Advance Care Planning NHS

The Three Documents That Actually Matter

Advance care planning in the NHS uses three main instruments, and they carry very different legal weight. Getting them confused — or relying on the wrong one — is the single most common planning failure.

An Advance Decision to Refuse Treatment (ADRT) is the only one that is legally binding on clinicians. Under the Mental Capacity Act 2005, a valid ADRT must be followed, even if the medical team believes treatment would help you. It covers specific refusals of specific treatments under specific clinical conditions.

An Advance Statement records your values, preferences, and wishes — where you would prefer to die, your religious observances, your dietary requirements, your views on pain management. Clinicians must consider it when making best-interests decisions, but they are not legally bound to follow it.

A Lasting Power of Attorney for Health and Welfare appoints someone to make medical decisions when you cannot. It only works after registration with the Office of the Public Guardian.

Most people need all three. The ADRT handles what you refuse. The Advance Statement handles what you prefer. The LPA handles everything you cannot predict.

Getting Your Documents Into NHS Systems

Writing the documents is only half the work. If nobody can find them during an emergency, they serve no purpose.

Book a routine appointment with your GP and ask them to upload your ADRT and Advance Statement to your NHS Summary Care Record. Ask for written confirmation that the documents are flagged as active on your electronic patient record. Re-verify during your next annual health check.

If you have a planned hospital admission, bring certified copies of your registered LPA and your ADRT to the admissions clerk. Ask the ward doctor to scan them into the trust's digital health record system. Check that the documents are noted in the nursing handover so they transfer between shifts.

For care home admissions, provide copies to the home's care manager and ask for them to be filed in your care plan. Review this annually, particularly if your condition changes.

The ReSPECT Form Is Not a Legal Document

The Recommended Summary Plan for Emergency Care and Treatment — the ReSPECT form — is widely used across NHS trusts, and many families assume it carries legal authority. It does not.

ReSPECT is a clinical communication tool. It summarises emergency care recommendations that emerge from conversations between you, your family, and your clinical team. Paramedics and A&E staff use it to guide immediate decisions. But it is advisory. A doctor can override it based on clinical judgement.

The same applies to a DNACPR order. It records a clinical recommendation not to attempt CPR. It is not a patient's legal instruction.

If you want your refusal of CPR to be legally binding on the medical team rather than a clinical suggestion, that refusal must be documented in a valid ADRT with the "even if my life is at risk as a result" clause.

The Practical Checklist

A complete advance care plan in England should include:

• A valid ADRT specifying your treatment refusals with precise clinical language
• An Advance Statement covering your preferences, values, and care wishes
• A registered Health and Welfare LPA appointing your decision-maker
• Copies filed with your GP, your hospital consultant if you have one, and any care facility
• A medical alert card or wallet note listing your ADRT and attorney contact details
• An annual review date in your calendar to confirm everything is still current and accessible

The England ADRT Guide provides the complete framework — from drafting clinically precise treatment refusals to coordinating all three documents, with a GP consultation preparation sheet and a storage protocol that ensures your wishes are findable in an emergency.

See more England guides →