"Possible chronic obstructive pulmonary disease or an as yet undiagnosed medical condition."
"[The] accident occurred at cross roads of two narrow residential roads with cars parked on both sides. Even with great care, it is extremely difficult to see approaching cars. As I crossed over I was suddenly struck with great force by an unseen vehicle and the impact was so severe and sudden that my foot was jammed on to the accelerator, causing me to crash into two parked cars. The only reason I accepted responsibility for the collision was because the other driver had right of way."
"I am unsure whether they are due to your chronic obstructive pulmonary disease or to an as yet undiagnosed medical condition. However, as they constitute a road safety issue, regrettably therefore I must recommend the revocation of your group 1 ordinary licence."
"As I am not disabled, physically or mentally, also confirmed by my GP, it is completely inappropriate for me to agree to such an examination."
"I should explain that the medical information obtained during the course of our medical enquiries, including the results of your previous driving appraisal, indicates that you may be experiencing problems with your cognition which, whilst not obvious during the course of performing day to day activities, may become evident when performing the complex task of driving. This was alluded to in correspondence sent to you following the revocation of your driving licence in September last year. I would advise that there is no single or simple marker or test for assessment of cognitive function. However, on-road driving assessments, which are only carried out at approved driving assessment centres, are considered an invaluable method of ensuring that there are no features present likely to cause the driver to be a source of danger. Such features can include visual inattention, easy distractibility and difficulty performing multiple tasks. In addition, it is important that reaction time, memory, concentration and confidence are adequate and do not show impairment likely to affect driving performance."
"Viewing your client's case as a whole, including all of the background information and the faults demonstrated during the course of the driving appraisal that she underwent in September 2012, the medical adviser was of the view that your client represented a likely source of danger to both herself and other road users and it was on this basis that her licence was revoked."
"I would advise that a disability may exist through age related cognitive decline which may not present in day to day living or to clinicians at this stage and not until quite late in the disease process. However, driving is an extremely complex activity in a novel, constantly changing environment, with multiple changing situations that have to be processed quickly, effectively and safely. It is the advice of the Secretary of State's Honorary Medical Advisory Panel that driving may come to highlight these deficits at a much earlier stage. This was implied in our letter of26 September 2012 in the phrase 'or to an as yet undiagnosed medical condition' ..."
"Based on the on-road driving assessment report, the claimant's ordinary licence was revoked by letter dated26 September 2012 ."
"It was therefore deemed Mrs Hitchen was suffering from a relevant disability as defined."
"29. The Panel discussed a scenario of an elderly driver stopped by the Police for erratic driving and where a mild impairment of cognition was felt to have possibly been a factor. In the scenario reports from the driver's doctors did not highlight any formally diagnosed conditions however, objective on road driving assessment highlighted significant difficulties. Discussion took place as to whether a licence could be revoked on the basis of the driving performance or whether in the absence of a recognised diagnosis a recommendation to retain the licence would have to be made. The erratic driving may require disqualification by the Courts if there is no recognised medical cause apparent. Panel reiterated that age alone was not reason to remove a licence entitlement and never should be. 30. There was a wide ranging discussion around the various methods of assessment available to the clinician. Panel stated that the absence of a recorded diagnosis may not correlate with the absence of pathology, the index event being the first presentation of possible problems. It was noted that driving is a high level skill and that difficulties present in forward planning and the processing of the multiple, complex sensory inputs required for safe driving may pre-date the formal recognition and diagnosis of cognitive impairment or dementia by a doctor. The Panel indicated that the commonly used assessment tools, particularly those used by non-specialities e.g the Mini Mental State Examination (MMSE) rating skill were designed as screening tools for dementia and do not correlate with driving ability and have a limited role. 31. Cognitive abilities of particular relevance to safe driving are executive skills, frontal lobe function and the ability to forward plan particularly in new situations. These were not measured accurately by the MMSE rating scale. Panel indicated that the Addenbrooke's Cognitive Examination and Montreal Cognitive Assessment are probably better at assessing driving related functions. Panel stated that the most relevant assessment to determine whether a driver was able to drive safely in traffic was a functional assessment of ability by means of an on road driving assessment or similar process. Parallels were drawn with the assessment of commercial pilots and use of simulators in assessing performance. 32. The MMSE rating scale is dependant on a subject's language skills and pre-morbid functioning. A subject with a high level of pre-morbid function may still experience a significant loss in function before it becomes apparent via the rating scale."
"(i) Medical evidence presented by the appellant since revocation of her licence is not indicative of her condition on the day of revocation. (ii) The evidence and reports from the accident and driving assessment supports that the DVLA were reasonable in their conclusion that the appellant was suffering from age related cognitive impairment and they were correct to revoke Mrs Hitchen's licence. (iii) We gave weight to the learned medical panel's decision, whose sole focus is driving and psychiatric disorders. (iv) We accept that Dr Pawley is an expert in the field of applying standards of fitness to drive. Conclusion: we believe that the appellant has not proved her case on the balance of probabilities, that the decision by the DVLA to revoke her licence was incorrect and therefore the appeal is dismissed." (e) In rejecting the application to state a case as frivolous, the bench chairman stated that the questions posed in the application appeared to misunderstand the nature of the proceedings before the magistrates court. He stated that the appeal was by way of a re-hearing so that the court looked at the matter in issue afresh, considering all the relevant evidence, including that arising between the original decision appealed against and the appeal hearing. Significantly, in answer to the third question he said that what the Secretary of State or DVLA decide to do is irrelevant in the sense that "we heard the matter afresh and made up our own minds"
"(1) An application for the grant of a licence must include a declaration by the applicant, in such form as the Secretary of State may require, stating whether he is suffering or has at any time (or, if a period is prescribed for the purposes of this subsection, has during that period) suffered from any relevant disability or any prospective disability. (2)In this Part of this Act— “disability” includes disease “relevant disability” in relation to any person means— (a)any prescribed disability, and (b)any other disability likely to cause the driving of a vehicle by him in pursuance of a licence to be a source of danger to the public, and “prospective disability” in relation to any person means any other disability which— (a)at the time of the application for the grant of a licence or, as the case may be, the material time for the purposes of the provision in which the expression is used, is not of such a kind that it is a relevant disability, but (b)by virtue of the intermittent or progressive nature of the disability or otherwise, may become a relevant disability in course of time. (3)If it appears from the applicant’s declaration, or if on inquiry the Secretary of State is satisfied from other information, that the applicant is suffering from a relevant disability, the Secretary of State must, subject to the following provisions of this section, refuse to grant the licence."
"DVLA were reasonable in their conclusion that the appellant was suffering from age related cognitive impairment ..."
"It is clear that any appeal is by way of re-hearing so the court looks at the matter in issue afresh. At the hearing we heard all of the evidence that the parties sought to put before us. We made findings of fact and decided to refuse the appeal on the basis of what we heard ... no question of law arises. Moreover, it is clear that, as the appeal was by way of re-hearing, we were entitled to consider all of the relevant evidence, including that arising between the original decision appealed against and the appeal."
"What the Secretary of State/DVLA decides to do is irrelevant in the sense that we heard the matter afresh and made up our own minds."
"Question 1 is a question of fact and, in any event, it is irrelevant to refer back to the date of revocation in this way."