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This is our first newsletter, which we’ve launched to help safeguarding partners stay up to date with the latest patterns in practice from serious incident notifications across the country.
By disseminating some of the learning we are gaining from rapid reviews and local child safeguarding practice reviews quickly and easily, we hope it will help you in developing your frontline practice.
As lockdown continues, we know that the ‘new normal’ may be challenging as we deal with the lasting effects of the Covid-19 on vulnerable children. Given the current set of circumstances some of the content aims to address those issues.
We hope this newsletter provides you with up to date information and links to learning and tools to help make improvements to safeguarding practice in your area.


In This Issue

  • Safeguarding Spotlight – What are the risks for babies under 1 in lockdown?
  • Local Child Safeguarding Practice Reviews – What are the guidelines?
  • Safeguarding Children at Risk from Criminal Exploitation – What is the challenge to local areas?
  • Panel Updates – What’s the latest news about the Panel’s reviews and work?
  • Stakeholder News – What recent resources have been published?
  • Have Your Say – Share good practice from your area
Safeguarding Spotlight
What are the risks for babies under 1 in lockdown?

Like you, some of our development work has been slowed by Covid-19 but we are progressing the work we set out in our annual report. We do not want to lose the focus on the lessons we can learn from serious child safeguarding incidents. This includes planning for the publication of our second national review into Sudden Unexpected Death in Infants (SUDI) this summer.
Despite the overall decrease in the number of babies dying in this way, the Panel continues to see a worrying number of cases. There has been a shift towards these tragedies happening mainly in families whose circumstances put them at risk of harm, not just of SUDI, but of several other adverse outcomes.
Almost all of the cases of SUDI notified to the Panel involved parents co-sleeping with infants in unsafe sleep environments, often after consuming drugs and alcohol. In light of Covid-19, there is a worry that SUDI may increase due to the pressures of lockdown. Domestic violence, anxiety about money, unsuitable housing, substance and alcohol abuse, as well as disruption to normal routines may mean that more families are unable to engage effectively with safer sleeping advice.
We are about to publish our national review on SUDI, setting out what we have heard from local partners about the issues, and about effective approaches. It will include a number of questions that local safeguarding partners can start to address right now, as well as making national recommendations. Let’s work together locally and nationally to make sure that every sleep is a safe sleep.
Local Child Safeguarding Practice Reviews
What are the guidelines for a review?

We are updating our Practice Guidance and would like to initiate some discussion with safeguarding partners about the inconsistency in approaches to undertaking a local learning review across the country.
The Panel has received a considerable number of rapid reviews in which safeguarding partners have identified a need for a further learning review. Rather than commission a Local Child Safeguarding Practice Review (LCSPR), some partners have chosen to commission an alternative form of review. These have variously been referred to as ‘learning reviews’, ‘multiagency reviews’, ‘window on the system reviews’, ‘practitioner workshops’ or other locally defined processes.
Working Together 2018 is clear that, where the potential for further learning is identified, then this should be through the commissioning of a proportionate LCSPR. We believe there are many successful ways of reviewing cases and want to see partners continue to use and develop alternative models. However, when a further review is warranted, then that should always be labelled as an LCSPR regardless of the approach taken to complete it.
We are concerned that reviews which are not LCSPRs are not bound to be published. Not only does this detract from the crucial importance of transparency and openness into the safeguarding system, it means that other partnerships and we as a National Panel are not able to benefit from the contents and the learning.
Therefore, we are planning to host a webinar to hear more from safeguarding partnerships about this issue, and to raise the following questions with you, both for discussion within your own partnerships and for feedback to us.
  • When your partnership is considering a further review, are you confident that there is a flexibility of approach and an identification of a methodology best suited to expose the issues within the case?
  • What might be the circumstances in your view when a review other than a LCSPR is warranted?
  • In what ways would an alternative review differ from a proportionate LCSPR?
  • Can you anticipate any difficulties in completing LCSPRs that adopt some of the different methodologies set out and still capture the voice of the practitioner and of the family?
  • Can you anticipate any difficulties in conducting LCSPRs using a range of methodologies and then making them available through publication to the wider safeguarding system in the country? 
We are strongly committed to ensuring the case reviewing system in this country is characterised by learning and the identification of improvements to the safeguarding of children, and welcome your feedback. Keep your eyes peeled for registration details for the webinar this summer.
Safeguarding Children at Risk from Criminal Exploitation
What is the challenge to local areas?

We published our first national thematic review into adolescents at risk from criminal exploitation in March 2020. The review titled, ‘It was hard to escape’, examines the lives of 21 teenagers from 17 areas across the country. It aims to understand if the services designed to keep young people safe from criminal exploitation are working.

The findings show that criminal exploitation is one of the most real and present dangers to children today. It includes recommendations for central government and a challenge to local safeguarding partners.

The findings include:
  • Known risk factors around vulnerability don’t always act as predictors
  • Moving children away from the local area isn’t an effective long-term solution to protect them from the reach of criminal gangs
  • Exclusion from mainstream school can escalate the risk of manipulation by criminal networks
  • Relationship based practice and making use of the reachable moment, such as arrests, school exclusion and physical injury, is critical for this group of children
The review makes important national recommendations, including asking for more focus in Working Together on extra familial harm. It offers local partners a framework for assessing and improving their practice. Criminal exploitation of our children is a growing concern across the country. That risk may well be heightened as one of the “hidden harms” during Covid-19, as many children are not in school and their families experience increased financial pressures.

The Serious Case Review (SCR) recently published by Waltham Forest into the death of Jaden Moodie reinforces some of this learning, particularly around pivotal moments in children’s lives. Three months before his death, Jaden was arrested in a flat in Bournemouth known to be used by county lines drug gangs. The SCR states that while detained in Bournemouth and then on his return, work could have begun at this moment of crisis on the broad issues of his vulnerability for a child who was clearly being criminally exploited. We would encourage partnerships to look at the recommendations in this review, including the appendix that analyses the SCR in line with our national thematic review.

Through our thematic review, we have identified a series of questions and challenges in four key areas that we believe every partnership should be working on and be able to answer. We urge safeguarding partners to look at their practice against the challenges that are set out in our review and to think about how patterns of exploitation may be shifting as a consequence of the pandemic.
We hope that you can find a way of progressing this work in the current circumstances and we will be seeking updates from you in the months ahead.
Panel Updates
  • Karen Manners QPM been appointed interim chair of the Panel and will remain in place until late 2020. A member of the Panel since its inception, Karen was Deputy Chief Constable of Warwickshire Police and has over 32 years of experience in policing.
  • We’ve launched a new Twitter account! Follow us @CSPR_Panel for the latest updates and news from the Panel.
Stakeholder News
We’ve rounded up a few resources from our stakeholders:
Have Your Say
Have you experienced any good practice during Covid-19 from your area?

Please fill in this form or email your examples to us and we will endeavour to share across the country to maximise the learning.

If you have any feedback on this newsletter, or want to suggest colleagues to add to our mailing list, please don’t hesitate to email us at
We’ve also created a short survey so you can immediately let us know your thoughts. Click this link with five questions that can be answered in less than 5 minutes!
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Child Safeguarding Practice Review Panel · Sanctuary Buildings · Great Smith Street · London, London SW1P 3BT · United Kingdom

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