ISE27/20-21
| Subject: | transport, road safety, fitness to drive, older drivers, driving licence |
- To enhance road safety, it is not uncommon for authorities that issue driving licences to require medical proof on "fitness to drive" from two particular driver groups: first, older drivers, considering the common perception that sensory, motor and cognitive functions would usually deteriorate with age; second, commercial vehicle drivers, given the involvement of above-average driving mileages as well as passengers and/or goods on board of their vehicles.
- In Hong Kong, the current road traffic laws mandate that all driving licence holders, regardless of the class of vehicle driven, must undergo medical assessment when they reach the age of 70. As far as drivers of commercial vehicles are concerned,1Legend symbol denoting There is no legal definition of commercial vehicles in Hong Kong. The Transport Department issues driving licences based on the class of vehicles that the licence holders are permitted to operate, and it considers private light buses, public light buses, taxis, private buses, public buses, public franchised buses, medium goods vehicles, heavy goods vehicles, and other special vehicles as commercial vehicles. those employed by franchised bus operators have to undergo medical fitness assessment once they turn 50 years old, following a review of the safety arrangements in the 2000s at the request of the Transport Department ("TD"). However, no such arrangements were established for other commercial vehicle drivers such as those who operate taxis, public light buses and goods vehicles.
- The policy of fitness to drive had been raised and discussed in Hong Kong from time to time.2Legend symbol denoting The fitness to drive policy was discussed on various occasions over the past decade or so. In 2010, the Legislative Council had a motion debate on "Medical check-ups for professional drivers". In a reply to a Legislative Council Question in 2011, the Government stated that a majority of driving licence holders were not engaged in driving as their main occupation. If it was a mandatory requirement for these drivers to produce medical reports when applying for or renewing their driving licences, many of the drivers not engaged in driving commercial vehicles as an occupation would be affected. On the other hand, in 2013, the Secretary for Transport and Housing told the Public Accounts Committee that a review on the policy was ongoing, and they were also looking at the privacy issue of how to secure the health data without the consent of the drivers. In 2019, the Transport Complaints Unit indicated that the Transport Department was reviewing the policy pertaining to the age-based mandatory medical assessment. Apart from government reviews, the Road Safety Council had also discussed relevant issues in 2011 and 2012. See GovHK (2011), Legislative Council Secretariat (2010) and (2013), NOW新聞(2013年), Transport Complaints Unit (2019), and Road Safety Council (2011) and (2012). Recently, it has come under spotlight after the Office of The Ombudsman (the "Ombudsman") decided to initiate a probe into TD's "requirements for physical fitness certification of driving licence applicants/ holders". The Ombudsman, in particular, noted that many overseas countries and regions have introduced measures to ascertain older drivers' physical fitness to drive and implemented more stringent requirements for medical examination of drivers of heavy commercial vehicles to enhance the safety of road users.3Legend symbol denoting See Office of The Ombudsman (2021).
- This issue of Essentials reviews the fitness to drive policy in Hong Kong. Relevant experiences in Australia, including New South Wales ("NSW") specifically, are studied in depth, spanning the promulgation of two distinct sets of standards for private and commercial vehicle drivers as well as how a set of national guidelines on assessing fitness to drive, jointly formulated by medical professionals and other stakeholders, helped develop NSW's sophisticated age-based fitness to drive assessment system for driving licence applicants and holders.
Common approach to designing fitness to drive policy
- Drivers with medical conditions that could seriously undermine their driving ability, if left undetected, may endanger both the drivers concerned and other road users. As the first line of defence, licensing authorities usually require drivers to report their medical conditions through self-declaration upon licence applications and notification within the licence validity period.
- As an additional layer of safeguard, places like Canada, Singapore, the United Kingdom, and parts of Australia further required certain groups of driving licence applicants and holders to pass relevant medical assessment before the issuance and renewal of licences. Although there is generally no conclusive evidence that older drivers necessarily have a higher accident involvement rate than the younger counterparts,4Legend symbol denoting Some studies found that older drivers (aged 65 or above) were more likely to cause road accidents than general adult (25-64) drivers, but they were also far less likely than young drivers (under 25), as they tend to drive less and more cautious in driving. However, it is generally agreed that older drivers were more prone to injuries in road accidents. See, for example, RAND (2007). the fitness to drive assessment is often made progressively more stringent and frequent as the licence applicants and holders age, though to varying degrees.5Legend symbol denoting For example, for private vehicle drivers, Singapore sets the age at 65 whereas the United Kingdom at 70 and Western Australia at 80. At the same time, commercial vehicle drivers are typically subject to more vigorous and/or more frequent fitness to drive assessments, conceivably due to their greater driving responsibilities than private vehicle drivers. The challenge for policymakers is to formulate a fitness to drive policy with an effective and credible assessment mechanism that can identify drivers with adverse medical conditions without overly burdening driving licence applicants and holders.
Policy on fitness to drive in Hong Kong
- In Hong Kong, the Road Traffic (Driving Licensing) Regulations (Cap. 374B) (the "Regulations") set out the legal framework on fitness to drive. TD employs the following means to identify the at-risk drivers:
(a) Declaration on health conditions: all licence applicants must declare in their licence applications6Legend symbol denoting All new driving licence applicants must pass an eye sight test before the on-road driving test, which requires the applicants to be capable of reading a car plate from a distance of no less than 23 metres in good daylight with or without the aid of corrective lens. or renewals (a licence normally valid for 10 years) if they suffer from any disease or disability specified in the First Schedule of the Regulations.7Legend symbol denoting The diseases and disabilities include epilepsy, liability of sudden attacks of disabling giddiness or fainting caused by hypertension or other cause, mental disorder, any conditions causing muscular incoordination, uncontrolled diabetes mellitus, inability to read a car plate from a distance of 23 metres in good daylight, and any other diseases or disabilities that affect driving ability. False declaration is an offence liable to a maximum fine of HK$5,000 and up to six-month imprisonment;8Legend symbol denoting See Transport Department (2021a). (b) Notification on changes in health conditions: drivers holding valid licences are also legally required to give notices in writing to the Commissioner for Transport (the "Commissioner") any disease or disability developed which affect their driving ability.9Legend symbol denoting See Hong Kong e-Legislation (2021). Failure to notify is also an offence liable to a maximum fine of HK$5,000 and up to six-month imprisonment; and (c) Age-based mandatory medical assessment: while there is no legal upper age limit for drivers, drivers reaching the age of 70 will be subject to a mandatory medical assessment. They need to submit a medical examination certificate to prove their medical fitness to drive in their applications or renewals. Since drivers aged 70 or above are only issued a licence with a shorter validity period of either one or three years, the frequency of fitness to drive certification is accordingly set at either annually or every three years.
- Amid the trend of population ageing in Hong Kong, the number of licence holders subject to the statutory age-based fitness to drive assessment is on the rise: there were 260 000 licenced drivers aged 70 or over as at end February 2020, up 44% from end of March 2018 and accounted for 5% of all licence holders.10Legend symbol denoting It should be noted that as a person may hold more than one class of driving licence, the actual number of persons under this age group holding driving licences may be less than the number of licence holders. Meanwhile, those aged 61 to 70 accounted for 20% of licence holders according to the latest statistics. Such drivers will be required to undergo the medical assessment to prove their fitness to drive over the coming decade if they wish to retain their driving licences. See Transport and Housing Bureau (2020).
- The statutory medical assessment for a licenced driver aged 70 must be conducted by a registered medical practitioner (colloquially referred to as a doctor) who is required to complete and sign a "medical examination certificate" (TD Form T256), stating the conclusion of whether the driver is medically fit to drive, and if not, the reasons behind. In terms of scope, the assessment covers six areas, namely eyesight, mental state, musculoskeletal system, balance and coordination, hearing, and other areas such as whether the driver suffers from hypertension or any other disease that may affect the efficiency of driving a vehicle. The doctor may conduct, based on his/her professional judgment, any tests which he/she thinks appropriate to facilitate the conclusion.
- Regardless of whether there are adverse health conditions on the drivers reported through self-declaration, notification or mandatory assessment, the Commissioner can refuse or cancel a driving licence if there are reasonable grounds to believe that the driver concerned is not medically fit to drive. According to the Government's reply to a Member's question at Legislative Council in 2012, there had been only five cases in respect of commercial vehicle drivers between 2009 and 2011 where licence applications or renewals were rejected upon self-reporting for being not medically fit to drive. Meanwhile, TD has not released any data on the number of drivers aged 70 or above whose applications or renewals were rejected due to failing the relevant medical assessment.
Issues of concern
- Given that some commercial vehicle classes having higher accident involvement rates and more serious casualties in traffic accidents,11Legend symbol denoting In Hong Kong, taxi, public light bus and public bus drivers had a higher accident involvement rate than private car drivers. The respective rates per 1 000 drivers of these licence categories in 2018 were 20.9, 5.3 and 16.7, compared to 3.8 of private car drivers. In the same year, some commercial vehicle drivers such as truck drivers had a higher fatality rate in accidents than other classes of drivers. See Transport Department (2018). some members of the public have been calling for more stringent medical fitness standards for drivers of commercial vehicles vis-à-vis their private vehicle counterparts of similar age. In late 2012, the Government reportedly reviewed the policy of fitness to drive and studied overseas experiences, but the results appeared not published in the public domain nor any changes have been put forward thus far. Currently, driver education and voluntary measures remain the key channels to promote commercial vehicle drivers' health awareness, such as offering quota-based one-off free health check for commercial drivers in selected trades.
- As the local driver population continues to age in tandem with the overall demographic trend in Hong Kong, thus more drivers being subject to the mandatory fitness to drive assessment, an enhanced mechanism for physical fitness certification for older drivers is considered conducive to maintaining road safety. Hence, the Ombudsman has initiated a direct investigation on physical fitness certification of driving licence applicants and holders, to examine, among other things, whether appropriate requirements are being prescribed for such certification when doctors are currently not required to conduct any specified medical examination before completing the certification.12Legend symbol denoting See Office of The Ombudsman (2021).
Policy on fitness to drive in Australia
- In Australia, driving licensing policy falls under the purview of the respective local jurisdictions. While there is no uniform national policy or legislation over fitness to drive, Australian medical and road safety experts helped formulate a comprehensive set of guidelines on the subject for local driving licensing authorities and health professionals to follow.13Legend symbol denoting Prior to 2003, there were two separate sets of guidelines, one for the commercial vehicle drivers and another one for private vehicle drivers. In 2003, the two sets were combined into one document, i.e. the Assessing Fitness to Drive for Commercial and Private Vehicle Drivers - Medical Standards for Licensing and Clinical Management Guidelines. The standards in the new document were approved by the Australian Transport Council of Commonwealth, state and territory transport ministers, and Austroads, the association of road transport and traffi Known as "Assessing Fitness to Drive for Commercial and Private Vehicle Drivers - Medical Standards for Licensing and Clinical Management Guidelines" and first published by the association of Australian road transport and traffic authorities, Austroads, in 1998,14Legend symbol denoting The guidelines are updated from time to time, with the updated version published in August 2017, and the latest round of update being in progress in 2021. See Austroads (2017) and (2021). the 188-page document provides an important steer to medical practitioners across Australia to conduct the fitness to drive assessment in a consistent and appropriate manner. At the same time, the document helps state authorities design their fitness requirements for drivers, and make licensing decisions based on medical evidence.
- A notable feature of the document is its detailed coverage of 10 medical conditions considered to have long term impacts on fitness to drive,15Legend symbol denoting Based on scientific evidence, the guidelines now cover 10 conditions including blackout, cardiovascular conditions, diabetes mellitus, hearing loss and deafness, musculoskeletal conditions, neurological conditions, psychiatric conditions, sleep disorders, substance misuse, and vision and eye disorders. including conditions which are of growing public concern such as dementia.16Legend symbol denoting In 2013, following a recommendation from an Older Drivers Taskforce, the fitness to drive medical assessment form was revised and dementia or other cognitive impairment has been identified as a separate health issue requiring the general practitioner to specifically respond to. The document not only offers general assessment guidelines, it also provides two separate sets of medical standards for private and commercial vehicle drivers respectively, with the latter's being more stringent due to more time the drivers spend on road, higher demands from their work, and more serious repercussions in case of accidents.17Legend symbol denoting The relevant standard is in line with other prevailing industry practice in Australia that requires heavy vehicle drivers to undergo more stringent periodic medical assessment. For example, commercial vehicle operators accredited under a national driver fatigue management scheme must require their drivers aged up to 49 to undergo medical assessment every three years, and those aged 50 or above every year. Some drivers are mandated to undergo a sleep assessment as well. See NHVR (2021). For example, the minimum standard of eyesight for private vehicle drivers in visual acuity is 6/12, compared to 6/9 for commercial vehicle drivers.18Legend symbol denoting Vision acuity is defined as a person's clarity of vision with or without glasses or contact lenses. Acuity should be tested using a standard vision acuity chart. A reading of 6/12 means a person sees at a distance of 6 metres objects seen by another with normal vision at a distance of 12 metres. Regarding clinical assessment on hearing at initial licensing, it is imposed only on commercial vehicle drivers.
Policy and practice of NSW on assessing fitness to drive
- On top of the medical standards set out in Austroads' document, local authorities are free to stipulate additional requirements, like the types of tests involved and frequency of assessment. Compared to other states, NSW is considered to have the most sophisticated requirements with its three-tier assessment system comprising vision test, medical assessment and driving test. Generally speaking, the assessment frequency for vision test and medical assessment increases with age, while regular driving tests are mandated only for older drivers who have reached a certain age (80 or 85 years old). The key features of each test are summarized below:
(a) Vision test: All drivers must pass a vision test upon their licence applications, and are re-tested on a regular basis or upon licence renewals. For driving licences to operate private vehicles (i.e. mostly private cars and motorcycles): drivers under the age of 45 are re-tested every 10 years, and every five years when at or over 45 years old, and annually from the age of 75 onwards. For driving licences concerning commercial vehicle: most drivers including taxi drivers must be re-tested upon each licence renewal, regardless of their age. In addition, public bus drivers are tested every three years until the age of 60 and annually thereafter; and for those operating dangerous goods vehicles, every five years. The NSW authorities also require a vision test for persons with eye disorders be conducted by an optometrist or ophthalmologist. (b) Medical assessment: For driving licences to operate private vehicles and some commercial vehicles like taxi: drivers are required to undergo yearly assessment upon reaching the age of 75, and before this age self-declaration and notification on health conditions are mandated.19Legend symbol denoting The age threshold for medical assessment in other states are: 70 years old for South Australia, 75 years old for both Queensland and Australian Capital Territory, and 80 years old for Western Australia. Victoria, Northern Territory and Tasmania do not set any age threshold and they rely on health professionals to refer at risk drivers to the authorities. Regarding driving licences to operate other commercial vehicles (for which drivers are subject to more stringent requirements): public bus drivers are subject to the assessment at their initial licence applications and then every three years until the age of 60 and annually thereafter; dangerous goods vehicle drivers are required to be assessed upon their initial applications and thereafter every five years, and annually upon turning 75 years old.20Legend symbol denoting Doctors can fill in assessment form online, with driver's pre-existing medical conditions, if available, shown in the form. (c) Driving test: Apart from vision test and medical assessment, older drivers must also undergo driving tests as an additional requirement upon attaining a certain age. For driving licences to operate private vehicles: drivers must pass the on-road driving assessment every two years from the age of 85 in order to retain their licences. The test mainly focuses on application of road rules, vehicle control and decision making in response to road conditions. Effective from 2008, drivers who do not take or who fail the test may still be issued a modified licence21Legend symbol denoting A modified licence restricts a private vehicle driver to drive only within the local area negotiated with the licensing authorities. There is no such licence for commercial vehicle drivers, though licensing authorities can still attach appropriate conditions on their driving licences including requiring a periodic fitness to drive review by a specialist doctor. See Transport for NSW (2021a). with restrictions imposed on driving distance and time so as to strike a balance between individuals' rights and road safety. For driving licences to operate commercial vehicles: drivers must pass their annual driving tests upon reaching 80 years old. In case they fail the test, their licences will either be cancelled altogether or become restricted to operating private vehicles only.
- On top of the age-based assessment to identify at-risk drivers, the licensing authorities also tasked health professionals (i.e. general practitioners, optometrists, occupational therapists or specialists) to report any patients considered to be unfit to drive. Under the relevant legislation, health professionals making such disclosure will be protected from civil or criminal liability and will not be considered as breaching confidentiality undertakings. Austroads' guidelines set out three conditions under which such disclosure may be considered, i.e. when the patient: (a) is unable to appreciate the impact of their conditions; (b) is unable to take notice of the health professional's recommendations due to cognitive impairment; or (c) continues driving despite appropriate advice and is likely to endanger the public as a result.22Legend symbol denoting Most states in Australia provides similar legal indemnity to health professionals, except in South Australia and Northern Territory even though these two states also imposed mandatory disclosure obligations on health professionals.
- Under NSW's fitness to drive assessment system, there were an average of 5 400 driving licences cancelled per year between 2016 and 2020 by the licensing authority due to medical reasons though it is equivalent to just around 0.1% of the annual average number of valid driving licence during the period. However, the authorities did not make public the age profile of the driving licence holders or the types of driving licences being cancelled.
- Conceivably benefiting from the comprehensive fitness to drive framework, the accident involvement rates of drivers across all age groups had generally been on a decreasing trend between 2005 and 2014 in NSW , according to a report published in 2018.23Legend symbol denoting See Transport for NSW (2018). As far as heavy vehicles including heavy trucks and buses are concerned, the number of drivers involved in crashes have also declined from 2010 to 2019, based on road safety data of NSW.24Legend symbol denoting See Centre for Road Safety of Transport for NSW (2021). In addition, the modified licence policy introduced in 2008 also appeared to have improved road safety for drivers aged 85 or above as drivers of this age group had a lower accident involvement rate than those of same age group with unrestricted licence.25Legend symbol denoting See Transport for NSW (2018).
- Compared to other Australian states, the NSW government also regarded NSW as a top performer in the area of road safety for older drivers. The fatality rate for drivers aged 75 or above in NSW was the lowest among Australian states and territories from 2010 to 2016, while for drivers aged 85 or above the second lowest, according to a parliamentary report published in 2017. Nevertheless, it would be difficult to precisely judge how much of the stellar performance can be directly attributable to the fitness to drive assessment regime in NSW.
Concluding remarks
- Hong Kong's fitness to drive policy is a simple, straightforward and easy to understand for drivers. Most driving licence applicants and holders are subject to no more than self-declaration and notification on health conditions, while drivers aged 70 or above are required to submit valid medical examination certificates issued by registered medical practitioners in their licence applications and renewals. However, there are calls in the community for setting more concrete requirements in the medical certification process to ensure consistency and thoroughness of fitness to drive assessments on drivers as well as support for imposing more rigorous fitness to drive checks on drivers operating commercial vehicles on the premise of their longer duration on the road, heavier work demand and potential impact in case of road accidents.
- Compared to Hong Kong's policy, the Australian model appears to be more risk-based, elaborate and group-specific. The use of a comprehensive set of guidelines to facilitate health professionals in conducting the fitness to drive assessment, more stringent requirements imposed on commercial vehicle drivers, and the three-tier assessment system (vision test, medical assessment and driving test) with varying assessment frequency in accordance with the age profile and class of driving licences concerned can all serve as food for thoughts for developing a robust fitness to drive regime that is conducive to enhancing road safety.
Prepared by CHEUNG Chi-fai
Research Office
Information Services Division
Legislative Council Secretariat
20 September 2021
Endnotes:
References:
| Hong Kong
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| 1. | GovHK. (2011) LCQ11: Drivers' Driving Behaviour, Health Issues and Working and Rest Time Arrangements.
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| 2. | GovHK. (2012) LCQ1: Health Conditions of Professional Drivers.
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| 3. | GovHK. (2017) LCQ11: Health Requirements of Public Transport Drivers.
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| 4. | Hong Kong e-Legislation. (2021) Road Traffic (Driving Licences) Regulations.
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| 5. | Legislative Council Secretariat. (2003) Transport Panel Papers: Tuen Mun Road Traffic Incident Independent Expert Panel.
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| 6. | Legislative Council Secretariat. (2010) Official Record of Proceedings, 5 May 2010.
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| 7. | Legislative Council Secretariat. (2012) Minutes of Special Meeting of Panel on Transport of the Legislative Council. 27 November. LC Paper No. CB(1)1641/12-13.
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| 8. | Legislative Council Secretariat. (2013) Report of Public Accounts Committee on Report of No.60 of the Director of Audit.
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| 9. | Office of The Ombudsman. (2021) Press Release - Ombudsman Probes Transport Department's Requirements for Physical Fitness Certification of Driving Licence Applicants/Holders.
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| 10. | Road Safety Council. (2011) Summary of Discussion of 141th Road Safety Council Meeting.
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| 11. | Road Safety Council. (2012) Summary of Discussion of 148th Road Safety Council Meeting.
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| 12. | Transport and Housing Bureau. (2020) Replies to Initial Written Questions Raised by Finance Committee Members in Examining the Estimates of Expenditure 2020-21: Question Serial No. 0941.
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| 13. | Transport Complaint Unit. (2019) Quarterly No. 2 Report of 2019.
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| 14. | Transport Department. (2018) Road Traffic Accident Statistics 2018.
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| 15. | Transport Department. (2021a) Application for First Issue, Renewal and Addition of Full Driving Licence & Driving Instructor's Licence.
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| 16. | Transport Department. (2021b) Requirements for Physical Fitness for Driving.
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| 17. | 《NOW新聞》：《張炳良：參考外國檢討司機驗身規定》，2013年5月5日。
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| 18. | 《NOW新聞》：《視光機構促提升高齡司機視覺要求》，2019年9月25日。
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| 19. | 《明報》：《的士司機猝死 4日3宗》，2014年12月22日。
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| 20. | 《東方日報》：《擬強制全港司機60歲驗身》，2013年5月5日。
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| 21. | 《香港01》：《運輸署驗身續牌多漏洞 改革只聞樓梯響》，2019年6月19日。
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| 22. | 《香港01》：《的士、小巴司機四成逾60歲 團體促提升高齡司機續牌視覺要求》，2019年9月25日。
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| 23. | 香港執業眼科視光師協會：《駕駛者的視力檢查》，2019年。
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| Australia
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| 24. | ABC News. (2018) Fatal Crashes Involving Older Drivers Rise as Surgeon Calls for Advertising Rethink.
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| 25. | Austroads. (2017) Assessing Fitness to Drive – Commercial and Private Vehicle Drivers: Medical Standards for Licensing and Clinical Management Guidelines 2016 (updated August 2017).
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| 26. | Austroads. (2021) Assessing Fitness to Drive for Commercial and Private Vehicle Drivers (Draft).
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| 27. | Centre for Road Safety of Transport for NSW. (2021) Crash and Casualty Statistics - Heavy Vehicles View.
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| 28. | NHVR. (2021) National Heavy Vehicle Accreditation Scheme.
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| 29. | Parliament of New South Wales. (2017) Joint Standing Committee on Road Safety (Staysafe): Driver Education, Training and Road Safety.
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| 30. | Transport for NSW. (2018) Evaluation of Changes to the Older Driver Licensing System in 2008: Summary Report.
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| 31. | Transport for NSW. (2021a) A Guide to Older Drivers Licensing.
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| 32. | Transport for NSW. (2021b) Monthly Trend in Licence Cancellations and Suspensions (All Licence Holders).
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| 33. | Transport for NSW. (2021c) Older Drivers.
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| Others
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| 34. | European Commission. (2017) Study on Driver Training, Testing, and Medical Fitness.
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| 35. | Insurance Institute for Highway Safety. (2021) Older Drivers.
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| 36. | Langford, J. et al. (2004) Effectiveness of Mandatory Licence Testing for Older Drivers in Reducing Crash Risk among Urban Older Australian Drivers.
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| 37. | Langford, J. et al. (2008) Do Age-based Mandatory Assessment Reduce Old Driver Risks to Other Road Users.
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| 38. | RAND. (2007) What Risks do Old Drivers Pose to Traffic Safety?
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Essentials are compiled for Members and Committees of the Legislative Council. They are not legal or other professional advice and shall not be relied on as such. Essentials are subject to copyright owned by The Legislative Council Commission (The Commission). The Commission permits accurate reproduction of Essentials for non-commercial use in a manner not adversely affecting the Legislative Council. Please refer to the Disclaimer and Copyright Notice on the Legislative Council website at www.legco.gov.hk for details. The paper number of this issue of Essentials is ISE27/20-21.