A lasting power of attorney (LPA) for health and welfare lets you choose someone you trust to make decisions about your care and medical treatment if you're ever unable to make them yourself. It's one of two types of lasting power of attorney available in England and Wales and it covers a different set of decisions to its counterpart, the property and financial affairs LPA.

Many people put off thinking about this until a health crisis forces the issue, by which point it can be too late to act. Setting up a health and welfare LPA while you have mental capacity means your wishes are known and respected. It spares your family from having to guess what you would have wanted or apply to the Court of Protection for the authority to act on your behalf.

This guide explains what a health and welfare LPA covers, when it can be used, how it differs from a property and financial affairs LPA and the steps involved in setting one up.

Key facts about health and welfare LPAs

• A health and welfare LPA only takes effect once you lose mental capacity to make your own decisions.
• It covers decisions about medical treatment, care homes, and daily routine, but it doesn't cover money or financial affairs.
• It's a legal document that must be registered with the Office of the Public Guardian before your attorney can use it.
• Your attorney must act in your best interests at all times and cannot override a valid advance decision you've made about refusing treatment.
• You can appoint more than one attorney and decide whether they need to act jointly or can each make decisions independently.

What is a lasting power of attorney for health and welfare?

A lasting power of attorney (LPA) is a legal document that lets you (the donor) appoint one or more people (your attorneys) to make certain decisions on your behalf. LPAs were introduced under the Mental Capacity Act 2005 and replaced the previous system of enduring power of attorney, which only covered financial affairs.

There are two types of LPA: one for property and financial affairs, and one for health and welfare. You can set up one or both, depending on your circumstances. A health and welfare LPA allows your chosen attorney to make decisions about your day-to-day care, medical treatment, and where you live, when you're no longer able to make those decisions yourself.

What does a health and welfare lasting power of attorney cover?

A health and welfare LPA gives your attorney the legal authority to make a wide range of decisions relating to your care and medical treatment. The exact scope depends on the choices you make when setting up the LPA, but it typically includes the following.

Medical treatment and life-sustaining treatment

Your health and welfare attorney can make decisions about the medical treatment you receive, including day-to-day care and more serious interventions. You can also give your attorney the authority to make decisions about life-sustaining treatment on your behalf. This is optional, and you need to state clearly on the LPA form whether you want to grant this authority. If you choose to give your attorneys the authority to make this decision then they can speak with your medical team on your behalf as if they were you. Without it, decisions about life-sustaining treatment will usually be made by your medical team, taking your best interests into account.

Even where your attorney has this authority, they cannot override a valid advance decision you've made. An advance decision, sometimes called a living will, is a separate legal document setting out treatments you want to refuse in the future, such as a particular form of life-sustaining treatment. For example, if you've made a valid advance decision refusing a specific treatment, your health and welfare attorney must follow it, even if they would otherwise have chosen differently on your behalf.

Care homes and daily routine

A health and welfare attorney can decide where you live, including whether you should move into a care home. They can also make decisions about your daily routine, such as your diet, dress, and personal care. These decisions often involve working alongside social services or a social worker, particularly where a move into residential care is being considered.

What a health and welfare LPA does not cover

A health and welfare LPA does not cover your money or property. If you want your attorney to deal with your financial affairs such as managing your bank accounts or paying your bills, then you'll need a separate property and financial affairs LPA. The two types of LPA work independently of each other, and you can choose different attorneys for each.

When can a health and welfare LPA be used?

A health and welfare LPA only takes effect if you ever lose the mental capacity to make your own decisions. This is one of the key differences between a health and welfare LPA and a property and financial affairs LPA, which can be used with your permission even while you still have capacity, as well as after you lose it.

Mental capacity and the Mental Capacity Act 2005

Mental capacity means being able to understand, weigh up, and communicate a decision. The Mental Capacity Act 2005 sets out the legal framework for assessing capacity and its principles start from the position that a person has capacity unless it's shown otherwise. Someone can lack mental capacity for some decisions and not others and their ability to make decisions can also change over time, for example following an illness or a period of recovery. While you have mental capacity, you keep the right to make your own decisions, and your attorney cannot step in.

What happens without a health and welfare LPA

If you lose mental capacity without a health and welfare LPA in place, decisions about your care and treatment will usually be made by healthcare professionals, applying the best interests principle set out in the Mental Capacity Act. They should consult family members and anyone else with an interest in your welfare, but the final decision rests with them, not your family. In some cases, your family may need to apply to the Court of Protection for the authority to make decisions on your behalf, which can take time and add cost during an already difficult period. Organisations such as the Alzheimer's Society see this situation often among families affected by dementia, where mental capacity can decline gradually and a health and welfare LPA therefore needs to be set up well in advance.

How does a health and welfare LPA differ from a property and financial affairs LPA?

The two types of lasting power of attorney serve different purposes. A property and financial affairs LPA covers decisions about your money, such as paying bills, managing bank accounts, collecting benefits or a pension, and buying or selling property. A health and welfare LPA covers decisions about your medical care, daily routine, and living arrangements.

A property and financial affairs LPA can be used as soon as it's registered, if you choose to allow this, even while you still have mental capacity. A health and welfare LPA can only be used if you've lost mental capacity. Most people choose to set up both, appointing the same or different attorneys for each, so that both their financial affairs and their care and welfare are covered if they're ever unable to make their own decisions. We often recommend that clients think about the two together, and this guide pairs with our separate article on the property and financial affairs LPA for anyone weighing up which LPA they need.

What are the three types of power of attorney?

There are three types of power of attorney you might come across: ordinary power of attorney, lasting power of attorney, and enduring power of attorney.

An ordinary power of attorney gives someone the legal authority to make decisions about your money and property while you still have mental capacity, for example if you need help managing your finances for a short period, such as while you're abroad or in hospital. It stops being valid if you lose mental capacity, which is its main limitation.

A lasting power of attorney, as this guide has covered, remains valid if you lose mental capacity, and comes in two forms: property and financial affairs, and health and welfare. This is the type most people mean when they talk about setting up a power of attorney to plan for the future.

An enduring power of attorney (EPA) is the predecessor to the property and financial affairs LPA. EPAs were replaced by LPAs when the Mental Capacity Act 2005 came into force in October 2007 and it's no longer possible to make a new one. Any EPA signed and witnessed before that date remains legally binding and can still be used for financial affairs, but EPAs never covered health and welfare decisions, which is why a separate health and welfare LPA is worth setting up even if you already hold an older EPA.

How do I set up a health and welfare lasting power of attorney?

Setting up a lasting power of attorney health and welfare document involves a few clear steps. To create one, you need to be at least 18 years old and have the mental capacity to understand what you're agreeing to.

Choosing your attorneys

You can appoint one or more attorneys to act on your behalf, and you decide how they should make decisions. Attorneys can be appointed to act jointly, meaning they must all agree on every decision, or jointly and severally, meaning each attorney can act independently. You can also appoint a replacement attorney to step in if your original choice is unable to act. Many people choose family members, but you can appoint anyone you trust, as long as they're 18 or over.

Completing the LPA form

You'll need to complete the health and welfare LPA form, known as LP1H, setting out who your attorneys are, whether you want to give them authority over life-sustaining treatment and any instructions or preferences you want them to follow. The form must be signed in the presence of a witness and a certificate provider will need to confirm that you understand what you're signing and haven't been put under pressure to do so.

Registering with the Office of the Public Guardian

Once your completed forms are signed and witnessed, the LPA must be registered with the Office of the Public Guardian before it can be used. Registration usually takes several weeks, so it's worth doing this well ahead of time rather than waiting until it's needed.

How much does a health and welfare LPA cost?

The Office of the Public Guardian charges a registration fee of £92 for each LPA, so registering both a health and welfare LPA and a property and financial affairs LPA costs £184 in total. This is a government fee rather than a solicitor's fee and it applies whether you complete the forms yourself or with professional help. If you have a low income, for example if your gross annual income is under £12,000, or you receive certain benefits, you may be entitled to a reduced fee or a full exemption from the LPA registration costs. There's no separate charge for appointing more than one attorney on the same LPA. Solicitor fees for preparing and registering an LPA are on top of the government fee and we're happy to talk through the costs involved before you go ahead.

Can I revoke a health and welfare LPA?

You can revoke a health and welfare LPA at any time, but only while you still have the mental capacity to do so. To revoke an LPA, you need to notify the Office of the Public Guardian and inform your attorneys of the decision. Revoking an LPA can have significant implications, particularly if you don't have another one in place, so it's worth taking advice before making changes.

Why is a health and welfare LPA worth having?

A health and welfare LPA gives you peace of mind that decisions about your care and treatment will be made by someone who knows you, rather than left entirely to healthcare professionals applying general best interests principles. It reduces the burden on your family at a time when they're likely to be worried about you, since they won't need to guess what you would have wanted or go through the Court of Protection to get the authority to act.

Setting one up while you have mental capacity also means you can record your wishes and preferences clearly, giving your attorney guidance to follow rather than leaving them to make difficult decisions without any context. Many people choose to set up a health and welfare LPA alongside a will, so their future care and their estate are both properly planned for.

It's a common misconception that a health and welfare LPA is only for older people, or only worth having once you've received a diagnosis that affects your mental ability. In practice, capacity can be lost suddenly, for example after an accident or a stroke, as well as gradually. Putting an LPA in place while you're healthy means you're prepared either way, and it removes the pressure of trying to complete the forms during a period when a person's mental capacity may already be in question.

How Switalskis can help

Our wills and probate team has years of experience helping people put lasting powers of attorney in place, whether you need a health and welfare LPA, a property and financial affairs LPA, or both. We'll explain your options clearly, help you decide who to appoint as your attorney and make sure your forms are completed correctly and registered without unnecessary delay.

We understand that thinking about a future loss of capacity isn't always easy, so we take the time to talk things through at a pace that suits you and provide guidance that reflects your family's own circumstances. As a law firm, we also support clients with related matters, including wills and care fee planning , so we can help you plan for the future as a whole rather than looking at each document in isolation.

Get in touch

If you'd like to talk to us about setting up a lasting power of attorney health and welfare document, call us on 0800 1380 458 or get in touch through the form on our website . We're here to help you put the right protections in place, for you and your family.