Self directed support and adult social care in Northern Ireland

Abstract

Purpose: Often dominated by debate about healthcare, social care is a vital support for disabled people, individuals with mental and physical health conditions, and older people. Personalisation has been lauded as an approach to social care across the four nations of the United Kingdom (UK). The Westminster government and devolved governments in Scotland and Wales have legislated for forms of personalisation in adult social care. While the Department of Health affirm that self directed support has been implemented in Northern Ireland since 2014, there is no policy or legislative framework, and no clear definition of what is meant by this or what users should expect.

Methodology: A constructivist grounded theory approach was taken across a four-phase project. A review of literature provided a background of existing research and academic debate. This was used to develop research questions. A policy review was conducted, followed by qualitative interviews with service users, social workers, and policymakers. Data collection and analysis were conducted in an iterative process until theoretical concepts were identified and theory development had been achieved.

Findings: Two theoretical concepts were identified from the policy review: policy paralysis and ideological ambiguity. Self directed support in Northern Ireland lacks policy and definition and this has impacted on professional understanding of, and engagement with, self directed support and user knowledge and expectations. The thesis findings indicate current practices in Northern Ireland fall short of the definitions of self directed support as understood across the literature. The thesis identified a lack of boundary between self directed support and wider adult social care services in Northern Ireland. This deepens the sense of ambiguity and confusion regarding self directed support ideology and objectives. Four theoretical concepts were identified from qualitative interview data: control, connection, culture, and consensus. These concepts highlight the issues important to key stakeholders with regard to self directed support.

Knowledge contribution: There are few studies on adult social care in Northern Ireland and the thesis therefore makes an important contribution to the academic literature in this area. The thesis findings are supported by and contribute to three key theories: human need, citizenship, and street-level bureaucracy. These theories can contribute to a theoretical understanding of self directed support. A taxonomy was developed from a combination of the theories. The thesis recommends overarching legislation for adult social care self directed support, including clear policy definition and underpinning ideology and objectives. The policy recommendations identify that while policy is required to facilitate successful implementation, in isolation this would not be adequate to overcome the barriers to self directed support. Further action is needed to overcome issues such as system bureaucracy, lack of advocacy, private sector control and workforce crisis. The Northern Ireland Assembly should commit to a citizenship approach to self directed support. This would be centred around human rights, universal entitlement, and service user control. The social care workforce in Northern Ireland is in a state of crisis and requires a workforce strategy that will invest in improved pay and conditions, recruitment and retention and career progression pathways for all staff. Next, regulation of the social care market is required to ensure quality and cost-effectiveness are maximised. Finally, the thesis recommends development of a leadership and culture within Health and Social Care (HSC) Trusts that is trusting of the workforce and enthusiastic about embedding self directed support as an approach to all social care conversations.

Originality: This thesis presents the lived experience of self directed support in Northern Ireland. It elevates the voices of people who access and work with the services and provides a theoretical understanding of current practices from multiple perspectives. It provides an original review of existing policy and recommendations for policy development drawn from analysis of existing literature, policy documents and qualitative interview data. Application of the theoretical framework provides a theoretical understanding of the thesis findings. These theories are organised into a taxonomy of self directed support which can be applied to understand self directed support in other contexts. Furthermore, the thesis findings are applied to the theoretical framework to extend theory in a novel and modern-day setting.

Date of Award	Jun 2024
Original language	English
Supervisor	Ann-Marie Gray (Supervisor), Goretti Horgan (Supervisor) & Jennifer Hamilton (Supervisor)