Author and Publication
Author: Nellie Supports Ltd
Publication Date: 15/05/2026
Citation
PC v City of York Council [2013] EWCA Civ 478.
Copywright
Copyright © 2026 Nellie Supports Ltd. All rights reserved.
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Abstract
This guide explains capacity for personal welfare decisions under the Mental Capacity Act 2005. It sets out which decisions fall within personal welfare, why each decision must be assessed separately, the relevant information typically engaged by care, contact and treatment decisions, how personal welfare capacity differs from property and affairs capacity, and what a welfare capacity report should contain to be useful to families, local authorities and the Court of Protection.
What is capacity to make personal welfare decisions?
Personal welfare covers the decisions that shape a person's daily life, including care and support, medical treatment, and contact with other people. It is assessed under the same statutory framework as financial decision making, but the relevant information is different, the evidence base is different and the consequences of getting it wrong are felt immediately rather than at some later point. This guide explains how personal welfare capacity is assessed and what a robust welfare capacity report should contain.
What personal welfare decisions cover
Personal welfare is the broad category of decisions concerning a person's health, care and daily living, as opposed to their property and financial affairs. It includes decisions about the care and support a person receives, medical treatment and whether to consent to or refuse it, contact with family members and others, and matters of daily routine such as diet, hygiene and activity. Residence, meaning where a person lives, sits alongside personal welfare and is closely connected to it, but it is treated as a distinct decision with its own relevant information.
Why each welfare decision must be assessed separately
There is no such thing as capacity for personal welfare in general. The Mental Capacity Act 2005 requires that capacity is assessed in relation to a specific decision at the time it needs to be made. A person may be able to decide who visits them but unable to weigh the risks of declining a particular treatment. They may be able to choose what to eat but unable to understand the consequences of refusing all care. An assessment which concludes that someone lacks capacity for personal welfare, without identifying which welfare decisions were actually assessed, is unlikely to withstand scrutiny and is one of the most common reasons welfare reports are questioned.
Relevant information for care and support decisions
For a care and support decision, the relevant information usually includes what care is being proposed, what the person's needs actually are, what would happen if the care were not provided, the practical alternatives available, who would deliver the care and how it would affect the person's daily life and independence. The information should be tailored to the person's real circumstances and options. It should not be drawn from a generic template, because a person can only be expected to understand and weigh the choices genuinely open to them.
Relevant information for contact decisions
Contact decisions are often the most emotionally charged and the most poorly assessed. The relevant information typically includes who the person is, the nature of the relationship, what contact would involve in practical terms, and the reasonably foreseeable benefits and risks of having or not having that contact. Assessors should be careful to distinguish between a person who cannot weigh the risks associated with a particular individual and a person who understands those risks perfectly well and has simply reached a decision that others regard as unwise. An unwise decision is not, on its own, evidence of incapacity.
Relevant information for treatment decisions
For a decision about medical treatment, the relevant information includes the nature and purpose of the proposed treatment, the main benefits and risks, the likely consequences of not having it, and the alternatives. The level of understanding required is proportionate to the seriousness of the decision. A decision to decline a minor intervention engages far less information than a decision to refuse treatment which is necessary to sustain life, and the depth of the assessment should reflect that.
How personal welfare capacity differs from property and affairs capacity
The statutory test is identical, but very little else is. Financial capacity is frequently evidenced through documents, bank records and transaction histories, whereas welfare capacity depends far more heavily on direct observation, on care records, and on the accounts of people who know the person. Welfare decisions also tend to recur rather than resolve, which means capacity may need to be revisited as circumstances change. A person may lack capacity to manage complex property and financial affairs whilst retaining capacity to decide who visits them, and it is a serious error to treat a finding on one as determining the other.
Practicable steps and communication
The Act requires that all practicable steps are taken to help a person make the decision before they are treated as unable to make it. In welfare matters this often makes the difference between a finding of capacity and a finding of incapacity. Practicable steps include assessing at the time of day when the person is at their best, using plain language and short sentences, presenting one element of the decision at a time, using visual aids or communication tools, involving a speech and language therapist or advocate where communication is impaired, and returning on a second occasion where presentation fluctuates. These steps should be recorded, because an assessment which does not evidence them is vulnerable to challenge.
What a welfare capacity report should contain
A robust report should identify the specific welfare decision or decisions assessed, the legal framework applied, the relevant information for each decision, the evidence reviewed, the practicable steps taken and the person's responses in their own words. It should then set out the functional analysis against understanding, retaining, using or weighing and communicating, identify any impairment of, or disturbance in the functioning of, the mind or brain, and explain the causative link between that impairment and the specific inability found. Where capacity is lacking, the report should be clear about what it does and does not conclude, so that any subsequent best interests process starts from an accurate position.
Key takeaway
Personal welfare capacity is not a single question and cannot be answered as one. The value of a welfare capacity report lies in the precision with which it names the decisions assessed, sets out the relevant information for each, evidences the support offered and explains how a specific impairment affects the person's ability to make that specific decision. Reports which conclude on personal welfare generally, or which rely on diagnosis in place of functional analysis, tend to create more difficulty than they resolve.
Frequently asked questions
Can someone have capacity for one welfare decision but not another?
Yes, and this is common. Capacity is decision-specific. A person may be able to decide about contact whilst being unable to weigh the consequences of refusing a significant treatment. Each decision must be assessed and reported separately.
Is refusing care evidence that someone lacks capacity?
No. A person who understands the relevant information and can weigh it is entitled to make a decision others consider unwise. The question is whether the person can understand, retain, use or weigh the information and communicate a decision, not whether the outcome is one professionals would have chosen.
Does a welfare finding also cover finances?
No. Personal welfare and property and affairs are distinct, and a conclusion on one does not determine the other. Where both are in question, both must be assessed, and the report should address each separately.
Related mental capacity assessment pages
These internal links help readers move from this guide to the most relevant Nellie Supports service page, assessment option or legal framework page.
Need an independent personal welfare capacity assessment?
Nellie Supports provides independent, decision-specific capacity assessments for care, contact and treatment decisions across England and Wales, delivered by a permanent employed team with internal peer review on every report. Call 0333 987 5118 or send an enquiry at https://www.nelliesupports.com/contact and our client liaison team will respond the same working day.