Medway LCSPRs and Learning Reviews
The purpose of a local child safeguarding practice review (LCSPR) is to explore how practice can be improved through changes to the system itself. Reviews should seek to understand both why mistakes were made and to comprehend whether mistakes made on one case frequently happen elsewhere and to understand why.
A Lessons Learned Review is completed with the same approach to Local Child Safeguarding Practice Reviews. Each case will be examined individually to determine the most appropriate methodology to identify and maximise learning.
Read Working Together to Safeguard Children 2023
Medway LCSPRs
LSCPR Laura published February 2025
The Medway Safeguarding Children Partnership (MSCP) has published Local Child Safeguarding Practice Review (LCSPR) Laura. The LCSPR was undertaken following the death of 20day old baby Laura. The day before Laura’s death, the family – including Mother, Laura and her two older siblings - had been away with relatives at a caravan park. They returned home late, and all slept in the same bed. Laura’s mother had been drinking heavily during the day and so bottle-fed Laura. The following morning, Mother woke to find Laura unresponsive, and she could not be revived. The review gives an overview of the family background, identified good practice and lessons arising from the review for both individual agencies and the safeguarding children partnership.
LCSPR Julia published December 2024
The Medway Safeguarding Children Partnership (MSCP) has published Local Child Safeguarding Practice Review (LCSPR) Julia. The LCSPR was undertaken following the death of 5 year old Julia who was found to have drowned in the bath after being left unsupervised. At the time of her death Julia was in the care of Medway Local Authority and had been living with her siblings in a foster home provided by an Independent Fostering Agency for 7 months in another Local Authority area. The review gives an overview of the family background, identified good practice and lessons arising from the review for both individual agencies and the safeguarding children partnership.
LCSPR Isabel published September 2023
The Medway Safeguarding Children Partnership (MSCP) has today published Local Child Safeguarding Practice Review (LCSPR) Isabel. The LCSPR was undertaken following the death of three month old Isabel, who had been co-sleeping in bed with her mother. Isabel was subject to a child protection plan and it is thought (but not confirmed) that Isabel’s death was a tragic accident linked to an unplanned sleeping environment where drugs and alcohol were present. The review gives an overview of the family background, identified good practice and lessons arising from the review.
A copy of the review is available to download below along with a briefing sheet and video for professionals.
- Isabel Overview Report
- Isabel Briefing Sheet (PDF)
- Isabel Learning Video
- Isabel's Story - Hidden Neglect Conference 2024
Medway Serious Case Reviews
Serious case review - "Baby Harris" published March 2021
The Medway Safeguarding Children Partnership (MSCP) has published Serious Case Review (SCR) Baby Harris. The SCR was undertaken after emergency services were called to the home address by Baby Harris' parents after finding him unresponsive. Observations of Baby Harris’ body indicated that he had been dead for some time before emergency services had been called. The review gives an overview of the family background, identified good practice and lessons arising from the review for both individual agencies and the safeguarding children partnership.
A copy of the review is available to download below along with a briefing sheet for professionals.
Serious case review - "George" published March 2020
The Medway Safeguarding Children Partnership (MSCP) has published a serious case review following the death of three year old George. The Ambulance Service was called to a street in London to attend to an unresponsive three year old George. George had suffered a cardiac arrest and was taken to hospital where he died. Following a criminal investigation it was found that mother’s then partner had twice pushed his car seat back and crushed George.
A copy of the review is available to download below along with a briefing sheet for professionals.
Serious case review – “Faith” published January 2020
Medway Safeguarding Children Partnership (MSCP) has published serious case review Faith which was commissioned following a retrospective health review which identified that as a child Faith had been seen by health practitioners with symptoms that may have been indicative of sexual abuse and that there appeared to have been a failure of multi-agency responses to indicators of risk throughout Faith’s childhood.
A copy of the review is available to download below along with a briefing sheet for professionals:
Medway Secure Training Centre (STC) published January 2019
‘Learning for organisations arising from incidents at Medway Secure Training Centre’
Medway Safeguarding Children Partnership (MSCP) has published a serious case review in response to the identification of abuse of children by staff at the Medway Secure Training Centre (STC) in a television documentary broadcast in January 2016.
A copy of the review is available to download below along with a statement from the MSCP Independent Chair:
Learning Lesson Reviews (LLR)
Where the threshold for a serious case review is not met the MSCP may elect to complete a Learning Lesson Review to identify multi agency learning.
Video explainer for Jones Family
Read the Jones Family briefing
Read the Eve LLR recommendations
Read the Smith Family LLR briefing
Read the Williams Family LLR briefing
MSCP Reporting and Learning System
Read the notifications and referrals to the Medway Safeguarding Children Partnership- safeguarding children reporting, learning system and case review referral (including serious case review) below.