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Serious Case Reviews

A Serious Case Review is held when a child has died and abuse or neglect is known or suspected to be a factor in the child's death.

Reviews may also be held when a child has been seriously injured through abuse or neglect and where those who know about the child's circumstances believe that lessons could be learned to avoid a similar situation arising in the future.  The Review carefully considers the circumstance, surrounding the death/injury which took place prior to the incident.

This means that most child deaths do not lead to Serious Case Reviews.  However, it is important to remember that the death of a child is always tragic and we must take whatever steps we can to avoid a similar incident happening in the future. 

The Government provides advice and guidance to all agencies that work with children about how to conduct a Serious Case Review.  These are contained in "Working Together to Safeguard Children 2015" which defines the purpose of a Serious Case Review as follows:

The purpose of Serious Case Reviews carried out under this guidance is to:

  • Establish whether there are lessons to be learnt from the case about the way in which local professionals and organisations work together to safeguard and promote the welfare of children.
  • Clearly identify what those lessons are, how they will be acted upon and what is expected to change as a result.
  • As a consequence, improve multi-agency working and better safeguard and promote the welfare of children.
  • Serious Case Reviews are not inquiries into how a child died or who is culpable.

Please click on the link below to see the HSCB procedure for Serious Case Reviews:

Serious Case Review Procedure

Learning Lessons from Serious Case Reviews

Herefordshire's Serious Case Reviews

Serious Case Review Family HJ:

Overview Report  Progress Report Learnings/recommendations

Serious Case Review HH:

Overview Report - Serious Case Review HH 

A Polish version of the HH Serious Case Review Overview Report is available here

NSPCC Case Reviews pages

Click on the links below for NSPCC Case Reviews pages including the national Case Review Repository containing a searchable resource over 1,000 reports from across the UK:

NSPCC Case Reviews pages including Case Review Repository

NSPCC Learning from Serious case reviews

Practice Learning Review

Local Safeguarding Children Boards (LSCBs) are responsible for coordinating local work to safeguard and promote the welfare of children and for ensuring the effectiveness of work undertaken by the agencies working in their local area to safeguard children. The Boards have responsibility for undertaking Serious Case Reviews (SCR) as set out in Working Together to Safeguard Children 2015. The statutory guidance and local procedures should be followed for the consideration and carrying out of Serious Case Reviews

In some instances it will be apparent from the outset that the criteria for initiating a SCR have not been met. The Board recognises that reviews of such cases may provide opportunity to identify learning to be disseminated to staff in a timely manner. In order to enable all agencies to benefit from such, HSCB has produced the

Multi-Agency Practice Learning Review process.

The Multi-Agency Practice Learning Review process provides a timely approach which enables reflection upon a case by practitioners, and where appropriate, the child(ren) and family, and adults. The process aims to identify and disseminate learning in a timely manner.

The findings from two recent Practice Learning Reviews have been condensed into these useful learning guides for professionals:

7 minute learning guide.

7 minute learning guide.