Procedure for Safeguarding Adult Reviews

Where the s.44 criteria is met, the CYSAB Independent Chair is responsible for deciding whether a review is undertaken or not and agreeing the rationale for this. For instance, in some cases learning may already have been gathered through an alternative learning process and another review would only duplicate this learning.

Once the decision has been made to instigate a SAR, the Business Unit on behalf of the CYSAB Independent Chair will write to the nominated lead of each organisation concerned advising them that a SAR is being commissioned and requesting them to nominate an appropriate senior member of staff to support the review process (Partner Nofication Letter (.docx)). Contact will be made with the Senior Investigating Officer from the relevant police force if criminal investigation is underway, to ensure any review does not undermine police investigations. The SAR may include information already gathered through other investigations (e.g., Safeguarding Enquiries, NHS Patient Safety Incident Response Framework investigations).

An Independent Author with the requisite knowledge, skills, experience and availability will be identified to undertake the SAR. An Expression of Interest will be developed by the Business Manager and sent through formal procurement channels. The Expression of Interest will include brief details of the case, key area of focus and indicative cost. Commissioning an Independent Author will follow the formal framework as per the City of York Council procurement process.

The selection will include a declaration that the person does not hold any conflicts of interest in accepting the appointment. If any conflicts of interest arise during the process of the review the Independent Author must declare this at the earliest opportunity to the Business Manager and SAR Delivery Panel.

The Independent Author will be selected on their merits by the CYSAB Business Manager, SAR Subgroup and other relevant senior professionals. Information pertaining to the SAR will be shared with the Independent Author securely.

The CYSAB Business Manager will convene a SAR Delivery Panel to meet at the earliest opportunity. The SAR Delivery Panel will comprise of relevant senior representatives from the key organisations involved in the case.  A Chair will also be appointed to lead the SAR Delivery Panel; in most cases this will be the commissioned Independent Author of the SAR.

The relevant SAR Delivery Panel will be responsible for progressing the SAR process from commissioning through to action planning. (see section 15.8 to 15.10 in the Essential Guide) for more information about the role of the SAR Delivery panel) 

The methodology selected by the SAR Delivery Panel must offer the most effective involvement of key staff/family balanced with the anticipated length of time required to conduct the review and the proposed financial commitment in order to gain the most effective learning. Safeguarding Adult Review (SAR) Methodology Toolkit details the types of methodologies available, these are suggested types, and a hybrid approach may be used (see Making a decision on SAR methodology).

The SAR Delivery Panel will agree the Terms of Reference which will outline the most proportionate and appropriate methodology and avoid the potential for duplication of learning elsewhere. The Terms of Reference should follow the principle of Making Safeguarding Personal, and the six Adult Safeguarding Principles as set out in the Care Act 2014 and CYSAB’s Multi-6.9.

The Terms of Reference should include an appropriate pseudonym unless otherwise agreed by the Chair. Consideration will be given to asking family members (or the person themselves if they are involved in the process) regarding the appropriateness of the pseudonym.

The SAR Delivery Panel and the Independent Author once identified, should consider and record who will and will not be consulted as part of the review and the rationale for doing so.

If the subject of the review is alive, the SAR Delivery Panel will give consideration to a communication plan within the Terms of Reference. This will outline who is responsible for liaising with the person and/or their representative, and which relevant legal requirements will need to be followed.

Where there is agreed involvement of the person and/or their family, then in discussion with them, the SAR Delivery Panel and the Independent Author, will agree how they will be involved during the preparation of the report and in the final written report.

The SAR Delivery Panel will nominate and agree an individual within the SAB partnership to communicate with the family whilst the SAR is being undertaken and information for families (Safeguarding Adult Review (SAR) Methodology Toolkit) Where the person and/or their family do not wish to be involved in the development of the report this will be respected. However. they will still be offered an opportunity to review the draft report via a method as agreed with them with support if required.  More information about involvement of families is in section 11 of the Essential Guide to Safeguarding Adults Reviews (SAR).

Via the CYSAB Business Unit, the CYSAB Independent Chair will write to the family or significant others in cases where the subject is no longer alive to inform them of the SAR, explain the process and purpose, and inform them of their point of contact. This should be completed as soon as practically possible. Reasonable and appropriate support and adjustments should be made by CYSAB as required to enable the adult(s), their family and/or representatives to participate in the SAR.

Once the Independent Author has been contracted, the timescales for completing the SAR will commence. Every effort will be made to complete the review within six months from which the Independent Author is appointed. Where this will be not be possible, the matter will be discussed at the SAR Subgroup meeting and with the CYSAB Independent Chair. Updates will be recorded in the minutes of the SAR Delivery Panel and SAR Subgroup meetings. Interested parties, such as the family will be notified as felt appropriate.

The SAR Delivery Panel will monitor progress of the SAR and discuss whether any amendments to the Terms of Reference are required.

Nominated agency representatives are required under the Care Act 2014 to supply all information that may be relevant to the SAR within the identified time parameters. They must ensure that they coordinate with other relevant members of their organisation to obtain the fullest understanding of their interactions. Partner agencies will be sent a Letter to notify them of the SAR decision and likely involvement. 

Nominated agency representatives also have a responsibility to explain the SAR process to others in their organisation and provide reassurance and support to their colleagues throughout the process. This support should be clearly identified and communicated to all staff involved. The death or serious injury of an adult at risk will have an impact on staff and consideration will need to be given as to who is appropriate to represent the case and how that person is supported by their organisation.

The SAR Subgroup will receive and agree the draft report before it is presented to CYSAB, so that individually and collectively partners are satisfied that the panel’s analysis and recommendations have been fully and fairly represented.

Family or identified representatives (or adult(s), if alive) should be given the opportunity to see the SAR report and recommendations. Ordinarily, two weeks will be afforded to read the SAR and provide any response. However, extensions will be granted at the discretion of the SAR Subgroup Chair if deemed appropriate to do so.