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The School Health Service (SHS) began 90 years ago when the Education Act of 1907 introduced periodic medical inspections to address government concern over the poor health of school children and of recruits for the Boer war. Responsibility for the SHS passed from local authorities to the NHS in 1974.1 Although the only statutory duties2 are to provide inspections of pupils at “appropriate intervals”, the SHS offers a range of other services whose relevance and effectiveness have increasingly come under scrutiny.
The Polnay report3 preferred the term “health services for school age children”. Although this was a sound recommendation, SHS staff are still easily identifiable and to many purchasers the SHS is now virtually synonymous with school nursing. Community paediatricians and senior nurses with management responsibilities are often consulted about this service, which fulfils many functions (see ). School nurses work in a complex community, where both teachers and children have physical and mental health problems and needs. They have inherited many of the traditional duties of school doctors, notably universal screening and inspection of children. School health staff participate in various tasks prescribed by government statute or guidance and also respond to perceived local needs. It is perhaps not surprising that they have difficulty in assessing their optimum staffing (L Cotton et al, unpublished data, 1998),4 defining their role5 or measuring their own effectiveness.
This article will argue that community paediatricians and nursing managers must not be paralysed by the lack of trial based data, which may be impossible to obtain. Advice based on a logical appraisal of need will be better than an approach driven solely by political fashion or short term financial considerations. The paper does not attempt to consider all the tasks listed in the , but focuses on those …
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