With the regulatory approval of the first Covid-19 vaccine now in place and plans for immediate roll-out (with some estimates indicating this could be as early as next week), thoughts and plans really do now need to turn to how those in the first wave of immunisations will be able to actively engage in consent to the vaccine.

With care home residents and those over 80 years of age in line for the earliest slots, ensuring that there is a robust capacity assessment process in place and more specifically, a clear, bespoke and person-centred approach to best interests decision making about whether a person lacking capacity should have the vaccine will be needed. Blanket decisions have no place for anyone lacking capacity - and this includes care home residents. The Government have also made clear that mandatory vaccination will not be required.

But will and indeed can care providers require residents and prospective residents to have or have had the vaccine to remain or become a resident? This will no doubt be a developing area. 

Whilst it might be easy to assume that it will be in people's best interests to have the vaccine if that enables a more sociable, engaged and accessible life, there may be specific health conditions, past wishes and feelings, religious views, allergies or indeed a whole host of other factors that individuals will need to have specifically considered before consent - or best interests assessments - can be completed.

And if having or not having a vaccine will impact on residence or choice of residence decisions, how will this impact the assessment of whether someone has capacity or not, as the nature and impact of the decision might be substantially bigger than 'just' whether or not to have an injection?  

This is definitely an area those interested in capacity and best interests decision making will watch and engage with, with interest. 

In particular, the role of Health and Welfare Lasting Powers of Attorney (LPA) - whether their scope includes the ability to consent or refuse a vaccine and how, if that decision might have wider implications such as residence choices, that could be outside scope of the LPA will be an interesting space over the coming period.