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Advance Decisions Policy

It is a general principle of law and medical practice that adults have a right to consent to or refuse treatment. The courts have recognised that adults have the right to say in advance that they want to refuse treatment if they lose capacity in the future, even if this results in their death. A valid and applicable advance decision to refuse treatment has the same force as a contemporaneous decision. This has been a fundamental principle of the common law for many years and is now set out in the Mental Capacity Act 2005, which came into force in 2007 supported by the Code of Practice to the Act. Derbyshire Community Health Services NHS Foundation Trust aims to achieve a more balanced partnership between patients and healthcare professionals and acknowledges that it is the right of every adult patient with capacity to determine whether or not to accept medical treatment. In addition, it is the right of every adult patient to express views about their future care and treatment. The primary responsibility lies with the patient (the maker) to write an Advance Decision to Refuse Treatment (ADRT). The Trust endorses the good practice of staff, set out in national guidance and professional standards to provide information to and general support for patients who wish to write an ADRT. The Trust always encourages patients who wish to discuss their plans for future care and will provide advice to patients and support to advance care planning by helping to coordinate care and communicate plans. In addition, it is supportive of those patients who present with an advance decision and where this is valid and applicable, comply with that specific decision. This policy should be read in conjunction with the Trust’s Consent Policy and aims to raise awareness and give guidance to staff about advance decisions.

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This document should be read in conjunction with the overarching DCHS Standard Operating procedure on Clinical Harms which outlines the processes to be followed to deliver a consistent approach to. • Risk stratification to minimise clinical harm as a result of delays in care. • Embedding systems which take into account health inequalities. • Monitoring waiting times against defined thresholds across pathways of care. • Delivering personalised, patient-centred communications to patients who are waiting for care. • Implementing Harm Reviews that support the Trusts governance and assurance processes and maintains practice in line with national expectations. The intention of the service level document is to provide specific detail on. • The risk stratification process in operation and clinically appropriate to specific service lines and patient cohorts • Waiting time thresholds for the relevant patient pathways

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