Emergency Response: Drink-Driving Limits and Mandatory Eye-Tests Under Public Review

In August 2025, the government announced its Road Safety Strategy (1), outlining aims to address two of the most persistent causes of serious collisions: impaired vision and impaired judgement. In consideration is the introduction of mandatory eyesight tests for drivers over 70 and a reduction in the legal alcohol limit for motorists in England and Wales.

In 2024, road traffic incidents killed 1,633 people and seriously injured almost 28,000 others. Fatalities among drivers aged 70 and over accounted for 224 deaths, representing 8% of all casualties and 22% of fatalities. Drink-driving continues to account for around 240 deaths each year, a figure that despite sustained policy attention, has remained stable since 2010.

The Case for Reform

1. Mandatory Eye-Tests for Over 70s

Upon turning 70, drivers must apply to renew their licence. The D46P self-declaration form (2) allows drivers to assess their own visual acuity, with no mandatory vision assessment.

In his inquest (3) into the deaths of four elderly drivers, Dr James Adley, HM Senior Coroner for Lancashire and Blackburn, reignited concerns over this approach, concluding that in each case, the drivers’ sight “was well below the standard required to drive a car”.

More than half of optometrists (4) report seeing patients who fail the legal eyesight standard yet continue to drive, equating to an estimated 56,000 drivers annually. The risk of ocular disease escalates sharply with age, which combined with a 53% rise in the over-70 driving population since 2012 (5), intensifies the urgency for reform.

A pause for thought

Critics argue that older motorists are relatively safe compared with younger counterparts. In 2024 (6), drivers aged 17–29 accounted for 294 male fatalities, exceeding the 224 recorded among those over 70. Age UK’s Charity Director (7),Caroline Abrahams, questions the merits of the proposal when “people can develop eye problems at any age”, suggesting instead that “a regular eye test for drivers of all ages may be a better idea, one less open to the accusation of ageism”.

Large-scale trials have failed to demonstrate a consistent, causal link between age-related visual deterioration and accident frequency. A U.S. study of 2,000 drivers (8) aged over 70 found that while visual dysfunction modestly elevated collision risk, a screening approach lacked sufficient sensitivity or specificity to merit preventative value. Despite such reservations, professional bodies broadly support reform. The Royal College of Optometrists (9) has called for mandatory certification of sight tests at licence renewal, every

ten years for all drivers, and every three years from age 70. The Institution’s President, Dr Gillian McOptom, observes that this “would enable early detection and treatment of eye conditions that may otherwise be asymptomatic”. With institutional and public support for reform, the practical challenge lies in capacity. NHS optometry services (10) already face long waiting times, and a new testing requirement could generate a surge in demand. Without investment and public-private optometrist partnerships, enforcement could prove impracticable.

2. Reducing the Drink-Drive Limit

The Strategy (11) also proposes lowering the drink-drive limit from 80 milligrams of alcohol per 100 millilitres of blood to just 50, bringing England and Wales in line with Scotland. Despite overall road-deaths halving since 2005 (12), drink-drive fatalities have remained constant at around 240 per year, representing 12 to 18% of all road deaths.

A decade after Scotland's 2014 reform however, the Institute for Alcohol Studies (13) found “no discernible impact” on road accidents. The majority of drink-drive deaths involve drivers far above the limit, often over 100 mg per 100 ml of blood, indicating that the lower limit captures those at the margins, rather than habitual offenders.

Due to public budget cuits since 2010, annual roadside breath tests (14) fell from 600,000 to just over 300,000, and prosecutions have similarly halved despite unchanged casualty rates. Behavioural research (15) points to cultural attitudes, thrill-seeking and peer pressure as key drivers of recidivism. Public campaigns such as Northern Ireland’s RoadWise Up (16), which reframed drink-driving as socially unacceptable, have shown greater impact than marginal legal changes.

Alcohol interlocks, requiring a breath sample before ignition, have reduced re-offending by up to 65% in trials (17) and enjoy majority public support (18). In contrast, enforcement remains weak, and 88% of motorists consider themselves unlikely to ever be tested.

Implications for Insurers

A lower alcohol limit could increase the volume of convictions without necessarily reducing accident severity. While no indemnity arises from non-collision offences, many policies oblige disclosure of convictions (19) at renewal. Non-disclosure (20) would entitle insurers to proportionate remedies, such as premium loading, reduced claim payments, or policy cancellation.

There is also a reputational dimension. The manner in which insurers treat older motorists will be closely scrutinised by regulators and the public alike. A balanced approach will be vital, combining fair risk assessment with measures to avoid perceived age discrimination. This creates commercial opportunities, from discounted premiums for verified eye-tests, to opt-in screening partnerships and tailored telematics-based products.

The surge in drug-driving offences could embolden insurers to capitalise on the development of behavioural and technological measures. Court-mandated or voluntary interlocks would

reduce long-tail losses and enable premium discounts for safe drivers, enabling insurers to enhance reputation through proactive public policy support.

Conclusion

The Road Safety Strategy signals a renewed determination to confront persistent causes of preventable road deaths. Evidence suggests that regulation must be twinned with parallel investment in enforcement, education, and healthcare capacity. A careful approach to the challenges would enable insurers to refine underwriting practice, strengthen disclosure frameworks, and engage positively to shape safer mobility for all road users.