Advance Care Planning

Advance Care Planning (ACP) is a voluntary process of discussion between an individual and any of their care providers, whatever their role in the health care team. Aspects of ACP may include:

  • Discussing the individual’s understanding about their illness or prognosis
  • Exploring the options available to them
  • Identifying their wishes, preferences, priorities and concerns
  • Refusing specific treatment , if they wish to
  • Asking someone to speak for them if they are not able to do so
  • Appointing someone to make healthcare decisions for them, using a Lasting Power of Attorney
  • Letting people know their wishes for their future care

If the individual wishes, their family and friends may be included in the discussions. With the individual's agreement, this discussion should be recorded, regularly reviewed and communicated to key persons involved in their care.
Not everyone wishes to have conversations about these issues and there should be no obligation to do so.

Advance Statement (also known as Preferred Priorities for Care (PPC))
An advance statement is a written statement that sets down your preferences, wishes, beliefs and values regarding your future care.

It is held by the individual and taken with them if they receive care elsewhere. By writing your advance statement down, you can help to make things clear to your family, carers and anybody involved in your care. You can make sure people know about your wishes by talking about them. The aim is to provide a guide to anyone who might have to make decisions in your best interest if you have lost the capacity to make decisions or to communicate them.

An advance statement is not legally binding, but anyone who is making decisions about your care must take it into account. An advance decision (sometimes known as an advance decision to refuse treatment, an ADRT, or a living will) is a decision you can make now to refuse a specific type of treatment at some time in the future and is legally binding as long as it meets the necessary criteria for it to be considered valid and applicable.

An Advance Decision to Refuse Treatment (ADRT)
An Advance Decision to Refuse Treatment (previously called a Living Will or Advance Directive) is different from a Statement of Wishes and Care Preferences as it is a formal, legally binding document or verbal statement which allows the refusal of certain medical treatments. It cannot be used to demand medical treatments which are not thought to be of benefit to the individual, request to have life ended or the refusal of basic essential care. An ADRT which includes reference to life sustaining treatment must be in writing. A compliant advance decision is as valid as a contemporaneous decision, that is, one made at that time. An ADRT must exist, be valid and be applicable to the current circumstances.

An ADRT is made by an individual, over 18 years of age who has mental capacity. Its purpose is to specify specific treatments that they would wish to refuse in the future and may also specify circumstances in which they would wish to refuse treatment. They are sometimes made by those who have advance warning by age or illness of approaching death, impending mental incapacity or inability to communicate views.

Lasting Power of Attorney
A Lasting Power of Attorney is a legal document. It allows the individual (known as the donor) who has capacity, to appoint someone they trust as an ‘attorney’ to make decisions on their behalf. The circumstances under which attorneys can make decisions depends on the type of LPA.

There are two types of Lasting Power of Attorney.

1. Health and Welfare/ Personal Welfare Lasting Power of Attorney
This type of LPA may give the individual’s attorney(s) the right to make decisions on behalf of the individual e.g.

  • medical care
  • choosing place of care: moving into a care home etc.
  • life-sustaining treatment
  • daily care routine

This type of LPA only comes into force if the individual loses the ability to make decisions and is only valid once it has been registered with the Office of the Public Guardian.

2. Property and Affairs Lasting Power of Attorney
This type of LPA may give the individual’s attorney(s) the ability to make financial decisions for them e.g.

  • pay their bills
  • collect their benefits
  • manage their bank accounts
  • sell their property

Their attorney has the authority to take over the management of their financial affairs as soon as the LPA is registered with the Office of the Public Guardian, unless the LPA states that this can only happen if they lose mental capacity to manage their own affairs.

There are special rules about appointing a LPA. Please visit the website Office of the Public Guardian at www.gov.uk/office-of-public-guardian telephone 0845 330 2900.

Further information about Advance Care Planning
Planning Your Future Care - A Guide - This booklet provides an explanation about advance care planning and the different options available, visit www.nhs.uk/Planners/end-of-life-care/Pages/planning-ahead/advance-statement

Advance Statement (also known as Preferred Priorities for Care) - For further information and examples of documents to help write down preferences and wishes for the future, visit www.nhs.uk/Planners/end-of-life-care/Pages/advance-statement and www.westonhospicecaregroup.org.uk

Office of the Public Guardian - To help with protection of people who lack capacity, visit www.publicguardian.gov.uk

Making Decisions- A Guide - Information booklets about the Mental Capacity Act, visit www.dca.gov.uk/legal-policy/mental-capacity/mibooklets/booklet01.pdf

Advance Decision to Refuse Treatment - For further information visit www.nhs.uk/Planners/end-of-life-care/Pages/advance-decision-to-refuse-treatment and www.macmillan.org.uk/Cancerinformation/Livingwithandaftercancer/Advancedcancer/AdvanceDecision

Gold Standards Framework - Is an approach to optimising the care for patients nearing the end of life delivered by community health care teams. It is concerned with helping people to live well until the end of life and includes care in the final years of life for people with any end stage illness in any setting. visit www.goldstandardsframework.org.uk/patients-amp-carers

You may be able to get help to access these through your Community Nurse, GP or Hospital Specialist Nurse.