End of Life Planning Wales — Documents, Deadlines, and Where to Start
The Four Pillars of End-of-Life Planning in Wales
End-of-life planning in Wales sits across four distinct domains — personal wishes, legal authority, clinical protocols, and financial administration. Most people tackle one and assume the rest will sort itself out. They won't. A valid ADRT without GP registration is invisible in an emergency. An LPA without a will leaves a spouse locked out of joint accounts. A DNACPR without a Green Bottle stays in a filing cabinet while paramedics are performing chest compressions on your living room floor.
Here's the complete framework, in the order you should address it.
Pillar 1: Legal Documents (While You Have Capacity)
Advance Decision to Refuse Treatment (ADRT): A legally binding refusal of specific medical treatments under the Mental Capacity Act 2005. If it covers life-sustaining treatment, it must include the declaration "even if my life is at risk or may be shortened," and be signed, dated, and witnessed by an independent adult.
Lasting Power of Attorney — Health and Welfare (LP1H): Appoints a trusted person to make healthcare and care decisions if you lose capacity. Registration with the OPG costs £92 (£46 if income under £12,000) and takes 8–20 weeks.
Lasting Power of Attorney — Property and Financial Affairs (LP1F): Appoints someone to manage your finances. Same registration process and fee as the Health and Welfare LPA.
Will: Without a valid will, your estate follows the statutory intestacy rules — cohabiting partners get nothing, and your assets may go to relatives you wouldn't have chosen.
All four require mental capacity on the day of signing. Once capacity is lost, the Court of Protection may be needed for matters not covered by an existing authority — a process that costs upwards of £5,000 and takes months.
Pillar 2: Clinical Registration (Making Documents Findable)
GP surgery scan: Deliver your original ADRT to your GP practice and ask the practice manager to scan it to the Welsh Care Records Service (WCRS). This activates the "Future Care Plan discussed" flag on the Welsh Clinical Portal, visible to emergency teams across NHS Wales.
Green Bottle scheme: Place copies of your ADRT, DNACPR form, medication list, and emergency contacts inside a container in your fridge. Stick a green sticker on the inside of your front door. Welsh Ambulance Service paramedics are trained to check for this sticker and go to the fridge.
LPA registration confirmation: Once the OPG registers your LPA, ask your GP to note it in your medical records. Hospitals sometimes miss that an LPA exists because it's registered at the OPG but not flagged in the patient's clinical file.
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Pillar 3: Clinical Conversations
DNACPR discussion: Ask your GP whether a DNACPR form is appropriate given your current health. The All Wales DNACPR form is a clinical decision — you can't fill it out yourself — but your wishes (especially if documented in an ADRT) should drive the conversation.
Organ donation position: Under the Human Transplantation (Wales) Act 2013, consent to organ donation is deemed for adults who've lived in Wales for over 12 months unless they opt out. Active registration of your decision (either way) on the NHS Organ Donor Register matters — research shows family support for organ retrieval rises from approximately 50–60% when consent is merely deemed to 90% when the person actively registered.
Palliative care ceiling: For anyone with a progressive or terminal condition, discuss with your clinical team which active treatments (antibiotics, transfusions, non-invasive ventilation) you want and at what point you'd want them stopped.
Pillar 4: Financial and Administrative Preparation
Death registration: Must happen within 5 days of the medical examiner releasing the Medical Certificate of Cause of Death (MCCD). The registrar issues the Green Form (Certificate for Burial or Cremation) and a Tell Us Once reference number.
Tell Us Once: Submit within 28 days of receiving the code from the registrar. This service notifies HMRC, DWP, local council, DVLA, and the Passport Office in one go. Miss it, and you'll be contacting each agency individually.
Bereavement Support Payment: The surviving spouse or civil partner, or an eligible cohabiting partner with dependent children, must claim within 3 months to receive the full 18 monthly payments (higher rate: £3,500 lump sum + 18 × £350; lower rate: £2,500 + 18 × £100). Claims up to 12 months still get the lump sum, but monthly payments reduce pro rata.
Funeral Expenses Payment: For qualifying benefit recipients, Form SF200 covers burial or cremation fees plus up to £1,000 for other costs. Must be claimed within 6 months of the funeral.
Probate: Application via PA1P (with will) or PA1A (without will) to HMCTS. The fee is £526 for estates over £5,000. Clean digital applications take 2–5 weeks; applications with errors can take 15–20 weeks.
Where to Start
If you're planning proactively, start with the ADRT and both LPAs — the documents that require capacity. Everything else can be done later.
If you're reacting to a diagnosis or a sudden change in someone's health, prioritise the ADRT and the GP registration — ensuring treatment wishes are documented and visible.
Our Wales ADRT planning guide covers the clinical-legal documents in detail: drafting, signing, witnessing, GP registration, Green Bottle setup, and coordination between the ADRT and LPA so neither document inadvertently overrides the other.
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