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IN TOUCH 鈥� DWP High Court Case; The Esterman Visual Field Test for Driving

TX:听 01.11.2022听 2040-2100

PRESENTER:听 听听听听听听听听 PETER WHITE

PRODUCER:听 听听听听听听听听听 BETH HEMMINGS

White

Good evening.听 Tonight, is the test that determines whether someone鈥檚 eyesight makes them fit to drive fair and appropriate?

Clip

The Esterman test was never designed for testing the ability to drive safely.

听

White

We鈥檒l be hearing more from Lou later in the programme.听 And also, from some blind listeners springing to the defence of supermarkets and the help they offer with shopping.

But first, if you鈥檙e comfortable with technology the email has made quick accessible communication far simpler over the last couple of decades or at least it should have done if various public bodies weren鈥檛 so inconsistent and unreliable in their willingness to use it in their communications with blind and partially sighted people.听 Over the years we鈥檝e received a constant stream of complaints about this, notably about health providers and various government departments.听 Well now, Dr Yusuf Ali Osman has been given permission to bring a judicial review against the Department for Work and Pensions for what he says is their consistent failure to communicate with him over his benefits in his communication method of choice and he joins us.

Yusuf, first of all, explain the circumstances in which you want the DWP to communicate with you.

Osman

Like many other people I get letters each year about how benefits are going to increase the following year.听 And because I鈥檓 in receipt of employment and support allowance I also get letters around permitted work.听 So, this is around how much work I鈥檓 allowed to do and how much I鈥檓 allowed to earn.听 I鈥檇 like the DWP to communicate with me in Word format electronically, so they鈥檇 send me those letters by email in Word format.听 What they have been doing is sending me print letters, which I then have to scan or letters in braille, which don鈥檛 arrive sometimes for five to six weeks after they were dated, which, as you鈥檒l know, is really important because sometimes you鈥檙e being asked to provide responses to questions or you鈥檙e being given a time limit to make a mandatory reconsideration.

White

Okay.听 So, what has the DWP said when you鈥檝e asked them to do this?

Osman

Not very much.听 They have sent me electronic communication but it鈥檚 always been pdf format, which can be made accessible but in the case of the DWP isn鈥檛 accessible because they鈥檙e sending me scanned images of text, so, my screen reader can鈥檛 read it.听 I get a message from JAWS saying 鈥� the document appears to be blank; this might be scanned text that requires optical character recognition software.听 Often optical character recognition gets zeros and Os mixed up and Is and ones.听 So, if you鈥檝e got a lot of financial information, that can be quite an important mistake to make.听 And we shouldn鈥檛 have to try and guess whether the O is a letter or a zero, it should just be provided in a format that we can read straightaway.

White

And how long has this problem been going on for?

Osman

I looked at my records when I started this legal case and my first letter, asking the DWP to provide me things in braille or electronic format, goes back to 2005.听 But this particular issue began in 2017 when I was coming to the end of my PhD and I wanted to do permitted work because I felt it was really important that I try to earn an income and get off benefits as far as possible.

White

Okay.听 Well hang on there.听 As I鈥檝e already said, Dr Yusuf Ali Osman is by no means an isolated case and it鈥檚 a subject we鈥檝e raised several times before on this programme.

Mike Lambert will recognise a number of the things that Yusuf has said, he tried to bring a similar case against the DWP two years ago.听 Mike, what stopped you from being able to do that?

Lambert

It broke down because I couldn鈥檛 get the funding to bring things to a judicial review.听 I tried various avenues.

White

So, I mean, you鈥檝e heard what Yusuf has said, explain the problems you鈥檝e had 鈥� I guess some of them will be the same?

Lambert

Yeah, many the same, just not having my request listened to, getting print letters, getting scanned documents, getting things late as has been explained.听 And the latest thing is that they send me things which my JAW software tells me more or less not to open, it鈥檚 sort of warning 鈥� un-virus checked documents 鈥� and it wanted me to sign declarations that if things get lost it鈥檚 on me.听 I鈥檝e asked them if it鈥檚 more insecure than sending things by post or any other means and have asked them to provide examples of the risks I鈥檓 running and it provided no evidence.

White

Have you had this problem with other public bodies?

Lambert

No.

White

Never?

Lambert

狈辞鈥�

White

No.

Lambert

No, the DWP uniquely unhelpful and disobliging.听 And they鈥檙e the very organisation that should be setting an example, that they are the organisation that is charged with addressing the really serious unemployment problem amongst disabled and blind people.听 And they can鈥檛 get such a simple thing correct and I think that鈥檚 really dreadful.

White

We did, of course, ask the Department for Work and Pensions to take part in the programme, instead they told us: 鈥淲e support millions of disabled people in the UK and take the accessibility of our services very seriously.听 We cannot comment on ongoing legal matters.鈥�

Yusuf, can I just come back to you and ask you when is this case likely to be brought, so that we can discover what the DWP鈥檚 case is?

Osman

March of next year, I think the exact dates are the 7th and 8th, so not too long to wait Peter.

White

We鈥檒l be watching carefully.听 Dr Yusuf Ali Osman, Mike Lambert, thank you both very much indeed.

Now lots of response from you to another legal matter 鈥� Auriol Britton鈥檚 account, last week, of her successful court case about the branch of Sainsbury鈥檚 which hadn鈥檛 restored consistent help with her shopping after covid restrictions had been lifted.听 Notably response from two couples where both are visually impaired and with markedly different experiences.听 Lisa Jones tells us:

Jones

My husband, Shuish [phon.] and I are both blind, when the pandemic hit my husband took over shopping duties for us and his mother because she is elderly and I am clinically vulnerable, nobody would go around with him and we accepted that for a short period we must take a printed list.听 I鈥檝e had assistants telling me that I write very clear lists but that didn鈥檛 stop us getting two hands of bananas for two individual bananas or two litres of pop when we wanted 500 millimetres.听 Our local Co-op has continued to insist on a list to this day, even after blind and partially sighted people were permitted to be sight guided when restrictions were changed in September 2020.

White

But Sue Marshall and Alan Dudley鈥檚 experience has been a happier one.听 They say:

Marshall

We鈥檝e had no such problems in Edinburgh.听 We turned up at our favourite stores and were never refused an assisted shop.听 Sainsbury鈥檚, Tesco, Co-op and Marks & Spencer鈥檚 continued to treat us as they always did.听 It may have helped that we were regular customers but these rare outings were a welcome change from the other restrictions imposed at the time.

White

There were more and we鈥檒l try to fit those in when we can.

Now there鈥檚 plenty of evidence that very high on the list of fears people have who are told that their sight is deteriorating is the loss of the ability to drive and the attendant loss of independence.听 So, we were concerned to learn that there were doubts about the appropriateness and fairness of a test used by the DVLA to determine whether applicants for a licence had vision safe enough for them to continue driving.听 Put succinctly, are those tests looking at the right bit of the eye?听 Well, Lou, she asked us only to use her forename, is one of those who thinks the test is discriminatory.听 I asked her what she thought was wrong with it.

Lou

When you have a notifiable eye condition, such as glaucoma in my case, you have to notify the DVLA but the Esterman test was never designed for testing the ability to drive safely, it鈥檚 basically designed for ophthalmologists to establish whether there鈥檚 been any loss and what degree of loss of peripheral vision.听 You basically look at a dish which is like a small white satellite dish and they give you a little buzzer and you have to press the little button in your hand every time you see a flashing light.听 So, what you鈥檙e doing is you鈥檙e looking at a tiny light in the centre of the screen and that鈥檚 why it鈥檚 called a fixed Esterman because you have to keep your eye on that dot.听 Now you don鈥檛 drive like that, you don鈥檛 drive with your eyes fixed on a point in the horizon.听 There has been a lot of research that has already proved that glaucoma patients, for example, have a lot more eye movement to naturally compensate for what they may not be seeing peripherally very slightly.

White

So, can I ask you what鈥檚 your experience been of this and what鈥檚 been the effect on you?

Lou

I was taken into a room which can best be described as a broom cupboard without the door.听 The woman operating it wasn鈥檛 sure how the machine worked, she thumped it a couple of times to get it whirring.听 There was a light source coming in through the non-existent door and right next to that was a coffee machine, used by the staff in the shop, and I heard all about their weekend plans.听 It was absolutely appalling.听 And you have to remember having to press this little button every time you see a light because you think 鈥� did I see one, did I see one?听 You鈥檙e only allowed to press it three times wrongly, in other words, you鈥檙e allowed three false positives and if you get three false positives you fail.听 And that means you go home a couple of days later you鈥檒l get a letter in the post saying stop driving, you can鈥檛 drive from the minute you get this letter you are no longer legal to be on the road, your driving licence is revoked herewith and it鈥檚 absolutely devastating.

White

Has this actually stopped you driving?

Lou

Oh, I got the letter, I failed the test, not surprisingly, I didn鈥檛 fail it very badly but I did have false positives.

White

And what happens then?

Lou

So, it stopped me driving.

White

It stopped you driving but do they say that鈥檚 stopped you driving for good or do you get another chance later on, how does it work?

Lou

You get another chance to take the same test in the same place.听 Now I have passed at my ophthalmologists, in my local hospital, I have passed the test, sent it to DVLA but I had challenged them through a solicitor anyway to accept a test from my hospital and ultimately, they did because I was just a nuisance.听 So, I am still driving now.听 In a progressive condition they test you every year but in fact it鈥檚 every nine months because you have to apply for the test three months before the expiry of your one-year licence.

White

But you would agree that people with the responsibility for who can drive on the road are right to err on the side of caution?

Lou

Don鈥檛 get me wrong, I know that vision has to be tested, it has to be good for driving, of course it does, but there are severe limitations about the Esterman, it鈥檚 completely inappropriate.

White

Just finally, can I ask you 鈥� what do you think ought to happen, what would be an appropriate test?

Lou

Honestly, I wish the DVLA would really take seriously the research that鈥檚 been presented to them.听 I mean there鈥檚 been a great body of research which shows how inappropriate the Esterman is and also how the brain compensates for some marginal vision loss.听 For example, in some countries, they allow on-road assessments.听 So, I applied to the DVLA to do an on- road assessment and they actually did say to me that yes, they would accept the results but I couldn鈥檛 do an on-road assessment because I didn鈥檛 have a driving licence.听 It was a catch 22.

White

Catch 22, yeah.

Lou

Yes.听 I鈥檇 like to see them issuing, for example, a one-day licence or even they have simulators now.听 I consider myself a very good driver.听 I know there are certain conditions where I鈥檓 not happy driving in, such as at night, so I self-monitor but I accept that not everybody鈥檚 going to self-monitor in the same way.听 So, I know that there has to be assessments and certain restrictions but not the Esterman.

White

Well, that was Lou.听 Listening to that is Roger Anderson, who鈥檚 Professor of Optometry at Ulster University, he also sits on the DVLA鈥檚 advisory committee of vision and visual disorders, that鈥檚 a panel of clinical specialists that work with the DVLA to provide advice with the aim of improving road safety and they meet twice a year.听 Roger鈥檚 not representing the DVLA in this interview, he鈥檚 here as an independent expert.

Roger, you were listening to that.听 The Esterman test has been said to favour the lower field of vision, which it鈥檚 argued, by some, makes the test ineffective for accurately assessing your vision for driving.听 What鈥檚 your reaction to that and what you鈥檝e heard from Lou?

Anderson

The Esterman test, I mean it does equally test the upper and lower field of vision.听 Whilst it may not have been specifically designed for driving, I think we would all accept that visual acuity, which is the test where we typically read a letter chart or a number plate, is just a test of central vision and it isn鈥檛 sufficient for conditions where people have lost large parts of their field of vision.听 The Esterman test tests out further into the field of vision than maybe a traditional test would but it鈥檚 actually quite a simple test in that it only tests using spots of light at one fairly bright level, rather than lots of different levels that may be a normal test for glaucoma would do.听 So, the thinking is that if you can see a spot at that bright level, your vision is sort of taken to be relatively normal there.听 So, it shouldn鈥檛 be a particularly onerous test to pass for most people.听 Where the problems arise is when people are borderline.听 So, the result is sent to the DVLA doctors and they have to look at this test and decide whether or not the subject makes the conditions for driving according to the regulations within the UK.听 So, it has to be fairly simple and easy to interpret.

White

But is there a case, maybe, for having a more sophisticated 鈥� a way of assessing people?听 I mean, for example, Lou talked about the possibility of doing on-road tests because that was more in keeping with what you actually have to prove, rather than looking at a set of lights?

Anderson

That is correct.听 The problem with driving is it鈥檚 very multi-factorial, so if you do an on-road test 鈥� so it depends on the test conditions.听 I mean Lou mentioned research studies from Sir David Crabb鈥檚 lab at City University of London, which have looked at visual field on driving and it鈥檚 true that he found 鈥� he did some very good work 鈥� that found that the eyes make dynamic movements, they scan the road while we鈥檙e driving, as Lou said, and that is correct but we scan it with the whole field of vision, we don鈥檛 just scan it with our central vision, so even that scanning requires a very intact field of vision.

White

I mean Lou did explain that from her experience the test is sometimes done in poor conditions.听 Is that a fair comment?

Anderson

It is a fair comment, I think she鈥檚 definitely got a point there, it does need to be done properly.听 I mean the instrument itself is sophisticated, it has very carefully controlled light levels but if there鈥檚 an open door and people walking in and out and the background light changing yes, that鈥檚 not acceptable.听 But if a person doesn鈥檛 do well, they should be given a second chance, I don鈥檛 think the DVLA鈥檚 out to take people鈥檚 licences away, if someone has a bad experience it should be repeated and they should be given a chance to do it properly.

White

Can I ask you 鈥� has to validity of the Esterman field test ever come up on the advisory committee of vision and visual disorder panel which you鈥檙e on?

Anderson

Not as a suitable test.听 I mean the Esterman is used by a lot of countries and I鈥檝e never come across any suggestion that we do away with it, we have to have some kind of field of vision test for certain patients.

White

Lou is, understandably, concerned about people who might fail the test, is it possible that the test might pass people who didn鈥檛 ought to pass?

Anderson

Yes, it鈥檚 theoretically possible.听 There are some little subtle insertions in the test as measures of reliability, [indistinct word] as in a normal visual field test.听 I think the concern is more with people who fail it, particularly those borderline ones and maybe they just require a little bit more care and attention and another opportunity.

White

Roger Anderson, thank you very much indeed.

We did invite the DVLA on to the programme, they couldn鈥檛 make anyone available but they did send us the following statement:

DVLA statement

There are a range of assessments available, which are dependent upon an individual鈥檚 medical condition.听 We may seek additional expert advice as to alternative forms of assessment in certain circumstances.听 If a customer fails an Esterman test and their licence is revoked or application refused, there is no time limit for reapplication.听 Where we receive feedback from a customer regarding testing facilities we will investigate.

White

And that鈥檚 all for today.听 Your comments and experiences please on that and indeed anything else you鈥檝e heard in tonight鈥檚 programme.听 Do email intouch@bbc.co.uk.听 You can leave your voice messages on 0161 8361338 or go to our website bbc.co.uk/intouch.听 From me, Peter White, producer Beth Hemmings and studio managers Tom Parnell and Amy Brennan, goodbye.