With news that a vaccine may be on the horizon and roll out plans being put into place to ensure any approved treatment(s) can be rolled out as soon as possible, there is an undeniable optimism in the air that life might soon be able to return to something resembling what we once called 'normal'.

The Health Secretary indicated that priority for any approved vaccine would lie with those on the frontline of fighting Covid - our fantastic healthcare workers and carers - and those at the greatest risk. 

As age is a significant risk factor in Covid, the vaccine (if approved) looks set to be rolled out to the oldest of our population first - with some indication that those in communal settings such as care homes will be given greater priority due to the increased likelihood of transmission within such environments.

This gave me pause to think through how decision making will operate in such circumstances. Whilst some people reside in care homes through choice, and some due to physical need, many care home residents (as well as members of the public at large) have limited capacity or no capacity to make medical treatment decisions for themselves and would not be able to provide informed consent for the administration of a vaccine.

In such circumstances, the treating clinician - Doctor, Nurse, Pharmacist or similar administering the treatment  - will have to assess whether receipt of the vaccine is in that particular person's best interests. 

The Government have indicated there is no intention to make the vaccine mandatory and no doubt guidance around best interests decision making for those who cannot decide for themselves will follow. In the interim, however, contemplating how  best interests decision making might be undertaken - and the potentially differing considerations and balance sheet assessment for those in a care home type setting versus living alone or with their family - will be a new and interesting consideration.

One way in which a clinicians' need to assess best interests might be mitigated is if the patient has in place a Health and Welfare Lasting Power of Attorney (LPA) which will appoint their chosen attorneys to be able and empowered to make such treatment decisions on their behalf.

With the possibility of widespread vaccinations on the horizon, for those people with particularly strong views regarding their receipt of this (or indeed any other) vaccine, whether in favour or against, a Health and Welfare LPA could ensure their wishes, feelings and views are clearly heard and listened to as part of the vaccination roll out. The existence of such documentation might just make the lives of those administering a vaccine a bit quicker and easier too as undertaking a personalised and full best interests assessment is not an instant process.

It will be interesting to see the guidance on best interests assessment for those lacking capacity in the context of the vaccine when available, and the weight that is accorded to the various factors at play in each scenario. 

But in the meantime, whether for yourself or those you love, putting in place a Health and Welfare LPA might ensure personal views on medical treatments of all types - and the vaccine if and when approved and available - are observed.