Source · Prevention of Future Deaths

Billy Warwick-Jones

Ref: 2021-0305 Date: 10 Sep 2021 Coroner: Lydia Brown Area: West London Responses identified: 2 / 3 View PDF

Inadequate advice to an older driver and their family about driving risks associated with acute illness-induced confusion, combined with insufficient testing and guidance for older drivers, highlights a systemic road safety failure.

Date 10 Sep 2021

56-day deadline 1 Nov 2021

Responses identified 2 of 3

Community health care and emergency services related deaths Other related deaths Road (Highways Safety) related deaths

Coroner's concerns

AI summary

View full coroner's concerns

The driver of the vehicle that caused this death was unwell with a urine tract infection. He had previously been treated for a urine tract infection. There is no evidence to suggest that he or his family were advised that he may demonstrate symptoms of confusion, agitation or delirium as a consequence of this and they would render him unfit to drive. There appears to be insufficient testing and instruction of the older population with regards to road safety, which led to this tragic outcome. While there are guidelines for driving with dementia or mild cognitive impairment produced by the General Medical Council, there appears to be nothing specific to other sudden onset confusion or delirium which is a well recognised and common symptom in the elderly when physically unwell. It is recognised that our population are growing older and that an increasing number of this cohort will have a driving licence. It is of concern that a situation can arise that leads to the loss of another drivers life, and additional lives could very easily have been lost as a consequence of this incident. Consideration should be given to more frequent, rigorous testing and to consider the duties that should be placed on the driver, their medical practitioners and also family members/carers to report changes in presentation or health to the Driver and Vehicle Licensing Agency.

Responses

2 respondents

Department for Transport Central Government

26 Oct 2021 PDF

Noted

The Department for Transport explains current driver licensing arrangements and guidance for medical professionals, noting age is not an automatic barrier to driving, but they encourage drivers to discuss concerns with medical professionals, and points to an older driver website. (AI summary)

View full response

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

Our Ref: Your Ref:

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.

GMC Regulator / Inspectorate

29 Oct 2021 PDF

Action Planned

The GMC has contacted the Royal College of General Practitioners (RCGP) to raise awareness of the risks of confusion related to UTIs and driving among their members. (AI summary)

View full response

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.

Report sections

Investigation and inquest

On 2 September 2020 I commenced an investigation into the death of Billy Martyn WARWICK-JONES. The investigation concluded at the end of the inquest . The conclusion of the inquest was Road traffic collision 1a Multiple Injuries 1b 1c II Alcohol intoxication and Cocaine Use

Circumstances of the death

Billy was driving his motorbike southbound on the A3 at approximately 0540 on 29 August 8 2020 near the junction with Coombe Lane, Kingston when he was hit head on by a car being driven on the wrong side of the duel carriageway. The driver of the car was 91 years of age, was suffering from a urine tract infection and delirious and had been in his car driving across London and Surrey for 16 hours. He did not have capacity to drive, was driving dangerously and his actions caused Billy's death

Copies sent to

Metropolitan Police

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Report details

Reference: 2021-0305
Date of report: 10 September 2021
Coroner: Lydia Brown
Coroner area: West London

Responses identified

Responses identified 2 of 3

1 response not yet linked

Organisations named in PFD reports are normally expected to respond within 56 days. Deadline: 1 Nov 2021.

Sent to

Department for Transport

Driver and Vehicle Licensing Agency

General Medical Council

Source links

Judiciary.uk page → Report PDF →

Data: judiciary.uk under OGL.