Written evidence submitted by the National Association for Hospital Education

The factors causing persistent and severe absence among different groups of pupils, in particular:

       Disadvantaged pupils,

       Pupils from minority ethnic backgrounds,

       Pupils with SEND and those who are clinically vulnerable to covid-19,

       Pupils in alternative provision.

        Factors impacting on the different groups of pupils include:

        Chaotic home backgrounds

        Economic difficulties- not able to afford uniform, shoes PE kit etc

        Families not prioritising or valuing school

        Involvement in illegal activity such as county lines

        Children with complex medical conditions in mainstream schools - many of them do not have EHCPs and are under the radar.

        Punitive attendance strategies - become scared of attending and as the more is missed, the more it is harder to attend

Pupils in alternative provision are on personalised learning programmes where attendance strategies are part of individual plans. Staff there have a much more empathetic approach and are more likely to engage much more closely with families, involving them in programmes of support. Each day is a fresh start so it means that they do not worry about any repercussions from not attending, or displaying externalising behaviours when they come in the next day. They are also encouraged to come in, when they feel ready rather than be punished for being late. Smaller, nurturing environments mean that children want to come in and learn.

I would like to highlight children with complex health conditions, such as cancer, and the challenges that they face to meet the exacting attendance targets that are required in mainstream schools. There must be some leeway and greater understanding of the challenges and some empathy.

The summary of responsibilities document recently published is helpful in enabling schools to better understand the barriers faced by children with mental health difficulties. So much more can be done in schools to support this cohort of children, and possibly senior mental health workers in schools can provide that holistic care and support for the families and the child, to help them to attend more regularly.


       How schools and families can be better supported to improve attendance, and how this affects pupils and families who are clinically vulnerable to covid-19.

We have to stop vilifying families whose children are struggling to attend school. This is particularly the case for pupils with medical and mental health difficulties. The strategies schools use can be very accusatory and families are frightened of being taken to court, so are forcing their child into school, very often at the extreme detriment to their health.

A more supportive engagement with families is needed - each school to have a family liaison worker/social worker who can work with the family to support them to enable their child to attend school.

Please can schools take heed of advice from medical professionals about how much school - if any- a child is able to manage?

In recent guidance on remote education, it mentions that online learning can be used for short periods of time - schools need to stop making children think they have failed if they have to access online learning. More use could be made of the telepresence robots (see APIF project write up) to support children attending when their medical condition makes it impossible for them to attend in person.

Please support those children and families that feel isolated and cut off from school and help them to remain connected and belonging to the school community as this will make their return to school much easier.

Please do not think that because the pandemic is over, that all of the worries about covid and infections have passed. We are just starting to see the true impact of the pandemic, particularly on children’s mental health. We are seeing unprecedented numbers of children being referred to medical AP as the impact of their medical/mental health difficulty means that they can no longer manage mainstream schools and the pressures within it.


       The impact of the Department’s proposed reforms to improve attendance.

Since the proposed reforms and the campaign started by the Children’s Commissioner, the situation for pupils with medical and mental health difficulties has become much worse in schools. Children and families are being hounded to improve their attendance with no consideration being given to the child’s state of health. Systems designed to motivate children to attend - class treats, trips out, golden tickets to discos etc - just lead to pupils with medical needs being more marginalised as their peers blame them for never being able to go on a school trip. The children feel that they have constantly failed and are no good at anything. Not only are they dealing with the impact of their medical/mental health difficulty, but also becoming anxious about missing out on their education, losing their peers and their school life.


       The impact of school breakfast clubs and free school meals on improving attendance for disadvantaged pupils.

Can't comment on this


       The role of the Holiday Activities and Food programme and other after school and holiday clubs, such as sports, in improving attendance and engagement with school.

Sports in particular can be a big support in engaging pupils with mental health difficulties and encouraging them back into the school environment.

February 2023