Editor,—This important review of the school entry medical (SEM) examination1 is so flawed that the key messages cannot be supported. The School Health Service was introduced as a therapeutic, not just an epidemiological tool, when the Boer War revealed the extent of untreated disease for which neither treatment nor care was available. In 1976, the Court Report recommended that the SEM should be a statutory examination: not to identify missed disease, but to support needy children, because of the profound impact of indifferent health, disadvantage, and developmental delay on educational progress. The Polnay Report, Health needs of school age children (1995), clearly advised that the health care assessment by school nurses at entry should also advance health promotion.

School health varies dramatically …