Advance care planning is a process of thinking, talking, recording and sharing. It includes making decisions about personal issues and medical issues.  

It is a conversation between yourself and those who provide care for you such as: your loved ones, doctors, nurses, or care home manager. During this discussion, you have the opportunity to discuss your views and wishes about your future care. Advance Care Planning is a completely voluntary process and no one is under any pressure to take any of the steps.

Advance are planning can support you by providing the opportunity to plan your future care and support, including medical treatment. This involves the following:  

  • It is your plan to keep and share with those who are involved with your care  
  • Provides you the opportunity to think, talk and write down your concerns  
  • Provides you with the opportunity to let your friends, family and professionals know what is important to you for a time in the future when you may be unable to do so 
  • Allows anyone who has to make decisions on your behalf to take into account your wishes and preferences as written in your Advance Care Plan  
  • Enables you to discuss treatments that may or may not be suitable for you  
  • May help you if you choose to appoint a Lasting Power of Attorney.  
  • You can discuss your emotional and practical issues. 

An example of planning ahead is the ReSPECT process. This is where you discuss your wishes and preferences and document them in a Recommended Summary Plan for Emergency Care and Treatment. This is useful for guiding your doctors or any healthcare staff in any decisions being made about your treatment and emergency care.

Steps of advanced care planning

  1. Open the conversation.
  2. Explore your options.
  3. Identity your wishes and preferences.
  4. Refusing specific treatment, if you wish to.
  5. Ask someone to speak for you.
  6. Appoint someone to make decisions for you using a Lasting Power of Attorney (A Lasting Power of Attorney is someone who is legally appointed to make decisions on behalf of someone else, if they lose mental capacity. A Power of Attorney is usually someone close to you such as a family member or close friend).

There are different types of documents which can be used to support you to record your wishes and preferences.  Some of the options are explained below. 

Advanced care statement or advance care plan 

This is a record of your wishes and preferences about your care. It may include information on your preferred place of care and preferred place of death. It might also include personal care needs such as dietary preferences and religious and spiritual practices. 

Advance decision to refuse treatment (Advance Directive) 

This is a record of any treatments that you do not want to receive in a specific situation. For example, you may decide that you don’t want to be admitted to hospital if you get a chest infection. It’s called an ‘Advance decision to refuse treatment (ADRT)’, ‘Advance decision’ or ‘Living will’ in England. 

If someone doesn’t wish to receive cardiopulmonary resuscitation (CPR) if they have a cardiorespiratory arrest, this can be recorded in a Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR)  form.  

In Birmingham and Solihull clinical teams use the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT)  forms if a person does not wish to be resuscitated. Where possible discussions surrounding resuscitation should include the patient, their next of kin and the wider clinical team.

A Lasting Power of Attorney is someone who is legally appointed to make decisions on behalf of someone else, if they lose mental capacity. A Power of Attorney is usually someone close to the person such as a family member or close friend. 

There are different types of Lasting Power of Attorney: 

  • For financial and property decisions, this is known as Lasting Power of Attorney for financial affairs in England and Wales, continuing Power of Attorney in Scotland and Enduring Power of Attorney in Northern Ireland. 
  • For health and welfare decisions, this is known as Lasting Power of Attorney for health and care decisions in England and Wales and welfare Power of Attorney in Scotland. It’s not currently available in Northern Ireland.

Many different people might benefit from Advanced Care Planning conversations.   

Any individual who wishes to plan for their future care, or who may be at increased risk of losing their mental capacity in the future, should consider if they would like to explore an advanced care planning discussion with health professionals. This may include:  

  • people facing deteriorating health due to a long term condition or progressive life limiting illness, e.g. dementia, frailty, kidney, heart or liver failure, lung disease, progressive neurological conditions, incurable cancer.
  • people facing key transitions in their health and care needs, e.g. multiple hospital admissions, shifts in focus of treatment to supporting the patients with their symptoms as opposed to curing the illness, moving into a care home.
  • people facing major surgery or high risk treatments, e.g. bone marrow transplant.
  • people facing acute life threatening conditions which may not be fully reversible.

Please remember: Advance Care Planning is a completely voluntary process and no one is under any pressure to take any of the steps.

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