Safeguarding Adult Reviews (SAR)

Since the implementation of the Care Act (2014) there is a statutory requirement to undertake Safeguarding Adults Reviews (SARs). They are commissioned when:

  • there is reasonable cause for concern about how WSAB members or other agencies providing services, worked together to safeguard an adult,


  • The adult has died, and WSAB knows or suspects that the death resulted from abuse or neglect (whether or not it knew about or suspected the abuse or neglect before the adult died)


  • The adult is still alive, and WSAB knows or suspects that the adult has experienced serious abuse or neglect.

A Safeguarding Adults Review (SAR) is a multi-agency review process which seeks to determine what relevant agencies and individuals involved could have done differently that could have prevented harm or a death from taking place.  The purpose of a SAR is not to apportion blame.  It is to promote effective learning and improvement to prevent future deaths or serious harm occurring again.

Further information can be found in the Care and Support Statutory Guidance, Chapter 14, paragraphs 14.133 and 14.134.

The WSAB information sharing protocol can be found here WSAB Information Sharing Protocol V5

For all media enquiries relating to Worcestershire Safeguarding Adults Board please contact 01905 844474 or

Published Safeguarding Adults Reviews are available on the website for 3 years. This ensures that the most current learning messages and recommendations are reflected. If you require any archived SARs please contact:

Rough Sleeper Deaths

A Rapid Review will be undertaken when a person sleeping rough dies.  A Safeguarding Adult Review (SAR) referral should be submitted using the  this form Link to SAR referral form and a Rapid Review will be held. 

A member of Healthwatch will be invited to join the Rapid Review panel as an observer to ensure transparency and accountability. 

The Rapid Review will consider how agencies worked together to support the person and whether the SAR criteria are met.

Where the SAR criteria are met a SAR will be undertaken in line with the protocol. 

Where the SAR criteria are not met a decision will be made on whether a review needs to be undertaken by another Board or organisation and whether any leaning for agencies involved has been identified. 

The WSAB will collate the number of SAR referrals and SARs undertaken regarding the deaths of people sleeping rough annually and then identify any recurring themes that need to be addressed further and reported to the WSAB.  

SARs published in Worcestershire can be found using the link below:

WSAB Published SARs Page


Safeguarding Adults Review Protocol


SAR Library

WSAB contributes to the Safeguarding Adults Review (SAR) library, which contains reports and associated resources to support those involved in commissioning, conducting and quality assuring SARs. Use the link above for more information.