Most adults are able to make their own decisions about treatment and care. However, this can change due to illness. 

It is useful to think and talk about your preferences and priorities for future care. This planning ahead can be especially important at times of illness or a life-changing event. 

Here we explain what you might use to plan your future care. You can opt for as many as you like. Or you may decide you do not want any.

Informal plans:

  • Advance care plan – your own record of your wishes and choices about care. You can share this with whoever you wish.
  • Universal care plan – you can tell your GP or nurse your choices and they will create an online record that can be used by other health professionals across London.

Legal plans:

  • Lasting power of attorney – you can legally record who you want to speak for you and make decisions when you cannot.
  • Advance decision to refuse treatment – a legal document saying what treatments you do not want in the future.

These plans can be especially helpful if you become unable to communicate your own wishes. This is referred to as losing capacity.

Having capacity

To make decisions about your future care, you must have ‘capacity’. This means you are able to understand information, make a decision, and communicate your choice.

Examples of when capacity can be lost include:

  • if you have a brain injury, stroke or neurological condition
  • if you are unconscious
  • if you have advanced dementia, including Alzheimer's disease, which can affect your ability to make decisions.

Planning ahead while you still have capacity ensures that others understand your wishes, even if you become unable to tell them.

Talking to family and friends

Talking about future care can feel difficult or emotional. However, many people find these conversations helpful and reassuring. Discussing your wishes with those close to you can make it easier for them to support decisions about your care.

Advance care plan

An Advance Care Plan (ACP) allows you to record your wishes for future care if you ever become unable to make decisions for yourself. It is sometimes called an ‘Advance statement’.

You can update your plan at any time and share it with anyone.

What to include in the care plan

The ACP is personal to you. It is for you to record your wishes and preferences for your future. Here are some of the things you may want to include.

  • If you have any religious or spiritual beliefs and how you want these reflected in your care.
  • Who you want to be involved in decisions about your care when you no longer can be. This may be family but can be anyone you choose. 
  • Where you would like to be cared for – for example, at home, hospital, nursing home or hospice. 
  • Who you want to be with you at the end of your life. 
  • Your thoughts on different treatments or care you might be offered. 
  • Your personal preferences concerning personal care. 
  • Practical issues, such as looking after a pet.
  • Whether you ever want to receive CPR – see below.

Universal care plan

The Universal Care Plan (UCP) is an online record of your wishes and needs, shared with healthcare professionals across London. This includes hospitals, Ambulance Services, NHS 111, out-of-hours GP services and community services, such as district nurses.

Your UCP is created with your doctor or nurse after discussing your wishes. It can be updated at any time. You can include whatever you want, such as:

  • what matters most to you
  • particular communication needs, such as translation or sign language
  • your preferences for care in the future
  • what support you need and who provides this
  • people involved in your care, such as relatives or carers
  • your health conditions and important treatment decisions. 

Legal plans

The ACP and UCP record your wishes but are not legal documents. Legally-binding plans include the following.

Lasting Power of Attorney

A Lasting Power of Attorney for Health and Welfare allows you to appoint someone you trust to make health and care decisions for you, if you lose capacity in the future. 

To make an LPA, you need to fill in the required form and register it with the Office of the Public Guardian (which takes at least 8 weeks).

Advance Decision to Refuse Treatment

An Advance Decision to Refuse Treatment (ADRT, or ‘Living Will’) allows you to record treatments you do not want in specific situations, such as CPR. 

To make an advance decision, you need to fill in a form and get it witnessed. You should also give a copy to your relatives, GP and local hospital.

Cardio-pulmonary resuscitation (CPR)

You may want to discuss and record your preferences about cardio-pulmonary resuscitation (CPR).  

If you decide you would not want to receive CPR, this can be recorded in your care plans. This note may be called a DNR (do not resuscitate), DNAR or DNACPR.

What CPR involves

CPR is emergency treatment used when a person's heart or breathing stops. It can include repeatedly pressing firmly on the chest, pushing air into the lungs with a mask or tube, and sometimes using electric shocks to try to restart the heart.

What to expect 

CPR can sometimes restart the heart, but only some people recover well enough to leave hospital.  

In hospital, about 4 in 20 people who receive CPR recover enough to leave hospital. Outside of hospital, about 1 in 20 who receive CPR survive. 

CPR is more likely to help people who were previously fit and well and whose heart stops suddenly (for example, because of a heart attack). It is much less likely to be effective for people approaching the end of life.

Decisions about CPR are medical decisions made by the hospital team. They will consider your wishes, your overall health, and whether CPR is likely to help. Wherever possible, these decisions are discussed in advance with you and those important to you.

More information

Making a will

When planning for the future, a will is important. Kingston Hospital Charity has teamed up with the free will-writing service Octopus Legacy to make it easy to write or update your will. There is no obligation to leave a gift to our charity when using this service.