Safeguarding Adult Reviews (SARs)
What is a SAR?
The Care Act 2014 introduces statutory Safeguarding Adults Reviews (previously known as Serious Case Reviews), mandates when they must be arranged and gives Safeguarding Adults Boards flexibility to choose a proportionate methodology.
This policy has been developed in the light of the Care Act 2014 and the guidance contained within Chapter 14 and outlines a referral pathway, the convening of the SAR panel and guidance to the SAR panel on making recommendations to the Independent
Section 2 Care Act Statutory Guidance states that SABs must arrange a SAR 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.
- An adult in its area has not died, but the SAB know or suspects that the adult has experienced serious abuse or neglect.
In the context of SARs, something can be considered serious abuse or neglect where, for example the individual would have been likely to have died but for an intervention, or has suffered permanent harm or has reduced capacity or quality of life (whether because of physical or psychological effects) as a result of the abuse or neglect.
SABs are free to arrange for a SAR in any other situations involving an adult in its area with needs for care and support. Please note that informal carers should be included for consideration.
Salford Safeguarding Adults Board (SSAB) requires that all Regulation 28 notices issued by the coroner, where there is a safeguarding aspect to the case, should be referred into the SAR panel for consideration. This follows the principle that if the coroner has deemed there to be single or multi-agency learning in relation to a case with identified safeguarding issues, then the SAR panel should be made aware of this case to consider identifying and disseminating the learning across partner agencies as appropriate.
Where a case meets the criteria for more than one review process, such as a Domestic Homicide Review or a Serious Case Review (children's services), a referral should be made to both review processes so that the relevant boards can work in partnership to identify the most appropriate method to conduct the review, and the possibility of commissioning the review jointly. This will ensure that all aspects of the review are addressed and that the identified process dovetails with any other investigations that are on-going.
Learning lessons - SARs should seek 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 learned from the case and those lessons applied to future cases to prevent similar harm occurring again.
It is vital, if individuals and organisations are to be able to learn lessons from the past, that reviews are trusted and safe experiences that encourage honesty, transparency and sharing of information to obtain maximum benefit from them. If individuals and their organisations are fearful of SARs their response will be defensive and their participation guarded and partial.
Its purpose is not to hold any individual or organisation to account. Other processes exist for that, including criminal proceedings, disciplinary procedures, employment law and systems of service and professional regulation, such as CQC and the Nursing and Midwifery Council, the Health and Care Professions Council, and the General Medical Council.
The following principles apply to all reviews
- There should be a culture of continuous learning and improvement across the organisations that work together to safeguard and promote the wellbeing and empowerment of adults, identifying opportunities to draw on what works and promote good practice.
- The approach taken to reviews should be proportionate according to the scale and level of complexity of the issues being examined.
- The individual (where able) and their families should be invited to contribute to reviews. They should understand how they are going to be involved and their expectations should be managed appropriately and sensitively.
- The Safeguarding Adults Board is responsible for the review and must assure themselves that it takes place in a timely manner and that appropriate action is taken to secure improvements in practice.
- SARs should be led by individuals who are independent of the case under review and of the organisations whose actions are being reviewed.
- Professionals/practitioners should be involved fully in reviews and invited to contribute their perspectives.
- SARs should be completed in a timely manner, and within six months unless there is a reason for a longer period e.g. ongoing court proceedings.
- The findings from any SAR will be published in the SSAB Annual Report along with the actions taken in relation to those findings.
SSAB members agreed to a culture of openness, transparency and candour within their day to day work and with the work of the SSAB. In interpreting this "duty of candour", we use the definitions of openness, transparency and candour used by Robert Francis in his report into Mid Staffordshire NHS Foundation Trust:
Openness - enabling concerns and complaints to be raised freely without fear and questions asked to be answered.
Transparency - allowing information about the truth about performance and outcomes to be shared with staff, patients, the public and regulators.
Candour - any patient harmed by the provision of a healthcare service is informed of the fact and an appropriate remedy offered, regardless of whether a complaint has been made or a question asked about it. In practice, all member agencies of the SSAB have a responsibility to ensure they are open and transparent with the SSAB when certain incidents occur in relation to the care and treatment provided to people who use their services.
They also need to ensure that staff understand their responsibility to report all incidents that meet the criteria for a SAR. The SSAB will routinely assure itself that mechanisms are in place to respond to single and multi-agency concerns.
Every agency has a responsibility for identifying its own learning and multi-agency learning.
Consideration must be given to the type of review process that will promote effective learning and improvement action that will prevent future deaths or serious harm occurring again. No one model will be applicable for all cases. The SAR panel will need to weigh up what type of review process is proportionate to the case and will promote effective learning and improvements in practice to prevent future deaths or serious harm occurring again.
The focus must be on what needs to happen to achieve understanding, remedial action and, very often, answers for families and friends of adults who have died or been seriously abused or neglected.
A range of possible methodologies can be used for a SAR. Each methodology is valid in itself, and no approach should be seen as holding more importance or value than another. The methodology for the review will need to be agreed by the independent chair and SSAB members.
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