Dear Mrs Brown,

Thank you for your report of 10 September made under the Coroners and Justice Act 2009 and Regulations 28 and 29 of the Coroners (Investigations) Regulations 2013, following the inquest you conducted into the death of Mr Billy Martyn Warwick-Jones.

I was very sorry to learn of the tragic circumstances of this case and would like to express my sincere condolences to the families of those involved.

I have considered your report which highlights your concern that there is insufficient testing and instruction of the older population with regards to road safety, and its recommendations very carefully.

As outlined on Gov.uk, the current driver licensing arrangements are underpinned by a legal requirement that all drivers must inform the Driver and Vehicle Licensing Agency (DVLA) if at any time they develop a medical condition that may affect safe driving. Doctors and other healthcare professionals play an important part in the driver licensing process by advising their patients of the implications of their condition, the effect of any treatment or medication that they are receiving, and whether they need to notify the DVLA.

To support medical professionals, the DVLA has published guidance for medical professionals which can be accessed on Gov.uk. The DVLA also provides a dedicated and confidential telephone line for health professionals to contact one of its doctors for case-specific advice or general guidance. Although there is no legal obligation for doctors to notify the DVLA about a patient who is medically unfit to drive, they can and do make such notifications to the DVLA.

From the Secretary of State

Great Minster House 33 Horseferry Road London SW1P 4DR

Tel: 0300 330 3000 E-Mail:

Web site: www.gov.uk/dft

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The General Medical Council (GMC) also provides guidance for doctors. As well as circumstances where consent may be obtained from patients to notify the DVLA of a medical condition, the guidance also covers circumstances where patients do not consent, or where they are unwilling or unable to notify the DVLA themselves. Doctors must consider the patient’s needs, but also the risk to the public if a medical condition is likely to be a source of danger on the road. Doctors do not have to be aware that their patients are actually driving in circumstances where they consider that they are incapable of understanding the advice provided and should inform the DVLA as soon as possible. The GMC guidance sets this out clearly, and doctors must make a judgement in each case.

Turning to the specific condition in this case, a urinary tract infection is not covered by an individual section in the guidance for medical professionals, but there is a section on temporary medical conditions. This confirms that drivers generally do not need to notify the DVLA of conditions for which clinical advice has indicated less than three months of no driving. For this temporary condition, it should be discussed by the driver and the doctor providing treatment. If the judgement of the clinician is that the DVLA needs to be notified, they should advise the patient to do so.

A driver’s age is, in itself, not an automatic barrier to driving. But the likelihood of having a medical condition that can affect safe driving does increase with age. The current process for drivers renewing their licences at age 70 or over is designed to balance road safety and the needs of the individual. There is little evidence to suggest that introducing a stricter regime which included mandatory testing or medical examinations would improve road safety. Drivers are encouraged to discuss any concerns about their driving fitness with their own medical professionals.

The Royal Society for the Prevention of Accidents, with funding from the Department, has developed an older driver website which can be accessed at: www.olderdrivers.org.uk. The website contains information to help older people to continue to drive for as long as they are safe to do so. It includes general advice, as well as details on driving assessments and refresher training.

I can assure you that I and the DVLA take road safety very seriously, and while our roads are some of the safest in the world, I am not complacent. As such all policies relating to road safety are kept under constant review.

Dear Mrs Brown Regulation 28 Report to Prevent Future Deaths Thank you for your Regulation 28 Report ‘To Prevent Future Deaths’. I am responding as the Medical Director and Director of Education and Standards for the GMC. I am grateful to you for raising the matter with us, and I am sorry to hear of the circumstances of Mr Warwick-Jones’ death. The GMC is the regulator for the medical profession in the UK. As part of our role, we publish guidance for doctors setting out the principles of good practice and the professional standards expected of them in the course of their work. All doctors must be aware of and follow the guidance and we have powers to take action if those standards are not met. Our guidance Confidentiality: patients’ fitness to drive and reporting concerns to the DVLA or DVA sets out our expectations of doctors where patients have conditions that could impact on their ability to drive safely. We outline that the driver is legally responsible for telling the DVLA or DVA about any such condition or treatment. Doctors should therefore alert patients to conditions and treatments that might affect their ability to drive and remind them of their duty to tell the appropriate agency. Doctors may, however, need to make a decision about whether to disclose relevant information without consent to the DVLA or DVA in the public interest if a patient is unfit to drive but continues to do so. If a doctor becomes aware that a patient is continuing to drive when they may not be fit to do so, they should make every reasonable effort to persuade them to stop. If they do not manage to persuade the patient to stop driving, or discover that the patient is continuing to drive against their advice, they should consider whether the patient’s refusal to stop driving leaves others exposed to a risk of death or serious

harm. If they believe that it does, they should contact the DVLA or DVA promptly and disclose and relevant medical information, in confidence, to the medical advisor. We do not specify particular conditions that might affect a patient’s fitness to drive or give guidelines for driving with particular conditions as we do not set clinical standards or provide clinical guidance. This is the role of a wide range of other bodies. However, we outline to doctors that when assessing a patient’s condition and providing treatment, they should refer to the DVLA’s guidance Assessing fitness to drive- a guide for medical professionals, which includes more detailed information about specific disorders and conditions that can impair a patient’s fitness to drive. The Driver and Vehicle Licensing Agency (DVLA) in England, Scotland and Wales and the Driver and Vehicle Agency (DVA) in Northern Ireland are legally responsible for deciding if a person is medically unfit to drive, and we say that if a doctor is unsure whether the patient’s condition would affect their ability to drive safely, they should seek advice from an experienced colleague or the DVLA or DVA’s medical adviser. For the reasons outlined above, we are unable to specify particular conditions in our guidance or include a general duty for increased testing, as each patient would need to be considered by their doctor on a case by case basis before being assessed by the DVLA. We do however recognise the importance of highlighting the increased risks resulting from confusion where patients have, or have previously had UTIs, with the profession. To that end, we have contacted the Royal College of General Practitioners (RCGP) to alert them to these issues, so they can consider how best to raise awareness of this particular case and its implications with their members. I hope the information above is helpful.