A Health and Welfare Lasting Power of Attorney (LPA) is a legal document that allows you — the donor — to appoint one or more trusted people as your attorneys to make decisions about your personal care and medical treatment if you ever lose mental capacity. It is one of two types of LPA available in England and Wales, and it is the only document that gives someone the legal authority to make healthcare decisions on your behalf.
When Can a Health and Welfare LPA Be Used?
Unlike a Property and Financial Affairs LPA, a Health and Welfare LPA can only be used when you have lost mental capacity. It cannot be activated while you still have the ability to make your own decisions. Mental capacity under the Mental Capacity Act 2005 is decision-specific and time-specific — a person may have capacity for some decisions but not others, and capacity can fluctuate over time. The Act presumes that every adult has capacity unless it is clearly established otherwise.
What Decisions Can Your Attorneys Make?
Once activated, your attorneys can make decisions about your daily routine and personal care — what you eat, what you wear, and how your day-to-day health is managed. They can decide where you live, including whether you move into a care home. They can consent to or refuse medical treatments on your behalf, and they can liaise with your GP, hospital consultants, and social services.
Life-sustaining treatment is a separate decision. Your LPA must include a specific clause — either granting your attorneys authority to consent to or refuse life-sustaining treatment (Option A), or withholding that authority and leaving it to the medical team (Option B). This is one of the most important choices you will make when drafting your LPA.
What Your Attorneys Cannot Do
Your attorneys must always act in your best interests under the Mental Capacity Act 2005. They cannot use the LPA while you still have capacity. They cannot override a more recently signed advance directive (living will) on the specific treatments it covers — if both documents exist, the most recently signed takes precedence for those treatments. They must consider your past wishes, values, and beliefs when making decisions, and they must consult family members and carers where practicable.
Choosing Your Attorneys
You can appoint one attorney or several. If you appoint more than one, you must decide how they act: jointly (all must agree unanimously on every decision), jointly and severally (each can act independently — the most practical arrangement), or a hybrid of both. Choose people you trust completely — your attorneys will have significant power over your care and medical treatment at a time when you are most vulnerable.
The Certificate Provider
Before your LPA can be registered, an independent certificate provider must sign the document confirming that you understand what you are signing and that you are not being coerced. The certificate provider must be either a professional (such as a GP or solicitor) or someone who has known you personally for at least two years. Family members and your attorneys cannot act as certificate provider.
Registering Your LPA
A Health and Welfare LPA has no legal validity until it is registered with the Office of the Public Guardian (OPG). Registration currently takes up to 20 weeks. The registration fee is £82 per LPA in England and Wales. A 50% reduction is available for low-income donors, and a full exemption applies for those receiving certain means-tested benefits. We strongly recommend registering your LPA as soon as it is signed — do not wait until capacity is at risk.
What Happens Without a Health and Welfare LPA?
Without a Health and Welfare LPA, your family has no automatic legal right to make medical or care decisions on your behalf — not even your spouse or next of kin. Doctors will consult family members as a matter of good practice, but they are not legally bound to follow their wishes. If there is a dispute about your care, or if complex ongoing decisions need to be made, your family may need to apply to the Court of Protection for a Personal Welfare Deputyship — a process that is costly, slow, and rarely granted except in the most complex cases.
Once your LPA is registered, inform your GP and any other healthcare providers. Keep certified copies accessible — your attorneys will need to present the registered document to medical professionals and care providers before they can exercise their authority.