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Q&A WITH DR PHILL MARS: Why are taxi drivers reluctant to seek medical help and the changes needed
Concerns that seeking mental-health support could jeopardise a taxi or private-hire driver’s licence continue to discourage some drivers from asking for help. In a TaxiPoint Q&A, Dr Phill Mars discusses the reluctance he has encountered among drivers, inconsistencies between licensing authorities and the changes needed to give licence holders greater confidence in the medical assessment process.
Dr Mars is Medical Director at Driving Health, a UK subscription-based healthcare service for taxi, private-hire and other professional drivers. Drawing on his experience of providing Group 2 driver medicals across several council areas, he now offers drivers access to remote GPs, mental-health professionals, annual Group 2 health monitoring and financial support towards licensing medicals. The service operates independently of licensing authorities and medical-assessment providers, giving drivers a confidential route to seek advice and treatment.
From your experience providing Group 2 medicals, how widespread is the reluctance among taxi and private-hire drivers to seek help for mental-health concerns because they fear losing their licence or livelihood?
“We found this to be a common problem: drivers would present with very clear mental health issues and, when gently encouraged to seek help, would be reluctant because they felt that their licence might be at risk. Often we could explain how the standards actually work and reassure them that early intervention could prevent a situation where their licence is at risk. It is very rare for a problem to develop so rapidly that it goes from absent to catastrophic overnight. The key is to seek help early, both to remain compliant with licensing standards and for a better prognosis.”
The licensing authority response to a drivers’ medical history around mental health could be described as a “postcode lottery”. How do these inconsistencies affect drivers experiencing mental health difficulties, and what would a fairer national approach look like?
“The problem is not just with mental health, but with the whole assessment process. When we provided driver medicals we worked across 4 or 5 council areas. The standards were broadly mapped to the DVLA group 2 standards (often the council form is the DVLA one with the logos changed), but local nuances defy explanation. As an example, not mental health related, but an essential part of the assessment, we had three different councils that assessed diabetes differently. We had the absurd situation where a driver licensed with one council could drive whilst a driver licensed by the council a couple of miles down the road would have to wait to see his GP to get a blood test because the council still insisted on urine testing (no longer considered reliable in the medical world), which gives results that are far less accurate than the blood test, with frequent false-positives.
“With specific reference to mental health, we found that councils had different thresholds for acceptable mental health histories which bore little relation to the group 2 standards. This meant that, once again, a driver could retain their licence with one council whilst a couple of miles down the road the local council would have declined. In these days, when any council licence will allow you to drive more or less anywhere, it seems completely ridiculous to have these varying standards. A national approach would directly map to the DVLA standards as per the group 2 licence, without the extra bits some councils add in.
“The same form should be used across councils, as the existing D4 form would be a perfectly suitable basis, using nationally set standards rather than locally set. In an ideal world I would establish a national taxi driver licensing body and take the job out of the hands of councils completely. When you send a D4 back to the DVLA, there is a medical team who can advise; council taxi licensing departments rarely have any medical staff and really don’t fully understand the standards they are applying.”
How would an annual Group 2 “MOT” help identify potential concerns early while giving drivers a safe and confidential route to seek support?
“The annual group 2 MOT that we provide is not so much a test as a prompt to think about health; this is self-reported, so does not tell anyone but the driver if there are issues. As part of it there is a mental health check-in asking the driver to consider whether their mental health has changed since the last assessment and signposting to our GPs and Mental Health professionals.
“Our service is not linked to the driver’s GP (although they can update the GP should treatment be started), and is independent from any driver medical providers or licensing bodies—this is a safe space to get treatment. The most important benefit is the move away from the only prompting to think about health and get any problems sorted being the licensing reminder, instead the driver gets an annual check-in, which is directly linked to the services they need to help correct issues.”
What changes are needed from councils, medical professionals and the wider taxi industry to ensure drivers can ask for mental health support without automatically putting their licences at risk?
“We need to move away from the idea that a driver is assessed every 3 or 5 years, depending on what the council requires, and then isn’t seen again until the next assessment. Councils need to step away from this image they have as a distant, indifferent edifice that exists to catch drivers out (that really is how many drivers told us they felt)—a more open approach, with access to support and advice would be more likely to prevent problems from escalating; we have built our service to provide precisely this.
“The taxi industry should become more driver-conscious; we spoke to many drivers who felt that they were pretty much on their own when it came to anything other than picking up fares and coordinating when on duty. Similar to the wider transport industry, we need to change the mentality away from seeing drivers as an invisible and dispensable part of the business and regard them as absolutely integral to the ongoing existence of the business which, in reality, they are.
“Companies who are prepared to invest in looking after drivers will likely find that the savings in recruitment and hours lost to sickness would more than offset the cost of supporting driver health—we offer our services on either an employee or employer funded basis, so many ways of achieving that level of support are available.”
