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Health and welfare LPA: what it covers and how to set one up

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A health and welfare lasting power of attorney (LPA) lets people you trust make your medical and care decisions for you, but only once it is registered with the Office of the Public Guardian and only if you have lost mental capacity. It covers everything from daily routine and diet through to care-home placement and, if you choose, life-sustaining treatment.

The single decision that trips up most donors sits in Section 5 of the form: whether your attorneys or your doctors have the final say over life-sustaining treatment. Get that wrong, or leave it blank, and the OPG will hand the form back.

  • Attorneys can only act once the LPA is registered and you lack capacity, never before.
  • You must tick option A or option B for life-sustaining treatment. There is no default.
  • Registration currently costs £92 per LPA, with reductions available for lower incomes.

Key Takeaways

A health and welfare LPA only takes legal effect once registered with the OPG, and the Section 5 life-sustaining treatment choice determines who controls end-of-life decisions.

Point Details
Registration is mandatory Attorneys cannot act until the LPA is registered with the OPG and you lack capacity.
Section 5 is critical Choose option A (attorneys decide) or option B (doctors decide) on life-sustaining treatment.
Signing order matters Donor signs first, then the certificate provider, then attorneys, all on one original document.
Budget time and money Expect around 20 weeks to register and a £92 fee per LPA, with reductions for lower incomes.
Revoking needs a new LPA You cannot edit a registered LPA; changes require revocation and a fresh application.

Table of Contents

What does a health and welfare LPA cover?

A health and welfare LPA gives your attorneys authority over the decisions that shape daily life once you can no longer make them yourself. That includes consenting to or refusing medical treatment, including mental health treatment, and, where you have authorised it, life-sustaining treatment.

It also covers the ordinary business of living: what you eat, how you dress, who you see socially, and what your day looks like. Attorneys can decide whether you move into a care home and which one, a power families often underestimate until the moment arrives.

  • Medical treatment decisions, including consenting to or refusing care.
  • Day-to-day routine: diet, dress, activities and social contact.
  • Where you live, including care-home moves.
  • Life-sustaining treatment, but only if you select option A in Section 5.

Every attorney decision must meet the “best interests” test set out in the Mental Capacity Act 2005, not simply what the attorney would choose for themselves.

This is a separate document from a property and financial affairs LPA, which deals with bank accounts, bills and property. Many donors set up both together, but each has its own attorneys, its own certificate provider requirement, and its own £92 registration fee. You can appoint the same people for both, or different attorneys entirely, depending on who you trust with money versus who you trust with your care.

Opened filing cabinet with LPA documents

Who should you appoint as your attorney?

Choosing an attorney is less about who loves you most and more about who can act calmly under pressure, follow your instructions rather than their own instincts, and turn up when it matters. Anyone aged 18 or over with mental capacity can act, but they cannot also be your certificate provider or a witness to your signature.

  1. List two or three people whose judgement you trust in a medical crisis, not just family members you feel obliged to name.
  2. Decide whether attorneys act jointly (all must agree on every decision) or jointly and severally (any one can act alone).
  3. Appoint at least one replacement attorney in case your first choice dies, loses capacity, or steps down.
  4. Ask each candidate directly whether they are willing and able to take this on, including a frank conversation about your treatment preferences.

Joint appointments feel safer but can stall decisions if attorneys disagree or one is unreachable. Jointly and severally is faster in an emergency but relies entirely on trust.

Pro Tip: Give each attorney a printed copy of the registered LPA and their fellow attorneys’ contact details before an emergency happens, not after. Hospitals move fast, and a phone call at 2am is not the time to be searching for a solicitor’s number.

What is life-sustaining treatment and how do you record instructions?

Life-sustaining treatment means interventions like resuscitation, ventilation or artificial feeding that keep someone alive when their body cannot manage alone. Section 5 of the LPA form forces you to decide, in advance, who controls that decision.

Option A gives your attorneys the authority to consent to or refuse life-sustaining treatment on your behalf. Option B removes that power entirely and leaves the decision with doctors. Legal advisers note this tick-box is frequently overlooked, yet it determines who decides on life-preserving care the moment you cannot speak for yourself.

Section 7 lets you add written instructions narrowing how attorneys should apply that authority. Vague wishes (“nothing heroic”) are hard for clinicians to act on. Specific ones work far better:

That kind of scenario-based instruction gives both attorneys and doctors something concrete to follow. An LPA can also work alongside an advance decision to refuse treatment (ADRT), which is a separate, standalone document. Where both exist, the most recently made and clearly applicable one generally takes precedence, so keep dates consistent and tell your attorneys which document should govern which situation.

How do you make and register a health and welfare LPA?

Making the LPA is the easy part. Getting it signed in the correct order and registered without errors is where most delays happen. Follow the sequence below and you will avoid the vast majority of rejections.

  1. Decide your powers and complete form LP1H, the health and welfare specific form, available from GOV.UK.
  2. Choose your attorneys, replacement attorneys, and a certificate provider, someone independent who confirms you understand the document and are not under pressure.
  3. Complete Section 5 (life-sustaining treatment) and any Section 7 instructions.
  4. Sign in the correct order: you sign first, then the certificate provider, then each attorney, all on the same original paper document.
  5. Submit to the Office of the Public Guardian, preferably online, where built-in checks catch common errors before submission.
  6. Pay the registration fee and wait for confirmation.

The registration fee is £92 per LPA or £184 if you register both health and welfare and property and financial affairs together.

Budget realistically for time. Registration typically takes around 20 weeks, and allowing 22 to 24 weeks from the moment you instruct someone to help you through to receiving the registered document is sensible. Submitting online rather than by post reduces the chance of a query or return, since the digital form validates entries as you go. If the OPG queries anything, respond promptly with the specific correction requested; a slow reply restarts the clock on an already lengthy process.

What mistakes cause LPA applications to be rejected?

Most rejections trace back to the same handful of errors, and nearly all are avoidable with a careful read-through before posting. Signing out of order tops the list: the donor must sign before the certificate provider, and attorneys must sign after that, never before.

  • Attorneys signing before the donor, which invalidates the whole document.
  • A certificate provider who is also named as a witness or attorney, which is not permitted.
  • Section 5 left blank, with neither option A nor option B ticked.
  • Missing or incomplete witness names and addresses.
  • Digital signatures used instead of wet-ink signatures on the original paper form.

Before submitting, check every signature is dated correctly, confirm you are sending the original hard copy rather than a scan, keep a photocopy for your own records, and verify the fee payment has gone through. If the OPG does reject the form, it will explain why in writing; correcting that single issue and resubmitting is usually faster than starting again from scratch.

Pro Tip: Read Section 5 aloud with your certificate provider before signing. It sounds unnecessary, but it is the single section most likely to be left incomplete under time pressure.

Why does an LPA matter for home-care planning in London?

An LPA becomes very real, very quickly, once a family is arranging home care support. Decisions about whether a parent stays at home with support or moves into residential care, how a routine should change after a hospital stay, or who consents to a new treatment plan all sit squarely within an attorney’s authority once registered.

At Kells Domiciliary Care, we have supported families across London for over 30 years, and we are CQC-regulated with fully DBS-checked carers. We see, regularly, how much smoother care planning becomes when attorneys and care staff are working from the same information.

  • Share a copy of the registered LPA with the GP practice and the home-care agency, not just family members.
  • Keep a one-page, plain-English summary of major preferences alongside the LPA so new carers can act quickly.
  • Involve attorneys in early conversations about flexible home care options before a crisis forces a rushed decision.
  • Align care plans explicitly with any Section 7 instructions, so there is no ambiguity between what the document says and what the care team is doing day to day.

How do you revoke or cancel a health and welfare LPA?

You can revoke an LPA at any time, provided you still have the mental capacity to understand what revocation means. Revocation requires a formal deed of revocation, a written document stating clearly that you are cancelling the LPA, signed and dated by you.

Once signed, you must notify the Office of the Public Guardian in writing, enclosing the original LPA document (or explaining why it cannot be returned), so the register can be updated. Tell every attorney and any organisations holding a copy, such as your GP practice or care agency, that the LPA no longer applies.

An LPA is also automatically revoked in certain circumstances without any action from you. If an attorney dies, loses mental capacity, or is removed by the Court of Protection, and no replacement attorney was appointed, the LPA may become invalid or require the OPG to intervene depending on how many attorneys remain. Bankruptcy affects a property and financial affairs LPA but does not automatically revoke a health and welfare one.

If you lose mental capacity yourself, you can no longer revoke the LPA. At that point, only the Court of Protection can cancel it, typically because of evidence that an attorney is not acting in your best interests. This is one of the strongest reasons to choose attorneys carefully at the outset rather than assuming problems can be fixed later.

Can you update or amend an existing health and welfare LPA?

You cannot simply edit a registered LPA the way you would amend a will with a codicil. The document is fixed once signed, so if your wishes change, such as wanting to switch your life-sustaining treatment choice from option B to option A, you must revoke the existing LPA and make a new one.

Smaller changes are handled differently depending on what needs updating. If an attorney’s name or address changes, you can notify the OPG directly without cancelling the whole document. If you want to remove one attorney while others continue acting, this is possible under certain conditions but often needs specific legal advice, particularly where attorneys were appointed to act jointly.

Adding a completely new attorney to an existing LPA is not permitted. The only route is making a fresh LPA naming everyone you want involved, then formally revoking the old one once the new one is registered. This matters practically: do not let the new LPA sit unregistered while assuming the old one has automatically lapsed. Keep the original valid and in force until its replacement is confirmed registered by the OPG, so there is no gap where nobody holds legal authority to act.

Given the 20 week or so registration timeline, plan any amendment well ahead of a change in circumstances rather than scrambling once a health crisis has already begun.

How are disputes over a health and welfare LPA resolved?

Disputes usually fall into one of two categories: disagreement between joint attorneys, or a challenge from a family member who believes an attorney is not acting properly. Both routes lead, eventually, to the Court of Protection, but the paths differ.

When attorneys appointed to act jointly cannot agree, the LPA itself may stall entirely, since every joint decision requires unanimous consent. This is precisely why the joint versus jointly-and-severally choice, made when the LPA was first created, matters so much in practice. Where deadlock persists, the Court of Protection can be asked to rule on the specific disputed decision.

Where someone believes an attorney is failing the best interests test, perhaps ignoring the donor’s known wishes, isolating them from family, or making decisions that appear to benefit the attorney rather than the donor, they can raise a concern directly with the OPG. The OPG can investigate, and in serious cases, apply to the Court of Protection to have the attorney removed.

Evidence matters enormously here. Attorneys should keep a written record of significant decisions and the reasoning behind them, partly for their own protection and partly because the Mental Capacity Act’s best interests framework expects a demonstrable thought process, not just a good outcome. Families who suspect a problem should raise it early with the OPG rather than waiting, since removing an attorney through the courts takes time the donor may not have.

How are disputes over a health and welfare LPA resolved? — overview diagram

How does an LPA affect end-of-life decisions?

The life-sustaining treatment choice you make in Section 5 is, functionally, the most consequential end-of-life decision in the entire document. Choosing option A hands your attorneys real authority in the moments when doctors are asking whether to continue or withdraw treatment. Choosing option B keeps that call with the clinical team, informed by whatever instructions you have left in Section 7.

An LPA does not replace an advance decision to refuse treatment (ADRT), sometimes called a living will, but the two can work together. An ADRT lets you refuse specific treatments in advance, and it remains legally binding even without an attorney involved, provided it meets the formal requirements around witnessing and specificity. Where you have both an LPA with option A and an ADRT covering the same treatment, the more recent, clearly applicable document generally takes precedence, so keep both dated and tell your attorneys which one governs which scenario.

Without any LPA in place, and without an ADRT, doctors and family are left applying the Mental Capacity Act’s best interests test with no legally binding steer from you at all. Making an LPA before capacity is lost is the only way to guarantee your own voice, not a court’s interpretation of your likely wishes, decides what happens.

Getting the paperwork moving now

Once your LPA is drafted, signed and heading towards registration, the practical work of aligning it with actual care begins. Families who download our free home care guide often use it alongside their LPA paperwork to map out preferences before a crisis forces rushed decisions. If you are already exploring personalised home care options in London, sharing your LPA details with your chosen agency from day one keeps everyone working from the same page. Kells Domiciliary Care works with families across London to make sure care plans reflect exactly what an LPA sets out, not a rough approximation of it.

Official pages and guidance to consult

What the law gets right, and what it leaves to families

The legal framework around health and welfare LPAs is sound. The Mental Capacity Act’s best interests test, the certificate provider safeguard, the mandatory Section 5 choice: none of this is bureaucratic padding. Each piece exists because attorneys hold genuine power over someone else’s medical fate, and the law rightly makes that power hard to misuse.

Where I think the conventional advice falls short is in treating registration as the finish line. It isn’t. A registered LPA sitting in a drawer does nothing for a carer who arrives at 7am not knowing the donor refused resuscitation, or a locum GP unaware that a daughter, not a son, holds decision-making authority. The document’s legal validity and its practical usefulness are two different things, and most guides only address the first.

If you take one thing from this article, prioritise the conversation over the paperwork. Talk to your attorneys about what “quality of life” actually means to you before you ever fill in Section 7. The form captures your wishes; it does not create them. Get the thinking done first, and the paperwork becomes far easier to get right.

— Dan

This article is general information, not a substitute for advice from a qualified lawyer. Consult a qualified legal professional about your own circumstances before acting on anything here.

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