This guide is for members of the public and explains advance care planning. It outlines the different options available to people when planning for their end of life care.
This publication is a revised version of Planning for your future care (2009).
Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013
Self Awareness is the first step to success. If you do not know who you are, what will you do after you have gone where you wanted to. If you do not know who you are, you do not know what you are capable of, and you will never know where you can be. Permit yourself to make the journey from where you are and where you can be, not just where you want to be.
Time management-Its Importance by Jamshed Mukhtar KhanJamshed Khan
Most of us support time discipline but very conveniently forget to follow, this presentation/lecture would suggest some of the factors known as time tumblers or stumbling blocks,more so suggests its readers how to over come...
Being consistant is the most important aspect of working online or offline, especially if you are working with a team. Don't let procrastination cause your business to never get off the ground.
Self Awareness is the first step to success. If you do not know who you are, what will you do after you have gone where you wanted to. If you do not know who you are, you do not know what you are capable of, and you will never know where you can be. Permit yourself to make the journey from where you are and where you can be, not just where you want to be.
Time management-Its Importance by Jamshed Mukhtar KhanJamshed Khan
Most of us support time discipline but very conveniently forget to follow, this presentation/lecture would suggest some of the factors known as time tumblers or stumbling blocks,more so suggests its readers how to over come...
Being consistant is the most important aspect of working online or offline, especially if you are working with a team. Don't let procrastination cause your business to never get off the ground.
A framework for social care at the end of life
15 July 2010 - National End of Life Care Programme
This framework, developed by the NEoLCP with the involvement of a group of senior professionals and other stakeholders in social care, sets out a direction of travel for social care at end of life.
Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013
Patient Transport Audit 2012
Published by NHS Kidney Care March 2012
This publication draws together the key findings from a national audit of the experience of patient transport services. A survey of all people receiving haemodialysis was conducted in October 2012, asking about their experience of transport to and from haemodialysis, and comparing this with national standards. This audit is the third in a series of audits previously performed in 2008 and 2010. It was commissioned by NHS Kidney Care.
A Framework for Implementation
03 June 2009 - National End of Life Care Programme / NHS Kidney Care
A group of people with life-limiting conditions, and those who have experienced the death of a loved person, came together to discuss their involvement with people who had the task of supporting those approaching the end of life.
Through these discussions 'Finding the Words', the DVD and work book were developed to help staff in their conversations and care.
Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013
29 November 2012 - National End of Life Care Programme
This competency framework has been developed to support high quality practice by encouraging and assisting end of life care facilitators to continually review their learning and practice.
It provides a basis to support and improve the quality of practice by encouraging and assisting learning, and enhancing knowledge and skills. Based on best practice guidelines, in addition to national and local frameworks, this competency framework will help to capture evidence that will:
Support the development of the NHS Knowledge and Skills Framework (KSF) profiles
Demonstrate the readiness for career progression
Support ongoing registration with professional bodies
Support development into the role of end of life care facilitator.
It is designed to support facilitators' development by identifying the extent of knowledge and skill required for that level of practitioner. The framework is not intended to be a comprehensive, definitive guide. Individual job descriptions and person specifications give details of what is expected of end of life care facilitators - this framework is to be used as an aid to developing individual roles.
Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013
13 September 2012 - e-Learning for Healthcare / National End of Life Care Programme / The Association for Palliative Medicine of Great Britain and Ireland (APM)
This easy-to-follow starter pack is designed to help health and social care staff use the e-learning programme e-ELCA. It includes information on how to register and access the e-learning, as well as step-by-step quick guides, frequently asked questions and case studies.
Starter Pack Thumbnail
e-ELCA is free to access for health and social care staff delivering end of life care. Commissioned by the Department of Health, it is written and reviewed by clinicians and experts. There are over 150 e-learning sessions available across eight courses:
Assessment
Advance care planning
Communication skills
Symptom management
Integrating learning
Social care
Bereavement
Spirituality
Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013
The route to success in end of life care - achieving quality in ambulance services
28 February 2012 - National End of Life Care Programme
This guide sets out the key role and contribution of ambulance services in achieving high quality care at each step along the end of life care pathway.
Whilst highlighting the crucial role of ambulance services, the guide also acknowledges the unique set of challenges and barriers that need to be addressed and overcome.
Good practice examples and top tips are provided throughout to make this guide a key tool not only for ambulance services, but also for other health and social care providers, professionals, managers and commissioners.
Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013
(last offices) 05 April 2011 - National End of Life Care Programme
Developed by the National End of Life Care Programme and National Nurse Consultant Group (Palliative Care), this guidance sets out key principles is intended as a guide for training, as well as for informing the development of organisational protocols for this area of care aims to provide a consistent view that accommodates England's diverse religious and multi-cultural beliefs.
Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013
Death from liver disease : Implications for end of life care in England
22 March 2012
This report presents the latest data on place of death for those with liver disease and shows how this varies with sex, age, region, socioeconomic deprivation and place. It is aimed at commissioners and providers of end of life care, clinicians caring for patients with liver disease, and others concerned with providing quality end of life care for this patient group, including patients themselves and their carers.
Some key findings:
Liver disease causes approximately 2% of all deaths
The number of people who die from liver disease in England is rising (from 9,231 in 2001 to 11,575 in 2009)
More men than women die from liver disease (60% are men, 40% women)
Alcoholic liver disease accounts for well over a third (37%) of liver disease deaths.
If you are involved in treating patients, managing and/or improving health services or
managing or training those that do, you will understand the importance of providing the
best care possible for all our patients.
Great progress has been made in improving service standards and access and in reducing
waiting times, but there is still some way to go to ensure consistently high standards of
patient care across the NHS.
It is clear that we need to ensure we are getting it right first time, which means better care
and better value through the reduction of waste and errors and the prioritisation of effective
treatments. Quality, innovation, productivity and prevention (QIPP) is the mechanism through
which we can achieve this.
QIPP is about creating an environment in which change and improvement can flourish; it
is about leading differently and in a way that fosters a culture of innovation; and it is
about providing staff with the tools, techniques and support that will enable them to take
ownership of improving quality of care.
The Handbook of Quality and Service Improvement Tools from the NHS Institute brings
together a collection of proven tools, theories and techniques to help NHS staff design and
implement quality improvement projects that do not compromise on the quality and safety of
patient care but rather enhance the patient experience.
Here are five easy ways families can plan for elder care. For more information about elder care planning and senior home care options, visit www.brightstarcare.com/senior-home-care.
Have a look at this guide which addresses the problems you may face if you care for someone suffering from multiple system atrophy (MSA). Visit https://www.multiplesystematrophy.org/ or call us @ (866)737-5999
As citizens of a culture that worships youth, most of us find it nearly impossible to admit our own mortality, much less make plans for that eventuality. Denial, however, offers no protection from the inevitable.
Are you ready to take care of an aging Parents?? Many of us are faced with these challenges in our life and have no Idea about the ramifications on your life. It is a great to discuss ideas with your parents and family members about a strong network plan for the possibilities.
The problem of infertility comes as a shock to people. It is an issue we want nobody to face in real life. Counseling a friend suffering from the issue and recommending the required help is what can be done, in order to share the load.
aking care of your aging parents is something you hope you'll never need to do. It means helping them prepare for the future, which could be frustrating, physically, emotionally and financially. Should the need arise, there are two things you can be certain of: Your parents need you, and you need help.
This Guide for Executives is aimed at senior healthcare leaders. It provides 31 practical tips for leaders
who want to contribute positively to the culture for innovation in their organisations and systems.
A more in-depth practitioners guide, Creating the Culture for Innovation, provides much more
detailed advice and guidance, a host of additional examples, and information about an online staff
survey that can be used to assess, benchmark and understand the culture for innovation.
The Sustainability Model is a diagnostic tool that will identify strengths and
weaknesses in your implementation plan and predict the likelihood of sustainability
for your improvement initiative.
The Sustainability Guide provides practical advice on how you might increase the
likelihood of sustainability for your improvement initiative.
Pathways to Success: a self-improvement toolkit Focus on normal birth and reducing Caesarean section rates
Caesarean section (CS) has an important role in ensuring safe maternity care. How can we make
sure that every Caesarean is appropriate, effective and efficient?
The NHS Institute for Innovation and Improvement is working with NHS clinical staff to promote best practice in achieving low CS rates while maintaining safe outcomes for mothers and babies.
This toolkit is designed to help maternity services review and assess their current practice in promoting normal birth and reducing CS rates. The toolkit also provides practical techniques to support sustainable changes in maternity services.
A practical, introductory guide to thinking differently. It is not a comprehensive blueprint nor is it designed to make you an expert in thinking. But it will get you started on
a journey of thinking differently, and therefore doing things differently, that we hope continues well into
your future.
We have selected concepts and thinking tools that have proven their value, ease, and applicability in a
variety of industries and in over five years of experience with front line teams in various NHS organisations.
We’ll provide you with just enough background theory to help you see why the various thinking tools ask
you to do certain things that might seem a bit odd at first. But the emphasis here is not on dry theory or
abstract concepts. Rather, it is on developing new thinking that leads to new ways of doing.
The ebd approach (experience based design) is a method of designing better experiences for patients, carers and staff. The approach captures the experiences of those involved in healthcare services. It involves looking at the care journey
and in addition the emotional journey people
experience when they come into contact with a particular pathway or part of the service. Staff work together with patients and carers to firstly understand these experiences and then to improve them.
This guide is an introduction to the ebd approach (experience based design).
This guide and toolkit has been produced as
a result of work that the NHS Institute for
Innovation and Improvement has undertaken in collaboration with NHS organisations and external agencies, using the experience of patients, carers and staff to design better
healthcare services.
This document is one of a series of documents that was produced by the NHS Institute for Innovation and Improvement as part of the High Volume Care programme.
Produced by the Delivering Quality and Value Team, the aim of the Focus on series was to help local health communities and organisations improve the quality
and value of the care they deliver
Support Sheet 18: PPC
This support sheet provides a description of Preferred Priorities for Care, a tool for the discussion and recording of end of life care wishes and preferences.
Support Sheet 15: Enhancing the Healing Environment
This support sheet outlines key design principles for end of life care environments and provides tips for managing an environmental improvement project
Support Sheet 14: Using the NHS Continuing Health Care Fast Track Pathway Tool
This support sheet provides answers to frequently asked questions about the NHS Continuing Health Care Fast Track Pathway Tool.
Support Sheet 13: Decisions made in a person's 'Best Interests'
This support sheet outlines the process for making decisions on behalf of someone who lacks capacity.
Support Sheet 12: Mental Capacity Act (2005)
This support sheet outlines the main provisions of the Mental Capacity Act the four tests essential for assessing capacity
Support Sheet 11: Quality Markers for Acute Hospitals
This support sheet outlines the quality markers by which acute hospitals can measure the standard of end of life care they provide.
Support Sheet 7: Models/Tools of Delivery
This support sheet outlines the key elements of
Advance Care Planning (ACP)
Gold Standards Framework (GSF)
Liverpool Care Pathway (LCP)
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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2. 2
Planning for your future care
Planning for your future care
a guide
There may be times in your life when you think
about the consequences of becoming seriously ill
or disabled. This may be at a time of ill health or as
a result of a life changing event. It may simply be
because you are the sort of person who likes to plan
ahead.
You may want to take the opportunity to think
about what living with a serious illness might mean
to you, your partner or your relatives, particularly if
you become unable to make decisions for yourself.
You may wish to record what your preferences and
wishes for future care and treatment might be or
you may simply choose to do nothing at all.
One way of making people aware of your wishes is
by a process that is called advance care planning.
This booklet provides a simple explanation about
advance care planning and the different options
open to you. The booklet uses some of the terms
contained within the framework of the Mental
Capacity Act (2005), so some of the language used
may be new to you.
3. Planning for your future care 3
What is Advance Care Planning?
Advance care planning is a process of discussion between you and those
who provide care for you, for example your nurses, doctors, care home
manager, social worker, family or friends.
During this discussion you may choose to express some views, preferences
and wishes about your future care so that these can be taken into account
if you were unable to make your own decisions at some point in the
future. This process will enable you to communicate your wishes to all
involved in your care.
Aspects of Advance Care Planning
Opening the
conversation
Exploring your options
Identifying your wishes
and preferences
Identifying who you
would like to be
consulted on your behalf
Letting people know
your wishes
Refusing
specific
treatment, if
you wish to
Appointing
someone to
make decisions
for you using a
Lasting Power
of Attorney
These points will be explained in this booklet.
Advance care planning is an entirely voluntary process and no
one is under any pressure to take any of the above steps.
4. 4
Planning for your future care
Opening the conversation
Having an advance care planning conversation with someone may lead to
one or more of the points mentioned in this booklet.
A conversation about advance care planning may be prompted by:
The wish to make plans just in case something unexpected
happens
Planning for your future or for retirement
Following the diagnosis of a serious or long term condition or
being aware that you may have a limited time to live
After the death of a spouse, partner or friend.
Not everyone will choose to engage in such a conversation
and that is fine. However, talking and planning ahead means
that your wishes are more likely to be known by others. This is
important for those responsible for making decisions about your
care if you lose capacity to make your own decisions because of
serious illness.
5. Planning for your future care 5
Explore your options
Advance care planning can occur at any time you choose. Ask your care
provider or someone close to you to have the discussion with you. You
may want to plan an appropriate time and place for having an advance
care planning conversation.
To explore what options are available to you, you and the person with
whom you have the discussion may need to seek some support and
advice.
You might have strong views about things that you would or would not
like to happen. For example, some people may say they would always
want to stay at home if they become ill. However this may not be a
realistic choice in some circumstances.
An example about exploring options
Ella lives with her daughter, son-in-law and two young
grandchildren. She knows she is approaching the end of
her life and would like to remain in her home. But Ella
also feels that she really must go into a nursing home
to save her family any extra work or upset. The idea is
causing her a great deal of worry.
Ella has not told her family her wishes so she does not
know how they feel about the possibility of looking after
her. She has not asked her doctor what support is locally
available to help her stay in her own home or if there
are any alternatives available to her other than a nursing
home.
Discussing and finding out all of the options available
might help Ella resolve some of her concerns and make
her future plans together with her family.
6. 6
Planning for your future care
Identify your wishes and preferences
The wishes you express during advance care planning are personal to you
and can be about anything to do with your future care.
You may want to include your priorities and preferences for the
future, for example:
How you might want any religious or spiritual beliefs you
hold to be reflected in your care
The name of a person/people you wish to be consulted
on your behalf at a later time; this could be a close family
member but can be anyone you choose
Your choice about where you would like to be cared for, for
example at home, in a hospital, nursing home or a hospice
Where you would like to be cared for at the end of your life
and who you would like to be with you
Your thoughts on different treatments or types of care that
you might be offered
How you like to do things, for example preferring a shower
instead of a bath or sleeping with the light on
Concerns or solutions about practical issues, for example who
will look after your pet should you become ill.
If you become unable to make a decision yourself, this
information will help those caring for you to identify what is in
your best interests and make decisions on your behalf.
7. Planning for your future care 7
Refusing specific treatment
During an advance care planning discussion, you may decide to express a
very specific view about a particular medical treatment which you do not
want to have. This can be done by making an advance decision to refuse
treatment.
An advance decision to refuse treatment (sometimes called a living will or
advance directive) is a decision you can make to refuse a specific type of
treatment at some time in the future. This is to be observed if you can’t
make your own decision at the time the treatment becomes relevant.
Sometimes you may want to refuse a treatment in some circumstances
but not others. If so, you must specify all the circumstances in which you
want to refuse this particular treatment.
There are rules if you wish to refuse treatment that is potentially life
sustaining, for example, ventilation. An advance decision to refuse this
type of treatment must be put in writing, signed and witnessed and
include the statement ‘even if life is at risk as a result’.
If you wish to make an advance decision to refuse treatment you are
advised to discuss this with a health care professional who is fully aware
of your medical history.
An advance decision to refuse treatment will only be used if at
some time in the future you lose the ability to make your own
decisions about your treatment.
Remember you can change your mind at any time.
8. 8
Planning for your future care
Ask someone to speak for you
You may wish to name someone – or even more than one person – who
should be asked about your care if you are not able to make decisions for
yourself. This person may be a close family member, a friend or any other
person you choose.
If in the future you are unable to make a decision for yourself, a health
or social care professional would, if possible, consult with the person you
named. Although this person cannot make decisions for you, they can
provide information about your wishes, feelings and values. This will help
the healthcare professionals act in your best interests.
This is not the same as legally appointing somebody to make decisions for
you under a lasting power of attorney. We look at that on page 10.
An example of naming someone to
speak for you
Sheelagh lives alone and has no living relative. She has
always received help and support from her lifelong friend
and neighbour Jenny.
As Sheelagh gets older she starts to think about what
will happen to her if for any reason her health fails. She
knows and trusts Jenny well and she decides to ask her to
be the person she would like to be consulted and speak on
her behalf, should the need ever arise.
Sheelagh is happy that her financial affairs continue to be
managed by her solicitor just as they always have been,
and discusses that with her solicitor.
10. 10 Planning for your future care
Making a Lasting Power of Attorney
You may choose to give another person legal authority (making them an
‘attorney’) to make decisions on your behalf if a time comes that you are
not able to make your own decisions. This can be a relative, a friend or a
solicitor.
A Lasting Power of Attorney (LPA) enables you to give another person
the right to make decisions about your property and affairs and/or your
personal welfare.
Decisions about care and treatment can be covered by a personal welfare
LPA. An LPA covering your personal welfare (sometimes called health and
welfare) will only be used when you lack the ability to make specific health
and welfare decisions for yourself.
There are special rules about appointing an LPA. You can get a special
form from the Office of the Public Guardian (OPG) or stationery shops
that provide legal packs. The form will explain what to do. Your LPA will
need to be registered with the Office of Public Guardians before it can be
used (see details on page 14).
LPA has replaced Enduring Power of Attorney.
11. Planning for your future care 11
An example of appointing a Lasting
Power of Attorney
Kamal lives with a heart condition and has limited
mobility; he has started to think about what might
happen in the future if his illness gets worse.
Kamal has always handled the finances and affairs for
both himself and his wife. They are both concerned that
should anything happen to him, his wife would find it
hard to cope with any major decisions or he may become
too ill to make decisions about his own care.
To give him and his wife peace of mind they both decide
to give Lasting Power of Attorney to their daughter.
They both discuss with Farah their thoughts about any
possible future decisions which may arise around money,
property or healthcare. By doing so their daughter
understands their wishes and preferences and can act for
them in the way they would choose should the need ever
arise.
Farah will only make decisions for her parents if a
time comes that they are unable to make decisions for
themselves.
12. 12 Planning for your future care
Let people know
Advance care planning does not always need to be in writing unless
you are making an advance decision to refuse life sustaining treatment.
However the professionals involved in your care and members of your
family may find it helpful if your wishes and preferences are in writing,
signed and dated. It is a good idea to give a copy of your wishes to
everyone who needs to know. Remember to keep your own copy safe.
By letting people know about your wishes you may have an opportunity
to discuss your views with those close to you.
If you have made an advance decision to refuse specific treatment you
must be sure that the people involved in your care know this. Ask your
nurse or doctor to help you do this.
13. Planning for your future care 13
Key points about advance care planning
No one is obliged to carry out advance care planning
You may wish to discuss your wishes with your carers, partner
or relatives
Include anything that is important to you no matter how
trivial it seems
If you wish to refuse a specific treatment, consider making an
advance decision to refuse treatment
It is recommended that anything you have written down
should be signed and dated
It is recommended you seek the advice of an experienced
healthcare professional if making an advance decision to
refuse treatment
If you make an advance decision that refuses treatment that
is life sustaining it must be in writing, signed, dated and
witnessed and use a specific form of words
If you have named someone to speak for you or have a
Lasting Power of Attorney, remember to write down their
name in your advance care planning documents
If your wishes are in writing or if you have a Lasting Power of
Attorney, keep a copy of the documentation safe and provide
copies to those who need to know your wishes e.g. nurse,
doctor carer or family member.
Remember you can change your mind at any time.
14. 14 Planning for your future care
Where to find further information
The following information is found on websites. You may be able to get
help to access these through your GP, health or social care worker, your
library or at a hospital information centre.
Dying Matters
10 leaflets focusing on having discussions and planning ahead can be
found at www.dyingmatters.org/overview/resources
Mental Capacity Act
Information about the Mental Capacity Act and the supporting Code of
Practice.
www.justice.gov.uk/guidance/protecting-the-vulnerable/mentalcapacity-act
Office of Public Guardian
The Office of Public Guardian is there to protect people who lack capacity.
Forms and guidance on appointing a Lasting Power of Attorney are
available.
www.publicguardian.gov.uk
Tel. 0300 4560300
Preferred Priorities for Care
A document which can be used to help write down preferences and
wishes for the future.
www.endoflifecareforadults.nhs.uk/tools/core-tools/
preferredprioritiesforcare
The Mental Capacity Act in Practice
Guidance for End of Life Care (2008) – The National Council for Palliative
Care.
www.ncpc.org.uk
Tel. 020 7697 1520
15. Planning for your future care 15
Good Decision Making – The Mental Capacity Act and End of Life
Care
A summary guidance to introduce people to the MCA and its contents
and to explain the importance for End of Life Care decision making.
www.ncpc.org.uk
Advance Decisions to Refuse Treatment website
A training website for professionals which contains a patient section.
www.adrt.nhs.uk
NHS Choices
A website providing information on conditions, treatments, living well and
support for carers.
www.nhs.uk
Age UK LifeBook
The LifeBook is a free booklet to document important and useful
information about your life, from who insures your car to where you put
the TV licence.
www.ageuk.org.uk/home-and-care/home-safety-and-security/
lifebook/
Tel. 0845 685 1061 quoting reference ALL 721
Healthtalkonline
A website detailing people’s experiences of dying and bereavement,
including sections on caring for someone with a terminal illness.
www.healthtalkonline.org/Dying_and_bereavement/