Driving after brain injury, stroke or brain surgery: DVLA rules and assessment

Headway describes driving as a complex activity needing many cognitive and physical skills, along with the ability to coordinate them. Any can be impaired after a brain injury. Many people keep most of their previous ability and return to driving relatively soon, but the less obvious effects on thinking, memory, judgement, decision-making and emotions can be harder to compensate for than physical weakness, which can often be solved by vehicle adaptations.

Visual problems such as loss of field or double vision, slowed reactions, difficulty dividing attention, neglect, fatigue, seizures and reduced insight are the issues most likely to make driving unsafe. Insight matters particularly, because someone who is unaware of their difficulties may feel perfectly fit to drive.

The DVLA lists notifiable conditions as anything that could affect safe driving, and the general guide names strokes among them. The condition-specific pages give detail.

Headway says that after traumatic brain injury the medical standards generally require Group 1 drivers to stop for 6 to 12 months, depending on post-traumatic amnesia, seizures and clinical recovery, and that other forms of acquired brain injury have slightly different rules. Where there are lasting impairments affecting driving ability the licence is likely to be removed for a period. Every case is considered individually.

For stroke, the GOV.UK guidance sets a minimum of one month for car and motorcycle licences, and one year for bus, coach and lorry licences, with DVLA assessing the case and saying whether tests are needed. A general principle in the DVLA guide is that you must surrender your licence if your doctor tells you to stop driving for three months or more, or if the condition affects safe driving for three months or more, and you can apply to get it back when you meet the medical standards again.

For car and motorcycle licences you can report your condition online, or use the paper form named on the relevant GOV.UK page, such as B1 for head and brain injury and haemorrhage, STR1 for stroke and BT1 for brain tumour. Bus, coach and lorry licence holders use a different form, for example B1V, STR1V or BT1V.

DVLA may ask for medical information from your doctors, request an examination, a driving assessment or an eyesight test, and then decide whether to issue a licence, a time-limited licence, or refuse or revoke it. Northern Ireland drivers deal with the Driver and Vehicle Agency instead.

Headway recommends sensible precautions such as a formal driving assessment even if you feel your skills are intact, noting that many people with brain injury were injured in road collisions themselves. Driving Mobility offers assessments of fitness to drive and advice on adaptations. Assessments usually involve cognitive and visual testing, an on-road trial and, if needed, equipment trials.

People who receive the higher rate mobility component of Disability Living Allowance or the enhanced rate moving around component of Personal Independence Payment may be able to get a car through Motability, which lists accredited suppliers for adaptations. Vehicle changes address physical limits such as one-sided weakness, but do not change the need to meet the cognitive and visual standards.

GOV.UK says you can be fined if you do not tell the DVLA about a medical condition that affects your driving and may be prosecuted if involved in an accident. Headway adds that the licence would not be valid and you would be uninsured in the event of an accident. Telling your insurer as well as the DVLA is essential.

The treating team, including the GP, can advise but the decision on fitness lies with the licensing authority. NICE stroke guidance tells clinicians to consult the DVLA regulations when advising about visual problems and to give information about transport and driving, including DVLA requirements, as part of long-term support.

Loss of a licence can be a major blow to independence, work and identity, and Headway notes that stress and loss of independence are common after brain injury. Rehabilitation teams can help to plan travel training, public transport, community transport and taxis, and to link people with local services. Return-to-work plans should take account of how the person will travel.