Stroke survivor Jim is back on the road again

Like many stroke survivors , Jim Laing had to stop driving following his stroke in 2022. Now he documents his experiences from the day of his stroke to getting back behind the wheel...

My name is Jim Laing and I have had a bit trouble trying to get my driving licence back since suffering a minor stroke two years ago. I hope this story will be of particular interest to anyone who has lost their licence to drive after suffering vision defects caused by a stroke or brain injury. It is a story with a happy ending. The clue is in the title.

In August 2023, the Stoke Association Newsroom published an excellent article written by Jeremy Johnston. Having suffered a stroke in March 2017, Jeremy entered an uphill struggle to get his driving licence back. Following some major health setbacks, he finally applied for his licence in June 2020 and manged to get driving again six months after his application.

Everyone’s story is different. Jeremy’s was an epic tale about overcoming many health hurdles which, fortunately, I never had to face. There were, however, some parallels between our journeys and I think that if I focus my story on the practical issues that anyone in a similar position is likely to encounter, then together we might bring some hope to those who are about to face similar obstacles in returning to driving. Our stories don’t mean that everyone who has suffered a vision loss through stroke or brain injury can return to driving. Some defects are too serious to overcome. It is right that the authorities should ensure that people who cannot drive safely on the road are prevented from doing so. Our stories do illustrate, however, some of the anomalies in the DVLA procedures and how some eyesight problems can indeed be overcome even if a large government organisation, and even some health professionals, might initially suggest otherwise.

Stroke and the aftermath

My own stroke story began on February 19th 2022. I was a patient in Liverpool Heart and Chest Hospital. Two of my heart valves had been successfully repaired five days earlier using a very clever ‘minimally invasive’ procedure. I was looking forward to a return home within the next couple of days and hoping for a relatively short period of recuperation.

I was sitting beside my bed when something started to go wrong. Brightly coloured spots of light… yellow, red, blue, orange… flashed on and off in the left side of my vision. I called for assistance and an Advanced Nurse Practitioner examined me. He reassured me, “You’re not having a stroke”, were the words I’ll always remember. Unfortunately, it later transpired that I had indeed suffered a mild stroke resulting in left homonymous hemianopia. This means that I was left with a sort of blurred vision in the lower left quartile of my peripheral vision. I have adjusted well to this defect but whilst I am out walking, small children and dogs put themselves at risk if they foolishly approach me quickly from what I call a south westerly direction!

So that’s how my stroke happened. I’ll skip all the further medical details, procedures and referral appointments (and lack of them!) which followed and move on to deal with the issue of my ability to drive.

Research and early days

I had stopped driving after my stroke and I seemed to be receiving mixed messages from various medical sources. A few months afterwards, one consultant vaguely mentioned something he called an “exceptionality rule” that he had heard about. I remember him saying that he didn’t have any details but thought I would have to wait a year to apply for my licence He wished me …“Good luck with the DVLA!”

I am fortunate. My grown-up daughter lives on a four acre smallholding and I took the opportunity to drive both a car and a ride-on mower around the grounds. I decided that I could still see everything I needed to see by just very slight movements of my eyes. Could I possibly get driving on the roads again? I asked Mrs. Google the question: Can you drive with visual field loss? She answered: In some exceptional cases, some people with significant visual field loss can request a specialist on-road driving assessment to be considered for a return to driving. These people must be at least one-year post-stroke, have a stable visual field defect and have adapted well to their loss of peripheral vision.

This statement was backed up by a difficult to find paragraph on the government website: https://www.gov.uk/guidance/visual-disorders-assessing-fitness-to-drive#visual-field-defects … although I would add that the remainder of this website did not engender much hope of ever getting my licence back.

I also began an internet search of academic studies on the impact of visual field loss on driving skills. There were several useful papers including one by Patterson, Howard, Hepworth and Rowe (British and Irish Orthoptic Journal 2019): https://pubmed.ncbi.nlm.nih.gov/32999975/. A Canadian study (2005) also seemed interesting: https://pubmed.ncbi.nlm.nih.gov/16127331/. Another published in the American Journal of Occupational Therapy (2010) was also informative: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2964938/.

Stroke Association support

Then, in March 2023, just about a year after my stroke, someone got in touch with me. I had done some consultancy work for Alexis Kolodziej when she worked with another charity and she had now become a director at the Stroke Association. I had previously mentioned to her about my stroke and driving ‘frustration’. She surprised me by saying that she knew of someone who I might want to speak with about my condition.

With support from Alexis but without too much expectation, I sent an email off to Dr Claire Howard, a Stroke Specialist Orthoptist at Salford Royal Hospital, asking if she might be able to help. I was stunned to get an almost instant reply with the offer of an NHS appointment to see her within three weeks.

After meeting Dr Howard, on the 20^th April 2023 and being examined and tested in her consultation room at Salford, I set out on my long road to obtaining my driving licence. What follows is an edited version of the many updates I sent to Dr Howard after each stage of my ‘battle’ with the DVLA. Don’t get me wrong, there is no way I should have been allowed to drive without proving that I was capable of doing so. My big issue today though, is why did it have to take nearly two years after my stroke (during which time my vision remained stable) to prove that I was a safe driver?

April - July - Mixed messages and frustrations

23^rdApril 2023 - I write to the DVLA making a formal request for a driving assessment under the exceptional cases ruling. I enclose a copy of the letter that Dr Howard had already written in support of my application.

2^ndMay 2023 - Letter received from the DVLA telling me to go to Specsavers. I have make an appointment for next week for a “Group 1 DVLA eye test for driver licensing purposes.”

11^th May 2023 - I go to Specsavers for the same Esterman Visual Field Test that Dr Howard had carried out a few weeks previously in hospital. The eye test begins badly. I’m asked, by a young assistant, to keep my spectacles on for the field of vision test which requires me to press a button as random white spots flash on a screen. I do this but she stops the test a third of the way through because I am “missing some points.” I explain that I am bound to miss some points because of my hemianopia. She has no idea what that, or quadrantanopia, is. We start the test all over again. I am a bit stressed, but I do my best. I see the optician who says that the rims on spectacles can sometimes affect the test and so asks me to repeat the test with spectacles off, which I do. He also does a ‘letters on the chart’ test and said I am fine (20/20). I am not given the results but I ask for them later and when I receive them I send a copy to Dr Howard.

18^th May 2023 - I receive a disappointing letter from the DVLA, “You cannot meet the current visual field standards for safe driving.” There is, however, a line which reads, “If, however, you feel you meet all the exceptional criteria… please take the EXCVIS Reply Form (attached) to your medical professional for completion.” I feel that I do meet the criteria.

22^ndMay 2023 - I post the EXCVIS Reply Form to Dr Howard with covering letter requesting her to complete it. (Note: A ‘wet copy’ original form and signature is necessary because electronic signatures are not acceptable to the DVLA).

2^stJune 2023 - I receive signed copy of EXCVIS form from Dr Howard and post it (recorded delivery) to DVLA form with a brief accompanying letter.

29^stJune 2023 - I decide to chase up and manage to get through to ‘A’ in the Drivers Medical Group who informs me that my application had been referred for a medical review. I am told that the final decision will be made by a practising GP. He can’t tell me how long it was going to take because “…some GPs are very busy”.

14^th July 2023 - I speak to ‘B’ at the DVLA (medical). She says she would make a note of my call but there was no way she could prioritise my case. A week later I speak with ‘C’ who gave me a similar reply to ‘B’. I ask if she could give me some idea of the average waiting time for decisions to be made. She said she had no idea.

September - November- Perseverance

1^st September 2023 - I phone the DVLA again. I speak with ‘D’ and she tells me that, “a doctor had reviewed my case and revoked my licence” (I knew that as I had already surrendered my licence). She then asks me if I would like her to “send me a licence for a disabled licence.” I agree as I assume this means an application for Provisional Disability Assessment Licence (PDAL). I did wonder what would have happened if I had not phoned 4 times previously.

6^thSeptember 2023 - Two separate forms arrive today. A V1 (Medical Questionnaire: vision), and a D1 (Application for a Driving Licence). D1 needed both a photo and passport to be included with the completed form. Fortunately I have both available. I complete both forms and return them recorded delivery.

22^ndSeptember 2023 - Letter from DVLA (Drivers Medical Group) telling me that, “I must attend an appointment with a DVLA approved optician within 8 weeks to check that I meet the legal eyesight standards for a Group 1 driving.” This is exactly the same letter I had received back in April when I subsequently attended for the eyesight test. I contact Specsavers immediately and they tell me that they had definitely faxed (!) my results to the DVLA on the 10^th May 2023. I send the letter back to the DVLA with a note to suggest that it must have been sent in error.

26^th September 2023 - I receive a call from ‘E’ at the DVLA. She tells me she is checking the name of my GP as she is going to write to her to update the progress on my case.

28^thSeptember 2023 - I receive two separate envelopes from the DVLA. The first one contains a letter from the Drivers Medical Group headed “PROGRESS UPDATE ON MEDICAL ENQUIRIES”. It explains that they have written to my GP to “ensure that they do not have any concerns that my medical condition that affects your ability to safely control your vehicle at all times.” The second envelope contains a letter headed, “We need to make confidential enquiries into your medical fitness to drive.” I am asked to [1] “Complete the enclosed medical questionnaire” (Form STR1) and [2] “Complete the enclosed authorisation form”(there wasn’t one). It goes on to say “We will aim to make a decision within 6 weeks. However, we may need to write to your doctor or consultant, which could take longer.” I return the STR1 and explain that my “medical consultant” (Dr Howard) had already sent a letter to the DVLA (20/04/’23) and had also completed form EXCVIS.

3^rdOctober 2023 - I receive another letter from the DVLA asking me, for the third time, to arrange an eye test with Specsavers. This is exactly the same letter I had received back in April and just 10 days ago.

I phone the DVLA and, after 40 mins on hold, get through to ‘F’ who tells me that she isn’t sure but it was likely that I had been asked to have another eye test at Specsavers because they needed up-to date information. I explain that my field of vision loss was not a degenerative ‘eye’ condition but was the result of a minor stroke. I also suggest that if they keep trying to send me for Specsavers’ tests and then waited five months before telling me that the information provided needed to be updated, we would find ourselves in a never ending loop of bureaucracy! She tells me, after a long hold, that a ‘case worker’ had automatically sent me the letter about Specsavers not realising that the test had already been done.

10^th October 2023 - Although my online medical record is showing that my GP has received the letter from the DVLA over a week ago, it is not showing that anyone has responded yet. I chase up the surgery to make sure that the whole process has not got snarled up locally. I’ve ask for a copy of their letter to the DVLA.

13^th October 2023 - I receive copies of the communication between the DVLA and my local GP surgery. I am pleased that my GP seems to have ticked all the ‘right’ boxes on form STR2 giving no other medical reasons for me not being allowed to drive.

8^th November 2023 - A letter informs me that a DVLA doctor is considering my fitness to drive “and has decided to offer an on-road driving assessment to make a decision.” It advises me to find a driving instructor so that I can re-train after they have issued me with Provisional Disability Driving Licence (PDAL) and, if I wish to go ahead, I have to book with a DVLA approved assessment centre within four months.

I complete the ASSESSRT Reply (declaration) forms and return them immediately. I speak to a DVLA approved centre in Leeds and they sound very helpful.

28^thNovember 2023 - I phone the DVLA and speak to ‘G’ who tells me that they had sent the assessment letter to the Driving Centre and that they could not issue the PDAL (provisional licence) until they had heard back from the centre. I query this. Why did they have to wait to hear from the assessment centre as the DVLA doctor had already decided that I could have a provisional licence? Why could one not be issued immediately? I am told, “That’s not what it says on the screen.”

December - January - New year, new license

2^ndDecember 2023 - Letter received from DVLA with new Provisional Disability Assessment Driving Licence enclosed. I contact the William Merrit Assessment Centre in Leeds (the one I had indicated clearly on my “ASSESSRT” declaration form). They told me they had not received anything yet from the DVLA and so they could not book an assessment.

4^thDecember 2023 - Another letter from the DVLA asks me to contact the Assessment Centre in Manchester. This was not the centre I had chosen. I try six times to contact the DVLA but fail to get through.

5^thDecember 2023 - I explain the problem of the assessment centre to ‘H’ at the DVLA after a long wait to get through. He confirms that I had indeed asked for the Leeds Centre (with the actual assessment in York, closer to where I live). He apologised and said he would “get the team to re-refer me.” He couldn’t do it himself.

11^thDecember 2023 - Letter received from DVLA stating that I have been referred to the Leeds centre and that I should contact them in four days.

12^thDecember 2023 - Now that I have my PDAL, I arrange a 2 hr driving assessment session in a dual control car with a local Advanced Driving Instructor. It goes very well. I later contact the Leeds centre and they confirm that they have now received my DVLA referral. Despite previously telling me that they had a 6 to 10 week waiting list, I get lucky. They offer me a cancellation for an assessment next week!

18^th December 2023 - I go to York for my official DVLA Driving Assessment. I have a not very strenuous a physical assessment to determine my range of movement for driving and do a standard eyesight test (number plate from 20m). This is followed by a 30 minute comprehensive cognition and memory test conducted by an occupational therapist. I then go out in a car provided by the Centre, for about 45 minutes, with the driving instructor in the passenger seat and the occupational therapist seated in the rear. At the end of the process they said they would be sending a very brief report off to the DVLA immediately. They explained that it would be very brief because I had done nothing wrong! They both congratulated me and wished me luck. Sadly, they were also obliged to take away my PDAL (provisional licence) which they had to send back to the DVLA whilst awaiting the outcome of the final decision.

19^th January 2024 - My driving licence arrives through the post! Valid for 3 years. It is attached to a standard information sheet (D741) that I imagine anyone gaining a driving licence receives.

20^th January 2024 - I receive a formal letter about my application. It begins, “From the information received you satisfy the medical standards for safe driving.” It goes on the say that “my licence would be issued as soon as possible” and to “let them know if I hadn’t received it after 14 days.” I didn’t write back to say that I had already received it.

13^th February 2024 - After making a special online “Subject Access Request”, I receive an email attachment from the DVLA with my cognitive ability and driving assessment reports. They are interesting, very thorough and confidence boosting.

Back on the road

That is my story of getting back on the road again. I could not have achieved what I did without many people giving me support and confidence to persist in my quest. Key amongst these were: Dr Claire Howard (Salford Royal Hospital), Alexis Kolodziej (Stoke Association), and, of course, my wife and family.

A huge thank you to Jim for sharing his story and for his unwavering determination to help others in a similar situation.

For more information and support on driving after stroke, visit - https://www.stroke.org.uk/stro...