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Personal assistance (PA) services have been an evolving part of Irish provision for people with physical and sensory impairments for roughly three decades, but the lack of national standards for allocation, provision or data collection have made it an opaque system characterised by piecemeal or ad hoc local solutions to increasing need. This study approaches the system through the perspective of institutional insiders, eliciting the views and experiences of state and NGO based institutional stakeholders about the PA system and its challenges. A two-step exploratory mixed-methods design, incorporating a series of qualitative interviews and a survey of HSE disability managers, provides rich insights into the nature of PA provision in Ireland. The findings illustrate and explore several chronic issues facing the PA system, most notably around under-funding, inadequate administrative data records and variation in allocation and provision across the country.