Prevention of Future Deaths reports · 2020
Regulation 28 report to prevent future deaths, reference 2020-0128, written 16 Jun 2020. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.
| Date of report | 16 Jun 2020 |
|---|---|
| Reference | 2020-0128 |
| Deceased | Joan Williams |
| Coroner | Emma Whitting |
| Coroner area | Bedfordshire and Luton |
| Category | Road (Highways Safety) related deaths |
| Source | judiciary.uk record · original PDF |
| Responses published | none published |
Text extracted from the PDF text layer. Reproduced verbatim, including the scan's own layout.
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 Our Ref: I Emma Whitting (Senior Coroner) Bedfordshire & Luton Coroner Service The Court House Woburn Street Ampthill MK45 2HX 14 October 2020 Dear Emma, Thank you for your report of 16 June 2020 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 Mrs Joan Williams. I am grateful for the extension granted to my reply. I was very sorry to learn of the tragic circumstances of this case and would like to express my sincere condolences to the family of Mr and Mrs Williams. I have considered your report and its recommendations very carefully. You have suggested new legislation to require doctors and clinics to inform the Driver and Vehicle Licensing Agency (DVLA) of any diagnosis of dementia in patients, rather than relying on the patients themselves to notify the condition. The current driver licensing arrangements are underpinned by a legal requirement that all drivers must inform the DVLA if at any time they develop a medical condition that may affect safe driving. All drivers must meet the appropriate health standards and the DVLA will investigate those who notify a medical condition by obtaining information from them and from their doctor or specialist. Doctors and other health care 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 publishes guidance entitled “Assessing fitness to drive: a guide for medical professionals” and 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 on medical professionals to notify the DVLA about a patient who is medically unfit to drive they can and do make such notifications to the DVLA. Since 2018, the DVLA has received over 5,000 such notifications. The General Medical Council (GMC) also provides guidance for doctors. As well as circumstances where consent may be obtained from patients to notify the licensing authorities 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 have a duty to report a patient to the DVLA if it is in the public interest to do so. 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, for example, because of dementia, 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. The DVLA will also investigate notifications from others who may have concerns, including relatives and friends, in recognition that there may be occasions where a driver lacks insight into their ongoing ability to drive safely. A diagnosis of dementia is not a bar to driving and it is widely recognised that in its early stages, holding a driving licence in terms of independence and mobility can be important. The Alzheimer’s Society suggests that up to one in every three people with dementia still drives. What is key, from both a legal and a practical point of view, is whether the person is still able to drive safely. Assessing driving fitness in those with dementia can be complex as there are different presentations and rates of progression and its impact on driving can be difficult to assess. It is also important that investigations are conducted at the appropriate time so that those who remain fit to drive do not face unnecessary stress and inconvenience. However, drivers displaying symptoms of memory loss and lack of judgement are likely to have their licences revoked. With dementia, the doctor and patient relationship is hugely important as seeking a diagnosis can be scary or overwhelming. Those who receive a diagnosis may need the time to process the information and to be reassured that they have some control over their situation. Seeking medical advice is vital as a timely diagnosis can help the person stay well for longer by increasing their awareness of the condition. Medication and other interventions can be used to help manage and lessen the symptoms. It also allows those with dementia and their families to make adjustments to improve their quality of life. It is always better that a driver is encouraged to make the decision themselves to notify the DVLA. If doctors are legally responsible for notifying the DVLA as soon as a diagnosis is made, there is a danger that without the correct information and in fear of losing their driving licence, some people will delay finding out whether they have dementia. The Royal Society for the Prevention of Accidents (RoSPA), with funding from the Department, has developed an older driver’ website: 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 details on driving assessments and refresher training, and provides advice on making the decision to stop driving if an individual is no longer safe. Local authorities also provide driver education schemes, which are an effective way of providing support for older drivers and ensuring that they remain fit and competent to drive. There are no plans to place a legal obligation on doctors to notify a diagnosis of dementia. The current arrangements work well by respecting the rights of those diagnosed with dementia who retain insight, to be trusted to notify the DVLA. Where a doctor assesses that insight has been lost, a notification to the DVLA by the doctor is already allowed in the public interest. I can assure you that we take road safety most seriously, and while our roads are some of the safest in the world we are not complacent and keep our policies under constant review. Yours sincerely, SECRETARY OF STATE FOR TRANSPORT
48060-2019 Senior Coroner - Emma Whitting Bedfordshire & Luton REGULATION 28 REPORT TO PREVENT FUTURE DEATHS THIS REPORT IS BEING SENT TO: Secretary of State for Transport (Rt. Hon. Grant Shapps MP), Great Minster House, 33 Horseferry Rd, London SW1P 4DR CORONER 1 I am Emma WHITTING, Senior Coroner for the area of Bedfordshire and Luton Coroner Service 2 CORONER’S LEGAL POWERS I make this Report under paragraph 7, Schedule 5, of the Coroners and Justice Act 2009 and Regulations 28 and 29 of the Coroners (Investigations) Regulations 2013. http://www.legislation.gov.uk/ukpga/2009/25/schedule/5/paragraph/7 http://www.legislation.gov.uk/uksi/2013/1629/part/7/made 3 INVESTIGATION and INQUEST On 13 September 2019 I commenced an Investigation into the death of JOAN WILLIAMS aged 83 who died from her injuries along with her husband (a front-seat passenger in her car) following a road traffic accident The investigation concluded at the end of the inquest on 4 June 2020. The conclusion of the inquest was Road Traffic Collision. The medical cause of death was: Ia Hospital Acquired Pneumonia Ib Bilateral Rib Fractures 4 CIRCUMSTANCES OF THE DEATH At around 11.40 hours on 19 August 2019, the Deceased was driving her Vauxhall Corsa southbound on the A5120 from Flitwick toward Westoning when it collided head on with a heavy goods vehicle travelling northbound. Although the driver of the heavy goods vehicle took all possible evasive action the collision could not be avoided as it appeared she had not recognised what was going to occur. She was taken by paramedics to Addenbrookes hospital where she was diagnosed with multiple injuries including rib and long bone fractures and subsequently passed away on 3 September 2019; her death being confirmed at 16:43 hours. She had been diagnosed with Alzheimer’s dementia in April 2018 but had seemed to have trouble accepting this; although she had been advised by her diagnosing clinician and GP to inform the DVLA and her insurance company of her diagnosis, and had apparently confirmed that she would do so, she had also appeared confused by the process and had continued to deny her diagnosis and, on occasion, to drive. By the time of the incident the DVLA had still ##DW<<corAddress>> Tel ##DW<<corTel>> | Fax ##DW<<corFax>> not been informed of her diagnosis. 5 CORONER’S CONCERNS During the course of the Inquest the evidence revealed matters giving rise to concern. In my opinion there is a risk that future deaths will occur unless action is taken. In the circumstances it is my statutory duty to report to you. The MATTERS OF CONCERN are as follows : (1) It was the expert opinion of the Road Traffic Collision Investigator that “the collision resulted from a loss of control by the driver of the Vauxhall Corsa (the deceased), however, the cause has not been identified. It is thought most likely to have resulted from driver confusion due to her Dementia……” (2) The Inquest learned that following the Deceased’s diagnosis with Alzheimer’s dementia in April 2018, and the advice provided by the Memory Assessment Service that she should contact the DVLA and cease driving in the meantime, her GP, Dr Chowdhury, discovered that she was continuing to drive. Although he spoke directly to her on 10 May 2018 and was reassured that she understood the advice and would be both contacting the DVLA and ceasing from driving, it appeared from other evidence that this, in fact did not occur; the Deceased neither contacted the DVLA and, on occasion (apparently for short journeys), continued to drive. (3) Current legislation makes the driver legally responsible for telling the DVLA or DVA about Alzheimer’s dementia. Doctors are only required to alert patients to such a condition that can affect their ability to drive and to remind them of their duty to tell the appropriate agency. Doctors are only told that they should disclose this information directly to the DVA or DVLA without consent IF they are aware that the patient is continuing to drive and they consider it to be in the public interest to do so; (4) The Alzheimer’s Society reports that, in 2013, there were 815,827 people with dementia in the UK (including 1 in every 14 of the population aged 65 years and over) and that, if current trends continue, the number of people with dementia in the UK is forecast to increase to 1,142,677 by 2025 and 2,092,945 by 2051, which will be an increase of 40% over the next 12 years and of 156% over the next 38 years. (5) GPs are extremely busy professionals and may not always be made aware of a patient’s day to day activities. It was discussed at the Inquest that this tragedy, which involved not only the death of the deceased but also the death of her husband, might suggest that the public interest could be better served by the introduction of legislation to require ALL such diagnoses to be referred directly to the DVA/DVLA from the Memory Assessment Clinic and/or GP. Bedfordshire and Luton Coroner Service Tel 0300 300 8383 | FAX 6 ACTION SHOULD BE TAKEN In my opinion action should be taken to prevent future deaths and I believe you, Grant Shapps, have the power to take such action. 7 YOUR RESPONSE You are under a duty to respond to this report within 56 days of the date of this report, namely by 10 August 2020. I, the coroner, may extend the period. Your response must contain details of action taken or proposed to be taken, setting out the timetable for action. Otherwise you must explain why no action is proposed. 8 COPIES and PUBLICATION I have sent a copy of my report to the Chief Coroner and to members of both Joan and families as well as to her GP and the DVLA. I am also sending a copy to BRAKE, PO Box 548, Huddersfield, HD1 2XZ. I am also under a duty to send the Chief Coroner a copy of your Response. The Chief Coroner may publish either or both in a complete or redacted or summary form. He may send a copy of this report to any person who he believes may find it useful or of interest. You may make representations to me, the coroner, at the time of your response, about the release or the publication of your response by the Chief Coroner. 9 Emma WHITTING Senior Coroner for Bedfordshire and Luton Coroner Service Dated: 16 June 2020 Bedfordshire and Luton Coroner Service Tel 0300 300 8383 | FAX
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