Caring for People in Harrow & Brent

Advance Care Planning

If you became ill and needed to be looked after, who would know what your wishes about your care were? None of us knows what’s around the corner, so why not be proactive and make sure that your wishes are recorded.

Advance Care Planning (ACP) gives you the opportunity to think about, talk about and write down your wishes, preferences and priorities for your care, including medical treatment. These decisions are based on your personal values and preferences and will give everyone a clear idea of the things that are important to you. It will provide peace of mind for you, your loved ones and the professionals that look after you.

Talking about and recording your wishes in advance will mean that they are more likely to be known by others and followed if you are unable to make decisions for yourself.

An Advance Care Plan may include thinking and talking about:

  • Your identity – what makes you uniquely you
  • What care or treatment you might want or not want to have
  • How and where you would like to be cared for
  • Dealing with practical issues such as completing a will or Lasting Power of Attorney for Health and Welfare
  • Who will care for any dependents
  • Who will care for your pets
  • What you would like to happen at the end of your life
  • Anything else that’s important to you.

St. Luke’s Hospice is launching a new service to support patients of St. Luke’s as well as people in the community to start the conversation and write down their wishes.

If you are interested in finding out more, please leave a contact name and phone number so that we can get back to you with more information. The service is free of charge.

If you are ready to go ahead and request support for you or someone else, please complete a referral form, which can be downloaded from this web page, and send it to  We aim to get back to you within 10 days.

You can also download an Advance Statement or an Advance Decision to Refuse Treatment from this web page, although the latter should be completed with advice from a clinician or your GP.


All forms are virtually editable with text boxes to input information, removing the need for printing and filling in by hand. If you would rather print the forms, they can be printed as normal and the text boxes will disappear with blank space.

Once completed, save the form and attach it with your enquiry below, or attach it to an email to along with your full name and contact information.

ACP Enquiry Form

  • Max. file size: 512 MB.
  • Max. file size: 512 MB.
  • Max. file size: 512 MB.
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