to safeguard the public which in some cases can be fulfilled only by revoking a licence. Before doing so, however, great care is taken to ensure that this is the appropriate course of action.
