When Is an Independent Safeguarding Review Commissioned?
An independent safeguarding review is commissioned when a serious safeguarding incident occurs — typically when an adult or child has died or been seriously harmed, and abuse or neglect is known or suspected to be a factor.
There are two main types:
Safeguarding Adults Reviews (SARs)
Under the Care Act 2014, Safeguarding Adults Boards (SABs) must arrange a SAR when an adult with care and support needs dies or experiences serious harm as a result of abuse or neglect, and there is concern about how agencies worked together.
Child Safeguarding Practice Reviews (CSPRs)
Under Working Together to Safeguard Children, local safeguarding partners must carry out a review when a child dies or is seriously harmed and abuse or neglect is known or suspected.
Who Leads the Review?
Reviews must be led by an independent reviewer — someone with no prior involvement with the case or the agencies under review. The independent reviewer is typically:
- An experienced professional with a clinical or social care background
- Someone with expertise in multi-agency safeguarding
- Skilled in systems-based analysis and learning reviews
- Able to engage sensitively with families, practitioners and organisations
At CPGB Ltd, our reviewers bring frontline clinical experience combined with expertise in conducting rigorous, compassionate safeguarding reviews.
The Review Process
1. Commissioning and Terms of Reference
The SAB or safeguarding partnership commissions the review and agrees terms of reference, including the scope, timeframe and key questions to explore.
2. Information Gathering
Each agency involved submits a chronology and analysis of their involvement. The reviewer also gathers:
- Case records and assessments
- Meeting minutes and decision logs
- Relevant policies and procedures
- Perspectives from practitioners involved
3. Practitioner Events
Most reviews include learning events or practitioner panels — structured sessions where frontline workers reflect on the case, share their perspectives and contribute to understanding what happened and why.
4. Family Engagement
Best practice requires meaningful engagement with the family. This might include:
- An invitation to share their experience
- A dedicated meeting to discuss the review's purpose
- The opportunity to comment on draft findings
- A clear, respectful final communication of outcomes
5. Analysis and Report
The reviewer produces a report that:
- Tells the story of the case chronologically
- Identifies themes and systemic issues rather than individual blame
- Makes clear, actionable recommendations to improve practice
- Is written in accessible language for a broad audience
6. Publication
SARs and national CSPRs are published (usually anonymised) to support wider learning across the safeguarding system.
How to Prepare If Your Organisation Is Involved
If your organisation has been notified of a safeguarding review:
- Appoint a senior lead to coordinate your agency's response
- Gather all relevant records and documentation promptly
- Support staff who may be anxious or distressed about the process
- Cooperate fully and transparently with the independent reviewer
- Treat the process as a learning opportunity, not a threat
How CPGB Ltd Supports Safeguarding Reviews
Our team includes experienced independent reviewers and safeguarding specialists who have led SARs, CSPRs and complex multi-agency reviews. We provide:
- Independent chairing and review leadership
- Practitioner event facilitation
- Compassionate family engagement
- Systems-based analysis and report writing
- Post-review action planning and improvement support
Contact us to discuss your safeguarding review needs.