PA0206

Written evidence submitted by Clinically Vulnerable Families

Introduction to Clinically Vulnerable Families

Clinically Vulnerable Families [‘CVF’] was founded in August 2020 in response to the government decision to reopen schools without addressing the risks posed to people who are clinically extremely vulnerable, including the immunocompromised; clinically vulnerable; and their households. The group then expanded to support all clinically vulnerable households once shielding ended.

CVF has multiple purposes and these are primarily to support, educate, assist, advocate and campaign for clinically vulnerable families in the United Kingdom due to the risks posed by COVID-19.

CVF have contacted various MPs and the Children’s Commissioner and contributed to APPGs regarding the effect of the COVID-19 pandemic on the education of children in clinically vulnerable families.

Summary

The COVID-19 pandemic has brought unprecedented challenges to the UK education system, however, by not addressing ongoing risks posed to those who remain vulnerable some families have been left without viable safe learning options and this has resulted in persistent and severe absence for children in families that are clinically vulnerable.

Various factors contribute to persistent and severe absence for children and families who are at a higher risk of the worst outcomes from COVID-19. Ongoing risks remain to both those who are severely immunosuppressed and all vulnerable individuals. There is a growing number of UK Covid orphans, and an urgent need for safer learning options. We will also examine the risks posed by exam halls and the specific impact on children in exam years. Finally, we will discuss the mitigations required to reduce infections, especially the need for air filtration.

 

Children do catch and spread COVID-19

Government messaging from August 2020, when nobody was vaccinated, led the public to believe that all children were not only very low risk from the worst outcomes from infection but also that children did not spread infections. However, even early data from school closures (with mitigations in place) made it clear that this simply was not true. Vulnerable children do exist and for some children the risks remain high. For families that are clinically vulnerable it can be a high stakes gamble and the more vulnerable the more difficult can be. Guidance from the Department of Education (DfE) at that time told headteachers that vulnerable family members were ‘anxious’ and consequently most school staff offered little in the way of empathy or understanding.

In November 2021 Nadhim Zahawi (then Education Secretary) wrote to school leaders and Local Education Authorities to inform them that “maximising school attendance” was “a top priority” this added further pressure to families at around the same time as Omicron began to circulate, shortly afterwards the booster programme was announced for all adults.

The lack of uptake of children’s vaccinations has limited the protection offered by herd immunity1 allowing infections to pass unchecked between children, who (according to DfE guidance) must be in class on day 4 of a known COVID-19 infection when they are still infectious. Guidance also advises that children should not test for COVID-19 unless advised to by a healthcare professional. Consequently, schools are further driving community infections.

 

Risks to Those Who are Severely Immunosuppressed

For children and families who are severely immunosuppressed, the risks posed by COVID-19 are much greater. Despite up to 6 vaccines these individuals may have a very low or no immune response and therefore have retained incredibly high risks to the worst outcomes from COVID-19 infections. Consequently, household members are offered further booster doses to top up their immunity. However, following an update to current guidance those under 12 in severely immunosuppressed, will no longer be offered additional vaccines, this decision will further expose severely immunosuppressed householders to increased risks from schools and add yet more pressure to these families. NICE are evaluating the use of antivirals and the likely proposed remaining treatments are unsuitable for a significant proportion of this group due to contraindications, which will again add further risk.

Our survey data [October 2022] identified that 81% of children in severely immunosuppressed families had lost school days over and above non-vulnerable families at the same school, with over half telling us that their children had ‘lost a lot’ of schooling.

 

Risks to All Vulnerable

Current vaccines for COVID-19 have been effective at reducing severe illness and death, but their protection does wane after 4-6 months despite yet there is only an annual vaccine offer to this group.

All individuals who are vulnerable to COVID-19 are at risk experiencing severe symptoms should they contract the virus. They are not only at a higher risk of mortality but also of Long Covid. This means that there is an ongoing risk for all vulnerable individuals. This group, some of whom were formerly classified as Clinically Extremely Vulnerable (CEV) do not qualify for antiviral treatments.

Covid Orphans

By not protecting vulnerable lives there is now a growing number of Covid orphans, children who have lost one or both parents to the virus. The loss of a parent can have a significant negative impact on the children including mental health problems, financial hardship, and further difficulties in accessing education. For children who may have lost a loved one, perhaps as consequence of an infection they brought home from school, specialist support must be offered including counselling and targeted support for prior lost learning.

Current minimum estimates are that 16,800 UK children have lost a primary caregiver and 19,400 have lost a primary or secondary caregiver [Imperial College COVID-19 Orphanhood calculator].


Long-Term Exclusion from Education

A toxic mixture of attendance targets for schools; a lack of empathy for vulnerable lives, likely due to prior DfE guidance; and the use of inappropriate actions such as fines, children’s services referrals and prosecutions have resulted in families feeling that they have no option but to withdraw. Senior leadership from schools and local authority staff have threaten clinically vulnerable families with fines and prosecutions and quietly suggested that they withdraw to avoid them, a practice known as off-rolling. Since off-rolling is illegal, as it is not in the best interest of the child but of the school, staff have been careful to avoid documenting such conversations. However, our poll of CVF [November 2022] found that 56% of respondents had been told to consider withdrawing their children from school and 18% of clinically vulnerable families did so. These children may remain persistently locked out of education and denied access to essential learning and qualifications.
 

Children who have been excluded from formal education in this way will no longer feature in persistent and severe absences, we feel that this issue must also be given equal consideration along with the underlying cause, the airborne spread of COVID-19 infections, which must be addressed.

Additionally, having considered the draft proposals for the “School Attendance (Pupil Registration) (England) Regulations 2023” we are concerned that the proposed changes to “Deletion of names from admission register” points (i) and (j) appear to legalise off-rolling and so families who need to respond, far more rapidly than the government did at the start of pandemic, to an emerging threat to life may be forced to make a long term and unpalatable decision between human rights to education and life.

Should these families be subjected to a School Attendance Order (SAO) they may find themselves forced back into hazardous circumstances.

 

National Tutoring Programme (NTP)

The NTP was announced to provide targeted support for children who were the most affected by disruption to their education by the pandemic. Children in clinically vulnerable households shielded and also isolated the most due to a much lower tolerance to Covid symptoms than healthy families, yet a poll of our members found that only 5 had received tutoring. By neither identifying or supporting the needs of clinically vulnerable families it will have resulted in a learning gap, a known factor which can lead to persistent school absences.

Remote tutoring must be made available to this cohort.

 

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

Eating is an additional risk factor for children in clinically vulnerable families. Sitting in packed rooms with other noisy children whilst unable to mask (and therefore take personal responsibility to protect themselves). Alternatively, some may choose to not eat, which is far from ideal for their health and learning.
 

Lack of Safe Learning Options

Another factor contributing to persistent and severe absence for clinically vulnerable children and families in the UK is the lack of safe learning options. Remote learning became a common solution for many schools during the height of the pandemic, but it was never propositioned as an alternative for families who were not attending due to high clinical risks.

Hybrid learning could provide one part of the solution. Whilst remote learning is not without its disadvantages it is still significantly better than denying access to formal education due to the lack of a safe learning environment. If schools supported children to attend schools whilst infections are low and used mics and screenshares (as they did previously) it would not present a significant increase in workload for teachers. Children could still participate in the classroom via tablets in the hands of classmates. We support the proposal in the consultation for remote learning to be marked as in attendance under ‘attending any other place for approved remote education’ and we ask that this may also be extended to children in clinically vulnerable households.

For children in critical exam years, the risks posed by exam halls are particularly concerning. Exam halls are crowded, and children may be packed tightly together for many hours. Such circumstances increase the risk of COVID-19 transmission which can also be a source of stress and anxiety for children and families. Exam centres must therefore make appropriate access arrangements for those in clinically vulnerable households. Our survey data also identified that 41% of those applying for further education (e.g. university) had lost opportunities due to the household’s vulnerabilities – such consequences are significant and long lasting as they will affect lifetime earnings.
 

Mitigations Required to Reduce Infection Risks

To reduce the spread of COVID-19, it is important to implement measures that decrease airborne transmission of the virus through mask wearing and air purification.

Many children in clinically vulnerable families continue to wear masks in school but they frequently experience discrimination and bullying. Schools have varied in their approach to ongoing mask wearing and in common with previous government policy on masks, we have found that primary schools are the least supportive – which in turn has made returning to school more difficult for this age group. We would like to see more inclusive DfE policies actively supporting mask wearing for those who choose to continue to do so.

High-efficiency air filtration systems have been shown to be effective in reducing the transmission of COVID-19 by removing infectious virus particles from the air. This can help reduce the risk of infection for children and staff in schools, as well as for families at home. Air filtration systems can be cheaply installed in schools and should be a top a priority for the government in preventing the spread of not only COVID-19, but also other airborne pathogens such as: Influenza, RSV and Strep A alongside allergens and pollution.

For the cost of just one supply teacher for one day one classroom could be protected. This would not only make schools safer for clinically vulnerable families but also improve school attendance and long-term health by reducing infections, asthma and Long Covid. A reduction in staff absences would also be beneficial for school budgets.

Our poll in September 2022 found that 99.6% of CVF respondents felt exposed due to ongoing Covid risks and 75% told us this Christmas that they had or would withdraw their children due to the growing risk of infections (not just COVID-19) combined a lack of healthcare. However, 93% told us that they would be happy to send their children to school if mask use was supported and air filtration was added.

Conclusion

The COVID-19 pandemic has had a profound impact on children in families that are clinically vulnerable in the UK. We have examined the factors causing persistent and severe absence for these individuals, including the risks posed to vulnerable lives, the growing number of UK Covid orphans, families with no option but to withdraw or face serious consequences, the impacts on the children and the root cause being the lack of safe learning options.

Our recommendations to improve attendance and return children to the classroom are as follows:


We ask that the inquiry committee takes all of these issues into consideration as it works to support our children and families.
 

References

  1. Gurdasani, D (2022) ‘Covid-19 in the UK: policy on children and schools’, BMJ, 378. Available at doi: https://doi.org/10.1136/bmj-2022-071234

February 2023