Learning about safeguarding from experience
Guidance for local authority social care staff
- evaluate the outcomes of safeguarding cases, including whether the person feels safer
- share learning within the organisation and with partner agencies
- in the most serious cases ensure a Safeguarding Adults Review takes place.
Serious case reviews (to become safeguarding adults reviews and a statutory requirement under the Care Act) offer a way of examining evidence vital to the improvement of safeguarding practice. There is little evidence to date that multi-agency systems are changing as a result of available data, and so there is clearly room to improve by learning from mistakes. 
SCIE’s Learning Together initiative presents a ‘systems’ model of organisational learning that can be used across agencies involved in safeguarding. Initially developed in children’s services, the model is proving helpful in adult safeguarding. The approach supports an analysis that goes beyond identifying what happened towards explaining why it happened. This helps the safeguarding network generate new ideas about how to improve safeguarding practice.
Parry  highlights the lessons that have arisen from serious case reviews involving housing:
Internal: Housing providers should improve:
- data bases of all tenants ensuring that vulnerabilities are identified
- support and contract monitoring involving tenants with care and support needs
- awareness of safeguarding by all staff and ensure effective reporting of abuse.
External: Housing providers are inhibited in their effectiveness in adult safeguarding due to:
- barriers to information sharing, often caused by negative attitudes towards housing staff
- adult social care setting high thresholds for safeguarding referrals
- failures of risk and capacity assessment and diagnosis by adult social care.