For many people, driving represents far more than a means of getting from one place to another. It is an occupation that enables employment, family life, social participation, healthcare access and community engagement. Driving supports identity, routines, valued roles and independence. Consequently, conversations about driving are rarely about a vehicle alone, they are about preserving participation in meaningful occupations.

Occupational therapists are frequently asked to contribute to decisions about whether an individual can continue to drive following illness, injury or changes in function. These discussions can be challenging, balancing an individual’s right to independence with the responsibility to protect both the driver and the wider public.

However, occupational therapy has always viewed risk differently. Rather than asking “How do we eliminate risk?”, our profession asks, “How can we enable participation while managing risk appropriately?” This philosophy underpins not only driving assessments but occupational therapy practice as a whole.
 

Risk is an inevitable part of occupation

Every meaningful occupation carries some degree of risk. Preparing a meal, returning to work, caring for grandchildren, managing finances, travelling independently or driving all involve potential hazards.

If occupational therapists focused solely on eliminating risk, many individuals would lose opportunities to participate in the very activities that contribute to their health, wellbeing and quality of life.

The Royal College of Occupational Therapists promotes person-centred, strengths-based practice that enables occupational participation, while the Care Act 2014 places wellbeing, independence and individual choice at the centre of adult social care. Together, these reinforce the principle of positive risk-taking, supporting individuals to make informed choices while putting proportionate measures in place to reduce avoidable harm.

Driving is perhaps one of the clearest examples of this approach.
 

Understanding the legal framework

Unlike many everyday occupations, driving carries specific legal responsibilities.

In Great Britain, drivers have a legal duty under the Road Traffic Act 1988 to notify the Driver and Vehicle Licensing Agency (DVLA) if they develop a medical condition or disability that may affect their ability to drive safely.

The DVLA publishes detailed guidance describing the medical standards required for both Group 1 (cars and motorcycles) and Group 2 (lorries and buses) licence holders.

Conditions that may require notification include, amongst many others:

• Stroke and transient ischaemic attack (TIA)
• Dementia and other progressive neurological conditions
• Parkinson’s disease
• Multiple sclerosis
• Epilepsy
• Visual disorders
• Diabetes requiring insulin
• Significant psychiatric illness
• Traumatic brain injury
• Sleep disorders such as obstructive sleep apnoea where excessive sleepiness is present

Importantly, diagnosis alone does not automatically prevent someone from driving. The DVLA considers the functional impact of a condition, prognosis, treatment, symptom stability and clinical evidence before determining whether someone meets the required medical standards.

This aligns closely with occupational therapy’s focus on function rather than diagnosis.
 

The occupational therapist’s role

Occupational therapists do not decide whether an individual retains their driving licence, that responsibility rests with the DVLA. Neither are occupational therapists responsible for formally certifying medical fitness to drive, although we acknowledge that some specialist therapists working in driving assessment centres may have more formal ‘powers’ than a therapist working elsewhere.

Instead, occupational therapists play an essential role in assessing how changes in health affect the complex occupational performance required for driving.

Driving is one of the most cognitively, physically and perceptually demanding occupations many people undertake. Safe driving requires the integration of multiple performance components simultaneously, including:

• Vision and visual perception
• Attention and concentration
• Executive functioning
• Memory
• Information processing speed
• Insight and judgement
• Upper and lower limb function
• Balance and coordination
• Neck and trunk mobility
• Fatigue management
• Emotional regulation
• The ability to respond rapidly to changing environments

Occupational therapists are uniquely skilled in understanding how these factors combine during real-world occupational performance.
 

Looking beyond diagnosis

Two people with the same medical condition may have entirely different levels of functional ability.

For example, one individual living with Parkinson’s disease may demonstrate excellent cognition, good insight and minimal motor symptoms, while another may experience fluctuating mobility, slowed reactions and impaired executive functioning.

Similarly, following stroke, one person may safely return to driving after rehabilitation, whereas another may continue to experience visual neglect or reduced processing speed that significantly affects driving safety.

Occupational therapists therefore assess occupational performance, not simply medical diagnosis.

Assessment may include:

• Occupational profile and driving history
• Physical assessment
• Functional cognition
• Visual and perceptual screening
• Upper limb and lower limb function
• Fatigue and endurance
• Medication effects
• Insight into ability
• Ability to risk assess
• Previous collisions or near misses
• The occupational importance of driving within the person’s daily life

Most importantly, therapists seek to understand why driving matters.

Driving may enable employment, caring responsibilities, community participation, volunteering, shopping, healthcare appointments or maintaining social relationships. Understanding these occupational roles ensures recommendations remain person-centred rather than task focused.
 

Supporting informed decision-making

Occupational therapists have an important educational role.

Many individuals are unaware of their legal obligation to inform the DVLA about certain medical conditions, or they may incorrectly assume that healthcare professionals notify the DVLA on their behalf.

Where appropriate, occupational therapists should advise individuals to discuss driving with their GP or relevant medical specialist and explain the requirement to notify the DVLA where applicable. They should also signpost individuals towards the current DVLA medical guidance and encourage timely reporting where required.

Good practice includes documenting:

• Advice provided
• Information shared regarding DVLA notification
• Discussions about risk
• The individual’s understanding of the advice
• Agreed actions and referrals

Clear documentation protects both the individual and the therapist.
 

Managing risk rather than removing occupation

Risk assessment should never become synonymous with driving cessation.

Instead, occupational therapists should consider what interventions might reduce risk sufficiently to enable continued participation.

These may include:

• Vehicle adaptations, including hand controls or steering aids
• Seating and postural adjustments
• Rehabilitation to improve cognitive or physical function
• Fatigue management strategies
• Medication review
• Restricting driving to familiar routes or daylight hours where appropriate
• Referral to a Specialist Driving Mobility Centre for comprehensive off-road and on-road assessment
• Graduated return to driving following illness or injury

These interventions demonstrate occupational therapy’s commitment to enabling participation wherever possible.
 

When driving is no longer safe

Despite best efforts, there are occasions when assessment identifies risks that cannot be sufficiently mitigated.

These conversations require compassion, honesty and excellent communication.

For many individuals, stopping driving represents a profound occupational loss affecting independence, identity, employment, family roles and social participation. Research consistently demonstrates that driving cessation can contribute to reduced community engagement, loneliness, depression and declining health if appropriate alternatives are not established.

Occupational therapists therefore have responsibilities that extend well beyond advising someone to stop driving.

Our role includes helping people adapt.

This may involve identifying community transport schemes, improving confidence using public transport, exploring powered mobility options, supporting digital access to services, reviewing environmental barriers or helping individuals establish new occupational routines that preserve independence and wellbeing.

Supporting occupational adaptation is just as important as assessing driving itself.
 

Professional responsibilities

Occupational therapists must balance person-centred practice with their professional responsibilities under the HCPC Standards of Conduct, Performance and Ethics, particularly the duty to promote and protect the safety of service users and the public.

Most situations are resolved through collaborative discussion, education and shared decision-making. However, if an individual continues to drive despite presenting a serious and immediate risk to public safety, occupational therapists may need to escalate concerns in line with organisational policies, professional guidance and legal frameworks. Such decisions require careful clinical reasoning, senior consultation where appropriate, and clear documentation.

Throughout the process, occupational therapists should remain objective, evidence-informed and transparent, ensuring recommendations are based on functional assessment rather than assumptions linked to age or diagnosis.
 

Driving as an example of occupational therapy at its best

Although driving presents unique legal and ethical considerations, it illustrates a much broader principle that underpins occupational therapy.

Whether supporting someone to bathe independently, return to work, parent safely, travel within their community or continue driving, our role is fundamentally the same.

We identify strengths.

We understand barriers.

We evaluate risk.

We collaborate with individuals.

We recommend interventions.

And we enable participation wherever it can be achieved safely.

Effective risk assessment is therefore not about removing autonomy. It is about supporting informed choice through sound clinical reasoning, evidence-based practice and collaborative problem-solving.

By combining our understanding of occupation with knowledge of legislation, functional assessment and risk management, occupational therapists help people continue engaging in the occupations that matter most, safely, confidently and with dignity.