Health and welfare lasting power of attorney explained

By · Published 2026-09-19 · Last reviewed 2026-09-19

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A health and welfare lasting power of attorney is a legal document in England and Wales that lets people you choose make decisions about your care, medical treatment and where you live. Attorneys can only use it once it is registered and only for decisions you no longer have the mental capacity to make yourself. Scotland uses a welfare power of attorney instead, and Northern Ireland has no direct equivalent.

A health and welfare lasting power of attorney (LPA) lets someone you trust make decisions about your care, medical treatment and where you live, but only if you lose the mental capacity to make those decisions yourself. It applies in England and Wales, it must be registered with the Office of the Public Guardian before anyone can use it, and it has to be made while you still have capacity. Scotland and Northern Ireland have different systems, covered below.

Many families assume that being next of kin gives them the final say over a parent's care. It does not. Without this document, professionals must consult the family but the decision rests with them. This article explains what the health and welfare LPA actually does, where its limits are, and how it works in practice with hospitals and care homes.

What does a health and welfare LPA cover?

GOV.UK describes two types of LPA: one for property and financial affairs, and one for health and welfare. They are separate documents, registered separately, and an attorney under one cannot make decisions that belong to the other.

According to the GOV.UK guide to lasting power of attorney, a health and welfare LPA can give your attorneys the power to decide about:

Age UK adds that it can also cover the care and support you receive, who you have contact with and the social activities you take part in.

For a family arranging care, the practical effect is large. An attorney can speak to the GP, take part in hospital discharge planning as the decision-maker rather than as a consultee, agree a care plan, and decide whether a move into a care home, or to a different one, is right.

When can the attorneys start making decisions?

This is the biggest difference from the financial LPA. A property and financial affairs LPA can be used as soon as it is registered, with your permission. A health and welfare LPA can only be used when you are unable to make the decision yourself.

Mental capacity is judged decision by decision, not once and for all. Under the Mental Capacity Act 2005, which applies in England and Wales, a person is assumed to have capacity unless it is shown otherwise, and must be given all practical help to decide for themselves first. Someone living with dementia may be perfectly able to choose what to eat and who visits, while being unable to weigh up a complex decision about surgery or a move into residential care. The attorney steps in only for the decisions the person cannot make at that time.

What attorneys must do

Attorneys must always act in the person's best interests, and should take into account their past wishes, beliefs and values. GOV.UK's guidance for health and welfare attorneys says that when you start making decisions you must tell the people involved in the person's care. That includes family and friends, the doctor and other healthcare staff, care workers and social care staff. You may be asked to show the LPA and to sign medical consent forms.

What about life-sustaining treatment?

The LPA form makes you choose one of two options, and the choice must be signed and witnessed:

Neither option is the right one for everybody. Some people want a trusted son, daughter or partner to have the final word. Others feel it is too heavy a burden to place on a relative and prefer to leave it with clinicians. The Alzheimer's Society describes it as a very significant responsibility. Talk about it openly with the people you plan to appoint before you fill in the form.

How it fits with an advance decision

An advance decision to refuse treatment, sometimes called a living will, is a separate document in which you refuse specific treatments in specific circumstances. The two can clash. The Office of the Public Guardian's guidance says that if you give your attorneys power over life-sustaining treatment and have also made an advance decision, the LPA might override the advance decision. Equally, GOV.UK warns attorneys that they cannot always make decisions about treatment where a living will exists, and that a conflict may need a one-off decision from the Court of Protection.

If you have, or want, both documents, make sure they say the same thing, and take legal advice if there is any doubt about which should take priority.

What can a health and welfare attorney not do?

The power is wide, but it has clear limits. An attorney cannot:

The point about money catches families out. A health and welfare attorney can choose a care home, but cannot sign away the person's money to pay for it. GOV.UK says the attorney must ask the person in charge of the donor's funds. This is why most advisers suggest making both types of LPA at the same time.

How do you set one up?

You must be 18 or over and have mental capacity when you make the LPA. You can use the online service on GOV.UK or paper forms, and you do not have to use a solicitor, although many people do where family circumstances are complicated.

  1. Choose your attorneys. They must be 18 or over and have mental capacity themselves. They can be relatives, friends or professionals.
  2. Decide how they will act. Jointly means every attorney must agree to every decision. Jointly and severally means they can act together or alone. You can also mix the two, for example requiring a joint decision about where you live.
  3. Name replacement attorneys in case someone can no longer act.
  4. Add preferences and instructions if you want them. Instructions are binding on your attorneys. Preferences are wishes they should bear in mind. Badly worded instructions are a common reason for problems, so keep them few and clear.
  5. Choose a certificate provider. This person confirms that you understand the LPA and are not being pressured. It can be someone who has known you well for at least two years, or a professional such as a doctor, solicitor or social worker. It cannot be an attorney or a member of your family.
  6. Sign in the right way. You, the attorneys, the witnesses and the certificate provider all sign the same original document. Attorneys can witness each other's signatures but cannot witness yours.
  7. Register it. The LPA has no legal force until the Office of the Public Guardian has registered it.

You can also list up to five people to be told when the LPA is sent for registration. They have three weeks to raise concerns, which is a useful safeguard.

Cost and waiting time

When checked in September 2026, the GOV.UK registration page gave the fee as £92 for each LPA, so £184 if you make both types, with a reduced fee for people on a low income and an exemption for people on certain benefits. It says registration takes 8 to 10 weeks if there are no mistakes in the application. Fees and waiting times change, so check that page for the current position, and do not leave registration until a crisis.

What if you live in Scotland or Northern Ireland?

An LPA is legally binding only in England and Wales.

If a relative has moved between nations, or may do so, take advice from a solicitor in the nation where they now live.

What happens if there is no health and welfare LPA?

Age UK explains that without one, decisions about your health or care will be made by the professionals relevant to your situation, such as your doctor or the local council's social services department. They must act in your best interests and should consult your family, but the family does not have the final say.

In England and Wales a relative can apply to the Court of Protection to become a personal welfare deputy, but GOV.UK says the court will usually only appoint one where there is doubt that decisions will be made in the person's best interests, for example because the family disagree about care, or where someone needs to make decisions about a specific issue over time. In practice this makes the LPA the only dependable way to put a chosen person in charge of care decisions.

This article is general information, not legal advice. If the family situation is complicated, if there is disagreement, or if there is any doubt about whether your relative still has the capacity to make an LPA, speak to a solicitor who specialises in this area, and ask the GP about a capacity assessment.

Frequently asked questions

Can I make decisions for my mum as her next of kin?

Not legally. Next of kin has no formal decision-making status for an adult who lacks capacity in England and Wales. Doctors and social workers must consult you, but unless you are an attorney under a registered health and welfare LPA, or a court-appointed deputy, the final decision is theirs.

Can a health and welfare LPA be used while the person still has capacity?

No. Unlike the financial LPA, it can only be used for decisions the person cannot make themselves. If your relative can still make a particular decision, even an unwise one, it remains theirs to make.

Can an attorney decide that someone moves into a care home?

Yes, if the person lacks the capacity to make that decision and the move is in their best interests. The attorney should involve the person as far as possible and consider their past wishes. Paying the fees is a financial matter, so it needs a property and financial affairs LPA or another legal authority.

Is it too late to make an LPA after a dementia diagnosis?

Not necessarily. A diagnosis does not by itself mean a person lacks capacity. What matters is whether they understand what the LPA is and what it does at the time they sign. The certificate provider must be satisfied of this, so act early and ask a professional if there is any doubt.

Can a health and welfare LPA be cancelled?

Yes. While you have mental capacity you can end it by sending the Office of the Public Guardian the original LPA and a written statement called a deed of revocation. It also ends automatically in some circumstances, for example when the donor dies, or if your only attorney dies or loses capacity and there is no replacement.

Key takeaways