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Hope springs: further learning on self-neglect from safeguarding adult reviews and practice

Michael Preston-Shoot (Faculty of Health and Social Sciences, University of Bedfordshire, Luton, UK.)
Fiona O’Donoghue (Designated Nurse Safeguarding and MCA Lead in a Clinical Commissioning Group, UK)
John Binding (Department of Adults, Health and Integration Directorate, London Borough of Hackney, London, UK)

The Journal of Adult Protection

ISSN: 1466-8203

Article publication date: 1 September 2022

Issue publication date: 20 October 2022




The first purpose of this paper is to update the core data set of self-neglect safeguarding adult reviews (SAR) and accompanying thematic analysis. A second purpose is to rebalance the narrative about adult safeguarding and self-neglect by highlighting two case studies where the practice was informed by SAR and the evidence-base of best practice.


Further published reviews are added to the core data set, drawn from the websites of Safeguarding Adults Boards (SAB). Thematic analysis is updated using the four domains used previously. Two case studies are presented, using the four domains of direct practice, team around the person, organisational support and governance, to demonstrate that positive outcomes can be achieved when practice and support for practitioners align with the evidence-base.


Familiar findings emerge from the thematic analysis and reinforce the evidence-base of good practice with individuals who self-neglect and for policies and procedures with which to support those practitioners working with such cases. The case studies are illustrative examples of what can be achieved and signpost SABs and SAR authors to question what enables and what obstructs best practice.

Research limitations/implications

A national database of reviews completed by SABs has been established ( with the expectation that, in time, this will become a comprehensive resource. It is possible, however, that this data set is incomplete. Drawing together the findings from the reviews nonetheless builds on what is known about the components of effective practice, and effective policy and organisational arrangements for practice. Although individual reviews might comment on good practice alongside shortfalls, no published SARs have been found that were commissioned specifically to learn lessons from what had worked out well. More emphasis could be given to what might be learned from such cases.

Practical implications

Answering the question “why” remains a significant challenge for SAR not only where concerns about how agencies worked together prompted review but also where positive outcomes have been achieved. The findings confirm the relevance of the evidence-base for effective practice, but SARs are limited in their analysis of what enables and what obstructs the components of best practice. Greater explicit use of case studies with positive outcomes might enable learning about what enables positive system change.


The paper extends the thematic analysis of available reviews that focus on work with adults who self-neglect, further reinforcing the evidence base for practice. The paper presents two case studies where practice and the context within which practitioners were working closely aligned to the evidence-base for best practice. The paper suggests that SABs and SAR authors should focus explicitly on what enables and what obstructs the realisation of best practices.



Preston-Shoot, M., O’Donoghue, F. and Binding, J. (2022), "Hope springs: further learning on self-neglect from safeguarding adult reviews and practice", The Journal of Adult Protection, Vol. 24 No. 3/4, pp. 161-178.



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