It is a mistake to assume all vulnerable children are ‘at risk of harm’

People have been saying that the coronavirus pandemic is "the great leveler". Mostly, it's people who are sitting in comfortable homes without too much to worry about. But in one respect, it has most certainly divided the nation into two very distinctive camps: those who are considered to be 'vulnerable', and those who are not.

Never has the word "'vulnerable' been such an integral part of our national narrative. Coronavirus (COVID-19), has led to the word being used in a sweeping way by the media and politicians, to encompass anyone who might be 'at risk' of being more adversely affected by the pandemic.

It's a term is being used to describe a seemingly endless set of circumstances, from someone who has an underlying health condition, to an abused child on a child protection plan. But not all vulnerabilities are the same, and generalisations like this can lead to assumptions and ill-informed decisions being made by people in power.

Vulnerable catch-all in schools

Take the recent response from politicians to official government statistics showing that just 5% of children classed as ‘vulnerable‘ turned up to school in England after the Easter break. There was a range of reactions from different parties. Almost all centred on the fact that children in this group were 'at risk' and therefore needed to be in school as a safeguarding measure.

Labour MP, Tulip Siddiq, the shadow minister for children and early years, wrote to the education secretary, expressing concern that, "School is often a safe haven for vulnerable children... Teaching staff are worried that they are unable to see ‘at-risk’ children as they usually would and that they are not getting help".

The Liberal Democrats’ education spokesperson, Layla Moran, called for urgent government intervention. “This is utterly shocking and shows just how massive the problem we face is to look after vulnerable children during the pandemic”. Tom Hunt, Conservative MP for Ipswich went one step further and asked the children’s minister, Vicky Ford, whether it should be a requirement that all vulnerable children should be at school because of concerns about the low attendance rates of children deemed to be 'at risk'.

It seems there is a general misunderstanding about the difference between what constitutes being 'at risk of harm' and what classifies someone being termed 'vulnerable'. Of course, a child can be termed vulnerable because they are at risk of harm, but this only applies to some of the children in this group, with the majority of children coming from loving and supportive families. Many will be children with special educational needs and/or disabilities.

So who is considered as vulnerable?

The government's response to the coronavirus has seen the term vulnerable applied to many different groups of people, which only exacerbates the problems around generalisations being made, as everyone is getting confused. To understand who they refer to, and what the implications are, it's probably easiest to look at what vulnerable means in terms of someone's health and then their educational and social care needs.

Vulnerable because of a medical need

When the coronavirus pandemic first hit, we heard a lot about the vulnerable groups that would be hardest hit by the virus. Mostly this focused on those over 65 years old or adults with serious underlying health conditions. Families with medically complex children had to wait a little longer to get clarification that they too were considered to be in this group.

The government set about trying to build a database of everyone who is considered to be 'extremely vulnerable' in order to try and ensure that those that were most at risk of complications from Covid-19 could get access to support and priority for online shopping delivery. Although this was undoubtedly a positive initiative, there was concern that there could be a more sinister consequence for registering yourself or your loved one as extremely vulnerable in light of reports being released about how medical care would be prioritised if the NHS reached capacity.

It left many people, myself included, wondering whether, by accessing help, they would be inadvertently marking their loved one as being expendable if there weren't enough resources to treat everyone. I'm sure that most, like myself, have ended up feeling that it's a risk they have to take in order to be able to completely isolate themselves and their loved ones from this horrible virus.

What does the Government guidance say?

Government guidance defines extremely vulnerable people as including the following:

1. Solid organ transplant recipients.
2. People with specific cancers:
   • people with cancer who are undergoing active chemotherapy
   • people with lung cancer who are undergoing radical radiotherapy
   • people with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment
   • people having immunotherapy or other continuing antibody treatments for cancer
   • people having other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors
   • people who have had bone marrow or stem cell transplants in the last 6 months, or who are still taking immunosuppression drugs
3. People with severe respiratory conditions including all cystic fibrosis, severe asthma and severe chronic obstructive pulmonary (COPD).
4. People with rare diseases and inborn errors of metabolism that significantly increase the risk of infections (such as Severe combined immunodeficiency (SCID), homozygous sickle cell).
5. People on immunosuppression therapies sufficient to significantly increase risk of infection.
6. Women who are pregnant with significant heart disease, congenital or acquired.

People who fall in this group should have been contacted to tell them they are clinically extremely vulnerable, and if they haven't you can register online. If your child doesn't fall into these groups but is very medically complex or has underlying conditions that you think might make them especially vulnerable to complications from the coronavirus it is worth contacting your GP to ask if they should be on the list.

Vulnerable because of an educational or social need

Now here is where things get even more complicated. The government's guidance 'Supporting vulnerable children and young people during the coronavirus (COVID-19) outbreak' defines vulnerability in relation to children that they believe should continue to access education settings while the rest of the children in Britain stay at home (with the exception of keyworker children). This lumps together children with vastly differing needs under the single heading of 'vulnerable':

"During the coronavirus (COVID-19) outbreak, for the purposes of continued attendance at educational settings, vulnerable children and young people are defined as those who:

• are assessed as being in need under section 17 of the Children Act 1989, including children who have a child in need plan, a child protection plan or who are a looked-after child
• have an education, health and care (EHC) plan whose needs cannot be met safely in the home environment
• have been assessed as otherwise vulnerable by educational providers or local authorities (including children’s social care services), and who are therefore in need of continued education provision - this might include children on the edge of receiving support from children’s social care services, adopted children, or those who are young carers, and others at the provider and local authority discretion"

Refine the "vulnerable" definition

So here we have two distinctly different groups of children included - those children who need to be safeguarded due to abuse or potential for abuse, and those children with disabilities. Of course, there are many disabled children who might qualify as 'vulnerable' under this definition because they have a child in need plan, indeed many children with disabilities do, but this is simply due to the fact that they require additional services. The Children Act 1989's definition of the term child in need is:

"a child who is unlikely to achieve or maintain a reasonable level of health or development, or whose health and development is likely to be significantly or further impaired, without the provision of services; or a child who is disabled."

The Children Act 1989'

However, it is a very common misconception that a 'Child in Need' plan is simply one step down from a child protection plan. It wrongly implies that a child in need is considered vulnerable because they are 'at risk', most often through neglect. This misconception stems from changes made to the Children Act 1989, by the introduction of a supplementary Act in 2004. This Act saw safeguarding expanded to include all children, not just those needing protection from abuse or neglect.

Successive versions of the statutory guidance ‘Working Together to Safeguard Children’ has further eroded the boundary between children needing protection because they were actually at risk of harm from abuse, and all the other children in Britain (who aren't actually at risk, but might, possibly, vaguely, be at risk if you really thought hard about a scenario that could, possibly, arise at some undefined time in the future... maybe).

What we have been left with is a system that means that any child who is referred as 'in need' of any support from social care, has to be risk assessed using the same safeguarding framework. This is regardless of whether they are a disabled child who needs access to additional services, or a child where there is, in fact, evidence of abuse. It is hardly surprising that even ministers responsible for the legislation are left confused, believing that all vulnerable children must, therefore, be at risk of harm.

So what are the implications for children with SEND?

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Renata Blower

Co Director at Special Needs Jungle

Renata is co-director of Special Needs Jungle as well as being on the board of Hertfordshire’s Parent Carer Forum. She also sits on a variety of steering groups including the coordinated care of rare diseases (CONCORD) study funded by the National Institute for Health Research, community and public health strategies, delivering coordinated care and strategic planning for SEND. She also sits on various advisory committees for children’s charities.

Previously Renata has been at the forefront of successfully changing government policy so interventions are needs-led and no longer diagnosis-led, and creating the world’s first specialist nurse for undiagnosed children at Great Ormond Street Hospital.

She also helped establish and grow the first online support community for families of undiagnosed children and spearheaded the very first undiagnosed children’s awareness day, including producing information videos that were shown in parliament.

She is a regular speaker on TV and at events, is an RSA Fellow and the mother of three children with disabilities, two of whom have complex needs and one of whom also has complex medical needs.

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