Bob you raise some interesting points, and I did very briefly read the requirements for insulin dependant drivers the other day as well. It’s strange that the same requirements don’t seem to apply to those treated with a combination of other treatments where there is a significantly increased risk of hypoglycaemia such as exenatide (byetta) and sulfonylurea (glipizide). But you’re also ‘right’ in that it is possible to time the testing in order to ‘skew’ the test meter results. However, the HBA1C would reveal the true extent of control.

I hadn’t heard that trusts were considering limiting the provision of test strips, although there has been a suggestion that those suffering from T2 don’t need to test daily; but that of course depends on the type of treatment and the overall level of control, indicated by HBA1C.

I have dealt with one of our HGV (LGV?) drivers who was diagnosed with sleep apnoea and following treatment and stability if his condition he was able to return to driving duties pretty quickly, although I did have to chase the DVLA on a number of occasions.

But as far as ‘procedures’ go, if someone reports to me a medical condition or the taking of medication that could affect their safety or that of others, then I will deal with it as objectively and fairly as I can, even if the ultimate outcome might be to the overall detriment of the individual concerned.

However, I think you are right that some people won’t always be entirely candid about medical conditions for fear of not getting a job, losing their job or being restricted in what work that they can do. For them personally, it is a dilemma and as to you say certain conditions can potentially (although not necessarily) mean the loss of their livelihood.

We have had a number of cases of people failing to declare medical conditions on appointment, or since. We have also had cases of people subsequently been diagnosed with various ‘life changing’ conditions and both acute and chronic conditions and in many cases we have been able to work with them, their clinicians, Access to Work etc to keep them in work, albeit not always in the same role or same hours etc. I always feel that that is a real result to which I get a great deal of satisfaction. Unfortunately depending on the circumstances you can’t always help everybody, but there are many cases where you can; and should.

Ramble over!

The question is though is whether the strong action approach actually improves overall safety - Will it tend to cause people to hide things which thus is uncontrolled. It is a bit like No Fault accident investigations - they rarely happen so people hide what actually happened if t6hey feel there was something they may have contributed.

Bob

Sorry if I am being obtuse - My mind says that it may in fact be better to have less strong controls such that people are not concerned at the prospect of reporting and are thus more likely to allow us to develop workable solutions that keep people safe.

To put ity another way Is it better to know all who may be affected, rather than a small set of the affected? The same goes say for AI - if blame is established and acted upon does this not create an atmosphere in which things become hidden.

My brain is simply saying that the controlling the total level of safety in a "community" is better than a part only being controlled and safe!!! ie If we only know that say 2 in 50 of a particular disease is reporting then the other 48 are at risk to a greater extent than if 10 in 50 with the condition report and are managed less strenuously.

Just thoughts

Bob