Case reviews

Working Together to Safeguard Children 2018 requires Local Safeguarding Children’s Partnerships to make arrangements to identify and review serious child safeguarding cases which, in their view, raise issues of importance in relation to their area. They must commission and oversee the review of those cases where they consider it appropriate for a review to be undertaken.  

The responsibility for exploring how lessons are learnt from serious child safeguarding incidents nationally is held by the Child Safeguarding Practice Review Panel.

The Department of Education publishes a triennial analysis of Case Reviews in England: which can be accessed here. 

In Wales, a child practice review (CPR) should be carried out where a child has died; sustained a potentially life-threatening injury or sustained serious and permanent impairment of health or development.  

Working Together to Safeguard People: Volume 2: Child Practice Reviews (2019) provides the key guidance for conducting child practice reviews.  

A child practice review can be either a concise or extended review depending on whether the child involved was on the Child Protection Register or in care six months before the harm occurred. Final reports of child practice reviews must be published by the Safeguarding Children Board and submitted to the Welsh Government. Child Practice Reviews must contain an Action Plan. 

In Northern Ireland, a case management review (CMR) must be held where a child dies or is significantly harmed when abuse or neglect is suspected, or where a child (or sibling) is in care or has been subject to a Care Protection Plan.  

The key guidance for conducting a case management review is  'Learning from practice' case management review process multi-agency guidance (PDF).

The case management review panel will, on considering all of the information, decide whether a practice review is required and appoint a review team and chair. The case management website also outlines the process and provides further resources and contacts.

Also see: Department of Health, Social Services and Public Safety (2014) Guidance to Safeguarding Board for Northern Ireland (SBNI) (PDF) 

In Scotland, a learning review is required in cases which raise serious concerns about professional or service involvement and where a child has died and abuse, neglect or suicide is known or suspected to have been involved, or where the child is in care or has been on the Child Protection Register at any time. A learning review may also be held where a child has suffered or is at risk of significant harm and the case gives rise to concerns about professional involvement.  

The National guidance for child protection committees undertaking learning reviews (2021) replaces the National Guidance for Child Protection Committees – Conducting a Significant Case Review (2015). All references to ‘Initial Case Review’ and ‘Significant Case Review’ in other current policy and guidance documents will be understood as referring to a ‘Learning Review’ as defined by the present guidance. 

The overall purpose of a learning review is to bring together agencies, individuals and families in a collective endeavour to learn from what has happened in order to improve and develop systems and practice in the future and thus better protect children and young people. The process is underpinned by the rights of children and young people as set out in the United Nations Convention on the Rights of the Child (UNCRC).

See also: Scottish Government National guidance for child protection in Scotland (2021)

The Association of Independent LSCB Chairs and the NSPCC launched the National Case Review Repository in 2013 where LSCB’s share their published case reviews. The repository is a useful resource in understanding practice failures and lessons learned for practice development.  

The NSPCC also has some country specific summaries of the Case Review process in each of the four UK nations.