Free NHS ADRT Form vs Comprehensive Planning Guide in Wales — What's the Difference?

The All Wales ADRT form is a legitimate, free, bilingual document that produces a legally valid Advance Decision to Refuse Treatment. A comprehensive planning guide costs money. The difference between them is not the legal validity of the output — it's the distance between having a form with limited drafting prompts and knowing what to write on it.

If you already understand the Mental Capacity Act 2005's specificity requirements, know how to coordinate an ADRT with an LPA, have set up your Green Bottle for the Welsh Ambulance Service, and have registered your care plan on the Welsh Clinical Portal, the free form is genuinely all you need. If any of those phrases made you pause, the form alone will leave critical gaps.

What the Free NHS ADRT Form Gives You

The All Wales ADRT form is standardised across Welsh health boards. It includes:

• Personal details section — name, address, date of birth, NHS number
• Treatment refusal sections — pre-written scenarios plus space to describe which treatments you refuse and under what circumstances; a separate Advance Statement section records non-binding wishes, values, or beliefs
• Life-sustaining treatment declaration — the mandatory statement that your refusals apply even if your life is at risk
• Signature, date, and witness fields — the formalities required for a life-sustaining treatment refusal under the Mental Capacity Act
• Storage instructions — a note about keeping the form accessible

It's a well-designed form. It meets every statutory requirement. It is, on paper, everything you need to create a legally binding ADRT.

The Gap: What the Form Cannot Do

It Cannot Tell You What to Write

The form's custom refusal section is a blank box. What you write in that box determines whether your ADRT is followed or overridden. Under the Mental Capacity Act, an ADRT is only legally binding if it specifies the treatments being refused and the circumstances under which those refusals apply.

What most people write:

• "No heroic measures"
• "No life support if my quality of life is poor"
• "I don't want to be kept alive on machines"

What clinicians need to see:

• "I refuse cardiopulmonary resuscitation in the event of irreversible brainstem damage"
• "I refuse invasive mechanical ventilation in the event of end-stage chronic obstructive pulmonary disease where weaning is not clinically feasible"
• "I refuse clinically assisted nutrition and hydration in the advanced stages of dementia where there is no realistic prospect of meaningful cognitive recovery"

The first set of phrases gives a clinician in a Welsh A&E department nothing actionable. They cannot determine which treatments you're refusing under which conditions, so — legally — they must treat you. The second set leaves no room for interpretation. A planning guide provides broader clinical scenario templates; the form provides only its pre-written scenarios and a custom refusal section.

It Cannot Coordinate Your ADRT With Your LPA

If you're also setting up a Health and Welfare LPA — and most people should — the order in which you execute these documents matters legally. An LPA made after an ADRT, with authority over life-sustaining treatment, can override the ADRT's specific refusals. The free form doesn't mention this interaction. It treats the ADRT as a standalone document, which it isn't.

It Cannot Set Up Emergency Access

The form doesn't explain the Green Bottle protocol — the Welsh Ambulance Service's physical system for emergency document discovery. It doesn't walk you through requesting a Welsh Clinical Portal upload with the "Future Care Plan discussed" flag. It doesn't address the fundamental problem that a perfectly drafted ADRT locked in a drawer is functionally identical to having no ADRT at all.

It Cannot Explain the DNACPR and ReSPECT Relationship

Your ADRT is a legal document. A DNACPR (Do Not Attempt Cardiopulmonary Resuscitation) is a clinical order completed by a healthcare professional. A ReSPECT form is a clinical summary plan. These are related but legally distinct instruments with different authority chains. The form doesn't explain how they interact, how to verify that clinical teams have translated your legal instructions into the correct clinical orders, or what to do if there's a discrepancy.

It Cannot Prepare You for Estate Administration

End-of-life planning extends beyond treatment decisions. The HMCTS probate application fee for estates over £5,000 is £526; it rose from £300 on 13 July 2026. Land Transaction Tax rules for inherited Welsh property carry a 36-month surcharge window. Bereavement Support Payment has a three-month claim deadline. The form covers none of this — not because it should, but because the form is one piece of a larger planning system.

Side-by-Side Comparison

Who the Free Form Is Enough For

• Healthcare professionals who already understand clinical terminology and the MCA's specificity requirements
• People with a solicitor handling the broader estate planning and LPA, who only need the ADRT form itself
• Anyone who has already been through the planning process once (e.g., updating a previous ADRT) and knows what to write

Who Needs More Than the Form

• Adults drafting their first ADRT who aren't sure which treatments to refuse or how to phrase refusals in clinically enforceable terms
• Families coordinating an ADRT alongside an LPA, who need to get the execution sequence right
• Rural Welsh families where emergency access — Green Bottle, WCP registration — is a genuine safety concern
• Anyone who wants the clinical, legal, and administrative dimensions covered in one planning process rather than pieced together from six different agencies

The Honest Assessment

The free NHS ADRT form is a good form. It's not the problem. The problem is that a form without guidance produces documents that are technically valid but clinically vague — and clinically vague ADRTs get overridden in emergencies. The Mental Capacity Act says clinicians must follow a valid and applicable ADRT, but "valid" includes being specific enough to actually apply to the clinical situation at hand. That specificity is what separates an ADRT that controls your treatment from one that gets set aside.

The Advance Decision to Refuse Treatment (ADRT) Complete Wales Planning Guide provides the clinical drafting templates, LPA coordination checklist, Green Bottle setup instructions, WCP registration walkthrough, and family conversation scripts that the form doesn't include — along with 10 printable planning worksheets for the full end-of-life planning sequence.

Frequently Asked Questions

Can I use the free NHS form with additional guidance from elsewhere?

Yes. The All Wales ADRT form accepts additional pages. You can complete the form itself and attach typed sheets with more detailed treatment refusals, provided the additional pages are securely attached to the main form and the form's additional-pages box is ticked. Many people use the form as the structural wrapper and supply the clinical specificity from a separate source.

Is the free form recognised by all Welsh hospitals and ambulance services?

Yes. The standardised All Wales form helps Welsh clinicians and paramedics recognise an ADRT across Welsh health boards. That said, recognition of the form and enforceability of its contents are separate matters — its refusals are only enforceable if they're specific enough to apply to the clinical situation.

If I buy a planning guide, do I still use the NHS form?

That depends on the guide's approach. Some guides provide their own ADRT template; others walk you through completing the official All Wales form with proper clinical wording. Either approach produces a legally valid document. Using the official form has the practical advantage that Welsh clinicians instantly recognise its format.

What if I've already completed the free form — should I redo it?

Review what you wrote in the custom refusal section. If your refusals name specific treatments and specific medical conditions, the form may be adequate. If you used phrases like "no heroic measures" or "no life support if quality of life is poor," those refusals are likely unenforceable and worth redrafting with clinical specificity.

Does the form cover organ donation under the deemed consent law?

No. The All Wales ADRT form covers treatment refusals, not organ donation. Wales operates under a soft opt-out organ donation system (the Human Transplantation (Wales) Act 2013), meaning consent to donation is deemed unless you have opted out. This is a separate legal framework from the Mental Capacity Act. A comprehensive planning guide typically covers how your ADRT, organ donation preferences, and deemed consent interact.

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