An advance statement is a form that lets you record the care you want in the future. It can cover any aspect of your care including:
It is not the same as a living will (advance decision) which is only used to refuse specific medical treatments.
An advance statement will only be used to guide decisions if you lack mental capacity to make or communicate a decision for yourself.
Mental capacity is the ability to make a decision for yourself.
While you have mental capacity you have the right to make decisions about your medical treatment and care. You can choose to refuse or consent to treatment. Your advance statement can only be used if you do not have mental capacity to make or communicate a decision for yourself.
The law in England and Wales says that someone’s mental capacity should be assumed, unless there is reason to question it. For example, if they have had a brain injury or a diagnosis of dementia.
You must be able to do all four of these things to have mental capacity to make a decision:
Mental capacity is decision specific. This means that someone may have the mental capacity to make some decisions but not others. For example, someone with advanced dementia may have the mental capacity to decide what they want to eat that day, but not to make a decision about refusing CPR.
In Scotland and Northern Ireland the principle of mental capacity is similar, but they have their own definitions. The Office of the Public Guardian in Scotland has a helpful definition of incapacity on their website. The Department of Health NI define mental capacity in their Code of Practice (PDF, 2.8MB).
An advance statement is not legally binding. This means that the people caring for you do not have to follow the exact instructions in it, but they must use it as a guide when making decisions on your behalf.
Making an advance statement is a good way to start thinking about what is important to you and your quality of life. It can help you to make decisions about what care and treatment you do and do not want in the future.
Many people will lose mental capacity at some point towards the end of life. For example, some people with advanced dementia can live for several years needing care and support from others. In situations like this, an advance statement can be a very useful document for your relatives, nurses and doctors as it lets them know how you want to be cared for if you lack mental capacity.
If you want to talk to a friend or relative about planning for their future care, an advance statement can be a good place to start. You can use our advance statement template (PDF, 46KB) to guide your conversation about what is important to them now and in the future.
An advance statement can include any information that is important about your health or care. This is different from a living will which is only used to refuse specific medical treatments.
If you’ve made a living will then it’s a good idea to also make an advance statement as it can help the people caring for you to have a better understanding of your wishes for care. If you’re in a situation that is not included in your living will, an advance statement will help them to make decisions in your best interests.
A lasting power of attorney (LPA) for health and welfare is a legal document that lets you give someone you trust the power to make decisions for you. They can make any decisions about your treatment and care. For example, where you live, your daily routine and the people you see and spend time with.
If you have made an LPA then it’s a good idea to also make an advance statement to guide your attorney when making these decisions on your behalf.
In your advance statement you can include anything that is important to you and your quality of life, and how these things affect decisions about your care.
You can include:
You should not use your advance statement to refuse medical treatments because it is not legally binding. To refuse medical treatments in advance you should make a living will (advance decision).
If you do not want to be taken to hospital for treatment you can write this in your advance statement. You should also record the treatments you want to refuse in a living will.
You will need to have a conversation with your GP or care team to understand what will happen if you become unwell, and to put a plan in place so you can be cared for outside of hospital. This care plan will depend on your personal needs and the support available. They can also talk to you about options that may be available to you, including moving to a hospice or nursing home at some point in the future if you need more support.
If you have a clear care plan this will help to make sure you are not taken to hospital in an emergency if you do not want this and if it can be avoided. However, in some situations it may be necessary to take you to hospital.
If you are still worried about being taken to hospital you can talk to us:
Anyone over the age of 18 with mental capacity can make an advance statement. We have a helpful advance statement template which can guide you through what you might want to include.
To make one you need to:
You can make an advance statement using our template either online or by using our paper form.
Create an account to start your advance statement online. Using our online form you can:
Sign in to your account to access a form you’ve already started or finished.
Download our advance statement template (PDF, 46KB) and print it, then complete it by hand. If you do not have a printer you can call us on 0800 999 2434 and we’ll post the form to you.
We also have a paper advance statement form available in:
We also have a paper advance statement form available for people who have experiences of homelessness (PDF, 123KB)
If you would like to talk it through or need help with the wording you can contact us by:
Once you have completed your advance statement you will need to share it widely so that it is known about and can be followed. The NHS will not have your form on file unless you share it with them and we do not keep copies on your behalf.
You should share a copy with your:
You can make an appointment to discuss the form with your GP so that they understand your wishes. If you do not want to discuss it with your GP you should still make sure it is added to your medical record.
It is a good idea to keep a copy with your other important documents, for example your living will or LPA.
If you have an advance statement you should review it regularly, we recommend every two years or sooner if your health or wishes change. It is important to do this to make sure your advance statement reflects your current wishes for care.
To review your advance statement, read through each section to check that the information is still correct and it includes everything you want. If you need to make a lot of changes it is a good idea to complete a new form so that your wishes are clear and easy to understand.