This article follows the Project EDWARD discussion on Friday 05/05/2026.

This discussion focused on various aspects of the deteriorating situation with regards to driver health and some alarming trends uncovered by our two guests - Professor Stacy Clemes who is Professor of Active Living and Public Health at Loughborough University and Dr Grant Charlesworth-Jones.

As we get older, we know our health deteriorates. Commercial drivers are statistically well below average with worse health conditions and more co-morbidities. As they retire, they are being replaced by younger drivers, but new research is showing this younger cohort to have even worse health than those they are replacing. This is unexpected but critical information for those managing driver health as it leads to poor performance, service disruption and higher costs through staff absence and significantly increased corporate risk.

A recording of this discussion can be viewed in the Project EDWARD Showcase

These articles are available early for ARRM members only

The Data: What 500 Consecutive Medicals Revealed

Dr Charlesworth-Jones described a simple exercise. From D4's annual throughput of roughly 120,000 medicals, he took a sample of 500 consecutive bookings including bus, lorry, coach and taxi drivers, independent of age and postcode. Not a curated sample – just the next 500 people through the door.

Four of those 500 were sent directly to A&E with what he described as pre-terminal blood pressure – readings at or beyond the point where the electronic monitor stops registering, indicating the likelihood of an imminent and catastrophic cardiac or cerebrovascular event. All four had driven themselves to the appointment.

More troubling still is what happens to the drivers who pass. As Dr Charlesworth-Jones explained, the current regulations permit a driver to work far into ill health before the threshold for medical disqualification is reached. A driver may have stage three hypertension, kidney damage, and every clinical indication that they should have been under GP care for years – and still hold a licence. The medical is not calibrated to detect emerging risk. It is calibrated to detect terminal decline.

12 hours	Average daily sitting time measured in HGV drivers, compared with around 10 hours for typical office workers
5.5 hours	Average nightly sleep duration recorded in commercial drivers; 45% of one Loughborough sample slept under six hours
~50%	Proportion of drivers aged 25–34 with obesity in recent Loughborough data – far higher than comparable non-driving occupational groups
1 in 4	Drivers who, on D4 data, will not be fit to drive within a year of passing their medical – yet face no further check for at least five years
~20 million	People estimated to drive for work in the UK across HGV, PSV, taxi, van, company car and grey fleet

The Flawed Assumption: Younger Drivers Are Not Healthier

Perhaps the most arresting finding concerned age. There is, as Dr Charlesworth-Jones put it, a natural assumption that younger people must be fitter than older people. The data is dismantling it.

D4 has this year referred a 33-year-old female driver who suffered a heart attack, and sent a 29-year-old to hospital with pre-terminal blood pressure. Loughborough's data on a sample of around 600 drivers found that among 25 to 34-year-olds, close to half already have obesity – dramatically higher than a comparison sample of men in occupational roles who do not drive.

The implication for the medical schedule is severe. These drivers, already carrying substantial cardiometabolic risk in their twenties and thirties, will not present for their next medical until 45. Everything that happens in between is, in Dr Charlesworth-Jones's phrase, uncrystallised risk – present, accumulating, undetected, and entirely outside the regulatory framework's field of view.

His conclusion for operators was blunt: when it comes to risk assessment, age has to be taken out of it. A driver with diagnosed, managed, monitored diabetes is a better risk than one who has never been tested and assumes youth confers immunity.

Why the Job Itself Is the Risk Factor

Professor Clemes's contribution reframed the issue from individual lifestyle choice to occupational exposure – a distinction with significant implications for where responsibility sits.

The vocational driving role combines a cluster of independently serious health risks: prolonged sitting, limited opportunity for activity, poor food availability at rest stops, shift work, chronic sleep deprivation, high stress from routing and scheduling pressure, exposure to the unpredictable behaviour of other road users, and social isolation. Any single one of these would be a meaningful health risk in isolation. Drivers contend with all of them simultaneously, every working day, for decades.

This matters because it moves driver health out of the territory of personal responsibility and into the territory of occupational risk management – precisely where employers and the Safe System framework already operate comfortably when the subject is the vehicle.

"We spend so much effort focusing on the vehicle – which I completely agree with, yet the driver, ultimately the most important component of the driver-vehicle combination, seems to be neglected." Professor Stacy Clemes, Loughborough University

Her presentation contrasts a vehicle's daily pre-use check – all green, all verified – with a health profile of just under 400 HGV drivers showing far more red and amber than green. Very few drivers in that sample had healthy blood pressure. Rates of overweight and obesity substantially exceeded the national population and exceeded even comparable occupational groups.

Her qualitative work adds a further dimension. Drivers describe feeling neglected, underserved and not valued, which is itself corrosive to mental health, and which compounds the physical risks rather than sitting separately from them.

The Business Case Operators Are Missing

Both speakers were careful to avoid moralising. Neither is proposing that the vocational driving workforce be converted into athletes. What they are proposing is proportionate, interval-based monitoring – and the business case is straightforward.

Dr Charlesworth-Jones offered a concrete example. D4 conducts thousands of medicals on Saturday mornings, because that is when drivers prefer to attend. When a driver fails on a Saturday, the operator has an unfilled shift by Monday – with barely 48 hours to cover it and deliver on commitments. Set the cost of that disruption against the cost of periodic wellness check-ins that would have flagged the emerging problem months earlier, and the return on investment is not marginal – It is obvious.

There is a second, less comfortable argument. D4's occupational health work following incidents, near misses and bridge strikes rests on a well-evidenced relationship: the poorer a driver's health, the higher their crash risk, and the more serious the outcome is likely to be. Working backwards, where a driver has been involved in an incident, there is a reasonable probability that health was a contributing factor. Some of the more sophisticated operators now conduct a post-incident medical review as standard – and have picked up straightforward problems such as uncorrected eyesight defects through exactly that route.

The regulatory point that follows is one ARRM members in fleet and compliance roles should note carefully. Dr Charlesworth-Jones's argument is that passing the legislative threshold does not mean an operator is fit for purpose – because the legislative threshold is inadequate. An operator who has been proactive beyond the legal minimum, and who can evidence that their drivers were monitored and managed, stands in a materially different position after an incident than one who did only what the law required.

What Works: SHIFT, Wellness Checks, and Small Changes

The discussion was notable for offering practical, available interventions rather than only diagnosis.

SHIFT – the Structured Health Intervention For Transport – is an evidence-backed programme developed in partnership by Loughborough University, Leicester Diabetes Centre and University of Leicester over a decade, registered as a DVSA-accredited Driver CPC module in 2023. It is derived from NHS diabetes education, tailored for drivers, and delivered by experienced driver trainers who receive their training from NHS staff from the Leicester Diabetes Centre. It contains no PowerPoint. It is discussion-based, and it works by helping drivers identify small, sustainable changes within the genuine constraints of their job – not by prescribing regimes that ignore how the work actually functions.

Professor Clemes's favourite illustration involves a driver whose daily routine included an almond croissant. Two years after the programme, he still has his almond croissant – he simply buys one, cuts it in half, and has half a day. Combined with modest additional movement, he lost around two stones and is now enjoying a healthy retirement. That is what proportionate intervention looks like.

Alongside SHIFT, Loughborough and D4 are piloting onsite driver wellness checks: roughly 30 minutes per driver, at their workplace, covering finger-prick blood tests for diabetes risk and cholesterol, urine analysis for kidney function and dehydration, brief mental health screening, body composition, waist circumference and sleep apnoea screening – followed by personalised feedback and signposting to NHS and charity support services. Drivers respond well, particularly to the framing: they prefer the term wellness check to health assessment, and knowing that the team will return in six months appears to motivate genuine improvement.

The Barriers – and They Are Not What You Would Expect

The audience discussion that followed exposed the obstacles honestly. Jonathan described substantial interest from large national logistics clients that evaporates at the point of releasing drivers for training. Operational pressure, particularly in last-mile delivery, produces pushback from transport managers who need vehicles on the road.

More revealing was Professor Clemes's account of cost resistance. SHIFT carries a nominal licence fee – the universities and NHS partners responsible for SHIFT are not-for-profit, the charge covers staff time, NHS trainer mentoring and curriculum updates. Structured by business size, it works out in some cases at less than one pound per driver. Operators still go quiet when the fee is mentioned. Set against the scale of investment routinely made in vehicle technology, that resistance is difficult to justify.

There is also a fear that speaks volumes about the current framework: operators worry that if they measure their drivers, they may find problems and lose them from the road. As Jonathan put it in response – a brief inconvenience is surely better than an incident and a death on the road. Dr Zaheer Akhter, one of D4's clinicians, described a case from the previous day in which a manager's simple prompt to check on a stressed driver uncovered severe sleep apnoea, unreviewed since before COVID. The system worked because a human being noticed something and acted. It should not depend on that.

What the Road Safety Strategy Must Address

First, the medical assessment schedule requires reform. Aligning with international norms would mean a medical every three years from the point of qualification, rather than a two-decade exemption followed by a threshold test – is not a radical proposition. It is a return to what most developed nations already consider basic.

Second, the strategy's consultation on eyesight testing for drivers over 70 is welcome but reveals the gap. Vocational drivers can pass from 20 to 45 without an eye test, and eyesight is the second most common cause of medical failure in D4's data. A strategy that scrutinises the vision of a 71-year-old private motorist while ignoring a 40-year-old professional driving 500 miles a week has the wrong priorities.

Third, the strategy's technology and data theme should extend to driver health. D4 is developing digital risk profiling with wearables and behaviour-change coaching. The current system, as Dr Charlesworth-Jones observed, still runs on paper forms completed in ink and sent through the post. If the strategy is serious about data-led safety, this is an obvious and underexploited frontier.

Fourth, work-related road safety needs explicit recognition within the strategy's implementation. With around 20 million people driving for work, the occupational dimension of road risk cannot be a footnote. Operators respond to regulatory clarity and commercial logic – both are available here.

The Driver Is the Asset

Dr Charlesworth-Jones made a point during the discussion that deserves to be the organising principle for how the sector approaches this issue. Every vehicle in a fleet is quality assured. It came off a production line. It was designed on a computer, tested, certified, and it is inspected daily.

The person behind the wheel was not designed on a computer. They are the one component of the driver-vehicle combination that carries genuine, variable, accumulating and largely unmeasured risk – and they are, simultaneously, every operator's most valuable and least replaceable asset. Recruitment in this sector is difficult and getting harder. Treating drivers as consumable is not merely a safety failure; it is a commercial one.

National Driver Health Awareness Day on 4 September, founded by Dr Charlesworth-Jones and Professor Clemes, will publish the first formal outcomes of their joint research. ARRM members working in fleet, compliance, occupational health, road safety partnership and policy roles should engage with it. The data is arriving. The interventions exist and are accredited. What is missing is the will to treat the driver with the same seriousness we already apply, without question, to the vehicle.

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