Henry Prow
PFD Report
Partially Responded
Ref: 2017-0227
Coroner's Concerns (AI summary)
Limited DVLA mechanisms exist for medically reviewing drivers with deteriorating health, and GPs face conflicts of interest in reporting, potentially leading to drivers withholding information. Vehicle modification relevance also goes unchecked.
View full coroner's concerns
_ At the inquest concerns were raised by the police and a friend as to the criteria required by the DVLA and Department of Transport for the issuing and surrendering of driving licences and the terms and conditions for ensuring appropriate modification of driver's vehicles. Mr Prow had been fit and active man and worked as a training instructor in the Army for 3 years_ As a result of his deteriorating poor health he lost his mobility and he was keen not to lose his driving license which would reduce his independence At inquest it was considered that the collision was possibly preceded by Mr Prow having a medical issuelevent. The DVLA appears to have limited mechanisms for drivers to be formally medically reviewed for the purpose of being medically fit to drive. In particular in cases where drivers have deteriorating health or fluctuating health (of which may not have insight) as in the case of Mr Prow. It is understood that at present the treating GPIdoctors or the driver themselves have duty to advise the DVLA of medical issues which can affect a person's ability to drive_ A driver's voluntary surrender of a driving licence (especially in a rural area with little public transport) may have a serious detrimental effect on their health and sociallemployment situation making it unrealistic expectation on the driver in many cases. There was concern, that the driver's GPldoctors could have a conflict of interests in such situations as they would have a duty to inform the DVLA of medical issues which could result in the surrender of the driving licence which could/would result in deterioration of the patientldoctor relationship e.g. such as patients withholding significant medical information with their doctors for fear of losing their licence_ There were also concerns that there appeared to be no mechanism for ensuring the required modification to the vehicles were still relevant to the vehicle that they were driving at the time (he had changed cars since requirement made and his health had deteriorated) and were appropriately in place and used
Responses
Action Planned
The Department for Transport notes the DVLA is reviewing how restrictions imposed on driving licences are communicated to drivers. They also highlight existing processes for medical assessments of drivers, including the legal requirement for drivers to report medical conditions and revised GMC guidance to doctors on reporting concerns. (AI summary)
The Department for Transport notes the DVLA is reviewing how restrictions imposed on driving licences are communicated to drivers. They also highlight existing processes for medical assessments of drivers, including the legal requirement for drivers to report medical conditions and revised GMC guidance to doctors on reporting concerns. (AI summary)
View full response
TfcfiMn 2018 From the Parliamentary under Secretary of State Jesse Norman MP Department Great Minster House for Transport 33 Horseferry Road London SWIP 4DR Tel: 0300 330 3000 Dr Emma E Carlyon Email: jesse norman@dft gsi.gov.uk Senior Coroner for County of Cornwall Web site: WWW:gov.ukldft The New Lodge Newquay Road Our Ref: Inv/206274 Your Ref: EECILJB Penmount Truro 15 JAN 2018 TR4 9AA 6 Thank you for your letter and report of 7 September following the inquest you conducted into the death of Mr Henry Prow: was sorry to read of the circumstances of Mr Prow's death and | can assure you that have considered your report and its recommendations very carefully: Your report suggests that the process for issuing and surrendering driving licences on health grounds and the criteria used for assessing fitness to drive for those with health conditions should be reviewed. The current driver licensing process is underpinned by a legal requirement that all drivers must inform the DVLA at any time of a medical condition that affects safe driving: The required health standards for driving are based on the views of medical experts from across Europe and are provided for in law: The detail of these standards is informed by the opinion of eminent experts on a number of honorary medical advisory panels which consider health and driving: AIl drivers must meet the appropriate health standards for driving and the DVLA will investigate those who notify a medical condition: Such investigations usually involve obtaining information from the driver and possibly their doctor or specialist. The DVLA will only issue a licence to those who meet the required standards: reports suggests that when deciding whether someone is medically fit to drive, consideration should be given to using independent medical assessment. can confirm that in more complex cases, the DVLA already uses independent medical or driving assessments before deciding whether to issue a driving licence. G Your
The DVLA can also issue a licence of limited duration when required, as in Mr Prow's case, to allow someone's fitness to drive to be closely monitored on a regular basis. The length of the licence issued is based on the advice of medical experts and will depend on the medical condition concerned: After reviewing Mr Prow's records, officials have confirmed that he had been in regular contact with the DVLA about his medical conditions. Mr Prows driving licence had been regularly reviewed since 2001- Mr Prow had also notified the DVLA outside of the driving licence renewal process when he suffered a stroke in 2011 and when he had laser treatment on his eyes in
2013. In January 2014, the DVLA arranged for Mr Prow's visual acuity and field to be tested. Mr Prow's health met the appropriate standards and a driving licence, valid for three years, was issued on 18 February 2014. Mr Prow also had a driving assessment following a discussion with Motability Operations Ltd regarding the possible termination of the lease of his vehicle due to a lack of mobility following the stroke. The assessment recommended that Mr Prow should drive a car with automatic transmission and modified steering: The current process focuses on those drivvers who have a medical condition. It is designed to be fair and proportionate without penalising those drivers with disabilities who continue to drive safely: There is little evidence to suggest that introducing a stricter regime which includes mandatory medical or practical driving assessments would improve road safety. To impose such a requirement without the appropriate evidence would be overly bureaucratic and potentially very costly. Britain's roads are some of the safest in the world and our road safety record compares favourably with other countries with stricter and more intrusive driver licensing regimes. You have also suggested that there should be mechanisms in place to ensure that any required modifications to a vehicle are still relevant and are fitted and used appropriately. By law, drivers must ensure that are able to control a vehicle safely and be able to meet any conditions or restrictions on their licence. Drivers who require adaptations to their vehicle and whose licence is noted with the appropriate code can only legally drive a vehicle fitted with the specified adaptations. The police are responsible for enforcing compliance with the requirements of any restricted driving licence. There are a number of businesses and charitable organisations that provide advice on vehicle adaptation solutions for people with limited mobility: Driving Assessment Centres can also be a first point of contact to offer advice to drivers on driving aids and adaptations: Vehicle dealerships will also be aware of accredited manufacturers and installers and can offer advice about available vehicles and suitable adaptations: they
Every time a driver renews their entitlement are asked to confirm whether they require special controls to be able to safely control a vehicle and what these are_ These would be checked and recorded on any subsequent driving licences issued: However, can confirm that the DVLA is currently reviewing how restrictions imposed on driving licences as a result of a medical condition or disability are communicated to drivers, particularly when they change their cars note the concern you have expressed that GPs may have a conflict of interest in notifying the DVLA of their patient's medical condition. Medical professionals, and GPs in particular; play an important role in the driver licensing process by advising their patients of the implications of their condition on driving, the effect of any treatment or medication and whether they should notify the DVLA As have outlined, drivers are legally responsible for notifying the DVLA if have a medical condition. However, the General Medical Council (GMC) has revised its guidance to doctors on reporting concerns to the DVLA. The revised guidance states that doctors do not need to seek a patient's consent to contact the DVLA if do not feel it is safe and practical to do sO_ The GMC advises doctors to alert patients to conditions and treatments that might affect their ability to drive and remind them of their duty to tell the DVLA. Doctors may, however, decide to disclose relevant information without consent to the DVLA, in the public interest, if a patient is unfit to drive but continues to do. This can be done via a dedicated "doctor to doctor" telephone line or by email to one of the DVLA's qualified doctors. am grateful to you for bringing this case to my attention and for the recommendations you have made. hope the information in this letter reassures you that the appropriate processes in place for addressing the issues you have raised: However, can assure you that these processes are kept under review and where improvements are identified, these are in place. hvs _Ceel) JESSE NORMAN they they they put
The DVLA can also issue a licence of limited duration when required, as in Mr Prow's case, to allow someone's fitness to drive to be closely monitored on a regular basis. The length of the licence issued is based on the advice of medical experts and will depend on the medical condition concerned: After reviewing Mr Prow's records, officials have confirmed that he had been in regular contact with the DVLA about his medical conditions. Mr Prows driving licence had been regularly reviewed since 2001- Mr Prow had also notified the DVLA outside of the driving licence renewal process when he suffered a stroke in 2011 and when he had laser treatment on his eyes in
2013. In January 2014, the DVLA arranged for Mr Prow's visual acuity and field to be tested. Mr Prow's health met the appropriate standards and a driving licence, valid for three years, was issued on 18 February 2014. Mr Prow also had a driving assessment following a discussion with Motability Operations Ltd regarding the possible termination of the lease of his vehicle due to a lack of mobility following the stroke. The assessment recommended that Mr Prow should drive a car with automatic transmission and modified steering: The current process focuses on those drivvers who have a medical condition. It is designed to be fair and proportionate without penalising those drivers with disabilities who continue to drive safely: There is little evidence to suggest that introducing a stricter regime which includes mandatory medical or practical driving assessments would improve road safety. To impose such a requirement without the appropriate evidence would be overly bureaucratic and potentially very costly. Britain's roads are some of the safest in the world and our road safety record compares favourably with other countries with stricter and more intrusive driver licensing regimes. You have also suggested that there should be mechanisms in place to ensure that any required modifications to a vehicle are still relevant and are fitted and used appropriately. By law, drivers must ensure that are able to control a vehicle safely and be able to meet any conditions or restrictions on their licence. Drivers who require adaptations to their vehicle and whose licence is noted with the appropriate code can only legally drive a vehicle fitted with the specified adaptations. The police are responsible for enforcing compliance with the requirements of any restricted driving licence. There are a number of businesses and charitable organisations that provide advice on vehicle adaptation solutions for people with limited mobility: Driving Assessment Centres can also be a first point of contact to offer advice to drivers on driving aids and adaptations: Vehicle dealerships will also be aware of accredited manufacturers and installers and can offer advice about available vehicles and suitable adaptations: they
Every time a driver renews their entitlement are asked to confirm whether they require special controls to be able to safely control a vehicle and what these are_ These would be checked and recorded on any subsequent driving licences issued: However, can confirm that the DVLA is currently reviewing how restrictions imposed on driving licences as a result of a medical condition or disability are communicated to drivers, particularly when they change their cars note the concern you have expressed that GPs may have a conflict of interest in notifying the DVLA of their patient's medical condition. Medical professionals, and GPs in particular; play an important role in the driver licensing process by advising their patients of the implications of their condition on driving, the effect of any treatment or medication and whether they should notify the DVLA As have outlined, drivers are legally responsible for notifying the DVLA if have a medical condition. However, the General Medical Council (GMC) has revised its guidance to doctors on reporting concerns to the DVLA. The revised guidance states that doctors do not need to seek a patient's consent to contact the DVLA if do not feel it is safe and practical to do sO_ The GMC advises doctors to alert patients to conditions and treatments that might affect their ability to drive and remind them of their duty to tell the DVLA. Doctors may, however, decide to disclose relevant information without consent to the DVLA, in the public interest, if a patient is unfit to drive but continues to do. This can be done via a dedicated "doctor to doctor" telephone line or by email to one of the DVLA's qualified doctors. am grateful to you for bringing this case to my attention and for the recommendations you have made. hope the information in this letter reassures you that the appropriate processes in place for addressing the issues you have raised: However, can assure you that these processes are kept under review and where improvements are identified, these are in place. hvs _Ceel) JESSE NORMAN they they they put
Sent To
- Department for Transport
- Driver and Vehicle Licensing Agency
Response Status
Linked responses
1 of 2
56-Day Deadline
1 Dec 2017
About PFD responses
Organisations named in PFD reports must respond within 56 days explaining what actions they are taking.
Source: Courts and Tribunals Judiciary
Report Sections
Investigation and Inquest
Henry Prow (date of birth 22.11.1957) of Orchard View, Lower Carblake Cardinham; Bodmin died in a single vehicle road traffic collision on 12" August 2016. His death was referred to the Cornwall and Isles of Scilly Coroner: After a post mortem; an Investigation was opened on 18th August 2016 and an inquest opened on 6 December 2016. The Inquest hearing took place on 2nd June 2017 at Truro Municipal Buildings. The cause of death was established as 1a) Multiple injuries; 2) Diabetes; Renal, hepatic and vascular disease.
Circumstances of the Death
Henry Prow was returning from a weekly routine medical appointment at Derriford Hospital on 12th August 2016 in his Vauxhall Insignia VRN He had multiple medical and physical disabilities which required him to drive an automatic car with assisted steering: He was driving along the A38 Dobwalls by-pass at around 66 mph when he failed to reduce his speed for unknown reasons on approaching the Twelvewoods Roundabout resulting in the car colliding with the curb by the separation barrier at around 12.36 pm. As a result of this collision, the car left the ground and rotated about its longitudinal axis and then collided with the cheveroned sharp deviation of route sign and posts on the roundabout: Mr Prow received fatal injuries from the collision and died at the scene_ He was not wearing a seat belt or the required assisted steering at the time of the collision: A medical event to the collision could not be excluded. Mr Prow suffered from significant medical problems including severe diabetic nephropathy with vascular disease, left hemiplegia due to CVE, liver transplant for primary sclerosing cholangitis and hepatitis C , type Il diabetes and was on antidepressants_ This caused him to have no use of his left arm; limited use of his left leg and limited movement and feeling in his right foot It is understood that a condition of his licence was to have the vehicle modified to allow the using prior vehicle ancillary controls to be operated by the driver using one hand while driving: had held a driving licence since 1978.
Action Should Be Taken
In my opinion action should be taken to prevent future deaths and believe you [ANDIOR your organisation] have the power to take such action. To review the manner in which licences are issues and surrendered on health grounds and the method and criteria for assessing this e.g. the consideration of independent medical assessment or a compulsory medical at time periods. To review the mechanism for ensuring the required modification to vehicles are He very they still relevant to the vehicle and to the medical issues of the driver and that these modifications were fitted and used appropriately.
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Data sourced from Courts and Tribunals Judiciary under the Open Government Licence.