The birth (and death) of the school health service

Everyone in England is familiar with the concept of the National Health Service. But have you heard of the School Health Service?

A forgotten aspect of the 1944 Education Act is that it laid down duties on local authorities to look after the health of pupils. School medical officers were to be responsible for ensuring that every pupil received an inspection in their first school year, their last year of primary and the last year of secondary school.

In The Child At School, written in 1950 by J H Newsom, we learn that inspectors were to check, among many other things: “Ears: hearings and discharges; Nose: obstruction, crusting and discharge; Lower Limbs: knock-knee, flat-foot or other deformities.”

It was expected that abnormalities would be supported. Children found to have sight problems should be provided with glasses. Children with hearing difficulties given aids.

Dental inspections also were part of the service, with Newsom proposing an “ideal” of every six months for each child. (Though he admits that most only did one inspection during a pupil’s entire time at school).

It was expected that abnormalities would be supported

That this was taken seriously is evidenced by Newsom’s discussion of the “chief medical officer of the Ministry of Education” who appears to have made pronouncements on the development of children and how schools ought to respond to any deviations.

Today, the education department no longer has its own medical officer. However, Professor Dame Sally Davies, the chief medical officer for England, on occasion still makes comments about education. For example, in her 2013 annual report she recommended personal, social and health education become compulsory so children were guaranteed lessons about healthy living.

Compulsory lessons are a long way from a comprehensive in-school medical service, though. Why the shift?

Simply put, England in the 1940s had just been through two world wars in quick succession. In both wars young men were conscripted into the army, and their health came as a shock to many generals whose comfortable upbringings had shielded them from the woeful health of working people.

Where other countries had devised thorough education systems, often with a focus on physical education (such as Prussia), England had barely scraped together an education system able to get people reading before putting them into factories. This was not only embarrassing, but when the country was facing invasion, it was a serious liability.

That the checklist focused on issues that caused problems for the military (for example, flat-footedness and poor eyesight) gives an indication that, in part, England was concerned to ensure that its young would – at any point – be ready to go into battle if needed. This was not an irrational fear given the previous decades.

Sadly, over the years, this focus on children’s health seems to have broken down. Now, parents are expected to take their children to a GP when there are issues, and school nurse numbers deplete year-on-year. Funding structures simply didn’t support the model in the end and the trend doesn’t seem like it will reverse any time soon. Let’s hope another world war isn’t on the way.

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