Case Reviews

2022:

21st NOVEMBER: Essex Safeguarding Adults Board (ESAB) is publishing six Safeguarding Adults Reviews (SARs). Publication was delayed owing to the unprecedented pressures created by the Pandemic on the health and social care system, both in Essex and nationally, consequently ESAB proactively decided to pause our review processes in recognition of the demands faced by front line services and practitioners. Full narrative document can be found here.

Upon review of the recommendations contained within these six SARs, there are five common themes which have been outlined within this document

The Five Themes from 6 x SARs

  • Theme 1: Challenges when working with those who experience Complex Needs
  • Theme 2: Improving Making Safeguarding Personal (MSP) and hearing the voice of the adult at risk
  • Theme 3: The importance of a shared approach to setting high standards in safeguarding practice and oversight from ESAB
  • Theme 4: ESAB’s oversight of outcomes from partner’s quality assurance of safeguarding systems
  • Theme 5: Improving interagency communications between Health and Social Care

The development and delivery of action plans that enable the learning identified through the reviews will be monitored by ESAB and its multi-agency partners.

SARS:

Lucy - SAR

Sonia - SAR

Simon - SAR

Megan - SAR 

Miss J - SAR Executive Summary

John - Learning Brief 

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SEPTEMBER

Valerie - DHR/SAR

Valerie - SAR

FEBRUARY

Alan - SAR 

2021:

Frank - SAR

2020:

Wendy - SAR

Ruth - SAR

William - SAR

Leanne - SAR

Click here to access the ESAB Safeguarding Adult Review (SAR) e-Learning 

Safeguarding Adult Reviews

1. Section 44 of the Care Act sets out that Safeguarding Boards must arrange a Safeguarding Adults Review when an adult in its area dies as a result of abuse or neglect, whether known or suspected, and there is concern that partner agencies could have worked more effectively to protect the adult.

2. The Board must also arrange a Safeguarding Adults Review where an adult is still alive but has experienced serious neglect or abuse, and there is concern that partner agencies could have worked more effectively to protect them. Safeguarding Adults Boards are free to arrange for a Safeguarding Adults Review in other situations where it feels there is a value in doing so, for example to prevent or reduce abuse or neglect or explore practice.

3. The purpose of the Review is to determine what the relevant agencies and individuals involved in the case might have done differently that could have prevented harm or death. This is so that lessons can be learnt and applied to future cases to prevent similar harm occurring in future. It is not to hold any individual or organisation to account.

4. The Safeguarding Adults Board should include the findings from any Safeguarding Adults Reviews in its Annual Report and report what actions it has taken / intends to take in relation to those findings. Where the Board decides not to implement an action from the findings it must state the reason for that decision in the Annual Report.

These procedures aim to ensure that there is a consistent approach to the process and practice in undertaking Safeguarding Adults Reviews (SARs).

If you would like to refer a case to be considered for a review, contact the ESAB support team to request a review form (any personal information should be password protected).

Domestic Homicide Reviews

When someone has been killed as a result of domestic violence and abuse a Domestic Homicide Review (DHR) should be carried out. Professionals need to understand what happened in each homicide and to identify what needs to change to reduce the risk of future tragedies.

To access the reviews please head over to the Southend, Essex and Thurrock, Domestic Abuse Board (SETDAB) website by clicking on the below icon.