Health and welfare · England and Wales
Capacity for health and welfare decisions
Does the person have the mental capacity to make the specific health or welfare decision being considered?
When there is a genuine question about a person’s ability to decide about their health or welfare, we assess the particular choice they face. We use the relevant information about the proposal, its alternatives and its likely consequences, then explain our opinion in a written report.
We need to know what the person is being asked to decide, the options available and the information they have been given. An assessment of one decision does not answer every question about their health and welfare.
You receive a written report explaining our opinion, the evidence behind it and any limitations. We agree the question and any specific reporting requirements before the assessment.
Assessments for families and professional referrers across England and Wales.
When might you need an assessment?
A person may decline treatment, question professional advice or make a choice their relatives find worrying. The assessment asks whether they can make that choice themselves. We need a defined proposal and appropriate information from the treating team; a broad request to assess all health and welfare decisions is insufficient.
Treatment and investigations
Send us the actual proposal from the treating clinician or team, including the benefits, risks and alternatives. We use that information to assess the person’s ability to decide; we do not recommend the treatment or substitute our own medical advice.
Other welfare decisions
Explain what the person needs to decide and why the question has arisen. This might concern sharing health information or a particular aspect of a discharge plan. Decisions about care, residence or contact may also need assessment, but they should not be treated as one blanket question.
A report for proceedings
Tell us if there is a court application, order or deadline. We need to see the question and any directions so that we can agree the right assessment and report. The standard service does not automatically include COP3 forms or expert evidence for proceedings.
What will the assessor consider?
We begin with the presumption that the person has capacity and take all practicable steps to help them decide. We first consider whether they can understand, retain, use or weigh the relevant information and communicate their decision by any means. If they cannot, we then consider whether that inability is caused by an impairment of, or disturbance in, the functioning of the mind or brain.
Making the information accessible
We explain the proposal in manageable amounts and check what helps the person understand it. Written information, communication aids, extra time and breaks may be useful. We consider their decision-making with that support, rather than expecting them to manage an unfamiliar discussion unaided.
Understanding their reasons
The assessor explores how the person considers the options, not simply whether they give a yes or no answer. Refusing advice, taking a risk or making a decision others regard as unwise does not, by itself, show that they lack capacity.
What the report explains
The report names the decision assessed and records the information considered, the support provided and the person’s responses. It explains our reasoning, conclusion and any limitations. If several decisions are included in an agreed instruction, the report deals with each separately.
Checking and delivering the report
A second qualified professional peer reviews the reasoning, evidence and structure before secure delivery. This is a check of the report, not another assessment of the person. The person instructing us can ask for clarification after receiving it.
- What is being proposed and what it would involve for them.
- Why it is proposed and what it is intended to achieve.
- The expected benefits and how likely they are.
- The main risks or side effects, explained in terms the person can understand.
- The alternatives, including doing nothing, and the likely consequences of each.
- That they have a choice and can express agreement or refusal.
How to arrange the assessment
Tell us about the decision
Explain what is proposed, who needs the report and any deadline. Please mention disagreements, earlier assessments and any court involvement.
Agree the work
We confirm the question, records needed, fee and timetable in writing. We also discuss the person’s communication needs and a suitable place and time for the appointment.
Meet the assessor
We discuss the proposal and the available choices with the person, using the information supplied by the responsible team. A home visit is usual; another setting or remote appointment may be appropriate.
Receive the report
After peer review, we send the report securely. If the evidence is not sufficient for an opinion, we explain what is missing and whether further information or assessment is needed.
What should you send us?
Start with the decision, who needs the report and any deadline. We will explain which documents would help and how to share them securely. Please use the general enquiry form for a short summary; medical, legal and financial records should be sent through the secure route agreed with our team.
- The proposal from the treating clinician or responsible team, including alternatives, benefits and risks.
- Medical information relevant to the decision, including any recent changes in the person’s condition.
- A relevant health and welfare LPA, advance decision, court order or other existing authority.
- Earlier capacity assessments, care plans and relevant daily notes.
- The person’s expressed wishes and observations from people who know them, identifying who supplied each account.
- Communication or accessibility needs and the intended use of the report.
What does it cost?
The standard fee is £720 including VAT for one assessment and report on the agreed health or welfare decision. Relevant-record review, peer review and secure delivery are included. If you need several decisions assessed, we agree the work and quotation before booking.
Standard health and welfare capacity assessment
£720 including VAT
£600 net + £120 VAT
One standard assessment and written report for the agreed health or welfare decision, including relevant-record review, peer review and secure delivery.
Mental capacity assessment reports are delivered within five working days of the completed assessment. Appointment dates are arranged through our reception and client liaison team.
Common health and welfare questions
Does refusing treatment mean someone lacks capacity?
No. We assess whether the person can make the particular decision with the relevant information and practicable support. Refusal, disagreement with clinicians or an unwise choice does not, on its own, establish incapacity.
Is the assessment a best-interests decision?
No. It addresses whether the person can decide for themselves. If they lack capacity, a separate best-interests process may be needed. Our report can inform that process but does not replace the decision-maker’s responsibilities.
Can one report cover more than one decision?
Yes, where this is agreed in the instruction. Each decision needs its own relevant information, assessment and conclusion. For example, a finding about one treatment should not simply be applied to a different treatment or to where the person should live.
What if their condition changes during the day?
Tell us about any fluctuations and when they are best able to take part. Timing, support and the urgency of the decision matter. The report explains when the findings apply and any need for further assessment.
Can the report be used in court?
Tell us the intended use and provide any court directions before booking. We check the required form and scope and quote for court-specific work separately. A standard report is not a guarantee of acceptance by a court.
What if we disagree with the conclusion?
We explain the evidence and our reasoning. The opinion is independent of the wishes of the person paying for the assessment. If there is insufficient evidence, we say so; that does not itself establish incapacity.
The law and further reading
These sources explain the Mental Capacity Act 2005 framework for England and Wales. The related guides provide more detail about preparing for an assessment and understanding the report.