For more information, read the full policy by downloading the accessible Word document at the end of this page.
Who the policy applies to
- All NHS Essex staff
- People working in services funded by NHS Essex
- Organisations that provide care on behalf of NHS Essex
Why this policy is important
Some people may not be able to make certain decisions because of illness, disability or injury.
This policy helps make sure:
- people are supported to make their own decisions wherever possible
- decisions made for someone else are safe and fair
- people’s rights, choices and dignity are protected
- care and treatment meet legal and ethical standards
It also supports consistent decision-making across NHS services.
Supporting people to make decisions
The policy is based on five key principles:
- People should be assumed able to decide for themselves unless shown otherwise
- Staff must give support to help people make decisions
- People have the right to make decisions others may see as unwise
- Decisions made for someone must be in their best interests
- Choices should limit restriction on freedom as much as possible
Checking if someone can decide
Staff must assess whether a person can make a specific decision at the time it is needed.
They look at whether the person can:
- understand the information
- remember it long enough
- weigh up the options
- share their decision in any way
Making decisions in someone’s best interests
If a person cannot decide, staff must:
- involve the person as much as possible
- consider their wishes, beliefs and values
- listen to family, carers or advocates
- choose the option that causes the least restriction
This helps make decisions that reflect what matters most to the person.
Planning ahead for care
People can plan ahead in case they cannot make decisions in the future. For example:
- they can refuse certain treatments in advance
- they can choose someone they trust to make decisions for them
These choices must be respected if they are valid.
Support and advocacy
Some people may need extra help to be heard.
An independent advocate can:
- represent the person
- help explain their wishes
- support fair decision-making
This support is important when there is no family or friend to help.
Keeping people safe
Sometimes care needs to limit a person’s freedom to prevent harm.
The policy makes sure that:
- any restriction is necessary and proportionate
- it is used for the shortest time possible
- strong legal checks are in place when freedom is restricted
This protects people’s safety and their human rights.
Roles and responsibilities
NHS Essex and the services it funds must:
- follow the law when making decisions about care
- train staff to apply the policy correctly
- check that services follow these standards
- take action if concerns are identified
All staff must understand their role and act in line with the policy.
Policy review
This policy was approved on 1 April 2026 and is due for review in April 2028.
For full details, download the accessible Word version of the policy below.