Advance Statement UK: Examples & Uses

An Advance Statement lets you document your preferences, values, and wishes regarding future care when you might be unable to express them. Unlike legally binding Advance Decisions to Refuse Treatment, Advance Statements provide broader guidance about your personal preferences and beliefs. Though not legally binding, these documents play a crucial role in person-centred care by helping healthcare professionals and loved ones make decisions aligned with your values. This practical guide explores how to create effective Advance Statements with real-world examples and explains how they influence care decisions.

What Is an Advance Statement?

An Advance Statement is a written document that communicates your preferences, values, wishes, and beliefs about your future care and treatment. It comes into effect only if you lose the capacity to make or communicate decisions for yourself.

According to the NHS, Advance Statements differ from Advance Decisions to Refuse Treatment (ADRTs) in several important ways:

Legal status: While Advance Statements must be considered by healthcare professionals, they are not legally binding in the same way as ADRTs. They provide guidance rather than absolute directives.

Scope: Advance Statements can cover any aspect of your future health or social care – from medical preferences to daily routines, food choices, religious practices, and personal care preferences.

Format: There is no legally prescribed format for an Advance Statement, though clear, specific documentation increases its effectiveness.

The Mental Capacity Act 2005 Code of Practice establishes that while not legally binding, Advance Statements must be taken into account when determining a person's best interests. This means healthcare professionals have a duty to consider your stated preferences when making decisions on your behalf.

Key Components of an Effective Advance Statement

While Advance Statements have no required legal format, certain elements significantly increase their usefulness and influence in care settings.

Personal Information and Values

Start with clear identification and a statement of your overall values:

Identification details:

Full name and date of birth
NHS number (if known)
Address and contact information
GP details

Values statement:

Your general approach to life and health
Religious or spiritual beliefs affecting care
Cultural practices important to you
Overall quality of life considerations
What gives your life meaning and purpose

Research from the King's College London Cicely Saunders Institute shows that clearly articulated values help healthcare professionals interpret specific preferences in changing circumstances.

Daily Living Preferences

Detail your preferences for everyday routines and care:

Personal care preferences:

Bathing and hygiene routines
Clothing preferences and style
Grooming habits and preferences
Sleep patterns and bedtime routines
Preferred names and terms of address

Food and drink preferences:

Favourite foods and dietary preferences
Mealtimes and eating routines
Cultural or religious food practices
Food allergies or sensitivities
Comfort foods during illness

Daily activities:

Important daily routines
Hobbies and interests
Television or music preferences
Reading materials
Social interaction preferences

The Social Care Institute for Excellence emphasizes that these seemingly small details significantly impact wellbeing when receiving care.

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Healthcare Preferences

Express your wishes regarding medical care approaches:

Treatment preferences:

General approaches to medical intervention
Pain management preferences
Complementary therapies you value
Preferences regarding specialist referrals
Attitudes toward experimental treatments

Care environment preferences:

Preferred place of care (home, hospital, hospice, care home)
Environmental factors (lighting, noise, privacy)
Importance of access to outdoors or nature
Visiting arrangements for family and friends
Pet therapy or animal contact preferences

Communication preferences:

How you prefer to receive medical information
Who should be involved in discussions about your care
Language or communication support needs
Preferred level of detail about your condition
How decisions should be explained to you

Age UK notes that clearly documented healthcare preferences help ensure continuity of person-centred care across different settings and staff changes.

Emotional and Spiritual Support

Outline what brings you comfort during difficult times:

Emotional support needs:

How you typically cope with stress or illness
Whether you prefer company or solitude when unwell
Specific people whose presence comforts you
Topics of conversation that distress or comfort you
How you prefer to be supported when upset

Spiritual and religious practices:

Religious rituals or prayers important to you
Spiritual advisors who should be contacted
Religious objects you wish to have with you
End-of-life religious requirements
Cultural practices surrounding illness or death

Meaningful connections:

Key relationships to maintain during illness
Support for maintaining these connections
Important anniversaries or dates
Photographs or mementos that provide comfort
Digital connections important to maintain

Spiritual Care Association research demonstrates that honoring spiritual preferences significantly impacts wellbeing during serious illness.

Advance care planning examples

These real-world examples demonstrate effective Advance Statements for different situations:

Example 1: General Care Preferences

ADVANCE STATEMENT FOR CARE

Name: Margaret Wilson

DOB: 15/03/1948

NHS Number: 123 456 7890

MY VALUES AND BELIEFS:

I have always valued my independence and privacy. My family, especially my grandchildren, give my life meaning. I believe in living each day fully and would rather have quality of life than quantity.

DAILY LIVING PREFERENCES:

I prefer to shower in the evenings rather than mornings. I like to dress in coordinated outfits with matching jewelry—appearance has always been important to me. I enjoy reading the newspaper with breakfast, which I prefer at around 8:30 am. I do not like tea or coffee but enjoy hot water with lemon.

If I need assistance with personal care, I would prefer female carers. I am comfortable with medical students being present during consultations but would prefer examinations to be conducted with minimal people present.

HEALTHCARE PREFERENCES:

I prefer to know all details about my condition and treatment options, even difficult news. I want my daughter Jane (07700 900123) involved in all medical discussions when possible.

I would prefer to receive care at home for as long as possible. If this becomes impossible, I would accept hospice care but would prefer to avoid long hospital stays if alternatives exist.

I have a high pain threshold but would want effective pain management if needed. I am open to using morphine or similar medications if required for comfort.

COMFORT AND SUPPORT:

When unwell, I find comfort in classical music, particularly Bach. I enjoy having fresh flowers in my room and natural light. I find great comfort in my Anglican faith and would appreciate regular visits from a chaplain if I am seriously ill. My prayer book should remain with me.

Created: 10/09/2023

Signature: Margaret Wilson

Witness: James Wilson (son)

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Example 2: Dementia-Specific Advance Statement

ADVANCE STATEMENT: MY FUTURE CARE PREFERENCES

Name: Robert Thomas

DOB: 22/11/1952

GP: Dr. Sarah Johnson, Hillside Surgery

ABOUT THIS DOCUMENT:

I have recently been diagnosed with early-stage Alzheimer's disease. I am creating this document while I have capacity to record my preferences for future care when I may not be able to express them.

MY BACKGROUND:

I was a secondary school science teacher for 35 years. I enjoy gardening, walking, and playing chess. I have always been independent and enjoyed intellectual pursuits. I have two children, Michael and Susan, and four grandchildren.

IF MY DEMENTIA PROGRESSES:

DAILY ROUTINE:

I have always been an early riser and prefer to start my day around 6:30 am. I enjoy porridge with banana for breakfast. Structure and routine help me feel secure, so I would appreciate consistent daily schedules.

PERSONAL PREFERENCES:

I prefer showers to baths. I have always been clean-shaven and would wish to remain so. I prefer comfortable casual clothes (never been one for pajamas during the day).

If I become distressed, the following usually helps calm me:

- Going outdoors, especially to garden areas

- Looking at my family photo album (kept in my bedside drawer)

- Listening to jazz music

- Having someone sit quietly with me without asking too many questions

COMMUNICATION:

If I have difficulty communicating, please:

- Speak clearly and allow me time to process

- Use simple, direct sentences

- Don't correct me repeatedly if I make mistakes

- Use pictures or writing if it helps

- Respect that even if I cannot speak clearly, I may still understand what's happening around me

IMPORTANT RELATIONSHIPS:

My wife Jean knows me best and should be consulted about my care. If I do not recognize family members, please don't force me to remember but gently orient me if I seem receptive.

MEDICAL CARE:

I would prefer to avoid sedating medications unless absolutely necessary for my safety or comfort. I would rather have non-pharmacological approaches tried first for behavioral issues.

Created: 15/08/2023

Signature: Robert Thomas

Witness: Jean Thomas (wife)

How Advance Statements Influence Care Decisions

Advance Statements impact care in several important ways across different settings.

Integration into Care Planning

According to the National Institute for Health and Care Excellence, Advance Statements should be incorporated into care planning through:

Care plan documentation: Relevant preferences should be highlighted in care plans used by all staff members providing direct care.

Multidisciplinary team discussions: Key preferences should be communicated during handovers and team meetings to ensure consistency of approach.

Regular reviews: As needs change, care teams should revisit Advance Statements to ensure care remains aligned with documented preferences.

Flagging systems: Electronic records should flag the existence of Advance Statements to alert new staff members or teams.

In Hospital Settings

In hospitals, Advance Statements influence care through:

Admission processes: Identifying the existence of Advance Statements during admission helps establish person-centred care from the beginning.

Ward routines: Accommodations to standard routines can be made based on documented preferences.

Treatment discussions: Clinicians use Advance Statements to guide discussions with family members or appointed decision-makers about treatment options.

Discharge planning: Preferences regarding place of care help shape appropriate discharge arrangements.

The Royal College of Physicians recommends hospital staff actively seek information about Advance Statements when patients lack capacity to express their preferences.

In Community and Care Home Settings

In community settings, Advance Statements support:

Personalized care packages: Home care services can be tailored to individual routines and preferences.

Carer briefing and training: Family or professional carers use Advance Statements to understand needs and preferences.

Environment modifications: Living spaces can be adapted based on documented preferences for comfort and function.

Activity planning: Meaningful engagement activities align with documented interests and preferences.

Research from the Social Care Institute for Excellence demonstrates that care homes utilizing Advance Statements effectively show higher resident satisfaction and better care outcomes.

Updating and Secure storage for Advance Statements

To ensure your Advance Statement remains effective, consider these practices:

Regular Reviews

The Alzheimer's Society recommends:

Scheduled reviews: Set calendar reminders to review your Advance Statement annually or after significant life changes.

Health trigger reviews: Reassess your Advance Statement after new diagnoses or changes in health status.

Documentation of reviews: Note on your document the date of review and any changes, or confirmation that it still reflects your wishes.

Witnessing updates: Have significant changes witnessed, even though not legally required, to reinforce their authenticity.

Effective Storage Solutions

Ensure your Advance Statement is accessible when needed:

Multiple copies: Distribute copies to key people including your GP, close family, and any appointed attorneys.

Electronic records: Ask your GP to add your Advance Statement to your medical records and Summary Care Record.

Hospital records: If you have a long-term condition, provide copies to relevant hospital departments.

Home storage: Keep a copy in an obvious location at home, potentially with other important documents.

Digital options: Consider digital storage solutions with emergency access provisions.

Carry information: Carry a card in your wallet stating that you have an Advance Statement and where to find it.

Checklist for Creating Your Advance Statement

Use this checklist to ensure your Advance Statement is comprehensive and effective:

□ Identification Information

Full name and date of birth included
NHS number (if known)
Contact details current
GP information accurate

□ Personal Values

General approach to life described
Religious or spiritual beliefs documented
Cultural practices explained
Quality of life considerations addressed

□ Daily Living Preferences

Personal care routines outlined
Food and drink preferences detailed
Important daily activities described
Clothing and appearance preferences noted
Sleep patterns and preferences included

□ Healthcare Preferences

Preferred place of care stated
Pain management preferences addressed
Communication preferences explained
Environmental preferences described
Visiting arrangements outlined

□ Emotional and Spiritual Support

Comfort measures identified
Key relationships noted
Religious practices detailed
Coping strategies described
Important personal items listed

□ Practical Considerations

Document dated and signed
Witness signature included (recommended)
Storage locations noted
List of who has copies maintained
Review date scheduled

Next Steps: Creating Your Advance Statement

Begin documenting your care preferences with these practical steps:

Reflect on your values and preferences regarding daily care, medical treatment approaches, and what brings you comfort.
Discuss your thoughts with trusted family members or friends to refine your understanding of what matters most to you.
Draft your Advance Statement using the examples and structure provided in this guide as a starting point.
Review your draft with healthcare providers who know you well to ensure medical preferences are clear and realistic.
Finalize your document with signature, date, and witness signature (while not legally required, this adds credibility).
Share copies with relevant people including your GP, close family members, and any appointed attorneys.
Schedule regular reviews to keep your Advance Statement current and reflective of your wishes.

By creating a thoughtful Advance Statement, you provide invaluable guidance to those who may need to make decisions on your behalf. This document helps ensure that your care remains aligned with your personal values and preferences even when you cannot express them directly—an important component of comprehensive advance care planning that supports dignity and individuality throughout life's journey.

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Advance Statement (UK): Examples and How It's Used in Care