FOI/2025/26/161

Request

We support people to make informed decisions, start honest conversations about death and dying with loved ones, and record and revisit their wishes whenever they want to. We also support healthcare professionals to discuss, record and implement advance care plans with a particular focus on Advance Decisions to Refuse Treatment, Advance Statements and Lasting Powers of Attorney for Health and Welfare.

We receive over 4,000 contacts to our free nurse-led information line each year and are committed not just to supporting individuals to consider and record their treatment wishes, but to ensuring those wishes are known and respected when it matters most. The people we support consistently experience two particular challenges in hospital settings:

1) Advance Decisions to Refuse Treatment not being followed

2) Health and Welfare Attorneys being excluded from the decision-making process when someone lacks capacity

These experiences, which we hear through our nurse-led information service, are also reflected in a recent Court of Protection case (AB, Re (ADRT: Validity and Applicability) [2025] EWCOP 20 (T3) (10 June 2025) which examined how Advance Decisions to Refuse Treatment should be acted upon by NHS Trusts.

Response

1.           Do you have a policy (or policies) which outlines the responsibilities of health and care professionals and the Trust towards a patient who has an Advance Decision to Refuse Treatment (ADRT) or Lasting Power of Attorney (LPA) for Health and Welfare?

Central London Community Healthcare NHS Trust (CLCH) has in place policies and a procedures that set out the responsibilities of our staff to ensure our patients’ wishes and feelings are known, respected and legal when planning their care and treatment, including refusing care and treatment, at a time when they have mental capacity and if in the future they are unable to give consent themselves or they have appointed an LPA for health and welfare.

 

2            The relevant CLCH Policies and Guidance are:

• Consent to Examination, Treatment or Therapy Policy
• Mental Capacity Act Policy
• Advance Care Planning Standard Operating Procedure (SOP)

 

Copies of these documents are included as appendices to this FOI request.

 

2.           In the event that a patient or family member, or someone using the Trust’s services has a concern about the implementation of an Advance Decision to Refuse Treatment (ADRT) or a Lasting Power of Attorney (LPA) for Health and Welfare, does the Trust have a documented process or course of action that would be provided to the person to allow them to resolve their concerns?

Copies of the CLCH policies and the SOP are included as appendices to this FOI request.

 

3.           Do you have a named individual who is responsible for overseeing the Trust’s compliance with the Mental Capacity Act 2005?

Trish Stewart, Associate Director of Safeguarding is responsible for the Trust’s compliance with the Mental Capacity Act 2005.