HGV operators routinely give vehicles 27-point checks before use and van operators will also usually insist on thorough pre-use defect checks. However, HGV drivers will not have a statutory medical between licence acquisition and the age of 45 – often a gap of 27 years. 

Van and car drivers meanwhile have no requirement for health checks beyond a 20m number plate eyesight test. 

Drivers have a responsibility not to drive if they are not fit or able to do so safely, but in practice many drivers still get behind the wheel even when they are unwell because of financial and work pressures. Furthermore, they may not be aware that they have a serious or safety-compromising condition. 

Operators of any vehicle fleet have a legal responsibility to risk-assess their use of vehicles, including the vehicle, the route, the load and the driver themselves.  

Operators who ensure their vehicles are roadworthy but do not check their drivers are therefore only fulfilling one part of their legal responsibilities – and not the part which most commonly causes collisions. 

In a recent Loughborough University study, Professor Stacy Clemes found that: "Research correlates an increase in collision risk as well as a reduction in productivity with… unhealthy drivers. Interventions to improve health will naturally lead to a reduction in road risk and operators will benefit from the improved productivity." 

Drivers involved in incidents who have not been risk assessed, adequately or at all, expose operators to liability under health and safety law which can lead to seven figure fines. 

The right provider 

There are many doctors and organisations which provide driver health screening. However, employers should ensure that the provider is reputable. If drivers search online for a provider, they may end up with a service which lacks proper oversight or uses unsafe practices. Assessments which are done incorrectly are legally invalid and contribute nothing to the driver's health or safety. 

• Medicals assessment should take around 15 minutes, not less. 

• Medical assessments should be conducted and signed off by trained clinical staff. 

• All necessary checks including heart examinations or blood pressure readings must be performed. 

• All the relevant questions on the form must be addressed. 

Look for the following quality markers: 

• ISO 9001 with UKAS accreditation  

• SEQOHS registration – this is an occupational health service accreditation.  

Be wary of any provider which is unable to provide evidence of a quality assurance framework, supported by audits and good corporate and clinical governance. 

HGV driver medicals are also based mainly on a questionnaire which involves the drivers' full and honest cooperation. It is in a driver's best interest to be completely honest with the clinician conducting the test, as dishonest replies may leave them unwell and unsafe on the roads.  

Honest replies, even if they lead to a diagnosis, will mean that the driver can seek proper treatment and, if they are suffering from a physical or mental impairment that has a substantial and long-term negative effect on their ability to carry out normal daily activities in their job, then they should have protection under the Equality Act and can request reasonable adjustments. 

A positive intervention 

Most of us find the idea of a positive medical test alarming. However, it is important to reassure people that: 

• Early diagnosis of conditions leads to better health outcomes. Ignoring things generally makes them worse. 

• Most tests are minimally invasive. 

• Even with conditions which affect driving, most can be treated, allowing the driver to continue in their role once the condition is being managed. 

• Good testing is inclusive, not excluding. As an example, one in 12 men have a colour vision deficiency which means that until now they have not been allowed to drive trains. Better testing now means that many of these individuals can drive, because their specific difficulties can be understood and managed. (See Chapter 8.) 

• Reasonable adjustments can be made for any condition which requires it. 

• Those few who can no longer safely drive may be able to be assigned a non-driving role. 

• Continuing to drive with an impairing but undiagnosed condition puts you, any passengers and other road users at risk – not just when at work but when driving family and friends too. 

What driver screening and monitoring should employers undertake? 

You can find out more about each of the conditions below in Chapter 2. 

1. Eyesight. Our eyes change over time and needing correction, such as wearing glasses, is very common over the age of 45 years. Sight tests also give important insights into wider health issues. Frequency: a full sight test every two years.  
2. Blood pressure. This is one of the most common reasons why drivers fail their medical. Frequency: annual. 
3. Sleep apnoea. A leading cause of daytime sleepiness and lack of concentration in drivers. Frequency: annual but formal assessments should be carried out if any driver is showing signs of daytime sleepiness or is involved in a near-miss/incident. 
4. Diabetes. There are over one million people with undiagnosed diabetes in the UK and it is linked to many other health problems which can compromise safe driving. Frequency: Finger prick screening every three years from 35 years; and every other year from 45 years. 
5. Heart disease. Heart attacks and strokes at the wheel can cause potentially fatal incidents. Frequency: Every three years from 35 years; and every other year from 45 years. 
6. Obesity. Obesity is reaching epidemic proportions in the UK and has strong links to diabetes, heart disease, sleep disorders and stroke risk. Research shows that as obesity increases, safety decreases. If drivers are overweight, their screening for other conditions should be more frequent.  
7. Mental health. Anxiety and depression are both prevalent and can affect driver performance. Pilot mental health is assessed on licence acquisition, but no such tests are routinely carried out for drivers. However, if anyone may be experiencing mental health issues, they should see their GP. Employers can also incorporate mental health into general welfare checks. 
8. Drugs and alcohol. There are still unacceptable levels of drink and drug usage among drivers. In 2022, 22% of deceased drivers, and 34% of all drivers tested were over the legal alcohol limit, in England and Wales. In 2022, impairing drugs were detected in 19% of drivers killed, and 30% of those tested. Alcohol and drug testing is now relatively easy and available to any organisation. Frequency: On recruitment and randomly thereafter, or with cause. 
9. Medication. GPs are not necessarily aware that they are prescribing to drivers and impairing medications can also be bought over the counter. Many medications have side effects of their own or in combination with other medicines. Frequency: every new or newly combined medication should be certified driving-safe by a doctor or pharmacist. 
10. Ongoing medical investigations. If a driver is undergoing medical tests, but has not yet had a formal diagnosis, you cannot assume that they are safe to drive. Long waiting lists can mean that concerns are raised long before test appointments come through and many conditions cause impairment.