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I do not believe the future of the School Health Service lies in part-time officers
and general practitioners doing the work. Neither do I believe that it is good for the
child to be divided up into a series of "specialities" all enquired into and surveyed
by different technicians. The School Medical Officer himself should be equipped
to deal with the whole child and then refer to the specialist the deviations from the
normal when such referral is required.
Neither do I believe the work is best done by senior registrars serving for a year
to gain experience before becoming paediatricians, for the work only reveals its
interests and satisfactions when you have done it for a period of years and get to know
the school staffs, the children and the parents in a district. As in general practice
it is the personal element that counts. The impersonal, detached medical officer has
not the right personality for this work and should not be doing it; the medical officer
who finds it boring should quickly be told to go elsewhere—this work is not for him.
I do not feel that the fact that every child now has his own doctor makes our service
redundant. There is still much we can do for him. Nor the fact that the Regional
Hospital Board has taken the responsibility for the payment of the specialists to attend
the clinics we first created means we are no longer interested in seeing that the child
really gets the care he needs.
I do not feel a bit despondent about the service—though I sometimes do about
the lack of faith which afflicts many of our more senior medical officers who know little
of the practical work of the School Health Service. I believe that there was fashioned
some 46 years ago in the School Health Service an admirable instrument for the
promotion of physical well-being in our younger generation; I do not think it is the
instrument that is at fault when it fails; the areas where the personnel have been
keen and enthusiastic and where good services have been provided show that it works
admirably. I think that our next task lies in the extension to all areas of complete
services and the speeding up of that work; in senior officers taking far more interest
in the staff working in the field; not paying lip service to the need for research but
in seeing that the staff have time and encouragement to do research; and giving them
more responsibility in the arrangement of their own work.
The Service has never been treated as it should be; it has been cramped for money,
its services curtailed and its resources meagre in too many areas of the country;
it is not an expensive service. It cost the local education authorities just over £6,000,000
in 1939 and in 1951 that figure had risen to under £10,000,000. Even if you double
that it would compare more than favourably with the National Health Service bill.
It will not grow, however, to its full usefulness unless you have faith in it;
enthusiastic juniors need enthusiastic seniors. We have been suffering from an inferiority
complex too long; the clinicians and the hospital specialists have been
lecturing us about our work. Let us remember when we are so talked down to that
we have chosen a special branch of medicine to practice. In Dr. Weaver's appreciation
of the late Dr. Ralph Crowley, one of the architects of the School Health Service,
he says this, "His concern was not entirely with medical problems; he was as
interested in the educational as in the physical development of the child, so that
there was never any possibility of the school medical service being for him a mere
organisation for the ascertainment and cataloguing of defects "(1953, Brit. Med. J.).
Let us remember that we are disciples of Dr. Crowley and men like him, and let
me remind you, too, of the words of another great man, the late Dr. Rene Sand (1953,
Brit. Med. J.):
"Neither students nor practitioners fully realise that, as Hippocrates already said
long ago, in medicine the function of protecting and developing health must rank even
above that of restoring it when it is impaired.
"If the nobility of medicine resides in the selflessness of the physician, the
hygienist and their assistant, its greatness resides in the scope of the services which they
render; and, from this point of view, the medicine which preserves health has a
considerably greater influence for good than the medicine which restores health."