'We try to jump those hurdles': inter-agency dynamics of referral with self-neglect cases in England

In health and social care, disagreements over referrals involve professionals contesting between them the power to define the situation. An aspect of practice that commonly gives rise to such disagreements is self-neglect because of its high ambiguity for services. Self-neglect therefore provides a useful case to explore how professionals anticipate and respond to interagency barriers to referral when criteria and thresholds are only loosely defined, and collaboration is often ad hoc. To investigate the dynamics of interagency referral for self-neglect, we interviewed 69 practitioners: health and social care professionals; and fire and rescue, environmental health, and housing officers, all of whom regularly respond to both crisis and chronic situations of self-neglect. Dynamics that influence referrers and hinder coordination between interprofessional networks included uncertainties about the right route, perceived barriers to referral acceptance, and feeling unable to refer. These present barriers to the anticipatory labor needed to make interagency referrals land successfully with the receiving agency and may lead to a self-fulfilling cycle that discourages practitioners from thoughtful referral practice. Although referral failures are often treated in research on referral in safeguarding as a technical knowledge-deficit problem, the data show the significance of wider interagency relations, perceptions, and expectations in accounting for the barriers.