Learning from Case Reviews

Case reviews help us understand how the safeguarding system is working and learning from them can help improve practice. Resources on this page are designed to help disseminate learning.

All agencies and practitioners who work with adults and children should actively engage with the learning opportunities provided by case reviews. This can be done by:

reading published reports and learning briefings
including learning/slides in internal training
attending virtual briefings about reviews
using learning from case reviews to inform staff and team meetings and supervision
supporting colleagues and staff in implementing the learning from case reviews

Resources to help disseminate learning:

Domestic Homicide Review - Krystyna and Elzbieta (Salisbury DHR)

Wiltshire Community Safety Partnership published a Domestic Homicide Review for Krystyna and Elzbieta (Salisbury DHR) Alongside the Executive summary, a 7 minute briefing and slide set designed to disseminate the learning from the Review has also been published. The Executive summary has been translated into Polish and can be found here. There is a pre-recorded webinar to share the learning from this review, which is available to view as a learning module via our Learning Management System, Virtual College. Links to register or login to Virtual College can be found on our Booking Training page.

Domestic Homicide Review - Emily

Wiltshire Community Safety Partnership published a Domestic Homicide Review Executive Summary for Emily in June 2023. A 7 minute briefing designed to disseminate the learning from the Review within your agencies can be downloaded here. Key Findings and recommendations from the review can be downloaded here. There is a pre-recorded webinar to share the learning from this review, which is available to view as a learning module via our Learning Management System, Virtual College. Links to register or login to Virtual College can be found on our Booking Training page.

Safeguarding Adults Case Review - Alcohol and Substance Use

A learning event was held virtually in October 2023. This was an opportunity to hear about learning from safeguarding adult reviews where alcohol dependency has been a significant feature. This session also covered; support for practitioners when working with adults with significant safeguarding risks and the services available for individuals and families in Wiltshire. A recording of this event is available to view as a learning module via our Learning Management System, Virtual College. Links to register or login to Virtual College can be found on our Booking Training page. The recording is suitable for practitioners working with adults where alcohol or substance misuse might be present or any practitioner who would like to learn more about these issues.

Non-accidental injuries to a 3 month old baby

Report CSPR Baby Eva:Non accidental injuries to a 3 month old baby

7 minute briefing

Slides for using to disseminate learning within your organisation Slides

Child Safeguarding Practice Review: Long term sexual abuse of children in care

Report CSPR: long term sexual abuse of children in care

Slides to disseminate with teams Slides

7 minute briefing

Safeguarding children with disabilities

Briefing Learning briefing: Safeguarding children with disabilities

Safeguarding Adult Review: Adult L

7 minute briefing

National Reports

Learning for the future: Final analysis of serious case reviews 2017-2019 analyses 235 serious case reviews (SCRs) relating to incidents between April 2017 and September 2019. This is the ninth and final periodic analysis, covering the period before SCRs were replaced by Local Child Safeguarding Practice Reviews (LCSPRs).

A separate report: Serious case reviews 1998-2019: Continuities, changes and challenges has been published alongside the 2017-2019 report

Second national analysis of Safeguarding Reviews: April 2019 – March 2023

The purpose of this analysis was to identify priorities for sector-led improvement as a result of learning from SARs completed between 2019 and 2023, a period of time that included the COVID-19 pandemic.

This analysis builds on the findings of the first national analysis published in 2020 which considered learning from SARs completed between 2017 and 2019.

The analysis is split into three stages. All are available to download together with the executive summary and a range of briefings.

Second national analysis of Safeguarding Adult Reviews: April 2019 - March 2023 | Local Government Association