This advance statement of wishes document is a written statement that sets down your preferences, wishes, beliefs and values regarding your potential future care. It is meant to enable and empower you to have a voice about your future.

It is designed to be shared with anyone involved in your care and will give those around you (your family, friends and health or social care team) a clear idea of what you would want if you cannot tell them. In Somerset you can request this document is saved to the electronic shared care record SIDeR+.

Your advance statement is not legally binding. This means that a health or social care professional does not have to follow the instructions that are in it. However, what you write in your advance statement is still important. It must be taken into account when someone is making a decision for you in your best interests if you have lost the ability to make or communicate decisions. It can be used if you later become unwell or need medical treatment or care.

The following sections offer suggestions for you to think about; you do not need to fill in every section. If you would prefer to type this form you can access this by scanning the QR code or visiting somerset.eolcare.uk and search: Somerset Advance Statement.

Once complete either return to us at: FAO: Advance Statement, Palliative Care Office, Musgrove Park Hospital, Parkfield Drive, Taunton, TA1 5DA or email an attachment to: advancecareplanning@somersetft.nhs.uk