Health and Welfare LPA

What is a Health and Welfare LPA?

A Health and Welfare LPA is made using form LP1H. It lets you (the donor) appoint one or more attorneys to make decisions about your medical treatment, personal care and daily life, registered with the Office of the Public Guardian (OPG) before it can be relied on. It covers England and Wales.

It's separate from a Property and Financial Affairs LPA, which deals with money and property instead — the two forms work independently, and many people set up both at once. See the difference between the two LPAs if you're deciding which to make, or start with how the LPA process works.

What decisions can a health and welfare attorney make?

Once registered and in use, your attorneys can make decisions in areas such as:

• Medical treatment — agreeing to or refusing treatment offered by doctors, on your behalf
• Day-to-day care — decisions about diet, dress, routine and who provides your care
• Where you live, including moving into a care home if that becomes necessary
• Who you have contact with, and access to your medical and care records
• Life-sustaining treatment, but only if you've given them that specific authority (see below)

Read more in our guide to health and welfare attorney powers and care home decisions as attorney.

Life-sustaining treatment: Option A or Option B

One section of the LP1H asks you to choose how life-sustaining treatment decisions are handled. This choice deserves careful thought, and there's no right answer for everyone:

When can this LPA be used?

A Health and Welfare LPA works differently from a Financial LPA in one important respect: it can only be used once you lack mental capacity to make the specific decision in question. There is no option to let attorneys act earlier, even if you'd like them to.

Capacity is assessed decision by decision, not as a general label. You might, for example, be able to decide what to eat for dinner but lack capacity to decide about a complex medical procedure — in which case your attorney could only step in for the latter. This follows the principles set out in the Mental Capacity Act 2005, which starts from a presumption that you have capacity unless it's shown otherwise. See mental capacity explained for how this works in practice.

Instructions and preferences

As with the financial form, LP1H lets you add preferences (non-binding guidance) and instructions (legally binding limits). Examples for health and welfare decisions might include:

• A preference that attorneys try to keep you in your own home for as long as reasonably possible
• A preference about who you'd like consulted before major care decisions are made
• An instruction that attorneys must not agree to a specific treatment you object to on religious or personal grounds

Wording needs to be clear and cannot conflict with your Option A/B choice or with the attorneys' legal duties. See preferences and instructions for worked examples.

How this interacts with an advance decision

An advance decision to refuse treatment (sometimes called a 'living will') is a separate legal document specifying treatments you refuse in advance. If you make one after registering an LP1H that gives attorneys Option A authority, the advance decision generally takes precedence for the treatments it covers, provided it's valid and applicable. If you make the advance decision before the LPA, a later Option A LPA can override it. Getting the order and wording right matters — see advance decision vs LPA for a full comparison.

Choosing your attorneys for health decisions

Health and welfare decisions are often personal and time-sensitive, so many donors choose attorneys who know their wishes well — often a spouse, partner or adult child — rather than a professional. As with the financial form, you decide whether multiple attorneys must act jointly or jointly and severally, and you can name replacement attorneys in case an original attorney is unable to continue.

It's worth naming attorneys you trust to make quick decisions under pressure, since medical situations can move fast. See how many attorneys should I appoint and jointly or jointly and severally.

Registration, timescales and cost

The LP1H must be signed in the correct order and registered with the OPG before it can be used — registration typically takes around 8 weeks, including a statutory 4-week waiting period for objections.

Our fee covers guided completion and a check for common errors; the OPG's £92 registration fee is paid separately, per LPA. See LPA cost for the full picture, including fee reductions for low income.

Common mistakes to avoid

• Leaving the life-sustaining treatment section blank rather than making a deliberate choice
• Writing instructions that conflict with the Option A/B choice
• Appointing attorneys who live far away or may struggle to respond quickly in a medical crisis
• Assuming this LPA can be used before capacity is lost — it cannot, however it's worded
• Getting the certificate provider or signing order wrong, which can cause the OPG to query the form