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The purpose of this paper is to consider the role of housing and housing support services in working with systems of self-directed support (SDS). The paper draws upon findings from an evaluation and follow up study of three SDS Test Sites in Scotland and wider research.

The evaluation of the SDS Test Sites took place in 2009-2011 with a follow up study in 2011-2012. Methods included a literature review; an analysis of secondary data on the use of SDS in Scotland; interviews with key stakeholders; learning sets in the three areas; 30 depth individual case studies and a large-scale stakeholder event prior to finalising the report. These data are drawn upon to reflect on the implications for housing providers and practitioners.

The interviews revealed that some SDS users had housing and related support needs, such as to prevent or resolve homelessness, to facilitate resettlement, to prevent hospital admissions, to access supported accommodation or to move from shared to independent housing. For some people flexible housing support seemed to enhance community living, also well-informed independent advocacy could make a difference to outcomes. While there was policy support for the Test Sites, it was notable that linkages between agencies at strategic level were limited, with neither housing nor health services greatly involved in strategic planning. Training, alongside liaison and partnerships, may help to broaden SDS.

While housing and related support needs and services were not specifically investigated in this evaluation, data suggest that the contribution of housing services may be both under-developed and under-researched in the context of SDS. There are indications that SDS may act as a catalyst for improving housing opportunities provided that collaboration between housing and care services is maximised.

This paper suggests approaches that may improve and consolidate the role of housing in achieving SDS objectives of maximising user control and choice, improving outcomes and sustaining ordinary living.

This paper considers the less charted territory of the implications of SDS for the role of housing services. While drawing primarily on recent research in Scotland the themes raised will have wider relevance to housing and care services generally.

This paper aims to explore the possible connections between self‐directed support and adult support and protection, both of which are important policy developments in Scotland.

The authors draw on findings from the national evaluation of the test sites or pilots of self‐directed support in Scotland and interviews at two time points with adult protection leads in the test sites. These interview data are set in the context of Scottish developments in adult support and protection.

Self‐directed support and adult protection had not been joined up initially. In the three Scottish test sites those responsible for adult safeguarding had not been engaged with the changes. They were unclear about the new systems and were concerned about the implications of reduced monitoring of risks. Shared training between those implementing self‐directed support and those carrying out adult protection work was viewed as a way of bridging these different areas of practice through enhancing mutual understanding and communication.

Policy and legislation have used the word support to provide reassurance of social protection for adults in need of care services. This paper provides new opportunities to consider the ways in which early enthusiasm for self‐directed support in Scotland may have neglected the support inherent to support and protection and the ways in which some adult support and protection stakeholders seemed to be acting as “bystanders” rather than influencing new systems of self‐directed support.

The shift in policy discourse towards individualism is affecting service provision and access, which has become increasingly conditioned on individual agency and the “deservingness” of the recipient. Gendered and intersectional experiences of homelessness and excluded populations less likely to be living on the streets remain overlooked and unaddressed. This study thus aims to uncover what drives “invisibility” in services for women experiencing multiple disadvantage and the gendered constraints the women are facing when exiting and navigating multiple disadvantage.

The paper draws on in-depth interviews with women who face severe and multiple disadvantage and their support staff. Data is also gathered through survey data and observations with a wide range of frontline service providers, as well as support notes and numerical progress data recorded by one of the service providers.

Contradicting the common assumption that people act as rational actors in their interaction with services, the author found that women’s decisions to (dis)engage may be blinded by forces of multiple disadvantage and mistrust. These are often developed as a result of systemic and gendered constraints that limit women’s capabilities and exercise of choice. Barriers in service access often amplified the personal barriers they were facing and reinforced women’s decisions to not engage with services.

The author hopes that this paper sheds light on the particular set of barriers women with multiple disadvantage face, which will be vital to reach women who face severe disadvantage and provide more effective policies, care and support.

This study gives voice to a particular hidden population: women with multiple disadvantage. It contributes to existing frameworks on agency and choice by understanding gendered barriers behind service engagement and how services themselves may be contributing to women’s invisibility.

The move towards a “person-centred” or “personalised” system of adult social care has been at the heart of policy debates in Great Britain. However, policy developments in Northern Ireland are more limited than in other parts of the UK, and less attention has been paid to reforming adult social care. The purpose of this paper is to examine the views and experiences of adult social care users who receive care at home, to explore if and how a person-centred approach might work for older adults in Northern Ireland.

Using a qualitative approach, semi-structured interviews were carried out with 12 people aged over 70 years who receive social care provision at home.

The empirical findings show that social care users experienced limited involvement in their care planning process, reflecting a predominantly service-led approach. The importance of care worker continuity and consistency was crucial for all participants, particularly for maintaining discreet routines and promoting personal dignity. However many experienced different care workers which presented challenges caused by the inconsistency of carers.

The majority of participants in the study were women, despite attempts to achieve greater gender diversity. It was also difficult to recruit a range of ethnic groups for the study. It would be important for future studies to include these groups and to ensure their voices are represented in further work in this area. Nonetheless, the findings offer valuable insight into the views of adult social care users and can form a useful basis for future studies.

The findings provide a more nuanced understanding of what people want and expect in social care to generate future policy debates and discussions in planning long-term adult social care provision in Northern Ireland. It also provides important and timely contribution to this area, where there is currently limited research and information available.

The purpose of this paper is twofold: first, to update the core data set of self-neglect safeguarding adult reviews (SARs) and accompanying thematic analysis; second, to draw together the learning available from this data set of reviews to propose a model of good practice that can be used as the basis for subsequent SARs.

Further published reviews are added to the core data set from the websites of Safeguarding Adults Boards (SABs). Thematic analysis is updated using the four domains employed previously. A sufficient number of reviews have been performed from which to construct an evidence-based model of good practice. A framework is presented with the proposition that this can be used as a proportional methodology for further SARs where self-neglect is in focus.

Familiar findings emerge from the thematic analysis. This level of analysis, constructed over time and across reviews, enables a framework to be developed that pulls together the findings into a model of good practice with individuals who self-neglect and for policies and procedures with which to support those practitioners involved in such cases. This framework can then be used as an evidence-based model with which to review new cases where SARs are commissioned.

The national database of reviews commissioned by SABs is incomplete and does not contain many of the SARs reported in this evolving data set. The Care Act 2014 does not require publication of reports but only a summary of findings and recommendations in SAB annual reports. It is possible, therefore, that this data set is also incomplete. Drawing together the findings from the reviews nonetheless enables conclusions to be proposed about the components of effective practice, and effective policy and organisational arrangements for practice. Future reviews can then explore what enables such effective to be achieved and what barriers obstruct the realisation of effective practice.

Answering the question “why” is a significant challenge for SARs. A framework is presented here, drawn from research on SARs featuring self-neglect, that enables those involved in reviews to explore the enablers and barriers with respect to an evidence-based model of effective practice. The framework introduces explicitly research and review evidence into the review process.

The paper extends the thematic analysis of available reviews that focus on work with adults who self-neglect, further building on the evidence base for practice. The paper also proposes a new approach to SARs by using the findings and recommendations systematically within a framework designed to answer “why” questions – what promotes and what obstructs effective practice.

The purpose of this paper is to update the core data set of self-neglect safeguarding adult reviews (SARs) and accompanying thematic analysis. It also explores whether lessons are being learned from the findings and recommendations of an increasing number of reviews on self-neglect cases.

Further published reviews are added to the core data set, mainly drawn from the websites of safeguarding adults boards (SABs). Thematic analysis is updated using the domains used previously. The domains and the thematic analysis are grounded in the evidence-based model of good practice, reported in this journal previously.

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. Multiple exclusion homelessness and alcohol misuse are prominent. Some SABs are having to return to further cases of self-neglect to review, inviting scrutiny of what is (not) being learned from earlier findings and recommendations.

The national database of reviews commissioned by SABs remains incomplete. The Care Act 2014 does not require publication of reports but only a summary of findings and recommendations in SAB annual reports. National Health Service Digital annual data sets do not enable the identification of reviews by types of abuse and neglect. However, the first national analysis of SARs has found self-neglect to be the most prominent type of abuse and/or neglect reviewed. Drawing together the findings builds on what is known about the components of effective practice, and effective policy and organisational arrangements for practice.

Answering the question “why” remains a significant challenge for SARs. 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 research and other published SARs might assist with answering the “why” question. Greater scrutiny is needed of the impact of the national legal, policy and financial context within which adult safeguarding is situated.

The paper extends the thematic analysis of available reviews that focus on study with adults who self-neglect, further reinforcing the evidence base for practice. Propositions are explored, concerned with whether learning is being maximised from the process of case review.