Please note, the details for our district based local collaboration / help hubs are at the bottom of this page.

NSAB Multi agency Self-neglect and hoarding strategy

May 2025 Our multi-agency strategy has now been revised and updated through our
self-neglect and hoarding subgroup - our Practitioner Guide has too, see below.

This strategy is designed for all agencies, not just social care, to support best practice in working together with someone who may be self-neglecting and / or hoarding. It describes how agencies and practitioners should be working together to offer support and find solutions to identified needs.

All partners are encouraged to download the strategy and cascade within their organisations. More information is available further down this page too.

Please do give us feedback on the strategy and practitioner guide, so that we can make sure it is as useful as possible to you all.

 Download the strategy

NSAB Self-neglect and hoarding practitioner guide

Revised version May 2025

This guide is published alongside the multi-agency strategy, and is intended as a toolkit to support practitioners from a range of agencies with management of cases where an adult is deemed to be at risk due to self-neglecting and/or hoarding behaviours.  

The practitioner guide includes:

• The Clutter Image Rating Scale (CIRT)
• Assessment tool guidelines
• Guidance for practitioners
• Guidance questions which could be used during an assessment
• Hoarding self-assessment tool - this has been completely revised and designed to assess different types of risk more accurately
• handy hints and tips to build trust

Revised edition 2025 - this has been revised and improved through our multi-agency self-neglect and hoarding subgroup.

It is longer but we have added more around the self-assessment, making it more personalised and useful for thinking about the range of different risks in the context of the impact on the person. We have revised, updated, and added to the types of actions that might apply in different circumstances.

 Practitioner Guide

In conjunction with Norfolk Fire & Rescue Service and the National Fire Chiefs Council, we held a free webinar on emollient skin products and fire safety, on Wednesday 29 January 2025.  You can view this below.

The National Fire Chiefs Council has further information and resources available on its website nfcc | know the fire risk

Norfolk SN&H support - Provider Framework

A framework agreement is an umbrella agreement from Norfolk County Council (NCC), which enables the Council to quickly place orders (aka call-off contract). By signing up to the framework, providers are confirming that they want to work with NCC on the terms stated in the agreement; it does not however guarantee them any work.

Providers who wanted to be included on the framework completed applications that were assessed, and those that met the criteria were successful in joining the framework.

This framework agreement commenced in October 2023, and will last for five years, with an option to extend by a further five years. The framework will be reopened periodically for new providers to apply to join.

Who can use the framework?

The framework is designed to be used by colleagues within Norfolk County Council and Norwich City Council to choose the right support/services for individuals who are experiencing self-neglect and/or hoarding. The framework was designed with colleagues from the Norwich locality however is not limited just to the Norwich area.

The framework is also available to be used by colleagues from other public bodies within Norfolk – including district councils. Organisations who wish to use the framework need to sign an access agreement and confidentiality agreement. Please get in touch with Norfolk Council Council's procurement team if you would like to use the framework and they will send it to you. Email: [email protected]

You can read more and see who is involved here (updated July 2025):

Provider Framework

St Thomas Training - Self Neglect - Beyond the Basics to Effective Interventions

In Norfolk you can access this training via St Thomas training, it is free to Norfolk County Council employees (as they commission the training) or voluntary / unpaid roles, there is a small charge for other organisations. 

This is a half-day, face-to-face training session.

Target group: This training is open to social workers, occupational therapists, OT assistants, Assistant Practitioners and managers, and to employees and volunteers of other organisations in the county of Norfolk, who already have a basic understanding of self neglect, the Care Act definition causes and the ethical dilemmas involved

Aim: This event will provide a safe space for practitioners and managers who already know the signs and symptoms of neglect and who are aware of the ethical and moral dilemmas involved, to work through a range of case studies and consider the options available to promote the person’s well-being, to reduce the risks of harm and to know when a safeguarding response is required.

Learning outcomes - by the end of this event you will be able to:

• Acknowledge the challenges for professionals intervening in self neglect and be able to identify and implement evidence based interventions to promote the well-being of the person and safeguard them from harm when required using the Make Safeguarding Personal approach
• Apply local guidance and legislation to promote the well-being of people who self neglect
• Provide a person centred intervention to improve health and well-being for people who self neglect
• Ensure people who lack the capacity to safeguard themselves from the harm of self neglect /hoarding receive safeguarding intervention which identifies and reduces the risk of harm
• Develop the capacity for professional curiosity and asking curious questions about self neglect

You can find the link via our training page.

Self-neglect, hoarding and safeguarding adults

Self-neglect covers a wide range of behaviour which in general means someone is not caring for their own personal hygiene, health, safety or surroundings. It can also include hoarding behaviour, although not always. Hoarding can involve specific things, very general items, or animals – even data can be hoarded!

The reasons for self-neglect are often complicated, although sometimes there may be a simpler reason for a change in circumstance. Someone who develops dementia, for example, may forget how to do certain household tasks, or someone with a new disability may not be able to maintain their personal hygiene in the same way as they had before.

Self-neglect will not often be taken forward as a s42 (safeguarding adults) enquiry - however supporting someone who self-neglects or hoards will usually need agencies to work together closely, in line with safeguarding adult processes. Professionals meetings should be used to help that joint working, especially where a number of risks have been identified.

Chronic self-neglect and/or hoarding is likely to have developed over many years, and it may be considered a safeguarding concern at the point:

• where the person with care and support needs can no longer control their behaviour, so they cannot protect themselves;
• where there is a defined high risk of harm to the individual;
• or the physical / environmental risk to others is significant.

“Safeguarding duties will apply where the adult has care and support needs (many people who self-neglect do not), and they are at risk of self-neglect and they are unable to protect themselves because of their care and support needs. In most cases, the intervention should seek to minimise the risk while respecting the individual’s choices. It is rare that a total transformation will take place and positive change should be seen as a long-term, incremental process.”
Self-neglect: At a glance | SCIE

Organisations involved must look at any concerns raised to them under their existing duties and responsibilities under the law, and work together with the person to understand the underlying cause of the self-neglect or hoarding issues.

It often needs longer term involvement to build relationships, identify and work on any past trauma; and the workers involved need to come together to support the person to understand and manage any specific risks where possible.

Workers need to understand that people have the right to choose their lifestyle, balanced with their mental health or their capacity to understand the consequences of their actions.

It can often be a care or risk management issue rather than a safeguarding concern and may require a social care assessment - although it should be recognised that it will not always be appropriate to refer to the local authority straightaway. There may be initial support that other agencies can provide, especially where it appears unlikely that the person has care and support needs.

Lambeth Safeguarding Adults Board created this 3 minute video about self-neglect:

NSAB have developed and published Norfolk’s Self-Neglect and Hoarding Strategy (see above), which has more detailed guidance on how to work with and support individuals in this category.  Safeguarding Adults Reviews frequently highlight self-neglect signs and symptoms as a factor in or indicators of subsequent serious events that have resulted in life threatening consequences, or even death.

When seen in isolation, self-neglect and/or hoarding behaviours may not give rise to safeguarding intervention. However, when viewed alongside other potential risks, a very different picture often emerges.

To address and coordinate this important area of work across partner agencies, NSAB produced and published this strategy, which aims to be part of the growing work around early intervention and preventative agendas.

It directs collaborative multi-agency discussions of self-neglect and/or hoarding cases to the help hubs. To encourage a more preventative approach to cases of self-neglect and/or hoarding, the trigger point for taking a case to the help hubs is level 2 (image 4 upwards) on the Clutter Image Rating Scale (CIRT). The strategy sets out clearly that a collaborative and multi-disciplinary approach to those at risk is the most effective way to achieve creative and proportionate interventions that respect the individual’s right to self-determination. The strategy includes the Self-neglect and Hoarding Assessment Triangle which might be helpful to practitioners.

NSAB Self-neglect and hoarding strategy

In 2020, the Association of Directors of  Adult Social Services and the East of England safeguarding adults network published a learning support document. Recognising that working with adults at risk of self-neglect and/or hoarding is complex, they wanted to produce a document that supports frontline practitioners and reinforces good practice.

While this document is aimed primarily at adult social services social work practitioners and managers employed in statutory roles, its content is relevant to all professionals who may work with adults who self-neglect and/ or hoard.

Case studies are used as examples of how to work effectively with people who self-neglect and/or hoard and key points of good practice are included. These have been taken from research studies and particularly from the work of Michael Preston-Shoot, Suzy Braye and David Orr. 

ADASS self neglect learning support

Clutter Image Ratings - link to Hoarding Disorders UK

Self-neglect: exploring the social work response

It's from a social worker point of view, but we're sharing an interesting podcast focusing on self-neglect - what it is, the ways in which it affects people and how social workers can respond.

This episode considers how the approach to supporting people who self-neglect has changed over the years and the duties placed on local authorities by the Care Act.

Listen to the podcast here

Mental Capacity

Where there is a concern that a person may be unable to make decisions in relation to self-neglect and / or hoarding, as a result of a cognitive impairment of some kind, a mental capacity assessment should be completed in relation to each specific decision.

As part of any MCA assessment, you need to think about what the 'relevant information' might be - this is the information the person making the decision needs to be able to understand / retain / use / weigh in making a decision.

For hoarding, there is some case law which sets some examples - from AC and GC (Capacity: Hoarding: Best Interests) [2022] EWCOP 39 (section 14 of the judgement):

(1) Volume of belongings and impact on use of rooms: the relative volume of belongings in relation to the degree to which they impair the usual function of the important rooms in the property for you (and other residents in the property) (e.g. whether the bedroom is available for sleeping, the kitchen for the preparation of food etc). Rooms used for storage (box rooms) would not be relevant, although may be relevant to issues of (3) and (4).

(2) Safe access and use: the extent to which you (and other residents in the property) are able or not to safely access and use the living areas.

(3) Creation of hazards: the extent to which the accumulated belongings create actual or potential hazards in terms of the health and safety of those resident in the property. This would include the impact of the accumulated belongings on the functioning, maintenance and safety of utilities (heating, lighting, water, washing facilities for both residents and their clothing). In terms of direct hazards this would include key areas of hygiene (toilets, food storage and preparation), the potential for or actual vermin infestation and risk of fire to the extent that the accumulated possessions would provide fuel for an outbreak of fire, and that escape and rescue routes were inaccessible or hazardous through accumulated clutter.

(4) Safety of building: the extent to which accumulated clutter and inaccessibility could compromise the structural integrity and therefore safety of the building.

(5) Removal/disposal of hazardous levels of belongings: that safe and effective removal and/or disposal of hazardous levels of accumulated possessions is possible and desirable on the basis of a “normal” evaluation of utility.

For more information on mental capacity see our dedicated pages on mental capacity and safeguarding.