Advance Care Plans

• Advance Care Plans are usually made by someone with their healthcare team when they are approaching end of life, although they can be started at any stage in life. The plan is used to record the person’s treatment and care wishes and can be reviewed and updated. 
• If the person you care for has made an Advance Decision to Refuse Treatment, Advance Statement, or Lasting Power of Attorney, a note of these must be made in the advance care plan.
• An Advance Care Plan is not a legally binding document; however, there has to be a good reason for health and care staff to ignore the person’s wishes. There could be circumstances where it is not safe to follow an aspect or aspects of the care plan and this should be fully explained to you. 
• There are a variety of national and local forms and templates that can be used to record different forms of advanced care planning in Surrey. For example:

ReSPECT is a Recommended Summary Plan for Emergency Care and Treatment and is currently being used across much of Surrey. If the person you care for has not been offered the opportunity to complete this template you can suggest they contact their GP for more information on ReSPECT. 

Proactive Anticipatory Care Plan (PAC) documentation is a personalised care management plan designed to provide a framework for the person you care for, you, and healthcare professionals to work together to plan care. It is being used with patients and families residing in Guildford and Waverley. If the person you care for has not been offered the opportunity to complete this plan you can suggest they contact their GP to view the PAC form. 

For more general information about advance care planning see Advance Care Plan or Compassion in Dying.

1. Talk with the person you care for about what you are willing and able to provide in relation to providing end of life care so that this is taken into account as part of their Advance Care Plan. 
2. Discuss sharing of information with the person and professionals. If the person has mental capacity, have they provided consent (either verbally or in writing) for you to speak to health and social care professionals?
3. If you have been appointed as the person’s attorney under a Lasting Power of Attorney for Health and Welfare then you should be given all the information you need, including a copy of the Advance Care Plan, to make decisions about the person’s treatment and care.
4. If you are not the person’s attorney, health professionals have a legal obligation to speak to you as their carer/relative to make decisions about what is in their best interests in relation to their future care. They should listen to your views, although legally they do not have to follow them.
5. Sometimes you might disagree with the treatment and care decision the health or care professional is making. In this situation, all relevant information should be reviewed with you. If you still can’t agree then you can ask for a second opinion or ask for an advocate. If this fails then you can make a formal complaint or speak to a solicitor. Finally, you can apply to the Court of Protection to make a decision. There are emergency procedures for this so, if urgent, your case can still be heard.

• A DNAR decision is a written instruction to medical staff not to attempt to bring a person back to life, in other words using Cardiopulmonary resuscitation (CPR) should their heart stop beating or they stop breathing. It does not relate to any other form of medical treatment.
• The decision is usually recorded on a form completed by a doctor. This makes it easy for health professionals to see it quickly in an emergency. Here is a link to an example of a DNAR form (PDF) still being used in Surrey Heath and Farnham. 
• In the rest of Surrey, the ReSPECT form is being widely used to record DNAR decisions. Go to Advance Care Plans.
• Only a doctor, or a senior nurse with specialist training, can make a DNAR decision or issue a DNAR form, but this will be done in close consultation with the person you care for and yourself. The person you care for cannot make a DNAR decision themselves, but they can ask their doctor or appropriate senior nurse to issue one and they will normally carry out the request. If the person you care for wants to ensure refusal of CPR is legally binding then this should be stated in an Advance Decision to Refuse Treatment (ADRT).

1. Talk to the person you care for about whether they want a DNAR decision to be made. See Resuscitation Council to help them understand what it means to be resuscitated and the complications that can arise. 
2. If the person you care for cannot make a decision for themselves because they are unconscious or unable to communicate, make sure you talk to their doctor about what you think they would have wanted. Although you cannot decide whether resuscitation should be given (unless you have legal power through a Lasting Power of Attorney), you should be consulted.