Driver and Vehicle Licensing Agency

The Stigma and Self-Stigma scales (SASS) measure multiple aspects of stigmatic beliefs about mental health problems, including cognitive aspects of stigma towards others (Stigma to Others) and emotional stigma toward others (Social Distance), anticipated stigma by others, self-stigma, avoidant coping strategies, and help-seeking intentions, alongside an index of social desirability. The properties of the SASS were investigated by employees of a large UK government organization. With minor exceptions, each of the SASS scales had strong psychometric properties, good internal reliability, and test-retest reliability. Social Distance, Anticipated Stigma, Self-Stigma, and Avoidant Coping were all strongly associated with a lack of help-seeking for mental health problems. Similarly, Stigma to Others, Self-Stigma, and Avoidant Coping were all associated with current mental health problems. Finally, absenteeism from the workplace was found to be negatively related to Stigma to Others, and positively related to Avoidant Coping and Anticipated Stigma. In conclusion, the SASS was able to measure several different forms of stigma about mental health simultaneously in people both with and without a history of mental health problems. The SASS can be used to monitor changes in mental health attitudes outcomes following intervention programs to investigate stigmatic attitudes to mental health problems across different samples.

The British population has been greatly affected by the rapid evolution in information and communications technology. In this digital society, we all leave extensive traces of our behaviour and interactions in the course of our normal, everyday lives. We have unprecedented opportunities to express ourselves, to connect and share knowledge, to be prosperous and inventive. At the same time, the digital society also presents new challenges, making citizens potential targets for fraudsters, criminals and possibly terrorists. The task for the police and SIAs has become more demanding as they try to stay abreast of rapid technological innovation and deal with threats that emanate from across the globe. It is important to ensure that the powers granted to these agencies to protect the public are explicit, comprehensible, and are seen to be both lawful and consistent with democratic values. The citizen’s right to privacy online as offline – and what constitutes a ‘justifiable’ level of intrusion by the state – has become a central topic of debate. As traditional notions of national security and public safety compete with the realities of digital society, it is necessary to periodically renew the licence of the police, security and intelligence agencies to operate. This report aims to enable the public at large to engage in a more informed way in the debate, so that a broad consensus can be achieved and a new, democratic licence to operate can be agreed.

Diabetes, and particularly insulin-treated diabetes, has important implications for motor vehicle driving, largely because of its association with potential hypoglycaemia. For this reason, most countries operate some driving restrictions on insulin-treated diabetic patients, as well as systems of intermittent reassessment of hypoglycaemic risk. In the UK, regulations are operated by the Driver and Vehicle Licensing Agency (DVLA), which is an agency of the Department of the Environment, Transport and the Regions (DETR). They are supported by an Expert Panel which advises the Secretary of State on diabetes-related issues relating to fitness to drive. The patient organization Diabetes UK is also concerned with diabetes and driving issues, largely from a position of lobbying policy-influencers and supporting individual cases. All parties involved with diabetes and driving issues recognize the need for more research on the subject, as the current literature is flawed in design, though no convincing excess of accidents amongst diabetic drivers has been conclusively demonstrated. Currently in the UK, Class 2 vehicles (large trucks and passenger vehicles) are barred to diabetic drivers on insulin. European law has recently extended this to so-called C1 (large vans and small lorries) and D1 (minibuses) vehicles, though the law has recently been revised to allow individual consideration for potential diabetic C1 drivers on insulin treatment. Diabetes and insulin-treated diabetes is an emotive and difficult issue, for which a stronger evidence base is urgently needed.

The potential role of serum carbohydrate-deficient transferrin (CDT) measurement in the assessment of 'High Risk Offenders (HROs)' applications for licence reinstatement in Great Britain was examined. Serum CDT determination would have provided useful confirmation of licence decisions in 70% of HROs assessed, would have resulted in a change in the licence decision in 8%, and most likely would have confounded the licence decisions made in the remaining 22%. Estimation of serum CDT could provide useful information to assist in decisions regarding licence reinstatement in selected HROs.

BACKGROUND: Common mental disorders are the leading cause of workplace absences. While the reasons for this are multifarious, there is little doubt that stigma related to common mental disorder plays a large role in sickness absence and in poor help-seeking. Frequently both managers and staff are unsure of how to approach and intervene with mental health related problems. We have therefore devised a mental health intervention programme (Prevail) that aims to reduce stigma and to educate staff about evidence-based low intensity psychological interventions. These can be used by the individual, as well as in collaboration with managers via co-production of problem-focussed solutions, with the aim of improving mental health, reducing sickness absence, and increasing workplace productivity. METHODS: This two-armed cluster randomised control trial (RCT) will evaluate the effectiveness of Prevail. Eighty managers at a large UK government institution (the DVLA) and their teams (approximately 960 employees) will be randomised into the active intervention group or control (employment as usual) arms of the study. All participants will be invited to complete a series of questionnaires related to mental health stigma, their current and past mental health, and their recent workplace productivity (absenteeism and presenteeism). All employees in the active arm will receive the Prevail Staff intervention, which covers stigma reduction and includes psychoeducation about evidence-based low intensity psychological interventions for common mental disorder. The managers in the active arm will also receive the Prevail Managers programme which covers communication skills, problem formulation, and problem-solving skills. The questionnaire battery will then be given to both groups again 4 weeks post training, and 12 months post-training. Official records of absenteeism from Human Resources will also be gathered from both active and control groups at 12 months post-training. DISCUSSION: The treatment trial aims to evaluate if Prevail reduces mental health related stigma (of a number of forms), increases help-seeking behaviours, and increases workplace productivity (via decreased absenteeism and presenteeism). TRIAL REGISTRATION: ISRCTN12040087. Retrospectively registered 04/05/2020.

International audience

Driving is an integral part of adult life and losing a driving licence is potentially a major problem. Many neurological conditions may impact on driving, either by increasing the risk of a sudden disabling event or by affecting cognition, vision, reaction speed, motor coordination, peripheral sensation or visuospatial processing. In the UK, the Drivers Medical Group of the Driver and Vehicle Licensing Agency (DVLA) decides whether an individual’s medical condition meets the appropriate standards for driving. The licensing decision rests with the DVLA and is not at the clinician’s discretion. However, clinicians must inform patients of their legal obligations towards the DVLA and how their neurological symptoms may restrict their driving. We discuss risk assessment, how chronic disabling neurological disease may impact on driving and the general principles of applying medical standards for fitness to drive. We also highlight how legal driving eligibility varies around the world. Finally, we discuss the practical applications relating to a specific case.

Abstract The Driver and Vehicle Licensing Agency (DVLA) relies on self‐declaration of a relevant medical condition, such as insulin‐treated diabetes, in determining medical fitness for licensing Group 1 (car or motorcycle) drivers. Problems such as severe hypoglycaemia (requiring the assistance of another person) may lead to revocation of the licence, but may not always be reported. The aim of the present study was to assess the sensitivity and accuracy of medical self‐declaration in drivers who had insulin‐treated diabetes of long duration. The study took place in 2007–08, involving 2779 drivers who had insulin‐treated diabetes for 15 years or more when applying to renew their Group 1 licence. The driver's self‐declaration was compared with the assessment made independently by their doctor as a medical report. Responses were analysed to assess risk of severe hypoglycaemia and presence of impaired awareness of hypoglycaemia (IAH); the accuracy and sensitivity of self‐declarations were evaluated. Overall, self‐declarations of 293 drivers (10.5%) were inconsistent with their doctors' reporting of recorded episodes of severe hypoglycaemia or IAH. This inconsistency was greatest in those treated with insulin for 20 years or more and in older drivers aged over 49 years. Detailed examination of these 293 cases with inconsistent declarations resulted in 25 drivers (8.5% of this subgroup) being refused a licence. One in 10 drivers with insulin‐treated diabetes of long duration (10.5%) had returned inaccurate self‐reports, resulting in 25 (8.5% of this group) having their licence refused. This resulted in a review of the process of licence renewal for those with insulin‐treated diabetes. Copyright © 2012 John Wiley & Sons.

BACKGROUND: Common mental disorders are the leading cause of workplace absences. The Prevail intervention programme aims to reduce stigma and to educate staff and managers about evidence-based low intensity psychological interventions for common mental disorders (depression, anxiety, stress, and distress). Prevail is innovative in taking a public health approach. It is designed to be given to all employees irrespective of their past or current mental health. Prevail was evaluated in three studies examining: (1) the acceptability of the intervention and perceived usefulness; (2) whether the intervention altered stigmatic attitudes and motivation to seek help; and (3) whether the intervention reduced sickness absence, both overall and due to mental health problems. METHODS: A two-armed cluster randomised control trial (RCT) evaluated the effectiveness of Prevail. Employees (N = 1051) at a large UK government institution were randomised to an active intervention or control arm in teams identified by their managers (n = 67). Employees in the active arm received the Prevail Staff Intervention. The managers in the active arm also received the Prevail Managers Intervention. Participants' satisfaction and analysis of the Prevail Intervention were gathered by a bespoke questionnaire. Questionnaire measures of attitudes to mental health and mental health stigma were taken 1-2 weeks prior to the intervention and approximately 4 weeks post-intervention. Data relating to sickness absence were gathered via the official records in the time period 3-month post-intervention and for the same period 12 months earlier. RESULTS: Prevail was evaluated highly favourably by both the staff and their managers. Prevail produced significant reductions in self-stigma and anticipated stigma due to mental health difficulties. Crucially, sickness absence was significantly reduced by the Prevail Intervention. DISCUSSION: Prevail achieved its goals of producing a palatable and engaging intervention that altered staff's attitudes and stigmatic beliefs related to mental health and, crucially, produced a strong reduction in work-pace absenteeism. As the Prevail programme is aimed at common mental health problems and was not specialised to this particular workforce, the study provides the evidence-base for a mental health intervention programme that could be used by many organisations across the world. TRIAL REGISTRATION: ISRCTN12040087. Registered 04/05/2020. https://doi.org/10.1186/ISRCTN12040087 . A full protocol for the randomised control trial was published: Gray NS, Davies H, Snowden RJ: Reducing stigma and increasing workplace productivity due to mental health difficulties in a large government organization in the UK: a protocol for a randomised control treatment trial (RCT) of a low intensity psychological intervention and stigma reduction programme for common mental disorder (Prevail). BMC Public Health 2020, 20(1):1-9.

Reports on a study, the specific aims of which were to look at the career progression of women in the internal audit profession, compare their experiences with those of their male counterparts and of women in the general management field, and to identify the level of support for specific remedies and actions aimed at overcoming the barriers faced by women in the workforce today.

Abstract In the interest of road safety those who suffer with a medical condition likely to cause a sudden disabling event at the wheel or inability to safely control their vehicle from any other cause should not drive. Diabetes is one of many medical conditions that may adversely affect driving ability and is therefore subject to legal requirements for the issue of a driving licence. The main concern is hypoglycaemia, especially if this is associated with impaired awareness. Other complications are also taken into account. The secretary of State for Transport, Local Government and the Regions (DfT) has responsibility, via his medical advisors at the Drivers Medical Group at DVLA, to ensure that all licence holders are fit to drive. © Crown Copyright 2002. Reproduced with the permission of Her Majesty's Stationery Office. Published by John Wiley & Sons, Ltd.

EDITOR,--The problem that Jo Alexander describes--of an aunt who continued to drive into her 90th year--is one of general concern.1 We will always make medical inquiries if a health condition is declared, but some elderly people refuse to accept that they may be unfit and omit to declare a medical condition even when specifically asked to do so on renewal of their driving licence. Advice about …

What is the role of an occupational health clinician when a worker refuses to notify the driver and vehicle licensing agency (DVLA) when required to by law? There is no specific guidance on this dilemma for occupational health clinicians, where the context and parameters of the doctor–patient relationship is different to the relationship between the worker and their general practitioner (GP) or specialist treating teams.

EDITOR—The DIGAMI study (diabetes mellitus insulin glucose infusion in acute myocardial infarction) suggested that insulin treatment at the time of myocardial infarction offered some improvement in mortality, particularly in patients not previously treated with insulin.1 As a result of …

EDITOR,—Contrary to the impression given by T Potamitis and colleagues,1 glaucoma in a single eye need not be notified to the Driver and Vehicle Licensing Agency. The condition can be regarded as a prospective disability and therefore …