A Lasting Power of Attorney for Health and Welfare (LPA) is a legal instrument created under the Mental Capacity Act 2005 that allows an individual (the Donor) to appoint one or more trusted persons (attorneys) to make decisions about their personal welfare, medical treatment, and daily care in the event that they lose the mental capacity to make those decisions themselves. It is one of two types of LPA recognised in England and Wales — the other being a Lasting Power of Attorney for Property and Financial Affairs.

The Health and Welfare LPA is fundamentally different from an ordinary Power of Attorney created under the Powers of Attorney Act 1971. An ordinary power of attorney automatically becomes invalid if the donor loses mental capacity, whereas an LPA is specifically designed to come into effect in precisely those circumstances. A Health and Welfare LPA can only be used when the donor lacks capacity to make the decision in question, as provided by section 11(7)(a) of the Mental Capacity Act 2005.

The scope of a Health and Welfare LPA covers a broad range of personal welfare decisions, including: where the donor should live and who they should live with; their day-to-day care, including dietary needs, clothing, and daily routine; giving or refusing consent to medical examinations, treatment, or procedures; the provision, continuation, or withdrawal of community care services; and participation in social activities, education, and leisure. One of the most significant powers that may be included is the authority to give or refuse consent to life-sustaining treatment under section 11(8) of the Act, though this must be expressly stated in the instrument.

To be legally valid, a Health and Welfare LPA must comply with the formal requirements set out in Schedule 1 to the Mental Capacity Act 2005. The donor must be aged 18 or over and must have mental capacity at the time the instrument is executed. The attorneys must also be aged 18 or over. A certificate provider must sign the instrument confirming that, in their opinion, the donor understands the purpose of the LPA and is not being subjected to undue pressure. The instrument must then be registered with the Office of the Public Guardian (OPG) before it has any legal effect. Registration currently costs £92 and typically takes 8 to 12 weeks.

A Lasting Power of Attorney for Health and Welfare is needed whenever you wish to ensure that someone you trust will be able to make important personal welfare and medical decisions on your behalf if you become unable to do so yourself. Without an LPA, your family members have no automatic legal right to make decisions about your care or treatment — those decisions would instead fall to the healthcare professionals treating you, guided by the best interests framework in section 4 of the Mental Capacity Act 2005, or ultimately to the Court of Protection.

Common situations in which a Health and Welfare LPA is particularly important include: progressive neurological conditions such as dementia, Alzheimer’s disease, or Parkinson’s disease, where the donor may gradually lose the ability to make decisions; following a serious accident or stroke that results in permanent loss of capacity; major planned surgery where there is a risk of post-operative cognitive impairment; and as a precautionary measure for any adult who wishes to plan ahead, regardless of their current state of health.

It is essential to create a Health and Welfare LPA while you still have the mental capacity to do so. If you have already lost capacity, it is too late — the only option in that case is for a family member or other concerned person to apply to the Court of Protection for a deputyship order under section 16 of the Mental Capacity Act 2005, which is more expensive, time-consuming, and subject to ongoing court supervision. Creating an LPA in advance avoids this and gives you the peace of mind that your wishes will be respected.

A well-drafted Lasting Power of Attorney for Health and Welfare should contain several essential elements, each of which plays a specific role in ensuring the document is valid, comprehensive, and reflective of the donor’s wishes.

The Donor’s details must include their full legal name, date of birth, and current residential address. The donor must be aged 18 or over and have mental capacity at the time of execution, as required by section 9(2)(c) of the Mental Capacity Act 2005.

The appointment of attorneys is the core of the LPA. The donor may appoint one or more attorneys, and if appointing more than one, must specify how they are to act: jointly (all attorneys must agree on every decision), jointly and severally (attorneys can act together or independently), or jointly for some decisions and jointly and severally for others. Each option has implications — if attorneys are appointed to act jointly and one can no longer serve, none of the remaining attorneys can act unless replacement attorneys have been appointed.

The life-sustaining treatment clause is one of the most critical sections. Under section 11(8) of the Mental Capacity Act 2005, attorneys have no authority to consent to or refuse life-sustaining treatment unless the LPA expressly grants this power. The donor must choose between Option A (granting this authority) and Option B (withholding it, leaving such decisions to the medical team).

Replacement attorneys are strongly recommended. These individuals step in if an original attorney dies, loses capacity, disclaims their appointment, or (in limited circumstances) their appointment is otherwise terminated. Without replacement attorneys, the LPA may become ineffective if all original attorneys can no longer act.

Preferences are non-binding wishes that guide the attorneys, such as dietary requirements, religious practices, or preferred living arrangements. Instructions are binding directives that attorneys must follow, such as prohibitions on certain types of care. Care should be taken not to include instructions so restrictive that they prevent attorneys from acting in the donor’s best interests.

The certificate provider’s declaration is a mandatory safeguard under Schedule 1 to the Act. The certificate provider must be either someone who has known the donor for at least two years or a professional with relevant expertise, and they must certify that the donor has capacity and is not being coerced.

Finally, persons to be notified may be named in the LPA. These individuals are informed when an application is made to register the LPA and have three weeks to raise objections with the Office of the Public Guardian, providing an additional layer of protection against potential abuse.