Health and Welfare LPA: The Complete Guide

Written by James Tyrrell · Reviewed by Anthony Dalton · Last reviewed 12 April 2026

A Health and Welfare LPA is one of the most personal and consequential documents you can ever create. It determines who speaks for you when you cannot speak for yourself — at a hospital bedside, in a care home, or at the end of your life. This complete guide brings together every aspect of the Health and Welfare LPA in England and Wales: what it covers, when it can be used, what doctors and attorneys can and cannot do, and why going without one is a risk most people would never consciously choose.

What Is a Health and Welfare LPA?

A Health and Welfare Lasting Power of Attorney is a legal document that lets you appoint one or more people — your attorneys — to make personal welfare and healthcare decisions on your behalf. Created under the Mental Capacity Act 2005 and registered with the Office of the Public Guardian (OPG), it is the only legally recognised way in England and Wales to give someone authority over your healthcare and welfare if you lose mental capacity.

Unlike a Property and Financial Affairs LPA, which can be activated as soon as it is registered, a Health and Welfare LPA can only be used when you lack the mental capacity to make a specific decision for yourself. Capacity is not an all-or-nothing state — someone might be unable to understand a complex surgical choice but still be perfectly capable of deciding where they want to live or what they want to eat. Attorneys can only step in for decisions the donor genuinely cannot make themselves.

For a side-by-side comparison with the financial LPA, see our guide on the differences between the two types of LPA.

What a Health and Welfare Attorney Can Decide

The scope of a Health and Welfare attorney’s authority is broad. Where the donor lacks capacity for a particular decision, the attorney can act on any of the following:

For a comprehensive breakdown of the medical decisions an attorney can and cannot make, see our guide on what medical decisions attorneys can make.

Life-Sustaining Treatment and End-of-Life Care

The most sensitive area of any Health and Welfare LPA is decisions about life-sustaining treatment — treatments that are keeping a person alive. This includes artificial nutrition and hydration, ventilators, CPR, and other interventions. An attorney can only make these decisions if the LPA form includes the specific opt-in provision granting this authority.

If you include the life-sustaining treatment option in your LPA, your attorney can consent to or refuse these treatments on your behalf — based on your known wishes and what is in your best interests. This can align closely with a written advance decision (sometimes called a living will), though the two documents interact in important ways that are worth understanding.

Related to this is the question of Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders. These are clinical decisions, not legal documents, and the attorney’s role in relation to them is more nuanced than many people realise. Similarly, end-of-life care — palliative care, hospice, and decisions about the final stages of life — is an area where a Health and Welfare LPA provides essential legal grounding for an attorney’s role.

For in-depth coverage of these topics: Life-Sustaining Treatment and Your LPA, Can an LPA Refuse Life-Saving Treatment?, DNR Orders and LPAs, and LPAs and End-of-Life Care Decisions.

Attorneys and Doctors: The Balance of Authority

One of the most common questions about Health and Welfare LPAs is how the attorney’s authority relates to a doctor’s clinical judgement. The short answer is that both have real authority, and neither can simply override the other.

An attorney has genuine legal standing. NHS staff are required to take their decisions seriously and to involve them in care planning when the donor lacks capacity. If a doctor wants to proceed with a treatment the attorney has refused, there is a formal process to follow — they cannot simply ignore the attorney’s position. At the same time, a doctor is not obliged to carry out a treatment they consider clinically inappropriate or harmful, regardless of what the attorney says. The attorney’s role is to represent the donor’s wishes, not to direct clinical care.

When disputes arise that cannot be resolved between attorneys and healthcare staff, the Court of Protection can make a final determination. In urgent situations, treatment to preserve life can proceed while the legal process gets underway.

For a detailed look at each side of this dynamic, see Can an Attorney Override Doctors? and Can an LPA Be Overridden by a Doctor?

Care Homes and Living Arrangements

Deciding where someone lives when they can no longer make that choice for themselves is one of the most significant decisions a Health and Welfare attorney will face. A move to a care home — whether residential or nursing care — involves assessing practical needs, researching options, negotiating fees, and ensuring the chosen home meets the donor’s physical and emotional needs.

An attorney has the legal authority to make this decision, but they must do so in the donor’s genuine best interests. That means considering the donor’s expressed preferences (if they stated any while they had capacity), their religious or cultural background, their social connections, and the quality of care available. Simply choosing the nearest or cheapest option, without weighing these factors, would not meet the best interests standard.

Attorneys also have ongoing responsibilities once the donor is in a care home — reviewing care plans, attending reviews, raising concerns with the care home or the local authority, and ensuring the donor is being treated with dignity. Our detailed guides on LPAs and care homes, what decisions can be made about care homes, and whether an attorney can choose a care home cover this area comprehensively.

Mental Health Treatment and the LPA

A Health and Welfare LPA can cover voluntary mental health treatment decisions — if someone has a mental health condition and lacks capacity to make treatment choices, their attorney can do so on their behalf. This includes decisions about medication, therapy, and care arrangements for mental health conditions.

However, the LPA cannot override the Mental Health Act 1983. If a person is formally detained under the Mental Health Act — sometimes called being “sectioned” — different legal rules apply to their treatment. Certain parts of the Mental Health Act give clinicians authority to treat the patient without consent, and an LPA attorney cannot veto that treatment. It is an important limitation that often surprises families dealing with mental health crises.

For a clear explanation of these crossovers and limits, see our guide: Can an LPA Cover Mental Health Treatment?

Accessing Medical Records and Information

To make informed healthcare decisions, an attorney often needs access to the donor’s medical records — test results, diagnosis summaries, care plans, and treatment histories. Under a Health and Welfare LPA, an attorney has the right to request medical records that are necessary for making decisions within their authority.

The process involves contacting the relevant NHS trust or GP practice, providing a copy of the registered LPA, and making a subject access request under UK GDPR on the donor’s behalf. Organisations should respond within one month. If a request is refused, the attorney can escalate to the Information Commissioner’s Office. It is important to know that access to records should be proportionate — attorneys have the right to information needed to make decisions, not unlimited access to everything in the donor’s medical history.

Our guide on whether attorneys can access medical records explains the full process, including how to handle refusals.

What Happens Without a Health and Welfare LPA?

This is the question that matters most. Without a registered Health and Welfare LPA, no family member — not a spouse, not a parent, not an adult child — has automatic legal authority to make healthcare decisions on someone else’s behalf. This surprises many people, but it is the law.

When someone without an LPA loses capacity, doctors and healthcare teams make decisions under the Mental Capacity Act. They must consult close family and anyone involved in the person’s care, but the final decision rests with the clinical team. If a family member disagrees with a proposed course of treatment, they have no legal basis to stop it unless they bring the matter before the Court of Protection — a process that is slow, expensive, and emotionally exhausting at an already difficult time.

An LPA does not prevent this reality — it replaces it with something far better: a named person who knows you, understands your wishes, and has the legal authority to ensure those wishes are respected. Our guide on who decides without a Health and Welfare LPA explains exactly what happens in practice.

All Health and Welfare LPA Guides

Our full collection of guides on the Health and Welfare LPA, covering every topic from the basics through to the most complex decisions attorneys face.

Common Questions About the Health and Welfare LPA

This guide was last reviewed and updated on 12 April 2026. Information is based on current legislation and OPG guidance for England and Wales.

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