Planning for the Future

Advance Care Planning

The Vesey recognises that patients with serious or life-limiting illness benefit from the opportunity to discuss and record their wishes and preferences about future care. Where clinically appropriate, our clinicians offer advance care planning conversations in a sensitive and unhurried way. Documented advance care plans are held in the patient record and communicated to other treating clinicians, including the patient's GP, with the patient's consent.

Mental Capacity Act 2005 — Application in Practice

All clinical staff are trained in the Mental Capacity Act 2005 (MCA) and the five key principles. When there is a question about a patient's capacity to make a specific decision, a formal capacity assessment is conducted and documented, following the two-stage capacity test. Where a patient lacks capacity, decisions are made in their Best Interests following consultation with family members, carers, and other professionals involved in their care. All Best Interests decisions are documented with the rationale, people consulted, and outcome.

• MCA training: mandatory for all clinical staff; included in training matrix
• Capacity assessments: conducted using MCA-compliant two-stage process; documented in patient record
• Best Interests decisions: documented with rationale, people consulted, and date
• Independent Mental Capacity Advocate (IMCA): referral pathway available where no family/carer involved in serious decisions

Lasting Power of Attorney and Legal Documentation

Where a patient has registered a Lasting Power of Attorney (LPA) — either for Health and Welfare or Property and Financial Affairs — this is noted in the patient record. Clinicians are trained to ask about and act on LPA arrangements when discussing significant medical decisions. Attorneys for Health and Welfare are involved in care decisions when a patient lacks capacity, and this involvement is documented. We do not make decisions contrary to the wishes of a legally appointed attorney without independent legal advice.

Palliative and End-of-Life Referral Pathways

The Vesey maintains documented referral pathways to palliative care services, hospice teams, and community nursing services. Patients with life-limiting diagnoses are offered referral to specialist palliative care at an appropriate point in their illness trajectory. Clinicians are trained in end-of-life communication skills and are familiar with tools such as the Gold Standards Framework (GSF) Prognostic Indicator Guide. Referrals to Birmingham Hospice and BSMHFT palliative care teams are made via agreed pathways.