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Free LPA Health & Welfare Template

A lasting power of attorney for health and welfare lets you appoint a trusted person to make decisions about your medical treatment, daily care, and living arrangements if you lose the mental capacity to decide for yourself. This template is designed for use in England and Wales under the Mental Capacity Act 2005 and must be registered with the UK Office of the Public Guardian.

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LASTING POWER OF ATTORNEY
Health And Welfare  ·  Mental Capacity Act 2005 Ss.9–14 + Sch 1  ·  England And Wales
DONOR
FULL NAMEMargaret Rose Whitfield
ADDRESS12 Maple Avenue, Leeds, LS1 4AB
DATE OF BIRTH1948-03-12
PHONE0113 244 7788
PRIMARY ATTORNEY
FULL NAMEDavid James Whitfield
ADDRESS8 Oak Street, Leeds, LS2 7TH
DATE OF BIRTH1975-06-22
RELATIONSHIP TO DONORSon
LIFE-SUSTAINING TREATMENTPower granted (MCA 2005 s.11(7)-(8))
Execution Date: 2026-03-09
Effective only on loss of capacity (MCA 2005 s.11(7)(a))
This LASTING POWER OF ATTORNEY FOR HEALTH AND WELFARE is granted on 2026-03-09 by Margaret Rose Whitfield of 12 Maple Avenue, Leeds, LS1 4AB (the "Donor") pursuant to sections 9 to 14 and Schedule 1 of the Mental Capacity Act 2005 and the Lasting Powers of Attorney, Enduring Powers of Attorney and Public Guardian Regulations 2007 (SI 2007/1253). The Donor confirms that, at the date of signing, the Donor has the mental capacity to make this LPA and understands its purpose and scope. This LPA has no legal effect until it has been registered with the Office of the Public Guardian ("OPG") and may only be used when the Donor lacks the mental capacity to make the relevant decision (MCA 2005 s.11(7)(a)).
1.
APPOINTMENT OF ATTORNEY(S)
The Donor hereby appoints David James Whitfield, of 8 Oak Street, Leeds, LS2 7TH (Son) as attorney to act in relation to the Donor’s health and personal welfare under section 9 of the Mental Capacity Act 2005. A second attorney, Susan Clare Whitfield, of 4 Pine Close, York, YO1 2AB (Daughter), is also appointed. The attorneys shall act jointly and severally, meaning they may act together or independently on any health or welfare decision.
2.
WHEN THE ATTORNEY(S) MAY ACT
This LPA for Health and Welfare may be used only when the Donor lacks the mental capacity to make the relevant decision, as provided by section 11(7)(a) of the Mental Capacity Act 2005. Capacity is to be assessed in accordance with the two-stage test in sections 2 and 3 of the Mental Capacity Act 2005 and the MCA 2005 Code of Practice (chapters 3, 4 and 7). The attorney(s) must assume capacity unless the contrary is established and must support the Donor to make the decision themselves where practicable (MCA 2005 s.1(2)-(3)).
3.
SCOPE OF AUTHORITY
Subject to any restrictions below and to the MCA 2005, the attorney(s) may make any decision about the Donor’s personal welfare that the Donor could make if they had capacity, including without limitation: where the Donor lives (including moves to a care home, sheltered accommodation or hospital); day-to-day care (diet, dress, routine, social contact); consent to or refusal of medical treatment; access to medical and care records under section 3 of the Access to Health Records Act 1990 and the UK GDPR Articles 15 and 23; and engagement with social services, NHS bodies and the Court of Protection. The attorney(s) may not, however, make decisions that would unlawfully deprive the Donor of liberty; any such deprivation must be authorised under the Deprivation of Liberty Safeguards (MCA 2005 Schedule A1) or the Liberty Protection Safeguards when commenced.
4.
LIFE-SUSTAINING TREATMENT (MCA 2005 S.11(7)-(8))
The Donor hereby EXPRESSLY AUTHORISES the attorney(s) to give or refuse consent to the carrying out or continuation of life-sustaining treatment on the Donor’s behalf, pursuant to section 11(7)-(8) of the Mental Capacity Act 2005. The attorney(s) may exercise this authority only where they reasonably believe that doing so is in the Donor’s best interests under section 4 of the Mental Capacity Act 2005, and must not be motivated by a desire to bring about the Donor’s death (MCA 2005 s.4(5)).
5.
DONOR'S BEST INTERESTS (MCA 2005 S.4)
The attorney(s) must at all times act in the Donor’s best interests in accordance with section 4 of the Mental Capacity Act 2005. They must: (a) consider all relevant circumstances; (b) take into account the Donor’s past and present wishes, feelings, beliefs and values; (c) consult, so far as reasonably practicable, anyone named by the Donor, any carer, any deputy and any other interested party; (d) encourage the Donor’s participation; and (e) not make a best interests determination merely on the basis of the Donor’s age, appearance, condition or behaviour. The attorney(s) must also comply with the principles in section 1 and with the MCA 2005 Code of Practice.
6.
INTERFACE WITH ADVANCE DECISIONS
Where the Donor has made an Advance Decision to Refuse Treatment ("ADRT") under sections 24 and 25 of the Mental Capacity Act 2005, that ADRT takes priority over this LPA unless this LPA is made after the ADRT and expressly covers the same treatment (MCA 2005 s.25(2)(b)). The Donor confirms that no ADRT exists at the date of this LPA. The attorney(s) must not consent to treatment on the Donor’s behalf where that treatment would contravene a valid and applicable ADRT (MCA 2005 ss.24-26). Treating clinicians must satisfy themselves as to the validity and applicability of any ADRT before relying on it.
7.
INSTRUCTIONS AND PREFERENCES
Instructions (binding on the attorney(s)): My attorney must consult my GP before consenting to any non-emergency medical procedure.
Preferences (non-binding guidance): I would prefer to be cared for at home rather than in a care home where this is safe and reasonable.
8.
REPLACEMENT ATTORNEY
The Donor appoints Helen Patricia Whitfield, of 22 River Lane, Sheffield, S1 3LK (Daughter-in-law), DOB 1980-02-07 as replacement attorney, to step in if any original attorney is unable or unwilling to act (for example, through death, loss of capacity, bankruptcy, dissolution of marriage or civil partnership with the Donor, or disclaimer). The replacement attorney assumes the same powers and restrictions as the original attorney(s), including (if granted) authority over life-sustaining treatment.
9.
CERTIFICATE PROVIDER (MCA 2005 SCH 1 PARA 2)
Dr Anita Patel, of 15 High Street, Leeds, LS1 1AB (General Practitioner, GMC 6534210) has signed Part B of the prescribed form, certifying that, in their opinion: (a) the Donor understands the purpose and scope of this LPA and its consequences; (b) no fraud or undue pressure is being used to induce the Donor to make this LPA; and (c) there is nothing else that would prevent this LPA from being created. The certificate provider is a person acting in a professional capacity (for example, a registered medical practitioner, registered nurse, social worker, or solicitor) who is not a family member of the Donor or of any attorney. The certificate provider is independent of the attorneys, is not a family member of the Donor or the attorneys, and is not an employee or business partner of any attorney.
10.
NOTIFICATION PERSONS (FORM LP3)
Before this LPA is registered, the OPG shall serve notice on the following persons on Form LP3 under Schedule 1 paragraph 6 of the Mental Capacity Act 2005 and the LPA Regulations 2007: Peter John Whitfield (brother), 17 Highfield Avenue, Harrogate HG1 2BJ. Each notified person has three (3) weeks from receipt of the notice to object to registration on a prescribed statutory ground (LPA Regulations 2007 reg.15; Form LPA007).
11.
REGISTRATION WITH THE OFFICE OF THE PUBLIC GUARDIAN
This LPA has no legal effect until it has been registered by the OPG under Schedule 1, Part 2 of the Mental Capacity Act 2005 and Part 2 of the LPA Regulations 2007. An application to register must be made using Form LP1H or online via the OPG digital service. The current registration fee is 82 GBP per LPA (with exemption or remission under Form LPA120 for Donors on low income or certain means-tested benefits). Searches of the statutory register may be made under section 58 MCA 2005 using Form OPG100.
12.
DEPRIVATION OF LIBERTY
Nothing in this LPA authorises the attorney(s) to deprive the Donor of liberty save to the extent permitted by the Deprivation of Liberty Safeguards in Schedule A1 to the Mental Capacity Act 2005 (and the Liberty Protection Safeguards under Schedule AA1 when commenced pursuant to the Mental Capacity (Amendment) Act 2019). Any deprivation of liberty must be authorised by the supervisory body or by order of the Court of Protection.
13.
REVOCATION AND GOVERNING LAW
The Donor may revoke this LPA at any time while they have capacity to do so by executing a deed of revocation and notifying the OPG and each attorney in writing (MCA 2005 s.13 and Sch 1 paras 17-18). This LPA is made under the laws of England and Wales. Any dispute as to the validity, scope or exercise of this LPA shall be determined by the Court of Protection under section 16 of the Mental Capacity Act 2005.
DONOR
Margaret Rose Whitfield
Date: ____________________
PRIMARY ATTORNEY
David James Whitfield
Date: ____________________
SECOND ATTORNEY
Susan Clare Whitfield
Date: ____________________
REPLACEMENT ATTORNEY
Helen Patricia Whitfield
Date: ____________________
CERTIFICATE PROVIDER
Dr Anita Patel
Date: ____________________
WITNESS TO DONOR'S SIGNATURE
Claire Elizabeth Booth
Date: ____________________

What Is an LPA for Health and Welfare?

A lasting power of attorney (LPA) for health and welfare is a legal document that allows you (the "donor") to appoint one or more people (your "attorneys") to make decisions about your health, care, and personal welfare if you lose the capacity to make those decisions yourself.

This type of LPA can cover decisions about medical treatment, where you live, your daily routine, diet, dress, and — if you choose — the refusal of life-sustaining treatment. Unlike the property and finance LPA, a health and welfare LPA can only be used when you lack capacity.

The LPA must be registered with the Office of the Public Guardian (OPG) before it can be used. Registration can take several weeks, so it is wise to create and register your LPA while you are well and have full capacity.

What's Covered in This Template

Our health and welfare LPA template guides you through the required sections:

Donor Details

Your personal information including full name, date of birth, and address.

Attorney Appointments

Names and details of one or more attorneys you wish to appoint.

Replacement Attorneys

Backup attorneys who step in if an original attorney can no longer act.

Joint or Joint and Several

Whether attorneys must act together on all decisions or can act independently.

Life-Sustaining Treatment

Whether your attorneys have authority to consent to or refuse life-sustaining treatment on your behalf.

Preferences

Non-binding wishes about your care, lifestyle, and values that guide your attorneys.

Instructions

Binding restrictions or conditions your attorneys must follow.

Certificate Provider

An independent person who confirms you understand the LPA and are not under pressure.

People to Notify

Individuals you want the OPG to notify when the LPA is registered, providing a safeguard.

Signature Sections

Signature pages for the donor, attorneys, replacement attorneys, and certificate provider.

How to Create an LPA for Health and Welfare

Follow these steps to set up a valid health and welfare LPA:

  1. 1

    Choose Your Attorneys

    Select one or more people you trust completely. They must be 18 or over and have mental capacity. Think carefully about who would respect your wishes and act in your best interests.

  2. 2

    Decide on Authority

    Choose whether your attorneys can make decisions jointly (together) or jointly and severally (together or independently). Decide whether to grant authority over life-sustaining treatment.

  3. 3

    Add Preferences and Instructions

    Write down your wishes (preferences) and any binding requirements (instructions) about your care, treatment, and living arrangements.

  4. 4

    Arrange a Certificate Provider

    An independent person — such as a solicitor, GP, or someone who has known you for at least two years — must sign to confirm you understand the LPA and are acting freely.

  5. 5

    Register with the OPG

    Submit the completed LPA to the Office of the Public Guardian for registration. There is a registration fee, though exemptions and remissions are available for those on low incomes.

Legal Considerations

Health and welfare LPAs are governed by the Mental Capacity Act 2005 and must be registered with the Office of the Public Guardian.

This template is for informational purposes only and does not constitute legal advice. Consult a qualified solicitor for advice specific to your situation.

Reviewed for England & Wales law

Mental Capacity Act 2005

The UK LPA framework is set out in sections 9–14 of the Mental Capacity Act 2005. Attorneys must act in the donor's best interests, consider the donor's past and present wishes, and follow the Act's statutory principles under English law.

Registration Requirement

A UK LPA is not valid until registered with the Office of the Public Guardian. Registration can take 8–12 weeks and requires a fee (currently £82 per LPA in England and Wales). You can register the LPA at any time after signing — you do not need to wait until you lose capacity.

Life-Sustaining Treatment

Under United Kingdom law, you can choose whether or not to give your attorneys authority over life-sustaining treatment. This is a significant decision and should be discussed with your attorneys and, ideally, your British GP. If you do not grant this authority, UK healthcare professionals will make those decisions in your best interests.

Safeguards Against Abuse

The UK Act includes safeguards: a certificate provider must confirm the donor's understanding and freedom from pressure, named persons can be notified when registration is applied for, and the British Court of Protection can investigate concerns about an attorney's conduct.

Frequently Asked Questions

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