Skip to main content

tv   U.S. Senate  CSPAN  November 11, 2010 12:00pm-5:00pm EST

12:00 pm
harsha from the governors highway safety association. first question is, why haven't we made progress in developing screening and assessment tools that have been evaluated, generally accepted and widely used and can there be anything done to expedite this? >> i guess i'll start. i think we are making some progress as i mentioned. some of the more comprehensive studies that are underway now but i think that some of the challenges are that the research that's needed to come up with really valid and reliable tools, as i said, is often expensive and time-consuming and we're not always able in this field to do the kind of randomized control trials that are essentially the basis of work in other areas
12:01 pm
like in biomedical areas. we can't necessarily randomly select older drivers. by its very nature older driver research often depends on recruiting volunteers and then we get into self-selection bias and things like that. i think apart from that there also has been some disagreement on the best way to validate measures. you know, what is the gold standard for looking at outcomes? should it be, should it be crash risk? should we be differentiating, you know, scores by crash involvement? and you know, to that end then we need large samples. . .
12:02 pm
>> so there's a lot of these different issues that i think make it maybe a little messier than in other areas. >> i think also the same that the same methodological issues that i was describing before for the interventions apply to screening as well. so unique individual in paramount's of sufficient prevalence in the community better looking at to find an independent on the outcome that you choose, you need a large enough study. if you're dealing with a relatively uncommon functional impairment or condition and a relatively uncommon event such as a crash, then linking those
12:03 pm
two together requires a large sample to be able to do that. part of the problem is gathering enough of that. some of the best efforts have been state based, large state-based programs where they're having a large number of drivers that come through, test a number of things and follow those people are at record available to monitor that in looking at different systems in doing that. the downside is a gathering that information sufficiently in that environment, particularly if you have a limited amount of time with those large numbers of individuals, you particularly have a less detailed information on them. and linking those two together. so i think gathering that information, putting it together, and ultimately considering sort of a larger scale studies is the way to try and narrow that a bit. >> is there a danger using tools that have any value a and r. these tools better than no screening at all?
12:04 pm
>> i think that's a tough one. because i think there can be negative consequences when screening tools are not valid. you know, they can either cause someone to worry when they shouldn't, or not too worried when they should. so i think it is a dilemma, and if we have talked about before, people need resources to use, and yet if the science isn't there, and so i think with -- i think with screening, that's really one reason it is so important to confine the outcome of screening to being this first step, and not to use it in and of itself as a licensing decision. i think that would be extremely dangerous. >> hesitating as we push for the next. you know, i think there is a danger to labeling. and i think it does have a
12:05 pm
tendency to stigmatize people, and it depends on the nature of that. we haven't really delved deeply into the impairment. but it is something that is fraught with a lot of angst for people, and i think if you label someone as being impaired, regardless of the nature of the impairment, that that can affect the very adversely. and so i think one needs to do that in a sensitive context of what you're trying to do with that information. and also, that not use those terms loosely or lightly. and i think that, you know, there's a wide range of ability within any capability. even when we get to the issue of dementia or cognitive impairment is a very wide range of manifestation in terms of that many of which may have no effect on driving capability until much later stages. and distinction that becomes a difficult. so i think the difficult is not serve labeling based on the presence of the but using that information to then work but not necessarily just sort of
12:06 pm
stopping at that level, but actually fairly out in more detail what's the importance or meaning of that particular deficit may be. >> i wholeheartedly agree, and just want to add the caution that self screening tools under tools run the same risk. so i think just to be cautious about overinterpreting or how we can miss administer them, they could be very valid given as there was supposed to be, and we have no control how people are actively using them. we have to be careful for the language that we are giving people about what the results mean. >> yeah, i just want to echo what was just said, and i was going to add to that, that self screening tools are intended for people who are cognitively intact. and so they are not an inappropriate instant for people with dementia who lack insight into their abilities. and they can be even detrimental
12:07 pm
if they are reinforcing inappropriately the drivers safety drive when they're not. and so in using self screening, there needs to be communication within the community of professionals about who to recommend that kind of self-screening to, and to make sure that hopefully it's done by people who get appropriately use it. >> my next question. when we are talking about screening assessments, are there any markers are indicators that identify those that may not be qualified to drive, or those that would be able to continue to drive? >> would you repeat that question? >> we were talking about the screening or assessment tools that you out there presently, are there any markers are indicators that would identify those that would be able to be
12:08 pm
disqualified to drive, or those that would be able to continue to drive? >> i think some of the work on the screening tools is trying to, at the initial stages, what we call sometimes identified are locking out the ends of the curve. people that don't have any, should any impairment in these other areas or physical ability at the time of the screening, that might be enough to determine make a determination if that's what you're talking about. and so glaring, sort of the glaring, the solid, severe, severe, the really mild to none decisions could be made to not, frankly, that doesn't push into the next level. and making sure that people that fall within a gray area with that have the next level of access to looking more specifically at their needs. i'm not sure if that answered the question.
12:09 pm
>> could i restate the question? are there some tasks that are more predictive of driving performance and others'? and is that what this is all about as far as the screening and assessment? it could just be yes as an answer. >> yes. i mean, i think there are. there are different aspects, different domains. different ways of potentially going about that that have been demonstrated to link the driver performance or crash risk. but there are a range of different measures of each of the abilities that we've talked about, that are linked to those. the difficulty is narrowing that down to a single measure that covers them. >> and i would just add, one of the previous slides, look at the battery that came out of the maryland work, for example,
12:10 pm
there were six abilities that were linked with crash risk with ranges from about 2.6, to 4.9. a lot of us had to do with visuals. i don't know if you can bring that back up. so there is at least some empirical evidence relatively strong. so these are the abilities that had ratios of about 2.68 to 4.9. >> i would say also in looking at those in general, the rehab specialist, areas in the domain of cognition are probably looking more towards the severity as towards the stopping. you can have very severe physical impairments and be able to compensate them through the equipment and vehicle
12:11 pm
modification. >> here's my last question. we use age as a marker, and medical screening all the time. i mean, i turned 50 years old, and my physician insisted that i have barbaric screening. so i'm at risk for certain kinds of disease, et cetera. and yet in this we always hear function, not age. function not aid because of the concern about discrimination, age discrimination and taking away the driving privilege. is there any reason that we can't determine age as a factor when we speak in screening? >> i think one of the things that we observe regardless of our outcome measures with respect to age is a tremendous amount of variability. so to the extent that variability in almost anything
12:12 pm
we measure increases the function of age, that suggests that chronological age probably isn't the best marker. not that we have great markers of functional age. coming, that clearly is a deficiency in the measurement of driving or anything else, but given this relationship between adult aging and variability, i'm not sure that we could set a particular chronological age at which to do some of the testing. i think when you get to extreme ages, and we are and we will, in the united states and throughout the world, maybe that will be a more reasonable thing to do. but i think in the general categories of old age there is tremendous variability in almost anything we measure. >> okay. >> i would just add, if i could, there has been some research done on looking at age-based mandatory screening in licensing agencies. some of the work has come out of
12:13 pm
australia. and the only study that really did find a safety benefit, as far as i know, was a study that looked at, that found that in person renewal among drivers aged 85 and over was associated with benefit. that being said, it's interesting. i think there's widespread consensus among people in the field that assessment should not be based on age. but at the recent licensing workshop that brought together experts from around the country, one of the recommendations that actually be merged and surprise i think a lot of people was that there might be some room for age-based screening. for example, in the form of having in person renewal, you know, required at a certain age so that people would have to come into the licensing agency and could be observed. >> thank you. thank you for your question. doctor garber?
12:14 pm
>> just a couple of quick questions. dr. marottoli, as has been noted a number of these individuals who may be at risk are going to come to the attention of the physicians, either they or their family members may bring this up, perhaps except the radiologist and pathologist, most of us has had that question asked of us at some point in time. what formal training to physicians receive, either in medical school or through state requirements, or through residency programs in how to assess drivers? >> no formal training in general. it is very variable in terms of the extent to which they have training in geriatrics or aging issues. and many times will be covered within the context of that, if indeed. but otherwise it tends to be pretty sporadic in terms of where the information is. i think that's where the
12:15 pm
outreach efforts that have, that have been undertaken in recent years by the ama in conjunction with nhtsa and other groups to try to reach both practicing clinicians and more recently physicians in training is an effort to make people aware of this issue. it does come -- if you raise the people with issue, and i encountered this all the time and talking to physicians, the issue comes up a lot. it's just not necessarily, there's a background or information that has been provided to them prior to the. so i think the field is right for those outreach efforts spent there are some guides available. the physicians guide that the ama developed in conjunction with nhtsa was mentioned as to when. to what extent is that getting out to the physician community? >> i think there has been an effort to do outreach with that, both at a local level and more broadly. i think, i would encourage continued effort to sort of get that information out there and also how to access it. as more that information becomes
12:16 pm
available online, i think that also makes it easy for people to assess and to gather information on it. so i think it is a broadening awareness of the fact that information is there. but i think the original update of that in 2003 and then the current one now, are major steps forward from what was available before. i know the canadian association does a similar thing as will on a regular basis so there is information available. >> i think one less question may be, i think it was doctor dobson mentioned that one of the big problems really is to mention and associated sort of your logic impairments that resulting cognitive decline. as we have noted, many folks are aware when division starts to fail when they become uncomfortable behind the wheel for other purposes. to what extent is that really the major problem? to what extent is that the thing that ought to be focused on because those are the folks who will not likely, that their
12:17 pm
impairment prevents them in fact from identifying their own impairment. >> again, i keep saying it is relative but i think it is relative in this case. to some extent, awareness of deficit is common to many functional changes. simply because they tend to occur very gradually and people tend not to be aware of them and telecoms to the consciousness at some level. and so that is to a vision that it is to come a physical abilities to of cognition. and i think the major potential difference is that with physical changes or with targeted visual changes one can be made aware of those deficits, and, therefore, you can be more likely to learn strategies. that tends to be less commonly the case in dementia, although if things are pointed out to them, you can effect changes in people who drive. if you point out what those deficits are to them, and
12:18 pm
explain why those deficits are likely to have a negative affect on the driving. it's just a matter of going through that process. and part of it is identifying what those carpeted abilities or limitations are, and then having that discussion. so it is trickier editing is an area of focus because of the inherent lack of awareness within. but i don't think it's necessarily unique to cognitive impairment. >> if i can add onto that answer, can i have this slight up, please. i absolutely, one of the things i've been worried about in the last two minutes, i've been thinking or talking a lot about screening and it seems to be a one way road again, the screaming toward stopping driving. the panel yesterday, talked about a lot of self-awareness, self-limiting behavior and wanted people to make good choices for themselves. screening efforts our education efforts should be for the majority, except for this subgroup of people we're talking about who really are trying to help people make, or what the exception, a different slant i
12:19 pm
should say with the dementia grew. want to help people make good choices. it's an education program that we have been rolling out with aaa and aarp for the last five years. we find people afraid to come. they are afraid to come and learn about how to make sure their seatbelt is on right because they believe we are covertly trying to take away their license. and so i think one of the struggles that we can have with education programs, screening programs that are truly, our goal is to try to help people drive safer, longer, try to get information in the right hands, where people can be fearful. and rightfully so because they're afraid if expose themselves they're putting oneself in that taken away my license can't. so i think it's really important that we think of screen, that we think of our interventions as i think we're all quite universally agreed, i'm guessing that we want people to continue to drive safer, longer. we really want access to people
12:20 pm
to share with them things we think would be useful, to help them drive safer, longer. and would only begin the road for driving cessation for that group where that's the only just and right thing to be doing. >> you've been talking today about a century remediation for events that occur in people's lives that reduce the capabilities of driving. one of those that you mentioned early on is fdr. and there's a fairly easy solution to that. if you can't use your feet, let's use your hands. but yesterday we also talked about technological solutions to a number of these problems. we're not quite as far as having a car drive you completely where you could sleep on your way to work. but there are potential solutions here today and coming
12:21 pm
in the relatively near future that may compensate for some of the things that you've been talking about this morning. the cognition issues are pretty difficult. but there's other solutions. and i wondered, to what extent you consider in looking at screening or assessment tools, the availability of technological solution that would take the issue off the table? and conversely, if you know, the extent to which engineering companies are looking at your material to try and find the solutions to your problems. >> i think that the technological advances will he hold promise for our people, for people that are challenged with various medical conditions. i think of the top of my head, early on with dementia or
12:22 pm
cognitive loss, there's a high risk of getting lost. and if we get lost, there's dyers -- dire consequences. if we have a gps, if we have an onstar system in the vehicle with a person can be located using technology, maybe that will assist with making some of these decisions of how far we can wait for a person to be able to drive with some diminishing abilities. certainly if we can employ the use of some of the technological devices earlier, people get more used to using navigation assistance, it might be able to assist them with the fear of getting lost, are not direction, different than the cognitive confusion of getting lost. just simply navigating. i think there really is some promise for some these technological aids for us, and i would, i would, i know i've had some conversations with the ago
12:23 pm
manufacturers. and i would think that there is some interest in figuring out what some of these needs are in more of a universal design concept that what is good for one is good for all. and try to consider the needs of the aging senior and their vehicles. >> i do worry a little bit about pushing too hard in technological solutions, especially with regard to perception cognition. and the reason i say this is that we know that there is something to the old adage, use it or lose it. and often there are technological solutions proposed to offload difficult aspects of cognition or perception that make actually even accentuate decline in cognition. so this could very well be a slippery slope that i think we really need to tread cautiously, and not over engineering solutions that may lead to more rapid declines than perception and cognition. and we don't know the nature of that slope. we don't even know if it occurs,
12:24 pm
but it is certainly a possibility. >> i do think there is an opportunity now that we have advances in technology that allow us to get objective driving data on people to possibly use that technology to provide information to people about their driving. >> we've been involved in a couple of studies at the university of michigan using instrument in vehicles with people with early stage dementia, having been tried as they normally would for a couple of months, collecting their data on their trip taking, their exposure, there suffered a torn behaviors it and then having them come back in and showing them essentially a summary of their driving and talking with them about problems they may have experienced. so this is just some popular query done, and i don't know where it might go in terms of actually being useful as a way to provide feedback. but i guess i would just add that i think rather than
12:25 pm
thinking about using technology to replace screening, i think that what we really need to move towards is much more of a systems approach, similar to what is used in many other countries. for example, in australia they have what's called a safe system approach. and it is based on the assumption that drivers are always going to make kind of honest mistakes. and, therefore, they need to make the roads and vehicles as forgiving as possible. so the hallmarks of those systems are safe roads, safe vehicles, safe speeds, strong efforts to reduce impaired driving so that it is more forgiving for the driver. but i think there will are always going to be situation where drivers to lose capabilities, and we can't replace the screening element. >> thank you. >> i know will get a little bit into this in the next panel, but i think in general large organizations, society in
12:26 pm
general, we are not very good at doing individualized assessment that i think everybody likes, even though you might be subjected to some testing that you don't want, i think about it once when you turn 50 these are the kinds of tests you need. yardstick. and they think it's very difficult, you know, we have established a gem you turn this age, this is when you go to school. it doesn't matter where your development and, you know, whether you're ready. this is when you start school. this is when you can drive. this is when you can drink. you know, this is when you start to collect social security. you may be ready to work for a lot longer after that, but this is when these things happen. and i think as a society, we are just not well equipped. and it's a very plausible responsibility to try to figure out how to give individualized assessment that and it seems like all the pieces of this are so compartmentalized. there's different, different parts of this that have to come
12:27 pm
together. and we are not so good at bringing all of those different pieces together. and so, you know, i ask when we look at transportation, we see as a bit of a patchwork system, to. we have a mandatory retirement age for pilots. maybe it is misguided listening to this conversation here, but it was recently raised from age 60 to 8065. but you have very rigorous oversight. you have two more scheduled passenger, two people in the cockpit who have to be qualified and who could perform the same tasks. they get medical exams on a regular bases by certified examiners to take a look at them. or not so good at trying to figure out how to do some of these things in other areas, because those medical exams and should allow people to be screened out early, if they need to be. you know, or identify problems and make sure that they are treated.
12:28 pm
what can we do that is feasible? because that is a very small set comparatively of people when you look at 30 million drivers over 65. and it's not even clear what the right age is as we talked yesterday, what is an older driver. i'm not sure when it even starts. what can we realistically expect society to do as far as screening and assessment, because i think what i heard was screening is not kind of, you're cutting off the end of the curve. i appreciated that example. but then you have to connect all these things once they get that, then you need to go get a vision test, or the need to go get some sort of additional assessment. how do we make sure all of those components are talking to each other? and we haven't done a very good job of it, and it barely this isn't going -- is a been going on since the 1930s. you can tell we haven't really figured it out.
12:29 pm
what is it going to take to get us to the point where it actually does work? do we need national legislation? you know, we do have sitting stations for child seats. every, all 50 states have those. we made recommendations about doing that to make sure that seats fit for kids. what do we need to do for older drivers? what is going to be kind of the catalyst that will bring all of these pieces together and make them function? >> i think partly this is a scientific and partly a policy decision. i think the scientific part of it is, can we come up with screening instruments that have high sensitivity and specificity come in terms of ferreting out those individuals that have problems and decided that those that don't, actually don't have problems. . .
12:30 pm
or other gold standards. we've set, we don't have the studies that transpire over sufficient numbers of years to do the longitudinal monitoring. we need those kinds of studies and we need different instruments to predict the outcome variables we're interested in. i think the policymakers have to get involved and decide what cuttoffs are appropriate. until we have both the scientific and the policy end, i think we will, as we have, go with chronological age to set various event
12:31 pm
times for vision screening or other kind of screening, the different states do at different ages. i think before we get to using functional measures, we need functional measures with the scientific ability we confidence in and we need policymakers to decide what cuttoffs should be to send people in different directions for remediation or perhaps training to use public transportation. >> dr. kramer, do you have any confidence that the longitudinal studies and the scientific community could agree on a measure by 2025? >> i think if the fund's there to start the studies, longitudinal studies. we heard about several studies mostly in other countries, not in our country, that are pursuing some of these issues. i think clearly the funding has to be there. the national institute of health has a number of
12:32 pm
consensus groups that designed studies. something called the national institute of health tool box for designing assessment instruments for different purposes, whether different disease or just normal aging, nonpath logical aging. i think it is a able to produce groups of experts in different areas. this should be a group of experts who comes together and picks the best instrument west have today, perhaps add a few additional instruments and begins this study so we can start to collect the data that sufficiently powered so we can come to some conclusion whether we have an instrument we would want to make policy decisions on the basis of. i think it is possible. >> i think in the meantime, we do have multiple points of entry and i think that's a reasonable approach to take. i think one is defining for people what their own responsibilities are so the driver has a responsibility. you know, their families should be made aware of what things they can look for.
12:33 pm
clinicians and physicians should be aware of things they could look for. it shouldn't be on one group be it the licensing agency, be it clinical group, be it individuals or patients. sort of having everyone be aware of potential things they can look for and moving forward. and potentially setting thresholds at a very high level. it is clear that most impaired individuals in any given condition or impairment would focus on that and sort of determine whether that threshold or bar should be moved further down to minimize the risk of making sure people have the most severe impairment are identified. >> and taking a step even further back, i think that in a lot of other countries that have systems approaches, the issues of older drivers are encompassed within a broader strategic vision and i know recently i've been reading about the efforts in the u.s. toward, towards zero deaths which involves
12:34 pm
trying to come up with the same kind of strategic vision for transportation safety as exists in a number of other countries that have been very successful keeping their traffic fatalities and serious injuries down and so i think that offers an opportunity to start to think about how all these pieces need to fit together, the vehicle design, the roadway structure, driver screening and assessment issues and so forth. >> and certainly funding is a barrier. it he is a barrier at multiple levels. we can identify impairment. we can identify risk and then sort of make it optional to get evaluated. and we put the burden on, even the licensing agencies, if they want to know if somebody, if they want to know more information, have an evaluation done, there are inconsistent funding approaches, often times people have to fund their own, their own evaluation to decide if they should lose their license or not.
12:35 pm
it is a question from a policy standpoint. is driving a right or a privilege? if we see somebody at risk, where does the, where does the funding become our responsibility to make sure we understand a person's abilities? when is it up to them to be making sure? it's inconsistent and it is certainly a barrier. >> the issue of polypharma has come up and we have very clear guidance as far as illicit drugs and alcohol use and impairment. i'm curious from the folks who look at this on the medical side, do we have any good guidance? i mean i think we're talking about different thresholds on where to make some cuts here. is there any understanding about all the multiple medicationing and how impairing they might be at the start? maybe a a list of meds might be impairing that people need to consider and physicians need to consider and people need to be
12:36 pm
counseled appropriately and have limitations? >> there is a fair amount of information on individual types of medications and their potential risks and effect on driving safety. less so on combinations of medications in terms of qauntfying that risk although there is an evolving literature on that. there is also ongoing efforts to try to put that information together in a useful way that both clinicians can use but also pharmacists as another group and that individuals can access as well. so i know there is an ongoing study now working to try to put that together. >> i like to give the example from remediation side. there are medical conditions that people are aging with that require a number of medications and there are some driver rehabilitation programs that assist people with understanding the impact of those medications on their driving. by taking them out driving when they are highly medicated. taking them out driving when they're low on their medication, to assist with their self-awareness and ideally helping people that must take a number of
12:37 pm
medications, be able to self-regulate and make wise choices because they're able to offer them that assistance. >> i think one of the challenges that you all identified and perhaps we'll talk about this on the next panel is the role that physicians think they play and i think, our concern as we've seen in a number of investigations, physicians for commercial drivers who don't feel that they have a concurrent obligation to report on, that they believe their primary obligation is to take care of their patient, the health of their patient in trying to understand how you impart to them the societal obligation if somebody has medical conditions, whether they're a school bus driver or passenger car driver. and maybe i'll close with a, with kind of a good news bad news on the vision side. just from some personal experience and i think is kind of an example to me
12:38 pm
about how separated the system is and how many different moving parts of it. i went in to get my commercial driver's license renewed and i don't have any physical issues that would prohibit me from getting a license but i ended up having to go to on of an audiologist separate to an opt tom tryst to get the -- optometrist to get a vision exam. it was clear all those individuals were not talking to each other because i ended up having my exam form signed before the vision test was even completed. i'm not a risk for sure but it just was clear to me that the primary person who was responsible for aggregating all that information hadn't done what needed to be done. ultimately my optometrist hadn't given me one of the tests i needed to sign off on the form. so i just was kind of a little bit of a guinea pig. when i went into the
12:39 pm
optometrist i asked him about vision tests for older drivers and if he gets referrals from the dmv? and one comment that he made to me was, you know, it is really hard for him because he felt like all he's asked to do is say, can they read the chart? and he said, a lot of times they can read the chart but they can't navigate around my office and they can't comply with, you know, directions when i'm trying to explain to them what they're supposed to be doing. he said, i don't really have a role in saying anything about that. i'm supposed to say can they read the chart. i think it is just an example how difficult it is, how difficult this issue is where you have lots of inputs. and maybe people have good observations but there is not really a mechanism for them to perform that way. the good news story on this, my mother, after listening to some of the presentations yesterday, my mother is one of those drivers that self-selected. she chooses not to drive at night. not to drive in bad weather.
12:40 pm
she is very comfortable having her friends pick her up, things like that. she always hands the keys to me when ever i come to visit her. but, so she is self-out. she does not see well at night. guess what? she had cataract surgery not too long ago this month, she called me on the phone, mrs. magoo can see. i can see the leaves on the trees and it is great. what struck me listening to that panel, i bet my mom isn't going to go back and say, now i can drive at night and now i can drive in these other conditions. she already pulled herself down where she is not comfortable doing these things because of that physical detriment that she had. now that she gained that back, i don't know, kind of what decisions that she makes coming after that. and so, miss davis, i would love to be able to see a screening program work for people, like you said, so it can go in reverse. not only take people out
12:41 pm
that need to be out but also help people that maybe have more performance than they know to get back in. so, you all sure made me think. so this is a been another great panel. i think trying to comprehend all of these pieces and put them together is the real challenge that we have as policymakers. i know we have a number of other questions. we're a little bit late on our schedule. i hope maybe you all would be available for those questions that didn't get asked to share with our researchers and our team your thoughts on those issues. thank you for being here. and thank you to the panelists for your questions. okay. and we're going to have the movie again and for those who missed it yet, i know you want to see it. it's going to show at 12:00. we have a lunch break until 12:30 today. we'll adjourn and come back
12:42 pm
for the last panel at 12:30. [inaudible conversations] [inaudible conversations] >> deborah, hersman, who you just saw the chairman of the
12:43 pm
ntsb will be on "washington journal" tomorrow morning at 9:15 15. she will talk about aging drivers and other transportation issues and we'll take your calls as usual. that is tomorrow morning, "washington journal" on our companion network, c-span. today is veterans day and there are several events making the, marking the occasion. one of them is from the vietnam veterans memorial. scheduled speakers include interior secretary ken salazar. that is at 12:50 p.m. eastern on our companion network, c-span. congress is not in session these days but will return to work november 15th when members return, work is expected on the bush-era tax cuts as well as federal spending for the next budget year. watch the senate live here on c-span and the house on, watch the senate live on c-span2 and the house on c-span. and january will bring the opening of the 112th congress with republicans in
12:44 pm
charge of the house following last week's midterm elections. but before that, it will be party leadership elections. in the house republicans will nominate the next speaker of the house on november 17th while democrats select the minority leader the next day. in the senate, both republicans and democrats will choose their leaders on november 16th. as the country marks veterans day learn more about the holiday and the men and woman who served in the military with the c-span video library. oral histories, authors on the nation's wars, and veterans day commemorations through the years. all searchable, all free on your computer any time. >> in an ideal world the fact that there were people shorting the mortgage market would have sent a signal to everybody saying wow, there are all these smart investors who think this thing is going to crash and burn but the market was opaque enough, you couldn't see that the way you can see it in the stock market.
12:45 pm
and because of the way these instruments work you were basically not betting on real mortgages but rather you were inventing on the casino version of a mortgage. >> in 2003 bethany mclean wrote about enron in, the smartest guys in the room. this week she talks about the current financial crisis and the current american economy in, "all the devils are here". sunday night 8:00 person on c-span's q&a. last month the british government unveiled some of the toughest budget cuts in recent history. at a british treasury committee hearing, chancellor george osbourne, similar to the u.s. treasury secretary, rejected claims he exaggerated the financial crisis to justify the cuts. opposition party members argue that the spending cuts are unfair to the middle class. this event is two hours.
12:46 pm
>> well good morning, chance lore.at thank you very much for coming before us this morning. and, there's quite a lot to get through on this csr. but before i do that, ig would just like to ask you aug couple of other questions. the first relates to the decision that the americans have just taken on their own qe plan and i think it would be helpful if you could tell us what coordination there i is at the moment between the treasury, between fiscal policy and monetary policy, between the bank and thefi treasury on this crucial issue? >> well, first of all, thank you for inviting me to appear before you. the first point i make is that, with the committee's forbearance, the monetary
12:47 pm
policy committee is currently meeting and ready p to announce -- make announcement at midday about the conclusions of that meeting.em i'm sure the committee willin understand if i don't get drawn into monetary policy.m at this particular time. i make this general observation, that theat economic situation as i see it is that the u.k. is currently growing actually slightly faster than was forecast earlier in the year.k. the world economy is growing faster than was forecast. but clearly, and agree with the governor of the bank,ec the world economic situation remains one that is choppy and that is entirely to be expected when we've had the biggest banking crisis ofti our lifetimes and the deepest recession since the second world war. now in that environment i have thought it was incredibly important to move britain out of the financial danger they are in. i'm sure this will be the subject of questioning over the next couple of hours and
12:48 pm
make sure that our fiscal policy was robust ands credible.ur now the governor of the bank himself observed and i a merely draw the committee's attention tov his words at the mansion house, that a robust fiscal policy gives more flexibility to monetary policy and that is the prince pril that i -- principle that i take to economic policy making. in a way this was the foundation to this laid down in the selection many, many years ago by nigel lawson that monetary policy is the principle tool for creating i demand or regulating demand and fiscal policy needs to be set for the medium term.. those are the broad principles that i expressed them before that i stick to.e >> my question was partly about process, the level of coordination taking place.io clearly you don't want to go into great detail about your discussions with the government but it would be helpful to have a feel about how frequent they are, where they're taking place between
12:49 pm
you. ng yeah. >> what is the level of coordination taking place at the moment and is it higher than usual? >> well, certainly, speaking for thes period i've been the chancellor it has remained f consistent. it is not that i have increased the frequency ofr meetings or decreased the frequency of meetings. they remain broadly theme same. i can't speak for my predecessor. i meet with the governor regularly. i have a meeting with him at least once a month, oftenha more than that actually the international gathering that chancellors now go to, g20 finance ministers, is also a central bank governors meeting anid the imf annual meeting involves central bank governors. whether it is the regular meetings here in britain which either take place at the treasury or number 11 or at the bank and we move it around, as well as those there are also regularas encounters, international
12:50 pm
conferences. so -- >> these foreign meetingsnf start to drag on you go off and do some business in the corner?et >> they never drag. nevertheless there are some opportunities to talk to the governor. >> okay. the second area i'd like to just refer to is the government's response to ourr report on the office ofe budget responsibility. i'm very pleased to say you have accepted the lion'ss share of our recommendations,u' all i think the main recommendations except, with one major exception which i just like to refer to now which is, almost everybody who came before us agreed that this innovation needs to be reviewed thoroughly after a period and most people suggested five yearsos was a good period to take a look at it over, after. and that included robert choate and professor nicole,
12:51 pm
two of the three appointees. i would be very grateful if you could reconsider your rejection of the proposal wet have a statutory review after five years in the legislation. >> well i'm very happy to look again at that prior to w the legislation comingp forward. i'm sure the committee will want to take part in the discussions on that legislation. for me i'm trying to establish an institutioni that is going to survive long after i have left thisng job that will operate in governments of different political persuasions.o it is incredibly important it commands the confidence of the whole house of commons. i will, as i say, take very careful consideration of your request, mr. tyre,er about having a statutoryo requirement for review after five years. i mean i won't say yes today
12:52 pm
because i only just confirmed that it is and you know, it is appropriate for the face of legislation we certainly review.ould be a the question whether itio should be primary statute or not. i wilrl look at it and gete back to you. >>y thank you very much on that too. i mean that many is very v good news that usually government pretty muchw accepted the proposals we've made and this committee hasuc had a significant influence over the shape of that body and it would be a pity if we end up at odds on one of the few, one of just one of those recommendations that we made. can i turn to the issue the next issue that has been flagged up enough in the about the carry. reading there is only one question i want to explorei which is what you and the government did once you
12:53 pm
realized that you had this astonishing contract, which given the substance, you have to leave us in this position with aircraftt carriers for 10 years withe no aircraft to put on them.i how carefully was renegotiation of thatw contract with bea considered? >> well, kind of make a broader point and then deal very specifically with yourke question.a but the browder point was this was clearly of all the problems we faced probably the greatest. it was an incredibly difficult contract for an incoming government that committed, whoever won the general election to an extraordinary amount ofhe expenditure to new aircraft carriers, the cost of whichur had increased significantly from 3.9 billion pounds to 5.2 billion pounds. this was confirmed by theto previous chief secretary in the previous government in january of 2010, which is
12:54 pm
when these contracts have been, further confirmed after intermediary stages in 2008 and 2009. in other words i would makeer the observation confirmed when it was very clear that the country was going to be short of financial resources going forward. and whatsh i propose to do with your permission, mr. chairman, give to you the, the committee, the confidential letter that was sent by the chief executive of british, bae systems to the prime minister on the fifth of october, 2010. bae systems are happy to, provide this letter to you. it goes through in some detail -- >> that doesn't inspire me with confidence? >> i pointed out bae systems this committee over the lastnt few days taken as considerable interest in this contract. i have thought it was appropriate that saw thet situation we inherited the contract that had been negotiated by the previous government and the come i
12:55 pm
complete bind it left british taxpayers in.a as you will see it will showi you the cost of canceling the carrier, the second carrier would have been more expensive than cost of actually building the thing even though of course we're not proposing to have it operational in order to save resources.p what i propose to do,de mr. chairman, is give you a copy of this letter and leave it up to you and your committee to decide when anden if to put it into the public domain. but that willen be youri decision. >> the more transparency can be brought to this, one of the most extraordinary decisions the time i've been poll following politics thep public find its incomprehensible as you know. leave it there.t others may want to come inay late and leave it there and see what that letter has to say. andy love. >> in 2009 conference speech the prime minister said,
12:56 pm
sometime kwan quantity willa have -- quantitative easing easing will have to stopmp because printing money leads to inflation.ti you don't really like quantitative easing do you as a party? >> if you allow me to repeat myself, mr. love, the monetary policy committee,ta the monetary policy committee is actuallye meeting as we speak and ime don't think it would be the appropriate for the exchequer while committee is meetingc with the public decision a couple hours a way for me to comment on the merits of what informs monetaryf policy. >> let me ask you a very slightly variant of that. in answers in the house of commons you have suggested that you would follow the same policy as your predecessor in effect, giving the green light tor the monetary policy committee in relation to quantitative easing.g why did you do that? >> well, when the original arrangements were created w
12:57 pm
for, for the independence of the bank of england on monetary policy it was very clear that the mpc had complete independence in thear setting of interest rates against an inflation target set by the chancellor. and i, it became clear sometime ago that as the crisis developed is the arrangements around the granting of permission for quantitative easing were notra so clearly set out in thef original statute. my predecessor came forward with arrangements that wouldrw allow the mpc to make requests for quantitative easing and iq thought it was appropriate to continue with that arrangement. i think if one poses the counter factual, which is if i have torn off the arrangements and said i o would pursue a wholly new set of arrangements i think people might have regardedse that as quite an q extraordinary decision.
12:58 pm
>> but we understand your decision in relation to that if the situation in ther united kingdom was similar that to in the united statesti which are embarking on qe2i but the situations are very,. very different. in fact the situations here would suggest that with inflation persistently higher i think than expectedp with long-term interested rates already reasonably low, that there was no need for quantitative easing. i wondering why in the context of the overall economic situation with you suggesting that you would have a robust fiscal policy, why you needed to indicated to the bank that you would leave them the free hand to defend on quantitative easing? >> well the situation was this i was asked a question by a journalist, would i continue with the arrangements that my predecessor had put in place for quantitative easing and i said yes. so if i'm guilty ofc
12:59 pm
answering the question so be it. that is what i think is appropriate. others say ask the counter factual if i said i'm not continuing with the arrangements between the treasury and the bank inea this regard what would have been reaction to that?g so i actually made this clear as it happens when i was in opposition, i was asked this question, if i became the chancellor would i continue the arrangements, i had said yes i would.t so i didn't regard it as particularly newsworthy. and as i think a more a newsworthy event would have been if i had torn up thosemo arrangements. >> well let me put it to you indeed there has been quite a lot of speculation in the news media whether they agree of uncertainty in the economy with the good news that i, growth rate in the third quarter was much better than expected although still showing signs that the economy is slowing. with those great uncertainties, quantitativet
1:00 pm
easing as your plan b, should be if things go wrong, how do you respond to that?yo >> well, as i said in my opening remarks, the answer to the chairman, you know, i, what i believe you've got to do in this situation that the united kingdom foundt itself this year is provide credible fiscal policy.fo that was obviously thel overriding need of anyone who took my job on in may. i have done that. the governor of the bank ofmy england has himself drawne attention to the fact that the monetary, in the speechel at the mansion house that ai credible fiscal policy was, a, essential and b providess flexibility for monetary policy and i think that is a good way to govern the country. . .d i think that is a good way to govern the country. >> you indicated earlier on in the year to your preference was
1:01 pm
to have 80% of deficit reduction from public expenditure cuts with 30% for tax tax tax entries. you subsequently changed that to roughly 70, 30. why if you do not when you play such great emphasis on the need for the predominate stevens to come from public expenditure? >> well, first of all, the >> that's partly because the tax lever is an easier one to pull. you can increase taxes rapidly if you have to, but public savings take longer to come into effect. i said at the time repeatedly i regard it as an absolute number as 80/20. i said that was a good rule of thumb or guideline for a
1:02 pm
credible fiscal consolidation package. that was not just my view, but the view of most international studies into fiscal consolidation packages around the world, the one that were the root cause of the problem causing an decrease and increase in spending and the best way of dealing with that is to tackle the root cause which is the increase in spending. >> was it not related to the experience in trying to implement such high levels of cuts in government departments, was that not taken into account? >> as i said, i wasn't seeking to readjust the figures. i mean, on the pac front i made my announcement on the budget of the public expenditure decisions, and i have not met
1:03 pm
resistance. this has been a collegiate process and we've been able to deliver what i believe is a credible package and what was looked at internationally and regarded as a credible package. >> let me say a comment you gave the press in we as one before us last week to tell us that the third year time scale of cuts in successive years is unprecedented and will be incredibly difficult to deliver. i say that in the context of the repore of the efficiency savings of the previous government and it was the fault of the previous government, but the reality of that report is to show how difficult it is to get the level of efficiency savings requested, but the greater problem of being
1:04 pm
able to deliver on the public expenditure is a huge task, and aren't you somewhat chastened by the experience so far? >> well, of course it's a big task not just for the government, but for the parliament to stand up to the largest deficit problem this country had to confront since the second world war, and we have to take collective responsibility as a department to solve it. i make a few observations. first of all, i see you're referring to lord turnball who was the secretary under the previous government. >> and two former members of the monetary committee. >> yeah. >> and in the department and social security. >> yeah, but i read lord turnbull's evidence, and he's clear to the committee that this was a, a necessary decision, and
1:05 pm
b, the pace was appropriate, and c, he says whoever run the election would pretty much be doing the same thing because of the facts on the ground. i think that's an interesting observation from him. i make another observation about the pac report that i read this morning. i think it points the dangers to announcing enormous sufficiency targets that we have not set for this reason and assume government departments can deliver on that. it says when this was done in 2007, no there was robust evidence about what could be achieved, and there was a lack of financial performance data. we are trying to resolve that and had a more resolving approach to administrative savings and reduction and the like, and we've also and are currently trying to improve the quality of financial data which
1:06 pm
i thought was pretty, you know, shockingly weak at the moment, and we're trying to improve that. we're also using other tools like, for example, transparency so that public expenditure is available for people to see, and we can create a nation of order and where that money goes, and you know, we're using a number of different tools, but as i say, we will face the same challenge, every single person in this room. it's a very large structural budget deficit. we have to deal with it. i think the most appropriate way to do with it -- to deal with it is by the international support and attacking the root cause of the problem which was a rapid increase and the state consumes half of the national income way above its long term average, and the measure i set forth which i can disagree to the initial measures, but i tried to put
1:07 pm
together a package that is credible, and doesn't rely on fast efficiency targets that were delivered as seen in 2007, but instead it's specific and gives control to departments perhaps deliberate. >> we now know that your preed sees son wanted to -- predecessormented to increase -- wanted to increase and did you find any evidence of that when you started work in the treasury, or was that kept from you? >> obviously, it was not made privy to me, the papers of the previous government. what was clear, frankly, quite a bit of work had been done, and that was confirmed recently he would have gone ahead, and also work on the housing benefit cap. that was a policy that was worked up and, of course, it's clear if you read now the labor
1:08 pm
manifesto and there was work done on specific policies, the policies i'm most now attacked by my political opponents for introducing, but a border plan which there was none, just an ambition to cut 42 million pounds from the expenditure with no plan behind that. >> can i press you on the efficiency savings because the psu report this morning makes clear at least a third of them were not achieved at all. there are efficiencies referred to in your document. how can you reassure us your efficiencies will be different than the claims we had in the last four or five reviews? >> first of all, we agreed with four or five different departments and reductions in their budgets.
1:09 pm
that is a fact on the ground. they are releasing their budgets and i required all departments to reduce nare budgets by a third. second, we are actually eliminateing some qawngers, and we are putting in place i believe reforms that will improve the efficiency of government through, for example, the place-based budgeting, the pilots we had to extend more broadly through the use of personal budgets and more extended areas of public policy and the like. the final point i make is i am actually cutting the budgets to the departments and the challenge is to deliver that through greater efficiency and greater profess gain and the center of government remains absolutely on the case to deliver those improvements because a challenge against the
1:10 pm
department is profitability declined while it was increasing in the private sector. >> if you remove the targets, how will we know you were successful? what's the bench mark to know these are successful? >> the first will be a complete transparency about where money is being spent so this committee and other members of parliament and the public is able to see what is being spent on the administrative budget in a way that has not been so transparent as i said before, and second, we will be publishing much more data on outcomes so people can judge themselves on whether things are improving or not. >> i think you were the first chancellor to be in the process. looking back on it, did that help? >> yes, i think it did. i think setting the dates in october, so early on, focused
1:11 pm
everyone's minds. i think it meant that you didn't come in the autumn not knowing when the spending review was going to take place in either october, november, or december, and people on this committee will know it was always a game of when is the spending review going to be. you know, i think it's perfectly sensible to put into place some structure and process, and there's no reason why you can't make a forward announcement, and then get the whole of the government working to that date. >> what did you learn? looking back over it, what have you have done differently for next time in >> i think the process, you know, you're sitting in judgment on this, but i think the process went pretty well and was as collegiate as possible. what i learned -- i mean, to say, i have learned that i think setting clear dates
1:12 pm
several months in advance for fiscal events is a good idea. >> we long recommended that the pbr date should be adequate dates noticed. when's the budget going to be? >> well, it's going to take -- the 23rd of march, 011, and then the, that's over four months notice, that you're getting, and the committee in the previous parliament recommended two months giving the chancellor two month notice, so the 23rd of march is the date for the budget. put it in your diaries and we'll appear on that. i'm already looking forward to it. >> just coming back to the spending review, can you tell us who the most difficult minister was to settle it?
1:13 pm
>> i don't think i can unfortunately. it's in my memoirs, but they are so boring. >> it might be a long wait. >> chancellor, i'd like to press you a little bit more about the process because years with big change measure programs, any measuring consultant says it's hard to come up with a plan, but it's almost impossible to implement it. just to press you in terms of how you actually now turn the plan into the reality. for example, when you have a finance director in every department ensuring that budgets are met, who will be the people on the ground, the rules on the ground to ensure this gets rolled out? >> well, ultimately, secretaries of state are accountable and indeed, the prime minister and myself are accountable to parliament and the accountant of the spending review.
1:14 pm
now, within the departments we're trying to increase the capacity in terms of the financial management, make sure there are proper finance director roles that the quality of da too is -- data is improved, and of course parliament secretaries are accountable if not to this committee, then the public accountant's committees. in a number of ways, we're trying to improve the quality of data which is shockingly poor at the moment, and seconds, the accountability of the delivery of the data, and i've made this observation what i have not tried to do is set up for every thought what everyone needs to do with every pound of the budget. there are many public sector employers, hospitals, local counsels, schools, and so forth,
1:15 pm
and in the end i want them to take responsibility for the delivery of their budget. now, i take responsibility for the budget i've given them, and they take responsibility for the delivery of that budget. >> is there a resolution in accountability then? >> i think we are trying to increase accountability, and frankly, there's a greater public focus on value for money and is thought about the real world situation, and partly, i would say it's because of the focus of this government as we made this a, you know, a focus of people's attention. >> so specifically then on cuts, are senior officials telling you that the inevitable reduction in head counts could cause problem in having the physical staff to make the cuts? >> no, we have not received that
1:16 pm
message. i think it's also the case that this consolidation is coming in after a period of very rapid increases in public expenditure, so there's certainly a capacity in the government to make these savings, and i think it is nonsense to be different from some previous consolidations that have had to come on the back of lean years already. if you look at the late 1970s really from the arrival of the ims to the beginning of the new decade, there have been attempts to control public expenditure and control wages and so on, and then a new government comes in and has to make new efforts. it's very difficult. i'm not underestimating the difficulties that face us all with this deficit, but we're facing a situation where there's been no attempt to control wages, and i think there's more capacity there.
1:17 pm
>> absolutely. do you ware with the reforms combined with the cuts in budget, that you might undershoot there? do you have a worry it might be extremely difficult to achieve the level of savings in managed expenditure? >> no, i think -- look, i think that's one of the big challenges facing the treasury, the annually managing expenditure bill because there's been no incentive on government departments to control those budgets, and we are looking at whether actually this whole framework of dell-aiming needs to be revisiting, particularly the aiming part of it because this is a very large budget. i think, you know, especially half of the government spending, is not really an annually managed expenditure, it's not really managed, so we are looking at new, a new framework, and i have to say more about
1:18 pm
that in the budget on the 23rd of march. >> thank you. final question on things you worry about. is there worries that if we do fail to deliver the cuts that we're intending to deliver, it's necessary to go for another round of cuts as some of our european colleagues have to do? >> that's certainly not the intention. what i sought to do is send out a delivers on our fiscal mandate which is to bring the structural budget into balance; and i am aiming to achieve that, and i may need to achieve that one year early, so i built caution into the plan, and actually this relates to an earlier question about the obr, it's a little understood point at the moment, but the government forecast now are built around a estimate, and not
1:19 pm
a cautious estimate and this would announce forecasts dreamt up in the treasury and say we built in caution, not that they can see what the caution was. now, we have a system of an independent body that produces estimates with a forecast with a central forecast and where we're building the caution into now is into the delivery of the mandate. >> thank you. >> thank you. chancellor, i want to get back to the question of the aircraft carriers. it's caused everybody in the committee aceps of bewilderment. how is it possible that a government facing 80-100 million pound deficit, how is it possible not to be more expensive to build them, and does this point by lbd captured
1:20 pm
by the contracting industry, and do you think the minister is just caring about his own interests? >> well, i believe -- [inaudible] i think this committee and the public to draw their conclusions about the last point although we welcome the return of the -- to the house of commons and the border point is a good one which i think there's going to be enormous lessons learned about this contract. i think it will be one of those things that hopefully will be talking about for years to come and pointing theming out as a very, very bad example of the taxpayer value money.
1:21 pm
we had a situation that it cost this country more money not to build a second aircraft carrier than to build one. that is a situation that we found ourselves in unfortunately. we also discovered and this is the reason that the decisions delay, for example and this is the last year, cost 600 million pounds, just a simple decision to delay cost 600 million pounds, and of course, we also face the situation where the carriers were going to be equipped to take a particular version of the joint strike fighter, the vertical takeoff version that was the most expensive of the three variances. there was a vertical version, a carrier version, and this is going to be the most expensive
1:22 pm
plane, so one of the decisions we've taken 20 try to -- to try to make sense of the contract and make sure there's maximum military utility, and it's important for a country to have vertical strick situations with the situation we will be in then, but we have the decision to fit the catapult system to the carrier so that it will be able to take a, a carrier version of the vertical strike fighter which is cheaper for the taxpayer, it will also be interoperateble with the french and american navies because we were building a plan that couldn't cooperate with the french planes. that didn't make sense either. we tried to make sense of it.
1:23 pm
as the saying goes, you don't want to start from where we have started, but we have started to make fiscal and military sense of the situation we were left. >> it's notable that many of the examples of overexpendture have been made with the initiative. i remember you saying at the conservative conference that it needs to be revisited. is that something that's to be taken over the next few monthings and years? did does -- it does seem thing an unfortunate thing and other schools and hospitals may be very badly affected by the squeeze in public spending. >> well, we are seeking to reopen contracts, although, of course, that's not the easiest thing in the world to do by definition, but what the private sector has done, private sector companies have sought to reopen
1:24 pm
contracts. we are doing that at the moment, that work is led by the office in the ministry of defense and there's an expectation from myself and i know from the prime minister that the measuring od is going to -- mod is absolutely going to get stuck into the contracts to see if they can be renegotiated and get better money from some of them, and i know the commercial job at the mod is currently open and we need someone of real quality to do this work. >> you talked about the very poor availability of data at the moment, and it does seem to me that one of the conclusions that comes from the arguments about that process and some of the cuts made there are that there may be technical weaknesses within the treasury. is thatting? that concerns you if they -- is that something that concerns
1:25 pm
you if they exist? >> treasury may be guilty of many things, but i'm not sure there's a weakness in terms of that kind of analytical ability. i don't know, if the committee wants to question me in detail about the tables we produced in the document and budget document on impact. like i said last time i was here, this is not a perfect science. we didn't claim it is. we are trying to model the impact both in changes to benefits and tax levels, but also changes to public expendture. now, this has been done in other countries, but it's not been attempted in the u.k.. we are drawing on the best international evidence to do this. we hope to stimulate a proper debate in the international circles and of course we also
1:26 pm
very much welcome the input of this committee into this, and as i say, this is not a, you know, this is work that i want to see developed and so there is an agreed and up stead of having an argument about the methodology, there's an argument on the actual policy methods. i think we can achieve something and then have a proper debate about whether this measure is the right measure or not. >> do you think the debates over the technicalities concluded the debate we ought to have about the overall measures? >> well, you know, i think it's a robust debate by all of these things. i mean, what i can tell you is honesty in this area of the treasury has sort of produced the data in the best possible way it can. it's not, you know, it's not sort of doing things from the political reasons or exclude
1:27 pm
thing for political reasons, but it's done it with the best national evidence, and i think speaking for the officials in that parliament treasury that they would welcome input on their work and i think they want an greed former methodology that could be with this committee and agrees is the, you know, the methodology to use in future budgets under whoever is the chancellor, and as i said, we can have a debate. i don't know if i should bring with the budget secretary. >> i want to say that i think actually the analysis around distribution is pretty impressive. this is cutting-edge stuff. in fact, we think like defense programs is quite the -- how do you negotiate that with
1:28 pm
individuals, but it's clear and transparent, and i think it represents an improvement as a credit to the treasury. >> it certainly is cutting edge stuff. the isf has been doing this for decades. >> how 1 it cutting -- how is it cutting edge? >> the distributional analysis of benefit and tax measures is certainly something they have been doing for many, many years, and it's in the treasury and sorry, the publisher's work have always been done in the treasury, and my previous chancellor had to information available on the distribution of tax and benefit changes, but they didn't publish it. what has not been attempted by the isf, and i think nay mentioned -- mentioned this in the expendture changes and the benefits and kind that come from those, and
1:29 pm
that is genuinely new, cutting-edge work from the secretary, and you know, it is again, we really welcome the committee, but the board of academic community and i'm sure they want to speak for members of other political parties here, but i think if we get to a point of the political parties about the methodology and not arguing about the public policy measures, i think we'd all be in a good place. >> to be fair to those who have taken issue with you, chancellor, you said in your budget this is a progressive budget, and it wasn't a progressive budget, measures in the budget were progressive, and subsequently as the many measures were progressive, and you can look at csr and say
1:30 pm
which is fair or unfair according to criteria, but it was overrating it a little bit calling it a progressive budget? >> well, i don't agree with that. first of all, the criteria to the budget, i think the total fiscal consolidation including the budget, includes the measures of the previous government, many of which i had to take to the house of commons or completely change like the tax benefits of pensions. i had to completely redo that and get house judgment on that and take them together, i believe, they are progressive and that the richest pay more than the poorest in proportion to their taxed income. >> there's other statements you made being on the brink of bankruptcy. suspect that a bit over the top
1:31 pm
-- isn't that a bit over the top in >> no, the situation i found myself in in may -- >> on the brink of bankruptcy? we all agree there was a fiscal crisis. >> let's be clear. i came to this office in the middle of a european debt crisis, highest deficit in europe and the bond was saying the u.k. guilts were a no-go area. this was the situation i found when i took this job, and i've done everything i can to move britain out of the financial danger zone and indeed the market interest rates that show that. there was an acronym at the time called pigs, and then thereto another one was the stupid and the u in stupid was the united
1:32 pm
kingdom. it was an interesting situation for the country, and we have taken to step to move out the financial danger zone, and we're not on watch anymore, and it's clear that the rating agencies say that is due to the measures we've taken and the question mark they always have is can we see the measures through, and i believe we can. you know, i think we have taken those decisions, and i think as a government and indeed as a parliament, we can be proud we have done that. >> there's tough measures on the deficit and to make the budget fair to come across more clearly if they had not been obscured in the debates with the counterclaim. there is something there to look at when making these remarks which do look to me more like the language of opposition of government. >> inevitably, inevitably, these
1:33 pm
are controversial decisions because they go through heart about why we're here which is public taxation and public finances, and as i say, we got the largest bond investor in the world telling people that the u.k. is sitting on a bed of nitroglycerin and the agencies for the first time in history put us on negative watch and you're thrown into a negative debt crisis, right, this is an incredibly serious situation. >> i take your point, chancellor, and i accept and welcome the fact there's a high level of transparency in the forecasting process of the decision made, and you have made an unprecedently check in trying to make the distributional impact which i hope these reflect on the points i've made about trying to make sure claims
1:34 pm
can be ready stood up and checked. >> thank you, mr. chairman. can i ask before i was going to ask about an answer you gave because i think andrew quoted the prime minister previously on whether he was pro or anti. they are meeting as we speak, and to talk about in march 2009, the parties had an easing that is a leap in the dark and you're telling the bbc i don't think anyone should be pleased we reached this point. it's failure with risk. can we take it from that that if there was a crisis maybe today maybe not or in the future, that to you is failure and an admission carries risk in the way you described last year?
1:35 pm
>> well, as i say, i don't think it is appropriate literally that the monetary policy committee is meeting while we meet to comment on the merits of the political monetary policy talk. >> but you -- >> it just would not be a very responsible way to conduct my job. >> okay, well in some senses the business secretary hasn't made a secret of his views. he did an interview last week on the "today" program about he was criticized about debate and on whether you should have a plan b or not, and he made it clear there's a opportunity to use monetary policy to institute some flexibility. >> well, this obsession with plan b, you know, i think we've got a pretty robust plan a, but plan a is all about providing
1:36 pm
fiscal creditability, and fiscal credibility allows the monetary policy to do, which by the way, could be increasing or decreasing interest rates or using any other monetary policy they have at their disposal, but even then greater flexibility, and they don't take intoability the government -- account that the government doesn't have a policy. what i have done that i believe allowed them to operate as they see best and not in any way prejudging what they may or may not do, that is an entirely independent decision for them. what i have done is hope i have provided that rock the fiscal stability on top of which they with operate. >> okay, it's their decision. have you asked the governor for an assessment of the likely effects of a further round of
1:37 pm
cuts as an impact again which is going to concern you. >> i'm not going to go into the private conversations between the chancellor and the governor of england which by the way should not be read into that i have or have not asked for the information you mentioned. >> is it fair to say that sense you stopped government and the prime minister is keen to introduce proper government where the previous government was crit sized for perhaps having a socialist power of doing business, the sort of government you've been looking to do with nor chamber -- >> look, no, i think -- probably -- my private view is this which i will now make public. i think prime ministers is always in opposition to talk about the merits of cabinet government, and then suddenly
1:38 pm
lose interest in them when they become prime minister. however, the fact of the coalition which, of course, we weren't planning for nor were the partners in the democratic party, have actually forced a degree of capital government that no one would have expected a few months ago under a labor government or a liberal democratic governor, and it's forced us in two ways. one is that our coalition partners need to be constantly involved. for example, decisions around taxation would be the preserve of the chancellor and prim minister discussing can to the and announcing to the cabinet on the day of the budget. here, it involves the prime minister, the chief secretary is much more involved than previous would have been in these decisions, and we established a process which was around the budget and spending review. second, it's an interesting
1:39 pm
effect as well. by consulting the liberal democratic partners, members of the conservative party and members of the cabinet also expect to be consulted and have a right to be, and so it has introduced a much greater degree of process capital government than i would have predicted frankly before appearing before you nine months ago. >> on that point obviously you announced a change in child benefit at the conservative party conference in october, and this is a change affecting over a million families. was this something that was discussed in full cabinet before you announced it to the party conflicts? >> it was discussed extensively and for a long period of time, a couple of months in the process, and it had been discussed intensively with the relevant secretary of state.
1:40 pm
now, technically on a technical reason, it attacks measure involving the use of the tax system and higher rate tax system and no requirement to take it to the cabinet to be technical about it. also practically this was a runup to the party conferences and best and most practical time we couldn't bring the cabinetting -- cabinets together, but you know, not every single decision that is made in government is -- >> this government or any government? >> but the people with the direct responsibility and the deputy prime minister were involved for many many weeks beforehand. >> i've heard what you said. you've been fopped of saying we're -- fond of saying we're all in this together, and you asserted this emergency budget we've had in
1:41 pm
the summer that we're having a look at this child benefit change. you says this takes a cabinet minister like yourself with two children and a great salary of 134,000 pounds claiming child benefit, you'd be entitled to 152,000 which is 1.3% of your gross salary. i think many of the newspapers referred to households where they are just above the high income threshold and a husband who has a salary just above the threshold, and they as a result lose their child benefits, and they fall in that middle that's being talked about and being hit hard by this. people like yourself not having an affect, but people like them
1:42 pm
it has a heavy effect, less income, less than 35,000 pounds. how is that fair in >> well, first of all, squeezed middle is used by the opposition, and i congratulate you, but there's a fair cross in distribution, and the truth is that many measures are means tested, and maybe there's a discussion later in the hearing about housing benefit, but there are many wealth measures that affect working families across the income distribution, and i wanted to make sure that people who i completely accept are not the superrich, but are better off and high rate taxpayers are in the top 15% of taxpayers that they, too, made a contribution to the consolidation. is this the kind of thing i want
1:43 pm
to do in completely benign economic times with a balanced budget? of course not. that's not what i face though. i had to make sure that it was progressive, that people in the richer made a bigger contribution. >> we're talking about something falling off a cliff edge when you have a couple and one in the higher income bract, do you think it's right that the parent is going to work overtime or go for promotion if it means they are losing their child benefits? >> well, what i sought to do is introduce this in the simplest ways through the system we have. we now who the higher tax rate
1:44 pm
payers are and creates a mean-tested system. i just don't think that was sensible because what i've done preserves the way child benefit is claimed by the vast majority of people this this country. i have not for the first time had to try to set the joint income tax of people on 70,000 pounds a year. i tried to in a simple way, and it's an interesting point and the treasury looked at this before and gordon brown looked at taking part of the child benefits away, and this has been looked up before, and there's a gap in the treasury, and the simple way to do it is this. >> in june, the prime minister said that taxing the deficit was going to affect our whole way of life and affect every single person in the country, and i
1:45 pm
went on to the interpret forum to see what people were saying about this and child benefits and for example, there's a person on there saying it's costing me 15,000 and that's a huge chunk. there's a lot of weary on that side. how has the csr affected your way of life? they proved the salary is 8.3 million pounds. how does it affect your way of life? the pm is affected and how is it going to affect your way of life? >> of course, but from the -- we got two children, but like everyone also as a higher rate taxpayer from 2013 onwards -- >> changes your way of life?
1:46 pm
>> you often play the man on the ball. i make this point and i made this point, there is an enormous budget deficit i inherited and i read your questions and you are under a misapprehension is delaying and taking longer means you can avoid these decisions. you can't. it's a structural deficit. it doesn't go away when the economy grows and if we don't do this child benefit cut, there's 2.5 billion pounds you have to find somewhere else. be my guest, find more alternative proposals. >> i'm not giving you benefits. >> i'm very aware you're not giving me all the benefits. >> thank you. can i talk to you on local government and the settlement they had. i'll give you an example. the security com over the last
1:47 pm
-- counsel over the last year are looking what would come in the csr and worked hard to make these decisions, but they were working with the 16% cuts over a three year period. what's happened is it's 28% over four years which is quite a lot higher than a lot were expecting. give me comments on why the government is hit quite so hard? >> well, local government is accountability for spending and it's a major delivery mechanism of public services and the presence of the state in our communities, and so it could not be immune from the changes we make. there's individual decisions and budgets within the local government world and the school settlement and the police
1:48 pm
settlement which are less than that number you gave, the 28% number, but i have to make a decision about where to place our priorities, and what i've done with local government is seek the aid chafes important -- that was important like a school budget increase and give them flexibility by stripping away grants and i like that gives them greater freedom to manage these budgets. again, i'm not for a second saying this is going to be easy for local government, but, you know, most people will have seen for some time that whoever won the general election was going to have to take some difficult measures. >> one of the things that the government said was raise in the risk evidence is that you got the 20.5 billion this year until
1:49 pm
2011, 26 billion, 24, 22. they are coming down and they are short term and have about eight weeks. a lot of their contracts are long-term contracts and built in services like revenue collections, disposal, housing benefits, and i appreciate that counsels are looking into by sharing some of these services, but actually the way you got the great amount of flexibility in the short term is when you have things like grants and that type of stuff, and i think the message that comes back from government is that it's going to be quite a few who get hit first not giving them enough time to look at the psi contracts and other contracts that referred to earlier. >> well, look, as i say, of
1:50 pm
course, like all areas of government, it's not particularly easy. i'm not claiming it is. what i think local government can do with the freedom we've given them is, you know, make some of the more ready to reach savings early on which is a lot of good counsels are preparing at this moment, and then as we get further into the spending review period, some of the points of the renegotiation of contracts and so forth come to bear. the problem with the consolidation is this. if you made the whole thing back loaded and said we are going to sort out our budget deficit, but we're going to do it in three or four years time, it's just not credible. no one was imf, the credit rating agencies, anyone who looks at that would say it's
1:51 pm
critical. i think it's an even consolidation that roughly speaking falls the same amount in each year, and that's required, different parts of the government to make a contribution to that, but local government, in a way they are a miniversion of a central government in their own areas. some areas they can make it short term or long term and some can do both. >> this is a question on the 2.5% rebate you give to keep tax increases at a minimum. people with 100 pounds are increaseed to keep -- there's no tax writeoffs. you'll do that in two years.
1:52 pm
one of the concerns raised to me by the work force and labour party is that what happens when ha comes to an end in three years time is that tax base will still be at 100 pounds and the pressure will be on them to be 105 pound, and they willment to increase their tax that is building up ahead of steam in the runup of this. do you have a plan -- >> it's a one year freeze, and you know, that is -- it's to achieve two things. first of all to help a balance package where the bills facing families are not going up excess bly, but second, i want to make sure thing government didn't reach for was counsel tax which would have been initially a temptation, so that why i think
1:53 pm
the freeze is a good public policy. >> actually then it's a check is a way to describe it because it's trying to make sure that, if i'm right on cutting taxes, i'm going not going to just -- >> you know, for all of us, i had to focus on the hard decisions, and as i said, parliament had to focus on this and i think in local counsels, they need to look to their own budget. i think a lot of very good local governments out there have been preparing for this, there's a lot of work, and enormous amount of thought into this and less well prepared counsels. there's shared services and shared chief executives for example, and there's many, many innovations taking place in local government under counsels
1:54 pm
of all different political persuasions, and the best need to look at what the rest are doing. >> thank you very much. >> chancellor, when you were -- [inaudible] now it's around .85. why do you have the highest in our history? >> because of inflation. >> what's the annual debtors percentage in gdp the highest in our history? >> it's not, no. >> # the debt repayments are the highest in our history in the sense of the gdp? >> the current rate debt payments this year are the highest -- >> well, in the second world war there was an extraordinary situation and they were high then, but the budget deficit is
1:55 pm
the highest outside of wartime, and debt interest payments -- >> as a percent of the gdp? >> yes. the national -- the national debt we have, is that the highest in our history? >> it is in cash sense. >> in terms of gdp? >> i think that was the first question i answered. >> is it the highest in your lifetime? >> well, it is -- i have a feeling you're about to tell me. [laughter] >> you're the chancellor, not i. let me give you six countries, italy, france, germany, japan, united states, and united kingdom. of those six, which had the
1:56 pm
lowest national debt today? well, what i point out -- >> it's a simple question. which has the lowest national debt related to gdp? >> the answer is the u.k.. >> the answer is united kingdom. >> but -- >> in serious times in the projections, we still have the lowest -- germany. why is that? >> well, because they have been fiscally prudent. >> the -- [laughter] the german percentage of gdp is 73%. >> well, i got the imf figures here, but maybe we can exchange -- >> my point is -- >>imf has an economic outlook.
1:57 pm
>> we can argue on the german versus u.k.. it's close. my point is of the six countries we have the lowest national debt than any of them, significantly lower than any of them, so why are workers paying the price of the risk of bankers? >> well, it's a bit of a leap there. the point i would make here -- >> the question is how do we handle national debt? that's the issue for us. you just agreed we got much lower national debt than the six countries i listed. >> yeah, but what i would say is this. the budget deficit is the amount which the debt increases by each year. we are running the highest in the g20, and then it adds to the debt, and our debt is rapidly
1:58 pm
increasing up the percentage range and up the rankings. this is very unstable. >> that's why we agreed we have to do something about it. the question is why are you doing far more than all the others when we have the lowest national debt? >> first of all, we have a higher deficit so our debt is increasing. second, many, many countries in europe are undertaking difficult fiscal consolidations including we mentioned germany and you look at what's happening in france and spain and other countries, look at the dates in the united states. >> they don't have the high -- they have the highest debt. >> well the deficit adds to the debt and the deficit is rapidly rising to 100%. >> you know that. you're overstating.
1:59 pm
you're overstating. >> let me take the imf numbers. 68, 64, 66 -- that is taking into act the measures of the budget with our consolidation, so, in other words, i think, you know, you have to accept that it's going to approach 100 percent national debt as many economic studies show and getting ourselves into very, very dangerous places. we are taking the steps -- >> currently we are today the lowest of those six in terms of national debt. >> well, i didn't -- >> you're overstating the imf here. you don't want to compare national debt which is actually the political factor in this. let me ask you the consequences if you overstate the case with your budget. your officials said that there will be families who will have
2:00 pm
to lose their homes and move. how many children as a result of what you're doing will have to lose their homes and move? >> no one should be without housing when we are paying -- >> it's 15,000 pounds -- >> look, as i said, we know the numbers of households affected by that benefit cap, household benefit cap; right, 21,000 or 17,000, but, as i say, they are going to get up to 20,000 pounds a year in housing benefits. .. benefits, the maximum limit which is 104,000 pounds a year. >> how do you justify that? >> how many children will be moved out of their homes as a consequence?
2:01 pm
>> as they say no one should be without a home when we have a housing benefit. >> well homelessness increase or decrease under your watch as chancellor in this parliament? will homelessness increase or decrease? >> no one should be without a home under the housing benefit package. >> so you are saying homelessness should decrease? >> i'm nets making a a forecast. >> you make a forecast on all sorts of things. will homelessness increase or decrease as a result? will. >> let me remind you of what the labor manifest is. >> hold on. will homelessness increase or decrease as a result of your forecast? >> i don't make a forecast. what i'm saying is world there be more full-time police officers? >> i'm trying to get some answers. i don't what the labor party policy is. i want to know, will there be
2:02 pm
more homelessness? i want to know will there be. >> what i would like to here is the reply on the police numbers, both the labour party and the liberal democrats have accepted there will be fewer police numbers. what we want to do is maintain the visibility and availability of policing on the front lines. there are currently many police officers working not on the front lines, it doing the tasks that qualify people. so what we want to do is maintain the visibility of policing at its current level and we would like to improve that, but--. >> there will be no. >> and availability and policing in our community. they have regularly told us this parliamentarians there are
2:03 pm
significant efficiencies that can be made. >> will there be any reduction in special-needs provisions for children? >> special-needs education, which we are looking at this and the role of special schools. your best a very specific question which frankly goes to special education needs of the policy. but we are looking at the appropriate balance between special-needs schools provisions >> one last question. >> chancellor told me, i just want to know about the implications. [inaudible] >> i say that leap oath take responsibility for the difficult decisions, since you voted for the budget.
2:04 pm
>> no, no. >> i am bringing these. >> we are not getting an answer. >> the exchanges between you and the exchequer. >> the floor is yours. [laughter] >> what i would like to do is go do something completely different. during the discussions, you seem to describe quick deals. i wonder if you can confirm to the committee that bp was happy with that deal and bullet points the way forward in the future? >> first of all i think that-- whether they are happy with agreement. i mean i think it is a good agreement. i think it recognizes that they
2:05 pm
are a public audience effectively under former taxation for licensing and that they too need to make savings and they need to contribute, and you know i want to thank mark thompson for engaging in that process. and agreeing to take the funding of the central government funding through the foreign office budget and funding various other things as well. and, d.c. monitor and parts of-- and also agreeing to freeze the figures and i think that will help keep them a bills down over the next years. so i think it is a big-- good package. the negotiations with the bbc were one of the last to conclude that actually discussions have been taking place for many many weeks if not months on for example of the elements of the package and have been engaging
2:06 pm
in discussions about licensing as well. so, they were brought together and i think a good deal was had for the bbc, for the british public and for the british government. >> thank you. on drugs, that will be an importantly-- an important part. the forecast of 290,000 public sector jobs will go. and rebalancing the economy going for world mean it should focus on the private sector for job creation. in the northwest, a number of people employed in the public your has gone up 70% of the last 10 years and the their flatlined at 24. so given that context, what degree of confidence you have for the regions who will deliver on jobs across the northwest?
2:07 pm
>> the first point i make is that the 490,000 figure comes from an independent body. it is a budget responsibility. it is not a secret it was published at the time of the budget, and if you are going to use that figure, you will have to accept the credibility that they give then you have to accept the credibility of the other estimates on employment. and they forecast a 1.3 million net jobs will be created, so they will be the first one and that of course comes from private sector growth. now, what we are seeking to do, and this is a big challenge and again, something i would suggest an interest in is how we move the british economy from a model where there was excessive,
2:08 pm
economic growth was fueled by excessive leverage in the banking system in the households and in government and also a model of growth where too much growth happened in one quarter of the country in one sector of the economy, financial services and where we need to move to a more balanced economy in many respects, geographically and a balance between the private and public-sector. i think a striking fact is that for every 10 jobs created in the southeast england, one is created in the north. so that is a challenge. we are seeking to use a number of different tools. capital investment in the regional growth fund. we are trying something which no one is tried in the country before which is a tax break for hiring new people that only applies to regions outside of the south east and the eastern areas. that is a geographically-based
2:09 pm
tax measure. we are also seeking to have a highly competitive corporation tax rate, and i believe the reforms to education, higher education will also produce structural improvement in the british economy. so, it is a number of tools. producing a new model of growth, which is not so dependent on dead or-- is a major turn for this department and i would agree with you. >> you mentioned about the-- an emergency budget. you said that needs to stop at 10 to 20%. hasn't started? are there any signs? >> that has started and they are are quite encouraging signs, but actually one of the things we ought to do is make sure that many people are aware of this and it is being taken up in across the country.
2:10 pm
i was in west yorkshire the other day and it was a good take up there, but actually they the take-up was hired by some people who are eligible for it. that might be, as they come to complete their taxes, their new business so they come to pay their national insurance and they will be aware of it and certainly i will be instructing to make sure people are completely aware of all they are entitled to because i think it is potentially are useful. >> further communication requires. >> i would say it is working well. it is one to say it is working better. >> would you anticipate or look at the possibility of extending that, given the importance of growth? >> i don't want to actually write the budget here, and so i'm not saying that would be in
2:11 pm
the budget are not in the budget. i'm not going to comment on the individual tax proposals. obviously it would be more expensive to deal with the stock of businesses rather than the flow. >> i know that it will be talked about in more detail in a minute that you have made several comments about the importance of tanks providing credit and i think most people around the state and members of of the parliament would accept that view but what steps can you take to get the banks to do what we think is important to the states economy? >> i think it operates at a number of levels, and i wish it would be-- right now. i think they are a number of tools some of which are working in some of which need more work. actually most important of all is getting international
2:12 pm
standards on capital liquidity and definition of capital because that at the moment is causing this problem not just in the united kingdom but many other countries, so this is not a unique problem to the u.k., but getting certain day on the capital liquidity requirements of the international banking system is essential and i hope the g20 at the end of next week, that will be-- second i think there are specific measures that the banks themselves can undertake and they have come forward with actually with a 1.5 billion version of small business lending funds which will help particularly startup funding. is a welcome thing that they have come forward with. it is not the last word necessarily but it is a good important step forward. we have extended and you can underpin some of the funding guarantee. we are also doing that so there are those three things and actually as it happens, the new
2:13 pm
lords chief executive is someone -- spectacularly increased small business spending and his-- [inaudible] and that is our largest retail bank. >> can i ask you a question? you have given the licensing monies, get they are highly resistant to what they are asking for which is community enterprise funds leading to that. will you use your powers to direct them to give monies to community enterprises imperative to the people? [laughter]
2:14 pm
i tread with trepidation in this area. one of the things i have had to sort out is the funding, because the mechanisms that have been in place for decades expired at the time of the general election and no arrangements had been put in place. you know what i sought to do is, with the agreement and consent of the palace, is put in place sensible restraints on current expenditures and as you correctly note, there is a freeze which is having an impact this year and next year, and then trying to develop and by the way you will all be glad to know this is the subject of primary legislation in the house of commons, a future funding mechanism for the sovereign, which is linked to the growth in
2:15 pm
the receipts and the revenues. we are just trying to create a permanent mechanism as part of the specific.. i suggest that we have not decided before then to introduce the community measures that you propose and you might want to raise them. >> was a point in the last parliament in this committee when we did the inquiry. the serious point is that there is a real opportunity to help communities to grow for commercial developers to look at that. calling on to-- speak and you just give us the likely timing of that legislation? >> the secretary and i have
2:16 pm
particular responsibilities for the royal finances. [inaudible] [laughter] >> if you could give us a rough idea. >> thank you. we have had evidence for a number of sources about the markedly different impacts that the measures taken will have within different regions. and, my question is, in this regard, is it inevitable collateral damage that these regions will not prosper as well as others. or, if the government-- is the
2:17 pm
government taking specific measures to help those regions? >> first of all know, i don't accept them, the terms. any particular region should work out of the economic government policy. we have a bit more of a rebalancing of this economy geographically in the way that i was just describing. the absolute precondition of investments in a country where the private sector is not as private as anyone would like it a dubious economic stability and they think they keep going back to the big picture which is this kind -- my government was not prove providing credibility and all parts of the country would suffer potentially. the parts where investment is marginal. the second, there are very specific regional tools that we are using that have heard for example that his jewish vision of the capital project, where they are located, partly through the regional growth
2:18 pm
regionally-based tax reduction which is again-- so there are a number of tools which also i think help. >> we were talking, you were talking earlier about traditionally in this country we have i think over relied on bank financing and i think it's response to financing a private sector recovery, where it says serious over capitalization of ritter small businesses, especially compared to the u.s. needs to be addressed. how can we go about encouraging more equity, and making, and what forces will the government do to actually get us toward a culture of less dependent on
2:19 pm
banks the i think currently the use of various funds, some of which are provided by the banks themselves and some of which are provided by the government, flows from venture capital. i think there is the tax treatment of equity which is also an interesting area, where actually the playing field is not particularly tilted in the favor of equity investment, and that is worth looking at. as i say don't want to prejudge the budget on the so i think you are a number of tools, but it is quite-- because you you are exay right. by the way i think also this applies to micro-businesses, what they are trying to get more of a corporate market developed in this country and the way of the united states.
2:20 pm
that is an important step again take. a number of tools to get away from a model that was over reliant on banks, and banks who around the world have in deleveraging. >> the banks 7.5 million growth fund he referred to could be very helpful and not, but not if they run-- which is to it to take sufficient and well-adjusted investment risks and companies that are looking or the same thing. how much will you be able to in the country, how much will you be able to direct so that lending goes to where the book is going to come from? >> as? >> as i say first of all their incentives you can bring. i mentioned the tax system. second, a the growth they are
2:21 pm
creating. >> some of the riskier start up investments which there are not enough of in the u.k. and there's a striking imbalance between that market here in the u.k.. in terms of directing lloyd's and rbs and other institutions, my general impression has been my predecessors in this regard, which is i don't think the idea of a politician directly running the bank is a good idea and we have the u.k. set up by the previous government. but of course, in my meetings with those chief execs, and make it very clear where i believe that prior to should be and as i say, the chief executive announced lloyd's, someone with a particular track record in increasing the lending which we
2:22 pm
were very aware that all so we are going to increase malt business lending so i think there are various tools. >> thank you. >> chancellor, think chancellor i should start by saying i'm going to enjoy future years when you are cheerful. seems to me this is a-- again i just raise something? i am going to raise regional spending but i just wanted to gently, peacefully get to the point where yesterday or the day before we were approached by-- who said your policies were right because the country was heading inexorably towards a financial crisis. the bad luck, were you not
2:23 pm
concerned chancellor that the final figure, the original estimate from that public borrowing in 09/10 was about $177 billion. the final figure is $165 billion so rather than having an economy running out of control, the last wave of government, we have actually taken over 20 billion off what was going to be borrowed. can i also ask you to confirm, just gently, that this year you might tell us how much money is coming out of med borrowing this year but as i understand that your contribution is 6.5 lien. now the amount of money coming out is considerably in excess of that, from the march budget. now, i liked your statement where you said to a collie,
2:24 pm
whoever won the election would be doing the same thing. you see i think you played a magnificent game in terms of politics and i take my hat off to you as a professional politician. the fact that a crisis happened, receipts dropped as they were spending come in because we were in a crisis, we didn't think it was opportune to cut expenditure until they got onto firmer, more confident economic ground which is economically sensible. but it is clear from mr. dowling's budget last march, as you said, we were all going to do what you were going to do. the difference in time. you are going to go further, shorter and the only difference between the two parties is that
2:25 pm
sensible in terms of the fragility of the recovery? do you care to comment? >> there a couple of points. a couple. a couple of points. first of all the fiscal forecasts of the previous of course was decided upon by the chancellor of the exchequer and the prime minister, and it is true that the march 2010-- turned out to be lower than they said it was going to be several months before. >> could i just interrupt you for a second? the point i'm making is the original estimate, the original project--. >> there were various estimates given. there was an estimate given by the government and now it turned out to be less than the estimate one was being very cynical and of course you might say with an election approaching they put it up there.
2:26 pm
we have created and independent office with budget responsibility that makes these forecasts on a central-- you referred to earlier and i do want to take too much time with this but actually a budget deficit was emerging before and i know paying people-- at tony blair says he was the primacy of the time come we should also accept that from 2005 onward, labor was limiting or eliminating the potential structural deficit. the fundamental savings review was enriches that the much bigger error than i ever thought of the time. he was the prime minister at the time and the institute of fiscal studies and the government have both made the point that the recession pudding and mourners damaged back an enormous strain on the finances but it was
2:27 pm
emerging in the middle part of the last decade and there was a--. >> when it was running at over 3% by the time the financial crisis came along, so it was designed to express the point made by the government of the bank. the fact is we came into this crisis with fiscal policy that was not sustainable in the correction was needed so we were ill-prepared. other countries use the good years to reduce deficit to build up surpluses and the opposite thing happened in britain. so that would be the second i would make her. the third i would make and i think this is-- the third i make is you asked about-- all political parties in britain want to eliminate the structural
2:28 pm
budget deficit. the structural budget deficit is the structural budget deficit. with anything there are more dead interest you have to pay, so the decisions we have to take which are structural loans like reducing child benefit for higher tax benefits these are decisions that will reduce the structural deficit. they are the kinds of decisions that anyone would have to take whether one to four, five or six years or eight years or whatever stood. you have still have half left in you have to make a further decision. it is not simple enough to say if we stay longer we can avoid these decisions. this is a structural deficit, not the actual deficit which of course is more volatile with the economic cycle. >> no, i think the conversation is a bit more calm and more objective.
2:29 pm
are you actually saying to the treasury committee that you would have no borrowing in the future? >> there is a fiscal mandate that is very clearly about the structural deficit, particularly adjusted so we are absolutely clear. >> it is a or dannatt. is very clear that the automatic stabilizers, and the fiscal mandates does not in any way-- so absolutely. >> just two years ahead, if that is not looking too far ahead what would you estimate? i am not trying to pin you down but are you saying it would e.-- i would be surprised if there is a western world government, country that doesn't have it.
2:30 pm
the e.u. is 3%, is that? >> the previous consolidation plan by the previous government. we put it then they all make country not to hit the 3% criteria even with the year extension. >> that is what i'm saying. to try to take the hysteria out of that whole debate. european nations except 3% of the upper limit, 3%. it has been labeled a hysterical over spender and for most of the time the structural side has been about for. a 1% difference between our colleagues. >> i will go one to the regional stuff. >> i just say by setting the fiscal mandate as the current structural deficit, and having a second target given extraordinary situation to get--
2:31 pm
by the end of this parliament,. [inaudible] setting the fiscal mandate i think allows the automatic stabilizers to operate and actually also provides freedom among capital expenditure which is then matched by the debt target. >> i think there's a difference between us in the time and amount but it was certainly going the same direction. we were going slower and you are going faster. which brings me to the worry we all have. now one of the things we worry about is the defendants on many areas of public sector jobs, and that rings us to the idea of-- now you have cut the rda and you have abolished the rda and taking the 4.2 billion pounds
2:32 pm
that would then spent by the rda's and you have substituted 1.4 through the regional fund. now the prime minister was saying, a relentless focus on growth, because of this we are going to be in some trouble. economy. >> my constituency -- make in my judgment of the constituency, the rda which covered all of the scottish border, just got too large and unfocused and after all, if you ask a question how is it that even after a decade of having regional development agencies, for every one, 10 were created in the southeast.
2:33 pm
>> it is the amount of resources, and the resources have come down from four-point two-to-one .4 over three years, which is if these are the engines for growth, it is worrying. but as i say, i think the rda resources word deployed as effectively and the fact that the economy was actually becoming more and balanced variations were growing. >> the previous created-- to increase the growth in particular regions and deal with the regional disparities in the economy, but actually at the end of more than a decade, the gap between the regions will grow so this was not an effective tool. >> the gap to train the northern regions and in the southeast was
2:34 pm
growing but we were still in better shape, but it is not about the ideas of, the ideas of body. is about the fact that he replaced it with the regional growth fund and local enterprise partnerships, and the funds available to the local enterprise partnerships are a third of what we have for rda's. >> if you would like to look at--. >> can i make another observation, which is, because we haven't really talked about it at this hearing. a reproach to capital spending has been very different from previous government. we aggregated all of the potential capital decisions across all the departments and simply gave the departments and said you make your decisions. we aggregated them all as road projects, hospital projects,
2:35 pm
investment in science and infrastructure and took all the capital to the government and then we sought to actually make sure that they were distributed in a geographically appropriate way as well, which we could take because we could make that judgment. i think you'll find that some of the capital projects are very specifically targeted in parts of the country which have not seen this much growth. >> in my area, the gateway is a big project in the area that has been underfunded for years. we been able to fund it and that will provide growth. >> you one last question. are you aware, if you work it through, how much money is coming to example to 11 local authorities. it will amount to just over 17 million pounds a year regeneration. now, that is not the price of
2:36 pm
one primary school. now, that is how the division reduce the sum. when you spell it out, it amounts to 17 million a year. >> the way he were coordinating economic policies across different councils and having the whole of the option under one regional agency. second their other decisions. for example, the traffic on the m. 62, the rebuilding of the lead station, which will help that economy, that local economy as well, as well as, and in leeds for the yorkshire businesn referring to-- quite a good take-up of the national insurance tax cut or new businesses, so they are a number of tools that are available but i don't think the rda will be
2:37 pm
the be-all and end-all because we'll probably would not have this unbalanced economy if they were. >> chancellor, this relentless forensic focus on growth at the prime minister speaks about requires a green economy, green jobs, green manufacturing and green investment. that will be driven in large part by the green investment-- what is the setup of the bank? >> well, i want to get enough money as soon as possible and we will come forthwith proposals on how it is going to be structured in the next, simply between now and christmas and of course i will set aside money to go into the green investment bank. in the csr, this is government money. i want on top of this, i want don't want this to be the only
2:38 pm
money going into the green bank that this is an important backstop. on top of that, future assets we should look at putting some of the proceeds of those into the green investment and also of course private money as well. >> indeed that was in the csr statement. the governments and business models of the bank, but that is not an inflationary at all. >> the thinking is pretty advanced. this is something new for the united kingdom, so we want to get them absolutely right and even though it is not just a discussion within government, which is quite easy to have, we have just got to make sure this is actually going to work. if we launch something and then it doesn't attract the private sector capital, that it won't be a great investment.
2:39 pm
so it keep getting this right and there is not an off-the-shelf model in the u.k. but just a few months after coming into office we have committed funding to it and i think that is a good thing. by the way we would hope that the scottish government is able to engage with us on the-- and make sure some of that money can be spent specifically in scotland. >> i'm sure the scottish government is already engaging with the u.k. government, but in terms of scotland, for the growth forecast to be met, they presumably need to tap into this 25% capacity, and the 20,000 jobs we estimate can be created in that field, bringing 7 billion plus into the u.k..
2:40 pm
now, you will be aware i am sure of the decisions which made in the next six to 12 months. you must be concerned that the absolute-- may delay the investment decision. >> as they say we were elected in may. now and november, i hope i christmas to have the structure of this bank bear and the thing being created. more money coming from government asset sales and from the private sector and sitting alongside some other policies which are directly benefited to the united kingdom this area. renewable heat incentives, support for wind turbines technology which is something the trade unions want to see and i met with tc-99 and we went
2:41 pm
ahead with that so i mean there are a number of things we are we are doing in this area which i think will help stimulate the green jobs that we want to see. >> the developments are incredibly important and very supportive of those but i'm trying to focus specifically on these other projects. you talked about finding a billion pounds in this is really the crux of this because a large chunk of the 100 lion so far is the fossil fuel levy that ought to have been available for use by the scottish government but would require a clawback on existing funding. why did you take the decision not to release that so we could have stimulus of these activities in scotland rather than-- and my fears that the bank may not be ready perhaps until 2013, 14 when the investment decisions are taken this year?
2:42 pm
>> it has come to my attention, on the fossil fuel blending the previous government would have no discussion about this at all. my predecessor did and want to talk to the scottish government about this. now what we are doing is engaging, talking and engage in an and second of all without going into if all the details, as you well know the release of that money would lead to an increase in public expenditure and in a way that the scottish government-- what we are offering is a different route which is to have the money channeled through the bank. absolutely for use in scotland and no other parts of the country, but i think that is, i hope-- we are trying to find their way through a problem which allows government didn't even want to look at. >> i mean, we will see if we get
2:43 pm
a solution to this, and they know the discussions-- [inaudible] the key concern and a new hope you take this on board that the possible delay in the investment decision to be taken quickly, we have a detrimental effect very quickly. that is the concern. >> i was one of the people in the development policy. we are seven months after the general election. is a complicated thing that has not been created before in britain. there are elsewhere in the world, but we are working you know very very hard to get the proposals out there so that it works. the last thing they want is for us to announce some proposal that sounds great on the day. i would rather get it right, get
2:44 pm
it right between now and christmas than something does not attract private sector investment. i provided the billion pounds as a backstop has what i hope is that substantially more resources are found from government assets but also from the private sector, leveraging in the green infrastructure and the whole united kingdom. >> chancellor thank you very much for coming to see us this morning. you have given some good answers and you have engaged in all sorts of issues since he became chancellor, not the least the lvr, where we are now collaborating on the appointment of the senior people at the odr. you have been announced to look at the tax policy, and we sent you a letter about that and we
2:45 pm
appreciate if you would consider that being put in the public domain today. today you have asked us to look at the methodology being used to assess the distribution again, and we will certainly do that. you have also responded to the great transparency by sending us a letter, which on the-- which i think is important. we are grateful for your openness on all of this, and i would be very grateful to the committee. we can adjourn for three minutes but-- [inaudible] thank you very much. >> thank you.
2:46 pm
a. >> president obama continues his trip to asia. are your he spoke to u.s. troops as part of a veterans day celebration. ag 20 summit also started today and will wrap up tomorrow with the president participate in a closing news conference. finally, president obama will travel to japan to take part in the asia-pacific economic cooperation meetings before flying back to washington on sunday. and a look at the u.s. capitol there were both the house and senate are out. the senate has been meeting every three days in a pro forma session to prevent the president from making any recess appointments. when the senate reconvene for business monday, possible legislative work includes builds on natural gas and electric vehicles, as well as as well as waged equality and food safety issues. watch the senate live right here on c-span do.
2:47 pm
as the country marks veterans day, learn more about the holiday and the men and women who have served in the military with the c-span video library. oral histories, authors on the nation's wars, and veterans day commemorations through the years. all searchable, all free on your computer anytime. >> in an ideal world the fact there were people shorting the mortgage market would have sent a signal to everybody saying they are smart investors who think this thing is going to crash and burn.
2:48 pm
>> next older drivers safety, the national transportation safety board hosted a two-day conference this week in washington. on of this final day of the meeting, the focus was on the screening and assessment of the physical and mental abilities of
2:49 pm
aging drivers. as well is what measures state and local governments have in place to address such issues. speakers include transportation safety researchers, as well as federal and state traffic safety officials. this portion is two hours. >> welcome back. our last panel is state programs and practices. this panel will look at a variety of the state department motor vehicle licensing approaches that have been enacted by state legislators in recent years, and consider the ongoing work of the state dot to determine if the statutory changes to the licensing of aging drivers has had a safety impact. the panel also look at nonstatutory dmp programs and other organizational programs to design to ensure that aging drivers are safe drivers, particularly in the areas of medical assessments. stephanie davis and steve blackstone have prepared questions for the panel. ms. davis, will you please introduce the panel was?
2:50 pm
>> thank you. in 2005 after serving as associate chief for three years. for 25 years prior to joining, doctor switch to was a member of the faculty of the trauma center of the university of maryland school of medicine and a senior researcher at the school's national study center for trauma and ems. he is currently adjunct professor of surgery at the university of maryland and an associate faculty member at the johns hopkins university, bloomberg school of public health, department of health and policy management at dr. soderstrom has authored over 100 scientific publications, many of which focus on substance abuse and injury, particularly as related to driving. his current research efforts center on medical fitness to drive. dr. soderstrom served on and are
2:51 pm
testified in a traffic injury prevention efforts, including the ntsb's hearing on medical oversight of the noncommercial driver. he has just completed a two-year term as president of the associate -- association for the advancement of automated medicine. in 2009 dr. soderstrom was appointed by the secretary of transportation to serve on a medical review board of the federal mortar carrier safety administration. this year he joined the nsc's crash injury research engineer networking. dr. soderstrom earned his medical degree on the downstate medical center of the state university of new york in brooklyn, new york. after completing his general surgery residency, he completed a year of trauma surgery fellowship at the shot trauma center of the university of maryland. next is dr. loren staplin. dr. staplin is the founder and principal partner of the consulting firm transanalytics. he has worked as a senior research scientist with the
2:52 pm
center for transportation safety at the texas transportation institute. vice president for transportation safety at the corporation and senior associate. before joining this, he worked for three years at lehigh university as an assistant professor in research scientist. he has successfully led 25 federal and state research grants and contracts since the early 1980s. doctor steven was pencil investigator for the national for the national highway traffic safety administration's sponsor project model driver screen and if i wish and program. which validated a set of functional measures as significant predictors of asphalt crash risk among older drivers. drivers. elected government of the federal highway administration's highway design handbook for older drivers and the addition. and is supporting its current update. he also led development of aaa's road wise review, an educational product for self training of safe driving training by seniors on their home computers.
2:53 pm
dr. staplin precede his doctorate in experimental psychology from arizona state university in 1979. he currently serves as chair of the committee on operation education and regulation at the transportation research board. dr. jane stutts. dr. stutts recently retired from the university of north carolina highway safety research center where she held the position of associate director for social and behavioral research. during her 30 year career at the research center, dr. stutts manage projects with a wide range of public and private sponsors and authored over 100 journal articles and research reports. her work focused on the behavior aspects of traffic safety, including older drivers, distracted and drowsy driving, motorcycle safety, bicycling tradition safety, and now this driver education. at the national level, dr. stutts serve the transportation research board in a variety of
2:54 pm
capacities, including committee chair, participation on several and national panels, and most recently chair of the system users group which includes the committee on older person stability and safety. since her retirement she is continue to consult in the field, including a recently completed project for the aaa foundation for traffic safety to develop a database of state practices and policies related to older and medically at risk drivers. dr. stutts received her undergraduate degree in psychology from wake forest university, and her ph.d in epidemiology from the university of north carolina at chapel hill. ms. essie wagner. mr. swagger has been working on older driver issues for 19 years. she as a program analyst working for the national highway traffic safety administration, safety countermeasures division on older drivers and safety programs. ms. wagner is this puzzle for the invitation of the agencies older driver program activities working with organizations include the american medical association, the american association of motor vehicle
2:55 pm
administrators, the american society on aging and other organizations that have an interest in older driver safety. she received her ba in psychology from the college of wooster in ohio, and went on to get an m.a. in applied psychology, human factors, from george mason university. before joining nhtsa out she worked for seven years at the federal highway administration where she conducted and monitored extensive research on older driver issues, including the development of the older driver highway design handbook. i'd like to begin by asking the panel, we've heard a lot of research yesterday and this morning, and i would like to ask him what do we actually know about what state are doing to address the safety and ability needs of the older driver? >> and i think i will take the first stab at that. mainly because i think one of the main reason i was invited to participate in this panel was the recent project, the
2:56 pm
opportunity i've had to work on a project with support from the aaa foundation and with assistance to develop a database and website of state policy programs and practices. so at the technical panel, or the panels or have any questions about specific state policies or programs, or what states do this without, then i think i may have a good resource to draw from in answering those questions. i have one slight here, just a couple slides showing a little bit about the database for those who may not get the money with it. it is housed on the aaa foundation senior drivers.org website. there's the address there up at the top of the slide. there are two parts to the database, and i know you can't read all the type there, but the first part is what we call the lpp, licensed policies and practices. and this is just sort of a nuts
2:57 pm
and bolts of current estate practices regarding particularly folder and medically at risk drivers. and again, this is focused on driver licensing agencies and all. so just a coin that's a bold and what are the policies in place by the very states that the second part is the initiative. you know, in addition to just serving as the resource and compelling and read information those are out there, in addition to just doing the nuts and bolts, we wanted to go in and ask some states what are you doing that you think is really pertinent, really helpful to older drivers, what initiatives could we possibly promote to other states and all? so we pulled these and do, together into a separate section of the database called no both passionate nobody initiative and have about 40 initiatives that there that we pull from. just to show you a couple of
2:58 pm
slides of what it looks like it if you go into the licensed policies and practices database here, this is just the first screen that pops up, the first table that you come to is on mission requirements for licensing. but you have the option, there's a pulldown box they're out of the top of 18 different tables of information. so we cover, and you click on the table and then pull up that information, which every are most interested in at the time. so the database covers vision standards for driving, renewal requirements for driving. and these are things that are google and other databases as well, but we tried to pull it all together. we have tables on physician reporting, reported by family members, and law enforcement. we have a table in a medical review process, both with medical advisory board in place him and those without a medical advisory board. information on referrals, or what our drivers license
2:59 pm
practices, or other outside referrals. information on restricted licensing practices, any particular training that they give for the local examiners and their staff. and then also information about whether or not they have a website with information for older drivers who are medically at risk drivers, and what information is in the hand of. so a lot of different information covered there. and again, i would stress that some of this information is developed along other sources. there are very good websites out there. gsh ahaz a good website of the insurance institute does. but they focus on the renewal requirements then maybe particular policies that are age base are in effect for older drivers to go we tried to cover a broader spectrum of issues that drivers licensing agencies are involved in. >> untracked this is a sample of the table up close, and one nice feature of the website is
3:00 pm
educated so click on any column and it sorts the column. like i was doing to prepare for this, if you asked how many states do this, how many do that, it makes it very easy to see, you know, where your state is. if the dmv is interested how they stand with respect to other states, it makes it easy to see where you stand. the other half of the database is a noteworthy initiative. . .
3:01 pm
>> i'm not going to get into any specific points now. we'll wait to see what specific questions come up, but i will say right off the bat, there's few few of these knishtives that have been -- initiatives that have been evaluated. >> thank you. you have conducted several studies defining functional fitness to drive involving at fault risk. should licensing practices change to take fitness into account in an aging society? >> thank you for the invitation to appear before this panel. i think that yes, it should. first off, we need to recognize the public health mandates that are licensing authorities are charged with carrying out. our society accepts driver
3:02 pm
qualifications broadly speaks, and most agree that we all need to see to drive, so we accept vision testing when we get licensing, and some states have more stringent requirements for commercial drivers. there's a lot what has to do with an analysis of risk that dictates how much we will accept or tolerate in terms of qualification requirements. until new risk analysis has been limited to a consideration of consequences, but ideally risk analysis takes into account the probability or the likelihood of a harmful event. we haven't been able to do that very well up to this point, but with the advent of the linking between functional fitness, functional measures, the fitness
3:03 pm
to drive, and outcomes that are perhaps somewhat in dispute, but broadly recognized as important, specifically crashes and more is at fault crashes with the ability to tie those things together. we have begin to have the ability to speak to the likelihood of probability in addition to just crash consequences. i'm going to take an exception to the points made earlier that in fact in this country over the last decade there has accumulated a responsible body of evidence using large population based samples, representative samples that have been tracked over a period of years of the relationships between function and crashes, and again at-fault crashes in particular, to the point where no researcher says we have all the evidence we need, but we do have a pretty respectable body so far, and enough, in fact, to have allowed us to take some of
3:04 pm
these relationships and build them into programs that are being implemented in licensing jurisdictions on an ongoing or pilot basis. i'm thinking of maryland and california and we'll talk about those probably as we go on. could i just have a slide real quick here? as a case in point, i want to put up -- let's go back to the first, yeah. i want to acknowledge a colleague of mine, jack joyce, who is minely responsible for this -- mainly responsible for this work when he retired at the maryland mva. i put this up here because we talked about how hard it is to pull elements together in a workable system in a licensing arena. this is a system that was developed and was presented
3:05 pm
interimly. i'm -- internally. i'm not suggesting its implementation is pending, but a lot of feasibility went into this and key aspects here deserve note. one is if a customer go through the normal process, a few, in this case by age are diverted into a brief screen focused on cognitive measures. most, a very vast ma pass. a few are tagged for continue examination, and there is a continual process improvement to set cut points so you have the specifics that you want and are compatible with the agency's resource allocations. it takes time to do this k and you want to make sure the money you spend is targeted at that segment of the population where you are likely to pick up those
3:06 pm
with related age deficits. finally, at the end of this the license agency has to promote awareness, facilitate to a biggest degree as possible, to other transportation alternatives. that's enough of that, please. i wanted to stress also that this whole issue of screening for functional fitness to drive is a very important cross-cutting issue. we heard yesterday from people responsible for developing the next version of the highway design handbook, and people involved in vehicle design improvement towards older person's safety. they need to have benchmarks. we can't accommodate everybody with safer highways or building safer cars. we need not a moving target, but an understanding of what level of capacity the design community can expect in the general driving population, a set of
3:07 pm
minimum qualifications that are going to be established and enforced through the licensing process. three closing points real quickly. the point was made before, screening does not equal assessment. when you implement a screen, it doesn't lead to a licensing action, but an assistance of that diagram earlier, additional opportunities for observation and assessment and tracking. second, i would say that, you know, the perfect is the enemy of the good. that's applying to a lot of things. there is no perfect screening tool. i didn't mean to suggest we are there yet, but i think we are pretty far along the path of getting to something that is scientificically defensible and practical for an agency to implement, and timely, i would say the prime research opportunity is now to develop
3:08 pm
and validate and calibrate such a tool. we have not been able to link vision acuity at least to crash experience because we've had vision screening criteria in place for so long, we have removed people with the worst vision from the population and range makes it impossible to have a significant relationship. right now, we don't do functional screening. if we want a program not just by 2025, but in five to ten years, now we need to have an ambitious research agenda that in one or more states for a limited period of time obtains this kind of screening data for a large number of people and follows them so you can do the analysis to have the tools appropriate in this regard. thanks. >> thank you. we heard dr. staplin talk to the
3:09 pm
maryland data for older drivers. could you talk about how an at risk driver would be referred to by the board? >> yes, first, can i have my sleds. it's an honor to be on this panel and in connection withed with all the other people here for the last day and a half. because my deceased colleague and mentor, dr. raleigh, was unable to attend this meeting in 2003, i testified before the board, and i have to say that meeting was a seminal meaning in the sense that for one of the first times brought together people from many different jurisdictions in the unite, and we suddenly began to see we had 51 ways of ding things, and really good things have come out of that initiative, and this is a god follow-up -- a good follow-up meeting to
3:10 pm
that. our board we think is the oldest in the world, founded in 147 and -- 1947 from florida and delaware. two-thirds of the states have advisory boards, but they function in different degrees throughout the united states. my colleague noted if you look carefully at the picture of our medical advisory board, that is a picture of 1947. there's ashtrays in the picture there and they with respect as healthy then as we would have liked to have been. there's an administrator from the mba to give a recommendation if they believe driving a vehicle by him or her would be contrary to public safety, so that's our job is to give advice, and maybe we can discuss
3:11 pm
later there's several venues in which we can give advice. the way that people come to us, the paths of the mba can be court referrals, requests for re-examinations from police who encounter a driver with a concern about their fitness to drive, the self-reported conditions at the time of application or renewal, report from clinicians, concerned citizen letters. i will say that a letter that says i'm concerned about the driving of my ex-husband is different from the i'm concerned of my father who had a couple fender benders and we're concerned about, and we also get referrals from customer service agents. dr. raleigh, john everhart, i'm not sure who gets credit for this, but it's about mobility for quality of life of the
3:12 pm
client and other uses of the roadway, and we want people to drive as long as they are safe and consider each driver on a case-by-case basis, and we accomplish this with medical assessments, rehabilitation and training programs. this is raising an important philosophical -- this is a true letter from a position that was referred to us. the above married couple have been patients of min for decades. i love them. they have significant impairments that i can supply full details to the appropriate board r but i feel they should not be driving. this is after they promised me she would not drive and her family was partners to that compact and now they have a new car with the intention of driving it.
3:13 pm
the important part of this letter is please advise the medical agency. i stress this that recommendation is not based on their age or diagnosis. it's really about function and not about any specific diagnosis that we focused our efforts on. this is an example of someone who is extremely fit. she's my mom, she's 91 years of age. i will challenge nip in the room to say she has less senior moments than all of us that she has in a month and we have in a week. just a raise a little provocative question, in the past we used to ask physicians who filled out a report this question and in my professional opinion this person is physically flesh and capable of operating a motor vehicle at this time, and the answer was yes, no, and comment. frequently the comment was i don't know, you tell me, or
3:14 pm
please make an assessment instead of checking yes or no. this brings us into a new ere rare of going about doing this, and that is based on your assesment of this patient. do you have any concern about his/her ability to safely operate a motor vehicle, and then the possible responses are yes or no or not sure. in not sure, please -- if not sure, please explain. thank you for letting me have these opening comments and maybe stir a couple questions up along the way. >> thank you. i want to turn questioning to steve. >> thank you. regarding the perspective on all of this, we've heard a lot of ideas and some specifically from the other spanlists about -- panelists about things that can be done by the states to enhance the ability of driver's licensing authorities. from this perspective, what are the things that can be done that
3:15 pm
states should be doing to enhance their ability to address older driver safety? >> wonderful. thank you so much for having me and asking this question. can we have my -- thanks. it takes a comprehensive approach to addressing older driver safety if we can manage that. the way that we go about is it we try to find the people who have a way to identify the at-risk driver, and i use this graphic here. we have the families and friends and the older drivers and the general public who have some way of seeing that something's not right that's going on, but we also have professional organizations and professional individuals who have the ability to recognize somebody, and that's driver's licensing, health care professionals, weave heard a lout -- we've heard a lot about those. your area agencies on aging and other organizations that may be
3:16 pm
involved in that. we also include, for example, the alzheimer's association and people with educational activities as well as law enforcement. all of these have the ability to identify an at-risk driver, but they also have the ability to do something about that individual, and i also want to point out that all of this is using a firm research basis. we don't want people to go ahead and just say, oh, you have to stop driving because you're old, and it goes alongside everything we have been talking about over the last couple of days here. that brings us just to a good example of how we've managed to address this from the national perspective. we developed the driver fitness medical guidelines in partnership with --
3:17 pm
they are here today, and it's an approach we have to use is this voluntary approach for assessing and monitoring the at-risk drivers. that includes the folks we've been hearing about over the last few days, people with dementia, epilepsy has been mentioned as well. it's covered vision, cognition, and physical function in a way that the dmv's need to be able to interact with these individuals and assess and monitor them over the course of the renewal cycle for that individual, but the nice thing about these particular guide lipes is that also -- guidelines is they identify the ways that dmv's should be working with other types of organizations. for example, there's educational information in there about what dmv's should be saying to physicians and other clinicians about ring you know, how should
3:18 pm
you be counseling your parties about this? we have ways to do this and educational information in there about people with those medical conditions that put them at that increased risk. we want in this case with this example we want the dmv to pay attention in monitoring the individuals, but getting these individuals into their system so they are not causing an advanced risk to the public. that same sort of model is used in other areas with education, medical providers and physicians, pharmacists, occupational therapists, and so on. it's that kind of approach where we need multiple players engained and making those referrals to the slide if you go
3:19 pm
back to the image. we want driver's licensing to be talking with law enforcement, and we want law enforcement to be making those referrals to the dmv, and we want law enforcement to be talking to social services saying, well, if this individual is found driving at, you know, 2 a.m. e radically, and they're not otherwise impaired, we want them to be taken care of appropriately, and we don't want them thrown into the dunk tank or whatnot. that's our approach to that. thank you so much. >> great, thank you so much. i have a number of other questions, but i'll turn it over to dr. garber before i use all the time here. >> i have a follow-up question for the panel which is if i take an eight hour drive from boston to d.c. if i do that in the middle of the night with no traffic, i'm going to pass
3:20 pm
through seven states in the district of columbia and the potamic, how do the different mva's share information about their drivers? if i am found in a particular locality to not be able to drive, is there a problem with me getting a driver's license in another state, and how do the states that are next to each other where some may have a physician in one state work in another state and actually have a driver's license from a third state, how do they share information to determine whether they are consistently applying those situations to folks who live in those states? >> i'll start by responding to that question. you're absolutely right, mitch, that -- well, you stated a premise. what the premise is we don't
3:21 pm
have a good way of communicating right now. because maryland is a little state and a lot of people pass through the state or work in our state that live in another state from time to time, our office ends up speaking to individuals at other jurisdictions and/or if they have an mab. right now, that dialogue is something that needs to be explored, and we are in the process of as a first baby step hopefully in the near future to get together with colleagues, at least for the states around us to begin to get to know each other, know each other's rules and regulations and get philosophically on the same page. you're right, a perfect example would be a number of years ago -- well, i'll specifically give you a case, but you could have a
3:22 pm
condition called narc help sigh, and if you don't have any symptoms or any episodes, in the state of pennsylvania, you can be free from all those symptoms and problems for six months and be allowed to drive, whereas in the state of mare, it's one year. because of the dialogue we had with pennsylvania, we came to a middle-ground decision on that one, but i don't think right now the dialogue is there, and it needs to take place. >> i think if and when a brief cognitive screen is to be adopted, there does definitely need to be some federal regulation with respect to methodology and criteria so that the policy is standardized across jurisdictions and the
3:23 pm
time to do that is when it's first implemented. you talk to people in sun state florida you have people from other states coming down for the winter, and the licensing firls, department of highway safety and motor vehicles are very frustrated by the different standards from other jurisdictions, so that's a very important point. >> just one additional comment to add to that is that, you know, recognizing differences between states and how they treat things and all, it also implies that, you know, in order to make a decision about which is best that we know which is best, that we've done some evaluation, and we know that, you know, one state's policies practices or policies are better than others in ensuring safety on the highway. at this stage, we don't have a lot of that evaluation information to make a decision, and so states are, you know, for
3:24 pm
the most part, making their policy decisions and requirements best, you know, based on best available evidence, but that is very weak evidence compared to what the medical community typically requires to making decisions like that. it's based on consensus or expert opinion or at the bottom end of the scale because they've always done things that way, so you do have implications there that right now we don't have the guidelines in place as to what's the best system to undertake. >> let me follow-up with a perhaps a very practice call question, and that is we recognize that virtually every state has very severe budget problems these days. resources are going to be very limited not just this year, but probably for some years into the future. given that background, where should the states put their limited resources? where do you start?
3:25 pm
i suspect this is is going to be an even greater constraint in the coming years than it has been the last few years if that's possible. >> i'll try tackling that and hope the others jump in as well. going into the basic guidelines here that we've provided to the states last year would be probably the best place to start. it will help them in reducing some of the litigation that may come in in terms of ada compliance so there may be funds that can be freed up that way, however, it's really more about, you know, making sure that we have safe people on the road. i would love to have medical advisory boards in every state, functioning medical advisory boards in every state, but what i want them to do more than that is adopt these guide lipes and actually -- guidelines and actually make sure they are screening and
3:26 pm
identifying the people at risk on their roads. >> are there other takers? >> i'll add too again is there is going to be doing something about older drivers to begin with, and i preface that by when i contact states lately if they are interested in certain initiatives or evaluating them, it's obvious that older drivers is not at the top of their radar screens. >> no, it is not. >> they're dealing with real id, you know, all kind of issues. commercial motor vehicles get a lot of attention and young drivers and alcohol are always at the top of their lists. i think our very first challenge to to really bring it to their attention and get them to wanting to do something, and then we can choose what. >> exactly. it is a matter of priorities.
3:27 pm
>> uh-huh. >> if i could chime in, i think we need to look at the practices and always reevalwait what we're doing -- reevaluate what we're doing. the maryland advisory board has student clinicians, and one of the things we looked at in the last several years is kind of how we did business and we needed to get more efficient -- well, it wasn't something we looked at, but we became efficient because they are good clinicians that serve on the board and to some degree we practiced as theirically nations. -- clinicians. in other words, if they had a certain disease like diabetes, we might ask for a report every two years. there's no real reason for us to do that. if you are having some unhealthy
3:28 pm
practices, i'll use the number 300. if your cholesterol is 300 with a blood sugar of 300, that's your issue of you not being in good health, but it's not the advisory's responsibility to keep tabs on you. one has to prove what conditions are reportable, and as signs come in, think about what are the conditions that really, really count. again with diabetes anyone with that in the past was supposed to refer themselves to the mab. well, the higher risk is obviously an inquiry diabetic and i understand there are some and people who are on insulin who were not on ipse lin before -- insulin before. we have to streamline those practices.
3:29 pm
one thing that a medical advisory board can do is we're fortunate to have a board with 12 nurses issue and i said there's ways we can give advice. well, if you have a well functions medical advisory board, you don't have to review every case that comes in. we do work with our driver wellness division to come up with ailing rhythms of where cases can be solved and taken care of, and most importantly it's a way to trim down the system in many states i understand from the first time i was here is once you get in the hopper, you never get out. you need to be able to close cases. if i have a brain injury and recover from that injury to a certain level of complete recovery or a good level of ot that i drive a certain way, that case should be closed. in the midst of looking at
3:30 pm
budget constraints in the future, i think all of our states with mab's are thinking of them and really look at what actions are they doing and are they efficient actions that they're doing? >> thank you. if i might follow-up on a comment you made which is an important one when you said we really should be looking for impairment, and not the age or the diagnosis, and yet i reviewed the insurance for highway institute analysis of state licensing laws, and they identified 18 states that shorten the renewal time for older drivers. the states vary in age from when that accelerated renewal starts between 61 and 85. that's a broad range there. how do we -- how do we discern what an appropriate age is for when we
3:31 pm
need to begin taking greater look at older drivers? the reality is the states are going to be looking for some guidance on that, and it's going to be very difficult to say just look for impairments. >> why did you do this to me? [laughter] >> i'm just telling you what the state's laws are now. >> i guess when you look at these panels that we have in discussions and forums, we're dealing with a very difficult issue right now and that is what is old? in my family system i'm 66, i just entered middle age, so i think we could work our way backwards and possibly say people who are 110 years of age need to be assessed and work backwards, but the question is, i think, where is old?
3:32 pm
what is senior? what is elderly? i don't think we have the answer to that question right now, and i thought the panels yesterday and today make is very clear that 185 is not equal to another 85, so i don't know where or what the magic age is, but we have to speak to the question with science, and i don't know if science has enough answers right now to tell me where. i'm not going to tell you my opinion about where i think it is, but i definitely do not think it's 65 or 70, and i don't think it's 75. >> i totally understand the dilemma, i'm just wondering what to say when i'm confronted by state legislators who are asking me that question. >> well, it was kind of alluded
3:33 pm
to before. legislative processes and press processes are very interesting as you probably all know. last summer in cape cod, massachusetts, there were six or seven crashes in older drivers in which some really horrible outcomes happened and people died and were seriously injured and because of the cluster that these occurred in the two month period, there was an immediate public outcry of we need to do something about this, and we got calls, i'm sure you got calls, jane got calls, loren got calls. i don't think we should let public outcry drive the conversation. unfortunately, it does drive the conversation to a great degree, but i think we need science right now about what constitutes
3:34 pm
when i'm frail or fragile, and then again, that's another 10 minute discuss because that's going to become a new diagnosis in the next five years of fragility. i don't think i answered the question very well. >> quick follow-up. one thing you can say to a legislator is show them data that would support the notion that if for whatever reason you'd like to start screening at the age of 25, you'll need to spend $10 to find one person who might have an issue with impairment. if you'd like to spend only $75, then you start screening at age 90. there's a definite relationship there that is demonstrable, so you know, think about that. >> that's an interesting response. >> unless others have comments
3:35 pm
i'm -- go to the panels. >> okay. go to the first table, fhwa. >> we have a couple questions here. the first one is for dr. sotestrom. do you see ways to foster older drivers in assessment and reporting? >> that's a great question. one of the recommendations that came out of the last 2003 effort was that part of the curriculum in medical schools should be that this subject be on the table. as far as i know, it still has not been accomplished. when i was at the trama center for many years, i know it was not part of my modum to send you home with casts on your body and tell you not to drive. probably didn't even think about
3:36 pm
it. in canada and in the state of maryland we're going out to the university hospitals and their major departments and all the community hospitals, and other facilities to try to get to the physician -- to get physicians and clinicians to put this on their radar. we need to educate them to think if someone in front of you is 16, 96, or 116 is they just said they have a new symptom, they're on a new medication, i just am going to do something to them, where does driving fit into that e equation? the education piece is beginning in many places, but it's far from complete, and i'd dare to say in most jurisdictions and states, clinicians have no idea one, whether there's a medical advisory board in place or no idea at all whether they have
3:37 pm
any obligations or the driver has obligation about reporting or talking to the dmv or mba. >> thanks. dr. stapl irk n, you said we're on the the path of having a tool and which is we're not really sure what the screening techniques are and we need to do more work to get there, but when do you think we're going to have that or be able to say to my father, well, go to the dmv, take a one 20 minute test and see what happens? >> >> thank you. i honestly think we could be at that point in a decade or less. i think where we are right now is we have a solid understanding
3:38 pm
of the constructs that most significantly predict the risk of an at-fault crash. now, the way constructs are operatallized, those are the actual tools, and tools need to have certain properties. they need to be standardized. they need to be reliable and so forth, but i think the key constructs have been reasonably well-validated at this point. i think it's always important to gather additional data and define those understanding of the relationships. i think honestly within a decade we could have something that is passing scientific muster. ultimately, as a previous panelist played out, will be implemented in terms ofcepsivity and specifics so that, you know, where you cut and say who passes and who fails is as much political as a scientific decision. there's a number of those issues
3:39 pm
to be worked out, but i think that's outside the realm of the issues that you are bringing up, so i don't think we are that far away quite honestly. >> i guess a follow-up question for anybody that wants to try it is i think it was said we need more science about what constitutes old for screening purposes. if loren is telling us we can have a tool in ten years, what do we need to do to get to the point to say who should be using that tool when they show up at the dmv? is it the 70, 75, 80, or 85-year-old? when we will know that? >> rather than pick an age, our practice has been for years is we do use function name capacity screening. we use it when we have drivers who are referred to us in which there are indications of cognitive problems.
3:40 pm
it's not a matter of how old you are, but rather that you are, your clinician, the police report coming in, the actions with the counter personnel at the agency pointed to there may be a cognitive issue involved, so it's not a matter of age of who gets screened, but an issue of whether there's manifestation of cognitive dysfunction. another very important thing we have to remember when we think about older people is dementia is different than di leer yum, and there older people who is placed in a new medication and it may cause them some confusion of the that's not dementia.
3:41 pm
unfortunately, i think a lot of clinicians are fast to pull the trigger and label someone of having dementia when really it was an episode that was a one-time thing, and now is gone and they are not demented. >> i want to add too that that age and screens is not just because you're a certain aiming. there's other ways into the system. one thing that pops in my mind is training those to observe at-risk drivers. there's some states who do this well and examiners can be that frontline screening. if they see something they are not certain about, then they are the referral to the additional
3:42 pm
screening or testing and such, so that can be a good avenue to open the door and not require it of everybody. >> and, beth, one thing when you're talking about what age is appropriate, if screening were to be implemented, and argument for starting at an earlier rather than later age is probably the most sensitive indicator is someone's departure from their own baseline. if you have several years of data on an individual and there was an abrupt change in function, that would be a logical trigger. >> thanks. another question from our table is for everybody, i guess. to what extent are the lipsing agency really able to limit older driver risks and provide availabilities? are such licenses effective and are drivers complying with them, or are they really giving that balance of mobility and safety that we are looking for when
3:43 pm
doing restricted licensing? >> i'll take a stab at that. restricted licenses are something that almost all states use. they don't use it to the same extent. we did ask specific information about what types of restrictions you are able to impose on licenses, and, for example, almost all states do restrictions for day-time driving only for limitations in vision and impairments. it's common to restrict to lower speeds, not freeway driving, and a few restrict to specific distances or geographic locations and all. there's a range of restrictions there. typically the drivers who are restricted more beyond daytime driving only or beyond a restriction that might routinely be imposed because of vision impairments and all, there's
3:44 pm
drivers in the medical review system in any case that allows the option of following up with them and examining their safety. there have been a few studies looking specifically at restricting licensing. i know the insurance institute just looked at the practice in iowa, and i think they basically concluded, and i think we heard about this the other day, but that when restrictions were imposed on licenses, that they did appear to be imposed to the right target audience. the drivers who had certain impairments, vision or physical impairments of cognitive. they are targeting the people most likely to be at risk, and then they found the people with restrictions did appropriately limit their driving, so there was less exposure. they could not go the final step of saying rereduced crash risk, but other studies that have been
3:45 pm
conducted, the one my marshall using the is a scatch won data, while they have a higher crash rate than drivers who don't have restricted licenses, it's still very much in the norm, and it's in fact lower than the crash rate for many other drivers, so they will basically conclude that it is a beneficial measure to take. it is keeping these drivers within a, you know, restricting them so they are able to continue to drive with reasonable safety. >> okay. >> my colleague and friend who i greatly esteemedded, dr. bonnie dobbs, said she was opposed to individuals who have early on set dementia being allowed to drive compared to an alcohol
3:46 pm
impaired driver. the american neurological association in april put out a guide, kind of a consensus statement about where that would fit in with driving, andçmvvv
3:47 pm
>> there is a project initiative to look at that specific question, so hopefully, you know, in 12-18 months, we've have a more definitive answer. >> thank you very much. >> we'll move to a second table, and if you'll, again, introduce your name and your group when you begin speaking. thank you. >> thank you. i'm davis from the american
3:48 pm
occupational therapy association, and i have questions for myself, aarp, and the on the metric -- on the me trick oh , oh , association. can you clarify for us the difference between functional screening and cognitive screening at your mab? >> it's the heard battery of elements that we use, really kind of have both. they have some cognitive aspects relative to executive functioning divided attention, some functional aspects of it is the idea of having someone walk down a 10 foot line and come back and almost everybody should be able to do that in seven
3:49 pm
seconds. there is beginning to be a body of literature that's going to tell us that those are going to be very important in the future because they're going to point to some thing that's getting into that diagnosis called frailty. another screening question, another part of the screen is have you had a fall in the last three years? that is again a physical function that that has been shown by several studies in maryland and elsewhere that just having had a fall in the last three years has some link to your risk of being at-fault in a crash at which you are at-fault in the next near future, so it's find of a mix of physical and cognitive matters. >> okay. thank you. our next question is, i know i taught this in the earlier panel about adaptive devices and
3:50 pm
vehicle modifications, and i know that medical advisory boards are inconsistent around the country. does your medical advisory board have a role in ensuring that vehicle modifications or the addition of equipment is monitored at all, and is that an important recommendation for why all states should have some kind of oversight? >> we have a really incredible situation in maryland right now that my colleague, dr. raleigh, started. we have a very regular dialogue of every three months we meet with the occupational their -- therapists. it's our meeting and we stay in touch with each other to be on the same page and be in some consistent manner or form
3:51 pm
evaluating people. because we also brought the adaptive equipment dealers into the equation and invited them to the meetings to make it complete, it's very unusual now that any driver can go off to an adaptive equipment dealer and ask them to put something into their car. they'll say, no, you need to go the route of having been assessed by an occupational therapist. yes, do you need this? they'll -- you need to go to that individual, those professionals, they will assess whether you need this and teach you to use it and recommend the right one before they will take care of that issue. i think it was brought up earlier, one of the sad things right now though is one, the number occupational driving therapists are unfortunately quite low for the need in this
3:52 pm
country right now, and unfortunately, third party payers rarely pay for that, so it's an expense when you have to go that route. >> thank you. >> this is for the panel. from your perspectives, which current state programs offer the most comprehensive assessment for driving capacity, and how can states learn from each other about successful models for driving assessment? >> i want to spare from having to self-identify maryland as being a leader in this, but they really do deserve recognition in that regard. there's things going on in california as well. we're all eagerly awaiting to hear, i think at ntrb, what the outcome of their three-tier pilot assessment program has
3:53 pm
yielded. i would say those two states right now are leading the pack. >> thank you, that was kind of you, loren. if i remember correctly, i'll leave someone out, but an effort by transanalytics years ago and looking at different capabilities and i'm going to leave out probably two more, but definitely one of the states that was high rankings for doing things well, and that was virginia. this comment goes back to dr. garber's comment on we have to communicate with each other real fast to do things on a consistent basis with some science. >> this next question follows up i think on what you said. is there any research that compares state policy that are
3:54 pm
evidence-based with those that are not to determine which are the most effective? >> precious little. the good news is the maryland activities and california are both undergoing rigorous evaluation. california's dmv has done their own evaluations there, but other than that there's precious few that have been evaluated. i mean, that's sort of the state's themselves not taking the initiative to evaluate it. i would remind a study that was brought up yesterday, a study that looked across the board at state practices to identify those that might, you know, which state driver's licensing renewal practices and driver's licensing practices are related to safety, and that study found
3:55 pm
that the only renewal requirement or licensing requirement that was related to safety was having in-person renewal, and i think the other practices they were looking at were more frequent renewal or the road tests that are required in illinois and new hampshire, and then vision screening in all. i think the renewal for the older driver, 85 and above, that's the only one that showed a significant relationship to crash safety, so it would be good to do more studies like that to rep kate it, and they -- replicate it, but they're very difficult to do. they pointed out states with one policy, they have other things in place too. it's very hard to do that study, do it well, and be confident with the results that you get. >> all right. i just want to add to that. that was the study done by the university of alabama birmingham
3:56 pm
team evaluating the license change in florida when they started requiring vision testing, and that was more or less a de facto in renewal in policy that came in, and they did find there were changes in mortality rates compared to the neighboring states in georgia and alabama that didn't have the changes of the age groups affected. i think the way it was done in florida may have good effects. >> do you remember the age that that was? >> it was older than 80. >> they added the vision test in >> 80 and older? i thought it was 81. >> older than 79. >> as i understand it, partially it was a financial decision that they made how many people they could process and how many people can be, you know, go
3:57 pm
through the system and be taken out of the driving pool as well. >> if i could just make one comment about that study. it was -- by enforcing this rule and saying you had to be visually tests at the age of 80, it turned out that one speed bump in the road, 20% of drivers in the state of florida did not renew their license which was kind of interesting, and of the 80% that continued to pursue getting licensed whether it was just a test of their vision at the mva or the dmv or going through their visual clinician about 98 or 97% of them did eventually pass the test. it's kind of interesting by just putting a something in place, does that cause a lot of drivers
3:58 pm
to drop out of the driving pools just because they think, oh, i probably won't be able to pass at that stage? >> i'd like to reenforce that that you always have to look at the effects you don't anticipate and look at large what you put in place. when looking at laws in place in different states and whether or not they are effective or not and we focus on states that impose additional qualifications and requirements for older drivers and all that that really is not the only issue here. i get florida as an example. we talk about states that require more frequent renewals for older drivers and all, and florida is one state that for example, their standard renewal process is eight years, and pass a certain age, it's six years. there's an age-based requirement there. you have to counter that with
3:59 pm
other states that have four or five years in renewal for every driver. just the fact that a state has, you know, some age-based requirements for older drivers, there's lots of states with that requirement, but it's for all drivers as their typical way of functioning. that's a typical way to pull out. i think what we've seen in the states over the past decade or so as their resources and all have been tightened up that instead of passing stricter requirements on older drivers in terms of length of renewal cycle, they will extend it for the middle age group. leave it for the young drivers, and extend it for the middle age group, and not change it for the older age group. that's easier for them to do because they're not up against a lot of fight of people who don't want to put a new requirement on older drivers, but it has the same effect eventually.
4:00 pm
>> if i may add on to that, i think it calls out the issue of years. we're talking about people who could, you know, have a stroke tomorrow or are more likely to have a stroke tomorrow than the younger population. we can't put all eggs into the licensing basket. we need to make sure we have a consolelation of professionals that you spoke of earlier who are engaged and looking at people who can potentially be, you know, have their risks reduced or be rehabilitated to a safer age of driving. everybody has to be involved with this. it just can't be a licensing issue. >> thank you. do we have time for another question? i think it's just a quick comment. you made me think once you open a case, it's difficult to close one. as we work at getting more programs to address driving risk, i think one the barriers
4:01 pm
might be that once we have had kind of a don't ask don't tell policy in many domains in our country, if we don't bring up the topic of driving, we're not responsible, and i was just wondering is there a policy suggestion or as we look at the recommendations from this panel to really looking at the perceived risk if the professional steps up and talks about risk they don't own the problem and can't close the case if you will or send it on to the next responsible party. ..ñññññññññññññoñ/ñ
4:02 pm
what was your responsibility of having not flag or been still responsible for that person? >> you mean for the nba or for the jurists or jurisdiction? >> i think the fda is one area coming out with two dots in health care. we see that with medical providers. the fear that if they prodded up, that they're somewhat playable. >> it works all different ways. one cannot litigation from all directions. i think there's a lot of inclinations out there that are greener than the one hand you talk about keeping a clinician patient relationship going.
4:03 pm
and on the other hand, you're wondering, am i going to be liable even though the state doesn't require physicians or other clinicians to report somebody come and i going to be liable for the medical record generally shows is a case being reviewed on the national level achieved, the last time the person or the last three times they saw their clinician, clearly someone at some point should have questioned their ability to drive here. >> thank you. >> were not in favor, by the way, of clinicians having to report people to the nba. we are very much in favor for communities that come from good fevers and clinicians. >> thank you. >> louangphrabang to you from triple-a for traffic safety and not be representing questions
4:04 pm
from alliance automobiles also. i'm going to go ahead and ask? this question that has slightly different spin.?? reporting of potentially unfit? but if they process inviting th mp, fishes and the families of all citizens are stable, some of liabilities. can you list a few of the liabilities? have -- are there or should there be laws similar to good will if you're a family member. and that is a concern many people have. and then it goes outward from there. you have the physicians who are afraid that their patients are
4:05 pm
not going to come back anymore and they're not going to receive the treatment that they need to have in order to maintain basic wellness. but there are other states out there that provide anonymous reporting as long as you sign it for family members. you can't just refer your neighbor because you don't like them. you need to provide a sacred information, law enforcement often don't know how to make that referral, so that's why we've been making sure there is good training out there. social services are oftentimes marketing is about make ensure that the client is taking care of, rather than -- they're concerned about the well-being of the individual as opposed to the potential to their license. there are a lot of players out
4:06 pm
there. if you have a good referral program, make sure there's a full and a full investigation that goes there for each individual referred in. it's not that bad. >> i would just add, too, what karl said, too, particularly for physicians having legislation that gives immunity to legislation for positions is a good thing to get them to report. it's not the only thing, but it is an important thing. and the confidentiality of report. and i varies greatly across the state. what we think ideally as for a state to have legislation in place that both provides confidentiality and immunity from reporting. and that's just not the case in all states. when we asked about this, you know, in terms of our reports and confidential, i think we had six that said yes they were in
4:07 pm
there were 16 more but said there were confidential as for some others their confidential unless the driver request them. if the legal position that the dmv will say there's a report about you. we can't prevent you from requesting it. and so, it's sort of a gray issue in terms of what you can do. beyond the legislation that's in place in the state, i think it's very important that the state have in africa make that legislation known to the positions, to the law enforcement, to the public, whoever. because you can have that legislation and some of the dmv people what topic did not know what the legislation was in their state. as you can have that unless they know about it and it doesn't make a big difference they are. so that's where were sort of trying to encourage them things
4:08 pm
like for reporting, make a form for reporting available -- readily available from the dmv website. having an information available and on that form state exactly what the legal, you know, requirements or what it is, so people can readily find this information, feel confident in their filling out the form and this goes for family members, law enforcement, whoever. >> can i make a comment? i believe it left out from the gao report that came out years ago, i think there are nine states that have requirements that physicians report unfit drivers or drivers that they have concerns about to the licensing agency. the problem with most of those states, which is well identified and i can't wait to see jane's report, but in the said to study
4:09 pm
they did a few years ago, some of those states that required reporting that physicians were so amorphous that if you had particularly a part days and you had a large number of shows older people can not practice, that if you wanted to comply specifically what that law, you would have to hire a part-time person to be sending in because it was just very, very vague. i think a state that has a good law that we know a lot about is if you're going to have a mandatory reporting lot is delaware. let's say i'm driving on the rich new york and i have a seizure can i go to christianity hospital. that physician who takes care of me must send a letter to the state that i might send an, whether it's missouri or washington state, california or
4:10 pm
maryland. and so yesterday i treated karl soderstrom for a seizure. that's a pretty discrete episode that definitely requires taking someone's driving privileges away for a while to make sure that condition is controlled. but if they're going to be reporting last mandatory, they can't be amorphous. and unfortunately, in the report that was put out through transanalytics shows that poor four or five states were very, very vague. >> this will lead to another question we have. so how worship medical advisory boards from other states have a standardized database in which reviews are entered into for researchers for policymakers to review, just to get a better picture but the overall population is. >> go back to dr. garber.
4:11 pm
we've got to start talking to each other first. that would be the holy grail i think, one where we all are talking to each other, the world to things in a very consistent fashion and that we have a database inputs and outcomes that we can really be talking from the science. jane stutts alluded to this before, i believe, that when you look to science for the decisions were making. i had the privilege to be on the federal review board and they do these very large literature reviews on various subjects. and it starts out with a classic, we entered all of these different terms we came up with 224 articles on the subject. and then it was down to we came down to eat studies. it had anything to do this when driving. none of them had anything to do
4:12 pm
with commercial truck drivers. and at the baddies, one was of good quality. three were of moderate quality and four were less than not. so we just -- what you just said would be the holy grail eventually for what we're doing. >> of funds for going to have that, let's throw in an active cuts process and that states of the crash outcome becomes factored in. >> so has state looked outside the u.s. for potential model programs that could be used by the state? >> well, what they're definitely looking out what's going on in canada and particularly in regard -- because canada has certain advantages to retail. their driver license are inextricably linked to their health insurance companies.
4:13 pm
so they're able to get some really good medical information and look at the crash risk of individuals with medical conditions. so we're really looking over to being able to hear some of the results of those studies. and in terms of other driver licensing opportunities, we have 51 here. if that's probably enough to go by, otherwise -- >> averages that i think what the canadians are able to do really is something we should be looking not from the dmv's disc, it's very difficult to get dmv is to look for european programs. you know, they do things a certain way and their state and they do things very differently in europe. so a lot of what's going on there may or may not be applicable in our state. and i think our states are
4:14 pm
best -- i think some of the programs that have been the most successful have been things like maryland project and the california efforts, where they see a nearby state doing something that has worked well for them and, you know, can we get other states to try this model. i think that's the most successful model to try to build on. >> i agree that our canadian colleagues are doing a lot that we are paying attention to and we will continue to pay attention to. we also have to make it her business to pay attention to what's going on in the e.u. there a lot of good reports that are coming out at the university in australia. so part of our job with this great world of communication that were in now, we really don't have an excuse not to know what's going on elsewhere. you just have to find the time in the 168 hour week to find out all the different models and variations that are out there. >> i just like to acknowledge
4:15 pm
the markets recently begun and the e.u. with respect to medication labeling explicitly with regard to the french have developed a system. i'm not sure it will be adopted throughout the entire system, but it's a real innovative accomplishment i think that we should look closely. >> for last question i'm going to go back to a comment that was made about the insurance companies. what will scan and should they play in the education referrals of drivers for screenings/assessments and could this be tied to a continuation of coverage when claims are filed there were traffic infractions were identified? and lastly, would state mandates be required to make this happen? >> and looking for a lifeline here. that -- that's a really challenging question.
4:16 pm
and i don't even know where to begin to answer that. i think it would do wonderful, for example, if health insurance where to contribute to driving assessments, the in-depth assessment that was discussed earlier today, except i come up with good ideas. i don't necessarily find ways to implement them in terms of that. do you guys have any other -- any hope for me? >> i think you give a good answer. >> okay, that's it for a table. thank you. >> thank you. amble coat the last panel and the last table. ms. harsha. >> barbara hershey of the governors highway association and with time manual. first of all, i'd like to thank
4:17 pm
dr. soderstrom for helping me have my father reviewed and evaluated by the maryland advisory board and helping to have a successful resolution on the driving problem. this was of her years ago. if it weren't for carl i think he would've continued to drive when he shouldn't have. so thanks, dr. soderstrom. >> i would need to make a quick comment that anything that happened relative to your brother had nothing to do to me. since we were colleagues, it was deferred to the right person and i didn't even actually know the outcome. so, thank you. >> well, someday i'll tell you. i guess my first question is for her staplin. as i understand it, you did a federally funded study with the maryland mva unfitness to drive and you came up with a protocol, which i understand was successful. why hasn't this protocol been
4:18 pm
adopted by other states? and what are the challenges to adoption? >> well, you certainly can't speak for other states. barriers to adoption are coming you know, political. their financial. there are -- there are lots of barriers. i think unfortunately what's likely to happen in this country is that the adoption of screening procedures will be driven by some media event. i think that what has been learned in maryland provides a set of tools to sort of have on the shelves that are being continually improved kaz, as has been noted on this panel, maryland is using functional capacity testing within the domain of his review of medical drivers. in addition to the work that was done earlier in this decade and maryland, there are -- there is
4:19 pm
ongoing work to obtain new population base samples. there was another study about to be launched within a few weeks is going to add several thousand more drivers using the same set of functional screening measures. again, prospectively looking at their safety outcomes over a period of a couple of years. so we are accumulating what will be within a couple years from now probably close to four or 5000. that gives you enough to have in each of those cells in your odds ratio analysis, enough of those who have at fault crashes and were above a criterion candidate cut point on one or more of your functional measures. so as that evidence builds, i think the acceptability of using that tool will probably grow as well. ultimately, i'm afraid what will drive the implementation of screening will be some sort of catastrophic events that gets a
4:20 pm
lot of media attention. and i should say, i really don't mean to appear as an advocate for screenings so much as someone who is resigned to the fact that we are incrementally moving in that direction. and what one of these events occurs, the triggers, a change in policy, we want to know as much as we can't have the best evidence available for we can make the right choices. >> question port jane stutts. companies look to the question for utilizing and is that something that is deserving of further research? >> we did not find any evidence of that. that is something that is sort of near and dear to my heart. it is a phrase that pat waller introduced back in the mate teen 80's. i know that really looked that young drivers inside well, by that we at the other end of the
4:21 pm
age spectrum talk about graduated licensing. in practice, so the states are doing that. and i think the initiative that comes closest to that is offering local or tailored drive test. and this is something that iowa and kansas and a couple other states to a lesser extent do, but particularly in iowa, kansas and i think minnesota, they offer the option for drivers who are unable to pass the standard license renewal requirement, edition testing, you know, road tested it comes to that or whatever. and iowa is setup so if you fail that test two times, you've got one more try and you can opt for a local drive test. and for that, the examiner goes out and you take a road test, just in the area, the streets and roadways that she mostly to drive by near your home.
4:22 pm
and if you can show that you can drive safely in that environment, then they will license you with all of these restrictions. so it's just a level of restriction that you can only drive during the daytime on these routes, you know, you can't drive an eight hour trips to florida, whatever. so any real practical sense, that is sort of a graduated licensing. and what we're in the process of just really starting an evaluation of that. because it was an initiative we did not want to necessarily promote strongly to other states until we knew that it didn't have any significant adverse safety outcomes. so we're still evaluating it and just getting started on it. but what we've been told to practice it really is a steppingstone down from driving, but people cannot qualify for their full license or maybe for iowa and kansas i think i spoke to your renewals about age 70 and over they require for this. and they need to up one time.
4:23 pm
they may do a two times, but eventually they know they're going to be stopping driving. so it is in a sense he graduated the licensing. and it may be a good solution. we're looking to really evaluate it more closely. >> dr. soderstrom, you said that not all states have medical advisory boards and they're not all robust medical advisory boards. what can be done to encourage states to adopt or implement medical advisory boards? and what are the barriers? >> well, i think one of the things is you get what you pay for. and we -- and maryland we pay our dock there's a certain amount of money. it's not a heck of a lot of money. in fact, i consider the fine men and women that are onboard when they're in their busy practice, i consider the amount of money we pay them is really nominal
4:24 pm
and what they are doing for us is a great deal of public service. and i appreciate that. but a little money can go a long way. it's important, i think, that -- another thing is when you have a medical advisory board, it is presented right, it's an incentive it's very much an honor to be audited in some states. that's a kudo. my brain is a little fried right now and that light is very, very bright and i can't give any other brilliant idea right now. if something pops and i have a get back to you. >> okay, thank you. >> i just want to add one thing they are. i certainly support the medical
4:25 pm
advisory board and every state should have one. i would note the rate that were about 15 states that do not have medical advisory boards. and it's not like they have nothing in place to deal with medical issues and driving. they often do have good procedures and policies in place. i mean, california, colorado, ohio, oregon are some of the states that do not have functioning medical advisory boards. for example, they will routinely -- the two issues of medical advisory boards typically deal with other policy issues on helping to set state policies regarding licensing. and also we review individual pieces. some of the states for example where policy issues when they come after having a policy meeting to be addressed or they're reviewing guidelines in such they will call in specialists to help with that. they may have sessions on staff
4:26 pm
that output that can help with decisions. so they do have other ways of dealing with that. and the same thing for reviewing individual cases. some of the states may rely heavily on the drivers on position, but also they may have their own positions on staff or someone they can refer to. so i just don't want to leave the impression the states that the medical advisory boards are dealing with the issue at all because most of them have found some way to handle it. >> thank you for that clarification. final question for your staplin. there were so many unknowns and so much more research that needs to be done on this issue. and given that, how can we convince the dmv to make older driver safety and mobility a higher priority? what arguments can we use to convince them to pay more attention to this issue?
4:27 pm
>> again, i wish this was going to be a rational process. i mean, a demographic argument is certainly a strong wind. i think someone tries to the front window at the licensing agency office as we saw on youtube a couple of weeks ago, that certainly makes a strong point. but those kinds of events of course should not drive the argument. i don't know. i think bringing attention to not just -- i don't want to call it a problem because overall drivers aren't the biggest group of operators on the road. when there's issues related to age it's not because of a lack of scale ironies are prepared for the purpose taking. these are people who have been skilled drivers and have learned tactics and strategy over a lifetime. so for a select few, a loss of the abilities needed to execute
4:28 pm
the safe driving skills a lot of time is important. and it is expensive to chile to identify those two people. how important is it to save x number of crises, x number of injuries and fatalities. i don't know if those injury and fatalities saving for themselves aren't a sufficient argument, then i'm afraid we ultimately are going to be left with the media deciding that this is an issue that needs to be in the forefront and essentially having a public opinion drive for policy process at the state level. >> not unlike other highway safety issues. >> indeed. >> thank you. >> thank you, dr. harper. >> i have just one quick question. there's a pretty good amount of literature that shows the single
4:29 pm
best predictor of having an accident is having a previous accident. and that's for everybody. for teens, adults, for older drivers. unfortunately, one of the property damage and unload incidents are not reported for medically related issues. medical issues that may have older drivers. how did the mbas -- how do you get referrals from various type of incident, since those are in fact some of the best predict yours we have? i do get that information and ensure you're getting accurate information on those tapes have been events? >> in maryland we could about 1400 cases referred by the police each year to run into -- that are at a traffic scene where something has occurred, which they think there may be a medical issue involved.
4:30 pm
our analysis of 500 of those cases show that most of them do involve a crash. another way that drivers come to the attention of the maryland driver wellness division is if they have a certain number of points that accrue relative to their insurance company. so i'm kind of an indirect fashion, if you're involved in a number of fender bender's and getting your car fixed an awful lot of times, they have a system where they'll just notified the division that works hand in glove with us to say we want to let you know that this person has seemingly an inappropriate number of crashes or incidents within the last period of time.
4:31 pm
>> mr. blackstone. >> thank you. i just wanted to follow-up on a couple points that were made earlier during discussion. first, which is a follow-up on dr. garber's question. i know with respect to young drivers, there often is an effort to try and attend whenever there is a police contact to identify -- whenever there's a police contact with the driver. they get stuck for some reason or another are not given any sort of citation. if anything like that than with older drivers? has there been any research been done on police contacts with older drivers that don't necessarily lead to the citation or result from an accident? >> we published a paper on the subject last year. it turns out that when police encounter tribe errs at a traffic incident, we look at
4:32 pm
whether if there was a violation involved in this contact with the driver, whether they gave a ticket in addition to referring them to the nba because of concern of medical condition, it turned out that a few were a younger driver -- and by younger, i mean in this case it was 55, more often than not you got referred and you got a ticket. where as if you were -- i'm sorry, 65. but if you are 65 years of age or older, if you had a violation associated with this incident, you got referred, she very frequently to get a ticket. and that's an important -- that we would encourage, nhtsa is a good training program for police. if they give the older drivers ticket for the violation that was involved for the traffic incident because this is the
4:33 pm
finest generation. these are people that are role players, this is really the first time they've been in a crash. and sometimes we bring in people for interviews with the family conference or some paint their advocate, their spouse, their kid say well, come on, it couldn't have been that serious an episode. the policeman didn't even give them a ticket to start with. so we would -- we think that if they are going to refer drivers for whom they have a medical concern to give them the ticket in addition to referring them. but the bias goes at least in our small study of giving the older driver the ticket they richly deserve. >> absolutely. >> and finally, there is a
4:34 pm
discussion earlier about imposing driver license restrictions. they think dr. stutts can imagine the kinds that are done. what about compliance with other classes of drivers? would have drivers license subscriptions or suspensions are not afraid. what about older drivers? is there any indication they tend to obey license restrictions more or are they like younger drivers? >> the insurance study i did earlier looking at iu your data and licensing restrictions did testify that they did comply with those restrictions they have a license. again, this goes back to sort of the generation that they are, you know, they do tend to be compliant with restrictions. i know with we've all heard stories and other people may continue to drive, but i don't think that is the norm. again, that is something we're going to be looking at a much more detail on what work going to be a study that's gotten
4:35 pm
underway looking at both restrictions come about the safety effects and compliance with restrictions. >> what are you using potentially as it's something we should continue to look at because the generation ats different than the next generation. >> it may be changing as we get up there. >> are baby boomers weren't always as compliant. >> a little headstrong. >> thank you, madam chairman. >> i'm curious, dr. soderstrom, this is a little bit off-topic, but because you talked about your involvement with the fm csa medical review board, i'm curious if you could share with us what you think a couple of the kind of strongest accomplishments of the nrb that have translated into action or policy changes at nhtsa.
4:36 pm
>> i have to tell you i'm a new member to the board, so i'm not just been involved basically in several meetings. the word is mandated to have five members stood and three retired. and so, we have a map for quite a while. i'm not sure -- i know they've made a lot of good recommendations as far as obstructive sleep apnea and some other issues. but i'm not sure if a lot of those recommendations have been followed through with, but they're good recommendations. >> okay. thank you very much. ms. wagner, you and i had a little bit of a sidebar conversation yesterday after the session because i think you have some information about some pedestrian fatalities want to
4:37 pm
give you an opportunity to share that. >> the question was related to the traditional risks older people have is that the strands? and in terms of the fatalities that we see at our right now, older people represent 18% of pedestrian fatalities as opposed to the 13, 14% of the population that they are. is there definitely overrepresented. most of those fatalities are happening in urban-ish areas. back in the urban suburban and they're much more likely to be intersection related crashes than a younger person will have. so that means the countermeasures we have to use will have to be much more intersection related. that includes the engineering that needs to go into places as well as making sure there's good enforcement to make sure that people are not running red
4:38 pm
lights, for example as well as making sure that the individuals themselves, both the drivers and pedestrians have good education so they know what those risks are and what is the proper behavior that's expected of them. >> thank you. mr. staplin referred to the concern that probably we all have and we often see this in the aftermath of a major accident is that there's a response that sometimes comes. and sometimes the response tends to be swift. sometimes it takes a little bit longer. but the quality of the response depends on how much data and information is there really to support the decisions that get made. and so, i guess the good news is we have 51 little incubators of trying to figure out what works. but i guess the bad news is we also have 51 different
4:39 pm
incubators trying to figure out what works. and so, i would not miss his stutts you talked about iowa. they certainly have a different model them have been propagated throughout the country. can you help me understand -- i'm sure each of you has an experienced in a different state who you could talk to, what has prompted a state like iowa to take on the restrictions that certainly had to be a difficult is for them, maybe not politically popular for certain group of people. what was the impetus for them to be up to do that? in other states where they may be made from tough decisions of other panelists want to comment and help us understand how these changes occur. >> that's a good question. i don't particularly, i do not know exactly what prompted them to do this. it is something we need to find out because as we move to try to
4:40 pm
promote initiative and other states, we need to know how did this come about? what already is needed to be involved, what peace is in place. it could've been some paint as simple as they have the option of putting restrictions on licenses. so what are you not have a particularly difficult legislation or anything they had to pass. it's more of an internal policy of encouraging to really make use of that ability that they had been thinking about it in terms of older drivers. another issue that's closely related to that, for example, is almost all dmv examiners, the online examiners have the option of asking drivers to take a road test. that is something available to them. states may vary greatly in terms of the extent to which the examiners take advantage of that. and i think a lot of it boils
4:41 pm
down to what kind of direction they get from the height of driver licensing, you know, how important a person sees older driver, how they communicated, how they train their examiners and such. in the case of islet they have kim's note, who just has always been, you know, right at the forefront of doing things for older drivers. so in that situation particularly, it really involves a champion and the state doing that and someone willing to take it on. >> i want to reinforce with gene just said about have been chanting the efforts in maryland would've been referred to a number of times were large part driven by the activities or the involvement of the other fitter and pharaoh and then handed the mav dr. robert probably an assistant carried on by
4:42 pm
dr. soderstrom. having people are champions for the cost makes a difference. with respect to buy what they were also early adopters of the federal highway design of the pedestrians insisted. and you have to believe that a large part it's driven by demographics here because after florida, iowa and pennsylvania, to more northern states have the highest proportions of older persons of strivers in their state. >> and if i might add, i was very concerned about the severe lack of transportation options that they were able to provide, so that they recognize they had to do some things. and if they could let people drive a couple more years, then they would not be another burden and other areas. >> i would also like to acknowledge that we've been very fortunate as brought up by laura that literally for 63 years we
4:43 pm
have had -- we've had administrator after administrator in maryland that sees the value of the medical advisory board. and when we think about fiscal cuts we feel very confident that we know right from the top that we are considered a valuable resource to the states and that continues through the current administrator, mr. chabot. >> thank you all. and my last question has to do maybe with kind of maybe trying to encapsulate or summarize the issue. is this challenge that we have in front of us -- is it about older drivers? or is it about doing a good job handling medical issues? are they the same thing or are
4:44 pm
they different things? >> and an aging society, certainly you're going to a greater prevalence of medical issues and medications which are going to result in a functional issues that were most concerned about with respect to traffic safety. i don't really see how you could tease them apart in the foreseeable future. i mean, medical conditions circularity trigger, but ultimately the function has been underscored here and in other panels that we care about. and it's not just medical conditions and medications, but normal aging, normal aging causes a decline in a lot of these capabilities as well. not to use as severe an extent, but i don't think you can just say age is not important in this discussion.
4:45 pm
>> chairman hurts men, 2003 event by the ntsb, they used five examples of cases to set the stage for discussion and i don't believe any of them involved over drivers or epilepsy and one involved a driver who had a hypoglycemic episode. so i think you're absolutely on target. it's about health and driving, which is the issue right now, that you are leading the charge on right now. >> now, we'll sort of counter that a little bit, but when you talk about getting information to the public can have the public understand the problem in communicating with even law enforcement and such, that it is important for helpful to focus in terms of aging drivers because that is the target
4:46 pm
audience out there. that's the one you want to get the message. you want to communicate with. and to get a lot because for example, a number of states and those that seem to be the most progressive are states that have really put together coalitions of interested parties to address the issue of aging drivers, medically at risk drivers, whatever. but very important parties to bring to the table along with the dmv, you know, bring your occupational therapist in. bring your state division on aging. they're the ones that have all the information on alternative transportation and other resources for people. bring together at aarp because they have all kinds of resources they are. aaa. so, you know, i don't want to just ignore the fact -- i don't want to talk about things in terms of just aging drivers, but i think it is important to know
4:47 pm
that those are the parties we need to bring it to wendy to communicate with. i would hope to have them at the table. >> thank you all very much. this has been a great final panel to wrap everything up for us. i want to particularly thank all the parties for sitting here through these sessions. you bought or persons at a fantastic job staying on point, staying on time and actually asking questions and not making challenge when you have an open mic. it's a thank you so much for being so professional and representing your organization so well. we know all of you out our partners in this effort of education and advocacy. and so we appreciate what you're doing. so before concluding that of a few housekeeping reminders. as i mentioned in the opening because of our time constraints,
4:48 pm
we simply couldn't include and accommodate everyone who wanted to participate in our forum. so any individuals or organizations who wish to submit written comments may do so until november 30, 2010. so please check the ntsb's website under the forms webpage for the particulars. we will be posting a written transcript of the proceedings on our website and also archive video of the proceedings will also be available for a short. going forward. on behalf of my fellow board members, i see you does hear from the beginning to the end. i like to thank all the panelists imperatives for their participation. certainly our discussions over the last few days have been excellent and they're going to help inform the safe he board and our staff as we move forward. by appreciation also to show leaves haas who is in the back for sharing her documentary with us. the stories of march and herbert
4:49 pm
certainly personalize the issues for all of us. thank you to the staff, some who are with me on the dais and some of the audience. deborah site behind the table out there. you and your team of hard-working professionals never cease to amaze me and what you can do. so thank you for making this form possible. the discussions we've had over the past few days really reminded me of the opera sums of rising tide will fall above. this was first coined by sean the mass was an irish politician and it was later quoted an made famous by president kennedy. but i think this phrase so aptly describes much of what we discussed over the last two days. the older driver is certainly a rising tide of people live longer and continue to drive well into their older years, whether it's introducing inflatable seat belts to make an
4:50 pm
accident more survivable, providing the driver with a display of exactly the information they want to see, make a roadway signs easier to read or creating new tools to assess the driver's fitness, the basic improvements we make for some improve highway safety for us all. we make great strides at safety since the first drivers license was issued almost a century ago. hopefully through the sharing of best practices and experiences of the active participation of the licensing agencies, the physicians in the communities where these older drivers live, we can reach responsible and informed decisions on how to make the roadway safe for all of us. and to do so in a way that valances individual independent, mobility needs and safety. these goals are not mutually exclusive in our society.
4:51 pm
collectively we have the opportunity and the obligation to address them currently and with some urgency. 2025 will be here soon enough. this concludes our forum and if you don't mind to indulge me, i have some personal things i'd like to share. today is not just a milestone for the safety board, but we also have a personal milestones. mr. bruce mcgladrey who is the director of the office of highway safety is going to be retiring early next year. bruce -- this is his last official performance in the boardroom. he has served before coming to the safety board with the police officer. he worked for 13 years the baltimore county maryland in 12 of those as a detective. he came to the safety board in 1988 as an investigator in our human performance division. he investigated the accident and
4:52 pm
almost a transportation when he came here. he would enter jim didn't hurt injury while out who were kind of fantasy or at the ford. researched extensively on the board, studied petite, alcohol and drug and truck crashes and in 1997 he joined the office of highway safety as the chief of investigations division. in 2000 when he became deputy director. and in 2006, he began serving as the direct tour of the office. i have witnessed during my six years here at the board first with the leadership on big accidents like the big dig, the boston tunnel collapse in the minneapolis bridge collapse. both accidents were particularly complex and they required bruce's skills as an organizational leader and sometimes as a diplomat and as well as they detect that skills that he acquired so early in his
4:53 pm
years in baltimore. bruce has mentored me through the years and sometimes it was hard and sometimes it is easy. you know, when diane or beth mentioned to me that seems like there was 15 years ago we talked about older driver issues when i first came to the board. it was only six years ago. the time goes by fast. but motorcycle safety of older drivers were two issues i was very, very interested in when i came to the safety board. and you know, person i've worked through these issues together and i was struck. we had a motorcycle safety for them in 2006 emperors had to leave from that form directly because his first grandson, fan, was born. and two weeks ago, he welcomed his third grandson. and so i know that sin and present baby henry are looking
4:54 pm
forward to having grandpa bruce and his wife judy with them more often. but we will certainly miss you here. we wish you the very best in thank you for your service. [applause] >> i'm not usually a speechless guy, but i think i am today. thank you very much. >> we stand adjourned. [inaudible conversations] >> as you see at the bottom of your screen, deborah hurson who is a board member of the ntsb will be on the "washington journal" at 9:15 eastern on the
4:55 pm
span. a lucky at the iwo jima memorial just outside of washington d.c. on this veterans day. also a fence around the city in the country to mark the holiday, here's some of what we're covering. work is expected on the bush era tax cuts as well as federal spending for the next budget year. watch the senate life here on c-span 2 and the house on c-span. in january, will bring the opening of the 112 congress, with republicans in charge of the house following last week's midterm election result.
4:56 pm
>> earlier this year, president depalma announced that the u.s. would place more emphasis on international cooperation in space exploration is part of his national space policy. last month officials from some of the international space agency discussed their nation's priorities and how they envision international cooperation digging into those priorities. the center for strategic and international studies in washington post this two-hour event. >> i turn it over to kshemendra. i'm going to hide and do a brief introduction of him.
4:57 pm
obviously, were thrilled to have him here. use the program manager for the information sharing environment. he was appointed and a lot of people don't know and about pmi, by president obama in july. and i love his charter. his charter is governmentwide authority to plan or to see the growth of them manage the use of the ise. i'm sure there was a long line to get this job. it's a very challenging task. i think i had from my perspective seen some significant progress in the last few months with a kshemendra they are at least a more open and robust dialogue which is absolutely critical to making this work. you know, prior to this job, he would've served as the federal chief architect in omb, we focus on issues around interoperability of networks and databases and he also has extensive experience in the private sector. he is changed as an engineer to fly helicopters and write and
4:58 pm
talk. kshemendra understands the technology around it undefined status and engineering background is something that's incredibly important to developing the ise architecture. so would everyone join me in welcoming kshemendra paul. [applause] >> good morning. thank you for the kind introduction. i'm grateful to see sis for hosting the event today. this is a wonderful forum, which will allow us to explore the opportunities and challenges around building beyond the foundation, accelerating the information sharing environment. including clarifying the scope initiative will target patient towards which are building together and how we measure created value. our high calling is to support our mission partners, the federal, state and local, tribal
4:59 pm
and territorial agencies and our partners internationally and in the dirt. to protect the american people and enhance our national security through the use of information. thank you to our sponsors today. we're grateful you're supporting csis and continuing to shine a light on information sharing. there's a great leno speakers and moderators that i'm very excited about coming together. i appreciate all of them taken the time and i'll be taking the time to participate in this dialogue. now, my communications team asked me to shamelessly promote the ise website, so good at sure pens. it's at www.ise.environment for sharing that love. it's those who want to participate and for you all to get more additional information and stay connected to the dialogue. while you're at the site, be sure to sign up for e-mail

60 Views

info Stream Only

Uploaded by TV Archive on