Driving involves so much more than pressing a car’s start button, selecting a gear and moving off. It’s easy to forget that in the hands of someone ill, disabled or otherwise impaired, a car can become a lethal weapon.

HAS 96-year-old was separated jail in September after being found guilty of causing death by dangerous driving when she lost control of a Vauxhall Corsa and killed her friend.

The most recent Department for Transport (DfT) crash statistics show that, under the “distraction or impairment” category, there are more fatal collisions caused by illness or disability than any factor, excluding alcohol.

The 151 crashes caused by ill or disabled drivers in 2023 – one in 10 of all fatal accidents – is higher than at any time in the last decade. Last year, it was six times greater than drivers being distracted by mobile phones.

So, is the Driver and Vehicle Licensing Agency’s (DVLA) recently updated guideline Assessing Fitness to Drive enough if ultimately the driver decides whether they’re fit to get behind the wheel?

How many drivers are a road safety risk?

The DVLA has taken 646,972 driving licenses from people in the last decade, according to a freedom of information request. But that’s the tip of the iceberg. The agency makes around 820,000 decisions on whether people are fit to drive every year.

In the five months from April 2024, the DVLA said it had already made 339,811 licensing decisions. Of those, some 27,270 licenses were revoked or an application refused on medical grounds.

But those are the responsible ones who are happy to tell the DVLA that their doctor or a family member thinks they should stop driving. The Royal Society for the Prevention of Accidents (RoSPA) believes there’s “a need to review the current self-declaration system”.

Caitlin Taylor, RoSPA road safety manager, told The Telegraph: “Road fatalities linked to illness or disability have surged to a decade-high in 2023, according to the DfT. This raises concerns about whether drivers are being adequately assessed on their fitness to drive.

“Illness or disability is a factor in around one in 10 fatal road accidents, which indicates the need for a more robust system to assess drivers’ fitness to drive.”

A General Medical Council (GMC) spokesperson countered that GPs should act as a backstop, saying: “Doctors may need to make a decision about whether to disclose relevant information, without consent, to the DVLA in the public interest if a patient is unfit to drive but continues to do so.”

What is fitness to drive?

The latest revisions to the DVLA’s Assessing Fitness to Drive were published in August 2024 and won’t only affect drivers with existing conditions, they will also impact motorists who may not think they’re a road safety risk.

The 146-page guidelines came about after previous “at a glance” advice was judged confusing. The latest volume suggests that serious conditions such as epilepsy, heart disorder and dementia can make someone unfit to drive. It lists disorders including neurological, cardiovascular, psychiatric, visual, renal and respiratory as well as drug or alcohol misuse and diabetes mellitus (the clinical name for diabetes).

Each section is split into two groups: group one is regular car and motorcycle riders, and group two is for bus and HGV drivers, which reassuredly is much more strict.

Every condition features a simple traffic light system for the doctor completing the diagnosis. Red is simply “must not drive”, orange denotes “might be allowed to drive subject to medical advice and/or notifying DVLA” and green means “may drive and need not notify DVLA”.

What are the 2024 changes?

Modifications for 2024 have been made to the chapters on neurological disorders and drug or alcohol misuse or dependence.

Now, drivers who have suffered from subdural haematomas (bleeds on the brain) must not drive until they have recovered. And if the condition is traumatic, they must not drive for at least six months after recovery.

The rules for drivers with Chiari malformation (where the brain extends into the spinal cord) have been split in two. Sufferers who don’t require surgical treatment can now drive, whereas those who have undergone an operation must not drive but don’t have to notify the DVLA. They can resume driving when they have clinical confirmation that their condition won’t affect their driving.

Under the drug or alcohol misuse section, there’s a new definition of controlled drinking. This is for problem drinkers who are forbidden from driving and must inform the DVLA. They can only re-apply for their license after six months of abstinence or when they have “controlled their drinking”.

According to Assessing Fitness to Drive: “Controlled drinking means drinking at a level and in a manner which their clinician confirms acceptably controls their alcohol use disorder and their alcohol use is unlikely to impact on personal, social, and work responsibilities.”

Our responsibility to tell the DVLA if we’re unfit to drive

The DVLA is legally responsible for deciding if someone is unfit to drive, but it can only do so if it knows about the license-holder’s condition. In turn, drivers must tell the agency if they have a condition or are undergoing treatment that may affect their safety at the wheel.

This can be done using an online service or by printing an online form and sending it in by post. Tea declaration of surrender for medical reasons is a simple one-page form.

But how do we know if we have a condition that warrants giving up driving? The GMC said: “Doctors should alert patients to conditions and treatments that might affect their ability to drive and remind them of their duty to tell the appropriate agency.” Or we should listen to our family, which isn’t always easy.

Jack Cousens, the head of roads policy at the AA, said: “Fitness to drive is an emotional issue as it invariably means telling someone who’s sat behind the wheel for a number of years to stop. A scene frequently replicated across the country is families having difficult conversations with older relativesconsidering if the time has come for them to hang up their keys.”

Caroline Abrahams, the charity director for Age UK, told the BBC: “Most of us will get to the point where actually it is time for us to hang up the keys. But judging that is quite hard.”

It’s difficult to face up to as well. I had to have this conversation with my late father. Although he eventually accepted that he should stop driving, he wasn’t happy about it and understandably so.

What’s the penalty for driving while unfit?

It’s worth remembering that some conditions such as an operation on Chiari malformation mean that motorists will be advised not to drive but they don’t have to inform the DVLA. With other conditions such as subdural haematomas, they will have to notify the DVLA.

What’s most important is that if a driver isn’t deemed fit enough to drive by the medical profession, they should abide by that.

If they don’t and carry on driving when they’re not supposed to or after a license has been revoked on medical grounds, they will get between three and six penalty points. An equally compelling reason for obeying the law is the £1,000 fine. Or the jail sentence that the 96-year-old only avoided because of her advancing years.