Preferred Priorities for Care document (England and Wales)
Preferred Priorities for Care is a document where you can record simple statements of your wishes and preferences for your healthcare.
The ways people can plan ahead vary across the four nations of the UK (England, Scotland, Wales and Northern Ireland) and there are also some legal differences. The web pages in this section are about the ways people can plan ahead if they live in England and Wales. If you live in Scotland or Northern Ireland you should ask a healthcare or legal professional to give you information that’s relevant to that country.
Documenting your wishes means that healthcare professionals know how you’d like to be cared for if you ever become seriously ill and unable to tell others what you want to happen.
Although these statements about your wishes and preferences aren’t legally binding, they will be very helpful for healthcare professionals when they make decisions about your care.
You can downoad the Preferred Priorities for Care document [PDF, 99kb].
What to include in your Preferred Priorities for Care document
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As far as possible, you should include anything that’s important to you. If you’re worried about a particular aspect of your care, you can make a plan for what you would like and record this in your Preferred Priority for Care statements.
Where you would like to be cared for if you can no longer look after yourself - for example at home, in a hospital, nursing home or hospice.
What kind of care you would like - however, you can’t demand particular treatments.
Where you would like to be cared for when you are dying - for example at home, in a hospital, nursing home or hospice.
Information about specific spiritual or religious practices that you’d like to be carried out or reflected in your care.
Which people - family or close friends - you would like to be involved in your care.
Who you would like to act on your behalf if decisions need to be made about your care.
Who you would like to look after any pets.
Whether you would like someone to tell you how serious your condition is and the likely prognosis.
Before you write down your wishes and preferences, it can help to talk through your plans with your family or a close friend. This can be particularly helpful if you want them to be involved in your care or make decisions on your behalf.
You should also talk through your plans with one or two of the healthcare professionals looking after you, such as your GP or nurse specialist. You may want to discuss whether your choices and wishes are realistic and if not, think of some alternatives. For example, if you would prefer to die at home but have no close friend or family member who would be able to support you at home, it may be more realistic for you to be cared for in a nursing home or hospice.
It may not always be possible for your wishes and preferences to be met at the time when you become less well. For example, you may want to be cared for at home by a family member but if they become ill or over-tired they may be unable to care for you. In this case, healthcare professionals may be able to arrange care for you so you can stay at home. However, if this isn’t possible they will plan for you to receive the best possible care somewhere else, for example in a nursing home or hospice.
Example of some of the information included on a Preferred Priorities for Care document:
Your preferences and priorities
Here are some examples of the information you might be asked to include:
In relation to your health, what has been happening to you?
My doctors have told me that I am now only receiving care to control my symptoms. Curing my illness is no longer possible.
What are your preferences and priorities for your future care?
If I were to become less well I'd like my wife to be involved in making decisions about my care and I'd like to be kept fully informed about what's happening to me.
Where would you like to be cared for in the future?
I don't mind where I am cared for as long as my family are close by.
You will also be asked to sign and date the document.
Documenting your Preferred Priorities for Care
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You can ask your healthcare professionals for a document so that you can record your wishes and preferences.
Or you can use the National End of Life Care Programme Preferred Priorities for Care document [PDF, 99kb] (original document from NHS National End of Life Care Programme).
Once the document is completed, you should share it with anyone who is, or is likely to be, involved in your care such as a family member, close friend, GP or hospital doctor. You may want to give your GP or hospital doctor a copy for their records.
You can change your mind about your Preferred Priorities for Care at any time, but remember that you’ll need to make sure you record your changes. You will need to let your family, GP and/or hospital doctor know and give them an updated copy of the document.
Keep your written Preferred Priorities for Care document in a safe place so that it can be easily found by those involved in your care. Remember to regularly review your choices and keep them up-to-date.
If you’re admitted or transferred to a hospital or hospice, take your document with you so that the staff know what your wishes and preferences are for your care.
An example of Preferred Priorities for Care in action - Adrienne's story
In February, my father-in-law Dennis was diagnosed with small cell lung cancer. Unfortunately, the treatment didn’t work and in August the doctors told that him that he wouldn’t benefit from any further active treatment. Although disappointed, Dennis was relieved to stop as it was exhausting him.
During the course of the next few months, Dennis was referred to the Community Macmillan Nurse who helped him and my mother-in-law, Joyce, talk to each other about the fact that he was dying.
As an ex-district nurse myself, I was keen for the district nurses to discuss with Dennis and Joyce his preferred priorities for care and write them down. The district nurses were reluctant but when I spoke again to them they said Dennis had expressed a wish to die in a hospice. I knew this was not the case as he was petrified of hospices and had previously refused to attend the day hospice centre. I asked the district nurses to go back and speak to Dennis about his wishes, and help him document them using the Preferred Priorities for Care document. One of the district nurses phoned me back to say Dennis had stated, and written down, that he wanted to die at home (and not in a hospice as the district nurses had suggested) as long as Joyce could cope. As a family we knew this was what he wanted and we all agreed to help Joyce cope.
Over the next few weeks Dennis grew weaker. GPs suggested transferring him to the hospital or hospice, but each time we were able to show them his written Preferred Priorities for Care document and insist he stayed at home.
We had nurses overnight some nights and the family took it in turns the other nights. In October, Dennis died at home, in his own bed, with his dog Murphy lying beside him and his granddaughter Lauren holding his hand. It was a great comfort to Joyce and the rest of the family to know that Dennis’s wish to die at home had been fulfilled.