Type 2 diabetes, the most common type of diabetes, is at an all-time high; those who drive vocationally are twice as likely to develop diabetes. In this article, Rowenna Allen of Weightmans’ health and safety team has collaborated with the CEO of the Diabetes Safety Organisation, Kate Walker, discuss the relevant risks within the transport sector.
Driving risks relating to diabetes
A survey of Road Haulage Association members estimates that as many as 2 in 5 employees in road transport have diabetes. Diabetes affects 4.6 million people in the UK – this poses health and safety risks which should be recognised by organisations. There are various driving risks and diabetes can impact driving safety in various ways. These include:
- Severe hypos, or having very low blood sugar. The risk here is that an employee suffers sudden incapacitation requiring another person to assist. Even non-severe hypos lead to impaired functioning such as impaired awareness, coordination, fatigue and shaking.
- Foot nerve damage. This affects 50% of people with diabetes and driving simulations have shown it can lead to 3x more loss of control events.
- Visual impairment – those with diabetes can suffer blurred vision, sudden loss of vision, restricted field of vision, obstructed vision, difficulty seeing at night and glare.
- Hyperglycaemia, or very high blood sugar, can lead to impaired functioning such as difficulty with coordination, fatigue and shaking.
- Diabetes comorbidities - concurring conditions such as heart failure, stroke and sleep apnoea can also lead to sudden incapacitation and impaired functioning.
Criminal liability risks
From a health and safety perspective, in the UK, employers have a legal duty to ensure that so far as reasonably practicable, their employees and others affected by the employer’s operations, are not exposed to risk to their health and safety. This is governed by the Health and Safety at Work Act 1974. Breaches of health and safety legislation can lead to prosecution by the regulator, the Health and Safety Executive, which can result in significant fines based on company turnover. Company directors can also face custodial sentences, so compliance with safety legislation is vital.
Diabetes is ultimately a known and foreseeable risk which employers should mitigate where appropriate. Putting this risk into perspective - for every 1,000 employees, it is estimated that 82 will have diabetes and 25 will be at risk of a ‘hypo’ event due to their diabetes – this effectively translates into an estimated 49 mild to moderate hypos per month, and between two to five severe hypos each month in the workplace. These statistics illustrate how real the risk is to both employees and employers. There is a potential increased risk of an accident if an employee suffers diabetes-related symptoms whilst operating vehicles or machinery. If one of these hypos occurs whilst a worker is operating plant or driving, the consequences could be life-threatening or life-changing.
Obligations on employees / employers
Those with diabetes have a legal obligation to inform the DVLA. The DVLA states that people taking insulin must check glucose levels no more than two hours before driving – and this must be checked every two hours whilst driving. This reduces the risk of hypos if blood sugar is being effectively monitored. Depending on treatment type, some drivers are required to notify DVLA and may be required to attend medicals.
Under the Equality Act, those diagnosed with diabetes (or any disability) do not have to inform their company about their condition. However, many do and encouraging employees to do so will assist employers to fulfil their duties to make reasonable adjustments and to ensure, so far as reasonably practicable, that employees and those affected by what the employer does are not exposed to risk their health and safety.
For example, if an incident were to occur whereby an employee had a diabetic episode on-site which resulted in a serious incident, and the employer had taken no steps to assess or reduce risk, the employer could be at risk of having committed a criminal health and safety offence.
Employment law risks
Employers must not discriminate against disabled drivers and must ensure that reasonable adjustments are made. Nick Newman, a Partner at Weightmans who advises clients in the transport sector on employment law issues, notes that diabetes will often amount to a disability under the Equality Act 2010, if it has a substantial, long-term adverse effect on the driver’s ability to carry out normal day-to-day activities. It must be remembered that the impact of medication should be ignored when assessing whether an individual is disabled for the purposes of the Equality Act. In practice, any driver who is insulin dependent will certainly be disabled.
For example, an insulin-dependent person with diabetes is likely to need to undertake regular blood-sugar monitoring and if this impacts on their performance (i.e. if they take a little longer to perform their tasks), their employer should take this into account and make adjustments to facilitate this in the working day / arrangements. Similarly, if a driver with diabetes is unable to drive because of their blood-sugar levels and is delayed as a result, it is likely that disciplinary action that might be applied to non-disabled employees would probably be viewed as discriminatory. Put simply, allowances should be made and need to be balanced against business need.
This may also include giving consideration to changing shift patterns, or avoiding night driving given the potential for diabetes to impact upon eyesight (subject to consideration of DVLA guidance of course).
Although most individuals who have diabetes are relatively comfortable in sharing that information, it is nevertheless special category data under the GDPR; and the necessary considerations in respect of privacy should be considered.
If an employer is unsure how to support an employee who has diabetes, it is important to communicate with them in a sensitive manner so as to understand their own personal circumstances and, if necessary, discuss any concerns that you may have as the employer. It would usually be sensible to seek medical advice (i.e. from Occupational Health) so that professional guidance can be considered.
Industries at risk
The construction industry is more at risk, as it has a relatively high turnover of staff and subcontractors. Further, in the construction industry, employees are also more likely to be in control of dangerous plant and machinery, which could open the risk of severe consequences should an employee suffer a diabetes-related episode.
The transport and logistics sector is also comparably high-risk, especially where agency drivers are involved, or if there is a high turnover of drivers. The industry also involves various risks, including moving of heavy vehicles, exposure to various environments and road conditions, risks around fatigue and ensuring drivers are sticking to drivers hours, and limited access to immediate help on the road; vulnerable road users also use the roads every day.
Supporting employees with diabetes
Employers can help by increasing awareness and understanding of the condition amongst staff. Those in high-risk roles can be educated about the risks, and employers should foster a non-judgmental environment where employees feel comfortable sharing their condition.
Employers can also ensure they provide suitable places at work for staff members who have diabetes to test their blood sugar levels and inject medication.
Workers who drive should be reminded that they should ensure they are stopped in a safe place where they test blood sugar levels, and specific diabetes health and safety risk assessments and safe systems of work should be put in place.
Challenges to tackling diabetes safety
There is limited education on the impact of diabetes on driving at the point an individual is diagnosed. A person may not tell their doctor they drive for a living, out of fear of losing their licence and livelihood. An estimated 40% of drivers with diabetes are unaware of the requirements to report their condition to the DVLA and how to manage the condition on the road.
Key take-aways – what can employers be doing?
Work practices such as breaks, shift patterns, stress and access to nutritious food all contribute to a driver’s ability to manage their diabetes effectively.
Employers could put in place driving checklists for employees who are at risk of hypos. This includes encouraging employees to understand the symptoms of a hypo, keep spare test strips in the vehicle, check blood sugar levels before setting off and every two hours on long journeys. Always keeping hypo treatments where they can be easily reached in the car, taking breaks on long journeys and not delaying meals or snacks would also minimise risk.
Employers should consider possible risks arising from diabetes when carrying out health and safety risk assessments at work and taking any necessary control measures. An example of this could be a requirement for a worker to test blood sugar levels before operating high risk machinery, or ensuring drivers are testing blood sugar levels before driving and at appropriate periods throughout the journey. Employers should also ensure that suitable policies are in place – such policies can include for example, clarification that drivers must legally stop somewhere safe if they experience a hypo whilst driving.
Companies could consider incorporating provisions around diabetes safety into their drivers’ hours policies – both to ensure that drivers are taking suitable rest breaks, but also to ensure that those with diabetes are clear about obligations around blood sugar testing.
Educating workers about symptoms of diabetes can help encourage and signpost those who might be unaware they have the condition to seek a diagnosis and advice on managing their diabetes. It is also important that managers are educated so that they can appropriately support staff and carry out suitable risk assessments.
