Most health conversations start with “What’s the matter?” – blood pressure, blood sugar, pain scores, test results. Care plans and “What Matters to Me” documents are designed to flip that question around: “What matters to you?” They are where your life, your priorities and your limits are written down in your own words, so that professionals can see the person as well as the condition.

When these tools are used well, they can quietly shift the power balance. Decisions are no longer just about guidelines and targets. They become joint decisions about trade-offs you are willing – or not willing – to make: more tablets versus more side effects; more appointments versus more rest; longer life at any cost versus quality of the time you have.

What Is a Care Plan – and What Is a “What Matters to Me” Document?

In the UK, the language can be confusing, because different services use slightly different terms. In everyday terms:

• A care plan or personalised care and support plan is an agreed document that sets out:
  • your main health and care needs,
  • what support is being provided and by whom,
  • goals you are working towards,
  • and what to do if things get worse.
• A “What Matters to Me” or “About Me” document (sometimes called What Matters to You or About Me):
  • is usually shorter,
  • focuses on what is important to you as a person,
  • and often covers daily routines, beliefs, fears, likes and dislikes.
• An advance care plan or advance statement records your future wishes if there comes a time when you cannot easily explain them yourself – for example, what kinds of treatments or places of care you would or would not want to consider.

You do not need to memorise the jargon. The deeper idea is this: somewhere, in writing, there should be a document that says “this is who I am, this is what I’m living with, and this is what a good outcome looks like for me”.

Why Bother Writing Things Down?

When you are tired or unwell, it can feel easier to go along with whatever is suggested. But there are several reasons why putting your priorities on paper is worth the effort:

• Your memory and energy are protected. You do not have to start from scratch in every clinic or ward. The document does some of the talking for you.
• Professionals can coordinate around the same story. A good plan can be shared across GP, hospital, community and social care teams, so everyone sees the same “big picture”.
• Your non-medical goals are visible. Documents can record things like “staying in my own home”, “being well enough to attend worship” or “avoiding treatments that leave me confused”, which standard clinic letters rarely mention.
• Your future self is protected. If there is a time when you cannot speak up clearly – because of illness, confusion or emergency – your written wishes are there as a guide.

Think of it as creating a “user manual” for your own care: here is how my body behaves, here is how my life works, here is what helps and what harms.

Step 1 – Start with “What Matters” Before “What’s the Matter”

Care plans often jump straight into problems: diagnoses, risk scores, medication lists. A “What Matters to Me” section gently insists that you start somewhere else. For example:

• “The most important things in my life are…” (people, roles, activities).
• “A good day for me looks like…” (small details: morning routine, contact with others, food, rest).
• “A bad day for me looks like…” (what changes when your condition flares or your mood dips).
• “In the next year, I would love to be able to…” (realistic, specific aims).

Rare but powerful tip: describe the ‘shape’ of your week, not just single days. For example, “I can manage one big outing a week if I have two quiet days before and after.” This helps teams understand your energy budget, not just your diagnoses.

Step 2 – Map Out “Red Lines” and “Soft Lines”

A lot of distress in later life comes from feeling pushed into decisions that do not fit your values – or, equally, from refusing something that might actually help because no one has explained the options in your language.

One rare but very helpful way to use a “What Matters to Me” document is to separate:

• Red lines – things you really want to avoid if there is any safe alternative.
• Soft lines – things you would prefer not to do, but might consider if certain conditions are met.

For example:

• Red line: “I do not want to live in a place where I cannot go outside into fresh air at least a few times a week.”
• Soft line: “I would prefer to be cared for at home, but if there is a crisis and home is no longer safe even with support, I would want staff to involve my children in decisions and explain options calmly.”
• Red line: “I do not want treatments that leave me very drowsy and unable to speak with my family for days at a time, unless I am in severe distress.”

Putting this in writing does not guarantee that every situation will go your way. But it gives your GP, hospital teams and family something solid to lean on when decisions are needed quickly.

Step 3 – Use Four Simple Headings for Your Care Plan Content

Many official care plan templates are long and technical. If you have not yet been offered one, you can build your own using four headings on a single A4 sheet:

• 1. My health conditions and current support
  A short list of your main diagnoses, how they affect you, and who is involved (GP, clinics, home care, family carers). This can build on your One-Page Summary of Your Health Conditions.
• 2. What matters to me now
  Your priorities for the next 6–12 months: staying independent, seeing certain people, attending community or faith groups, managing pain, avoiding hospital if possible, protecting your carer’s health.
• 3. What I am working towards
  Small, realistic goals – “walk to the corner shop once a week using my stick”, “have fewer panic moments at night”, “reduce my falls”, “sleep through the night more often”.
• 4. How services can support this
  Space for you and professionals to write down specific actions: changes to medicines, referrals, equipment, community support, PHAT Zoom sessions, review dates.

This turns your care plan into a living document, not just a one-off letter. Each review is a chance to update what is working and what needs to change.

Step 4 – Linking Everyday Care Plans with Future Planning

For many people, the phrase “advance care planning” raises fears of giving up or talking about death before you feel ready. In reality, it is often more about protecting future you than about giving in.

A gentle way to think about it is:

• Today’s care plan – how to live as well as possible now.
• Tomorrow’s “what if” plan – what you would want if you became suddenly more unwell, confused or unable to decide for yourself.

You can use the same “What matters to me” headings in both. For example:

• “If I become very unwell and my condition cannot be reversed, being at home / being pain-free / having my family with me would matter most.”
• “I would prefer fewer hospital trips, even if that means fewer tests, as long as someone reviews me regularly at home or in the community.”

You do not have to decide everything at once. Many people find it easier to start with today’s plan and then, when trust has built up with a GP or nurse, add a short section about future wishes.

Step 5 – Making Sure Your Words Are Seen and Used

One of the biggest frustrations is spending time on a care plan or “About Me” document, only to find that no one can see it when it matters. To reduce this risk:

• Ask your GP practice whether they can upload your plan to your electronic record and mark it clearly as a personalised care and support plan or advance statement.
• When you attend hospital, tell staff that you have a plan and ask them to scan or upload a copy to their system too.
• Keep a paper copy in an obvious place at home (for example, with your medicines list or in a folder near the front door), so paramedics or out-of-hours doctors can find it.
• Offer a copy to key people: family members who support you, main carers, and trusted friends who may speak for you in an emergency.
• Check that your plan is reviewed at least yearly – for example, at your Annual Review or Long-Term Condition Check.

Rare tip: add a small line at the top of your document, such as “Version 3 – updated October 2025”. That way, everyone knows they are looking at your latest wishes.

Connecting Care Plans with Everyday Life and PHAT Support

A written plan is only powerful if it connects with the life you are actually living. To make this real:

• Use your plan alongside your one-page health summary and your appointment tools from Coordinating Appointments When You Feel Overwhelmed.
• When services don’t join up, take your plan to appointments and use the language from Speaking Up Calmly but Firmly to point to specific sections that are being ignored.
• Let our PHAT Health Pathways guide you towards one topic each month – for example mood, memory, falls or breathing – and add a short “what matters to me about this topic” line to your plan.
• Use PHAT Zoom sessions as a place to practise small goals from your plan: a few extra seconds of balance work, one more chair stand, a gentle breathing exercise paired with your daily routines.

Over time, your plan stops being “just a form” and becomes a quiet backbone for how you use your energy, appointments and support.