 Thank you for inviting me to participate in this session today. I'd like to first of all congratulate the organisers for a great program. It's not often you get an opportunity to hear from all the players who are affected and involved in assessing fitness to drive. I've been involved in reviewing the guidelines and was also involved in the review in 2003. So my role today is to introduce the new standard which came into effect on the 1st of March to give you a bit of background about it and to provide a very, very quick overview of some of the changes. You might be aware that the first edition of Assessing Fitness to Drive came out in 1998 and that dealt only with private vehicle drivers. The major review in 2003 combined private and commercial vehicle driver standards and we are still in that position and the current standard is similar. So in reviewing the standard this time as in all reviews we really sought to continue to improve the process and continue to improve how we manage health conditions with respect to driving. We've drawn on evidence from many sources, evidence about how health conditions affect driving tasks, evidence about crash risks including coronial inquiries, evidence from consumers in terms of how the standards affect them, from health professionals in terms of how usable the standards are and from driver licensing authorities and the transport industry. So it's been a comprehensive review and involved many people. Ultimately the review is aimed to retain that and maintain that balance between road safety and driver independence which as you can imagine is a tricky one when you all deal in the field. One of the ways of trying to improve the way we manage it is to make it simpler. So a lot of the changes to the standards are structural and hopefully will make them easy to use for you. The 2003 edition had 23 chapters. We've now reduced this to 10, trying to really focus on the conditions that affect fitness to drive. So you'll notice some of these conditions affect acute ability to drive, blackouts, epilepsy, sleep disorders. Others affect functional capacity like muscular skeletal disorders and vision. Perhaps one of the red herrings in there is hearing which there's not a lot of evidence for how hearing effects crashes. It has been retained because the licensing authorities felt there wasn't enough evidence the other way. So the next review will really focus on hearing. So we've also sought in practical terms to improve the guidance for health professionals so that they can undertake this difficult task more easily. There's more information courtesy of the Monash University accident and research centre literature review about how health conditions affect driving and also what the crash risk is associated with various conditions. The new standards emphasize functional capacity rather than diagnosis so in that way it's fairer and easier for health professionals to manage. We've also tried to incorporate more assessment tools and more guidance around how to assess the patient as well as flowcharts to guide the decision making process. Just one example of one of the flowcharts we've incorporated showing the various causes of blackout and guiding you to the different parts of the standard depending on what the cause is. We've also endeavoured to provide greater clarity. A lot of the feedback from health professionals was that the standards were expressed in a rather complicated way. So the review simplifies language. We've also endeavoured to emphasise that in the wording of the standard that it is the driver licensing authority who makes the decision about licensing not the health professional. And I think often that's one of the very difficult things for you as your patients feel that you're taking their licence away. So the wording of the standard is very much around health professionals providing information about whether certain criteria are met. The driver licensing authority then combines that information with a range of other information to make the licensing decision. So just looking very quickly at some of the specific changes you'll be aware that part of the standard there are recommended or minimum non-driving periods for certain conditions designed to help health professionals gauge how long they should keep someone off the road after a health procedure or a condition. As a general piece of guidance obviously it's a minimum requirement called a recipe book approach. But we found these quite helpful but some of them have been impractical and some of them have not represented the risk of the condition. So just some examples with the major changes. With epilepsy for commercial vehicle drivers the seizure free non-driving period has increased from five years to ten years which seems a lot and it is a lot but it is in line with international standards. Some of the non-driving periods have been reduced. So with acute myocardial infarction for commercial vehicle drivers I think it was three months it's been reduced to four weeks. That doesn't mean that every commercial vehicle driver goes back to driving his truck after four weeks but it reflects that we are now able to assess drivers at four weeks as to whether they are capable of going back to driving so that's fairer for them. Also we've introduced non-driving periods for some conditions and a good example is drug and alcohol dependence and that means we can biomedically test people's remissions so that's a fairly feasible non-driving scenario. Periodic review is another way we manage people with health conditions people with conditions like diabetes, progressive conditions like dementia. The periodic review process through VicRoads is designed to help monitor diseases so people can stay on the road for as long as possible and also to pick up any changes in their condition for example like psychiatric conditions. So for some of these periodic review areas we've relaxed the requirements for commercial vehicle drivers where specialist review is required. We've found that that's impractical for common conditions like hypertension and diabetes controlled by drugs such as Metformin so GPs are able to review those patients. We've also increased periodic review for some conditions or introduced periodic review. Dementia now requires reporting to VicRoads for assessment for conditionalised at the time of diagnosis. In the past it was reportable at the time of significant impairment. This aligns with other conditions like diabetes where it's a progressive disorder that needs to be monitored frequently in order to monitor their risk. There have also been a range of changes for in the licensing criteria. I didn't mention earlier some of the chapters that had actually been removed so they're now no longer specific criteria for diseases such as renal failure, liver failure and respiratory failure. By and large the effects of those conditions are on things like cognition which are covered elsewhere in the standard so that's how we've banished to reduce the numbers of chapters. Other conditions that no longer have criteria there's not a cancer chapter because in the end cancer affects various end organs and it didn't make sense to have a chapter on cancer. Some conditions like pregnancy and anesthesia there's no longer specific criteria for that. There's some general guidelines in Part A about temporary conditions like that. For other conditions where the feedback was that the standard was a bit vague and was causing inconsistent decision making we've introduced more specific criteria so monocular vision now has a specific criteria and so does things like subarachnoid There's a document on the Austro's website that summarises all these changes so I urge you to have a look through that. It's about 10 pages which is easier than trying to hunt through the book. One of the areas that may affect you in regional Victoria is access to specialists and this has been quite a controversial issue. In 2003 when we combined the commercial vehicle standards with the private vehicle standards one way of differentiating in terms of risk for commercial vehicle drivers was to require that for conditional licences they needed to be reviewed by a specialist. Access to specialists is obviously a challenge and you can imagine through this review we had a lot of arguments for getting rid of specialist review entirely particularly from Central Queensland and balanced against the very strong view of the medical experts that many of these conditions really couldn't be managed by the GP and they needed that input in order to ensure safety on the road. So we've made as I said earlier for common conditions like hypertension and diabetes control by Metformin a specialist assessment for conditional licences is required initially and then if the specialist and the GP and the DLA agree they can be reviewed by the GP subsequently. If there really is limited access for any other condition so it's not necessarily diabetes or high blood pressure if for any reason access to a specialist is difficult then the DLA will engage in a discussion about what sort of input is required to advise about a conditional licence for a commercial vehicle driver. Also one of the confusions that happened in Queensland in referring commercial vehicle drivers to a specialist they were actually taking them off the road for an assessment like early diabetes which is not the intention of the standard. So a commercial vehicle driver who's applying for a conditional licence doesn't need to stop driving if they've got a condition that's not immediately going to affect their fitness to drive. So in the part A you'll find quite a bit more clarity around how specialists need to be used for those sorts of assessments and we also encourage you to use telemedicine as well that's an option. So in terms of what NTC and Austroids are doing to get the word out I'm told that the books are on their way and I think OTs have received them this week could but the other recipients are all GPs in Australia will get a hard copy. Medical specialists in relation to the relevant areas will get a copy OTs, optometrists and diabetic educators. The book will also be available to be purchased online through Austroids so at $15 a copy and I think bulk orders can be negotiated as well if you have a need locally. So I think in years gone by bureaucracies like the NTC and Austroids felt that once they distributed that was implemented in their mind. So we have chipped away at that over the years and I think we are making some progress but I think implementation really relies on you at a local level to conduct this sort of session to engage you locally in education. So I think we are still very much reliant on that. However we are over the next six months there will be quite a lot of general communication through health professional organisations, through transport organisations, through a variety of groups to alert them to the new standard and through consumer organisations as well. We've produced a very short fact sheet which just talks about responsibilities of the patient in relation to driving. It's quite a handy fact sheet to give to patients when you're talking about fitness to drive but VicRoads and the various consumer organisations also produce some terrific resources. So I urge you to go out and have a look for those and there's I think a lot of them displayed in the room outside today. One of the things we're slowly making progress on and I think is really essential for GP management is to try and integrate some decision making tools into GP practice software, doctor practice software and we're already having some quite useful discussions with the major software provider. So I think that will be if it comes off quite revolutionary in how we can encourage doctors to manage this in a routine way. We'll also be continuing to liaise with major stakeholders. If anything comes out today for example we'd be very keen to hear about it in terms of ideas. NTSC and Austroids now see maintenance and implementation as an ongoing function rather than just turning off their ears and waking up in five years time to think about it. So which is great. And I think also finally you're very fortunate in Victoria to have really great support at VicRoads through the medical review area and through the Victorian Institute of Medicine. Very few states have this level of support where they can actually get sensible advice about individual patients and about the processes. So I encourage you to use them and support them because it's quite a unique service and we have struggled to get other states to take that on. So if you want to find out more about the review and supporting resources the Austroids website is the place to go that it has a review project report which explains all the changes from a medical viewpoint and explains the impact on licensing authorities and consumers and health professionals. And if you really want an interesting read have also a look at the Monash University report. And finally just acknowledging the very many players who have been involved in particular Dr Bruce Hawking who's been the medical advisor on the project. Thank you. Thank you.