Best-interests and care-planning assessment
An assessment of whether someone can make a specific decision about their care or treatment, and if not, what choice is in their best interests.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- It checks whether someone can make one specific decision, and if not, helps decide what is in their best interests.
- Capacity is decision-specific and can change; lacking capacity for one choice does not mean lacking it for all.
- A best-interests decision must reflect the person's own wishes and values and choose the least restrictive option.
- Wherever possible, the goal is to support the person to make their own decision, not to take it away.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your psychiatrist will give you advice for your situation.
Protects the person's right to make their own decisions wherever they can.
When the person clearly has capacity for the decision; the law assumes capacity and only the specific decision should be questioned.
The clinician completes the conversation and may share initial thoughts. Where capacity is present, the person's own decision stands.
A clear, written record of the decision, the reasons and who was consulted.
The clinician completes the conversation and may share initial thoughts. Where capacity is present, the person's...
A written record of the assessment, and any best-interests decision or care plan, is shared with those involved.
Any agreed care or treatment plan is put in place, with the least restrictive option chosen and the reasons...
The decision is revisited if circumstances change, as capacity can return or change over time.
What is a best-interests and care-planning assessment?
This assessment has two linked parts. First, a clinician checks whether a person can make a particular decision for themselves, for example about where to live, what care they need, or whether to have a treatment. Second, if the person cannot make that specific decision, the assessment helps work out what choice would be in their best interests.
The law that applies depends on where in the UK you live. In England and Wales this assessment is based on the Mental Capacity Act 2005. Scotland has its own law, the Adults with Incapacity (Scotland) Act 2000 (under which certain medical treatment is authorised using what is called a 'section 47' certificate). Northern Ireland has the Mental Capacity Act (Northern Ireland) 2016, but this is only partly in force, so which rules apply there can depend on the particular decision and setting.
The core principles are similar across the UK. The starting point is that everyone is assumed to be able to make their own decisions. A person is only treated as unable to make a decision if, because of a problem with their mind or brain, they cannot understand the information, remember it long enough, weigh it up, or communicate their choice.
Capacity is always decision-specific and can change over time. Someone might be able to decide what to eat but not manage complex money decisions, or may have capacity on a good day but not during an illness. The aim is always to support the person to decide for themselves wherever possible.
A best-interests decision is not about what others would prefer. It must consider the person's own past and present wishes, feelings, beliefs and values, and involve the people close to them. It does not give anyone unlimited power, and it should always choose the option that is least restrictive of the person's freedom.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Capacity vs best interests
| Has capacity | Lacks capacity for this decision | |
|---|---|---|
| Who decides | The person | A best-interests process |
| Role of family | Support and advice | Must be consulted |
| Main rule | Their choice stands | Least restrictive, in their interests |
An unwise decision is not the same as lacking capacity; people are allowed to make choices others disagree with.
Preparing for your test
- Be clear about the exact decision in question, as capacity is always assessed for one specific decision at a time.
- Gather relevant information: medical records, current medicines, and any previous assessments or letters.
- Note any advance decisions, a lasting power of attorney, or a court-appointed deputy already in place.
- Write down what you know of the person's own wishes, values and what matters most to them.
- Arrange glasses, hearing aids, an interpreter or a familiar supporter so the person can take part as fully as possible.
- Choose a calm time and place where the person is usually at their best.
- Think about who should be consulted, such as family, carers and the GP.
What happens
The clinician first explains the specific decision and gives the person the information they need, in a way they can understand, to support them to decide for themselves.
They then explore whether the person can understand that information, hold on to it, weigh it up, and communicate a choice. This is usually a conversation, taking time and using simple language, pictures or other aids where helpful.
If the person can make the decision, that is the end of it; their choice stands, even if others disagree. If they cannot make this particular decision, the clinician moves to a best-interests process. This means considering the person's known wishes, feelings, beliefs and values, consulting family, carers and anyone with legal authority, and weighing the options to find the least restrictive one.
The findings, and any decision or care plan, are written down and shared with those involved.
Is this test right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- When the person clearly has capacity for the decision; the law assumes capacity and only the specific decision should be questioned.
- When the real issue is a disagreement about care rather than capacity, which may need mediation rather than a capacity assessment.
- When an urgent medical problem needs treating first, before any considered decision can be made.
- When a child is involved, as different legal frameworks apply to under-16s.
Delay or rearrange if…
- There is a treatable cause of confusion, such as an infection, dehydration or delirium.
- Sedating or recently changed medicines may be clouding thinking and could be reviewed first.
- The person is exhausted, in pain or distressed and a calmer time would be fairer.
- Key information, such as records, advance decisions or power of attorney details, is missing.
- Steps to support the person to decide for themselves have not yet been tried.
Alternatives to discuss
- Supporting the person with information and aids so they can make the decision themselves.
- Treating a reversible cause and reassessing once the person is at their best.
- Mediation or a best-interests meeting where the dispute is about care, not capacity.
- Involving an attorney, deputy or IMCA who already has a role.
- An application to the relevant court for serious or contested decisions (the Court of Protection in England and Wales).
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Benefits
- Protects the person's right to make their own decisions wherever they can.
- Gives a clear, structured way to make a difficult decision when someone cannot make it themselves.
- Ensures the person's own wishes, values and family voices are properly considered.
- Helps choose the least restrictive option, protecting the person's freedom.
- Creates a clear record that supports good, lawful care planning.
Risks & complications
- The person feeling judged, upset or anxious by personal questions.
- Disagreement between family members, or between family and professionals, about the right choice.
- Capacity that varies, so a single assessment may not capture the full picture.
- A conclusion the person cannot make the decision, which can be distressing for them and family.
- A best-interests decision that goes against what some family members wanted.
- The need for an independent advocate (IMCA) or further assessment.
- A serious or contested decision needing referral to a court (the Court of Protection in England and Wales, or the equivalent court in Scotland or Northern Ireland).
- A formal legal process may be needed to authorise a deprivation of liberty if care arrangements are very restrictive; the exact process depends on which part of the UK you are in, and these rules are subject to change.
The hardest issues are that capacity can fluctuate, and that best-interests decisions can divide families. A common pitfall is confusing an unwise choice with a lack of capacity. Ask the clinician exactly which decision is being assessed, how the person's own wishes have been weighed, and what the least restrictive option is.
Published figures to discuss
There are no meaningful complication rates, because this is an assessment and decision-making process rather than a procedure. The real uncertainties are that capacity can fluctuate, that best-interests decisions involve judgement, and that families may disagree. The safeguards are careful documentation, consultation and review.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Capacity assumed rather than assessed decision-by-decision | Legal/process risk | Under the Mental Capacity Act, capacity is specific to the decision and time, not a global label. | Mental Capacity Act 2005 (legislation.gov.uk)legislation.gov.ukSource-linked context |
| Person's wishes and values not gathered | Common poor-practice risk | Best-interests decisions should consider past and present wishes, beliefs, family views and less restrictive options. | Mental Capacity Act 2005 (legislation.gov.uk)legislation.gov.ukSource-linked context |
| Restrictive plan used without justification | Governance risk | Care plans should use the least restrictive option compatible with safety. | Mental Capacity Act 2005 (legislation.gov.uk)legislation.gov.ukSource-linked context |
| Family conflict escalates | Common in complex decisions | Documentation, independent advocacy and clear reasoning help reduce disputes. | Guide sourcesClinical context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is no physical recovery. "Afterwards" means how the findings and any decision or care plan are shared, and what happens next.
- Feeling tired or unsettled after discussing personal and sometimes difficult matters.
- Family wanting time to talk through the outcome together.
- A short wait for the written record and care plan.
- Ongoing involvement, as decisions may be reviewed rather than fixed once and for all.
Aftercare
- Ask for a clear, written record of the decision and the reasons behind it.
- Make sure everyone involved, including the GP, knows the outcome and the agreed plan.
- If a reversible cause of confusion was found, follow up with the GP about treating it.
- Check whether an advance decision, lasting power of attorney or advocate (IMCA) should be involved.
- Keep details of who to contact if circumstances change or you have concerns.
- Diarise any review date so the decision is revisited as needed.
- The exact decision in question written down
- Medical records and current medicines list
- Any advance decision, power of attorney or deputyship paperwork
- Notes on the person's wishes, values and what matters to them
- Names of family, carers and the GP to consult
- A calm time and place chosen for the assessment
⚠ Get urgent help if…
- Sudden confusion, drowsiness or a marked change in behaviour, which can mean a treatable illness and needs urgent advice from a GP or NHS 111 (in Northern Ireland, contact your GP out-of-hours service or your HSC Trust's Phone First service instead of 111).
- New weakness, slurred speech or facial drooping, which needs a 999 call as a possible stroke.
- Signs the person is being pressured, neglected, harmed or financially exploited; raise safeguarding concerns.
- Severe low mood or any talk of self-harm, which should be discussed urgently with the GP or NHS 111 (or, in Northern Ireland, GP out-of-hours or your Trust's Phone First service), or call 999 in an immediate crisis.
- Care arrangements that feel very restrictive without clear authority, which should be questioned.
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your psychiatrist gives you.
Results & realistic expectations
A clear assessment sets out whether the person can make the specific decision and, if not, what option is in their best interests and why. A good outcome is one that reflects the person's own wishes and values as far as possible, involves those close to them, and chooses the least restrictive option.
The assessment cannot remove all disagreement, and it cannot predict the future. It is a careful, lawful basis for the decision at this time, and it should be reviewed if things change.
An assessment relates to a specific decision at a specific time. Because capacity can return or change, decisions should be reviewed as the person's health or situation changes. A care plan made now may need updating, and the person may regain the ability to make decisions they could not make before.
Related tests, treatments or support
This assessment often goes hand in hand with a wider care or treatment plan, a medication review where sedating medicines may be affecting thinking, and, where relevant, safeguarding processes or an independent advocate. It may also link to lasting power of attorney or, in England and Wales, Court of Protection matters (Scotland and Northern Ireland have their own equivalent arrangements).
Follow-up & long-term care
Follow-up is through the team or clinician responsible for the person's care. The decision and plan should be reviewed at sensible intervals or whenever circumstances change. If there is serious or unresolved disagreement, the matter may go to court — the Court of Protection in England and Wales, or the equivalent court in Scotland or Northern Ireland.
Repeat, follow-on and what comes next
- Decisions should be reviewed as the person's health or situation changes, as capacity can return.
- A care plan may need adjusting if it is not working or is more restrictive than necessary.
- Contested decisions may need a second opinion or a court ruling (from the Court of Protection in England and Wales, or the equivalent court elsewhere in the UK).
- An assessment for one decision does not settle other decisions, which must be considered separately.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- A clear, written record of the decision, the reasons and who was consulted.
- The least restrictive option chosen, with a plan to review it.
- Communication with the GP and care team about the outcome.
- Involvement of an IMCA, attorney or deputy where appropriate.
- A named contact for concerns and a clear review date.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Whether the assessment is part of NHS or social care, or arranged privately.
- Whether the clinician travels to a home, hospital or care home, or sees the person in clinic.
- How many decisions are involved and how complex they are.
- How much record review and consultation with family and professionals is needed.
- The seniority and expertise of the clinician.
- Whether a written report to a particular standard is required, for example for the Court of Protection in England and Wales (or the equivalent court elsewhere in the UK).
- The clinician's fee for the assessment and any written report.
- Any travel or home-visit charge.
- Whether more than one visit is included or charged separately.
- What the report will cover and who it will be shared with.
- The expected turnaround time.
- Any further fee if the clinician must attend a meeting or court.
- What happens, and what is charged, if the decision is contested or needs review.
On the NHS? Capacity and best-interests assessments are a routine part of NHS and social care when decisions are needed; private or independent assessments may be arranged for a second opinion or a contested decision.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Confusing an unwise decision with a lack of capacity.
- Assessing capacity in general rather than for the specific decision.
- Not first supporting the person to make the decision themselves.
- Making a best-interests decision based on others' preferences rather than the person's wishes and values.
- Choosing a more restrictive option than necessary, or not recording why.
Marketing red flags
- Offering a quick capacity sign-off without seeing the person or supporting them to decide.
- Suggesting a diagnosis automatically means a person lacks capacity.
- Promising a particular outcome to whoever is paying.
- Treating best interests as whatever the family or provider wants.
Choosing a specialist safely
- Check the psychiatrist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the psychiatrist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good psychiatrist will welcome every one of these.
- Exactly which decision is being assessed, and why now?
- What has been done to help the person make this decision themselves?
- How have the person's own wishes, values and family views been taken into account?
- What is the least restrictive option, and why is it being recommended?
- Should an advance decision, power of attorney or an IMCA be involved?
- When and how will this decision be reviewed?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the psychiatrist who carries out my test, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this test not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Does lacking capacity for one decision mean my relative cannot decide anything?
Can a person make a decision others think is unwise?
Who makes a best-interests decision?
Is this available on the NHS?
What is an IMCA?
What if the family and professionals cannot agree?
Does the same law apply everywhere in the UK?
Where can I get urgent advice if I am worried about the person?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: Mental Capacity Act 2005 (legislation.gov.uk) Mental Capacity Act 2005 Code of Practice (GOV.UK) SCIE — Best interests principle (Mental Capacity Act) NHS — Mental Capacity Act Royal College of Psychiatrists — old age psychiatry Adults with Incapacity (Scotland) Act 2000 — section 47 certificate guidance Mental Capacity Act (Northern Ireland) 2016 — information GOV.UK — changes to the definition of deprivation of liberty nidirect — urgent and emergency care services (Northern Ireland) nidirect — GP out-of-hours service (Northern Ireland)
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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