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New prescription for health

School doctors and nurses must change their ways, a Scottish Office review of health services in schools has recommended.

The review also found "cause for concern" at the lack of conclusive evidence on the effectiveness of the service. "There are very few documented examples of good practice to serve as benchmarks against which to evaluate provision and to aid planning," a report states.

The report acknowledges fears of an "over-emphasis on physical examinations" at a time when problems are linked to emotional, social and behavioural issues and are reflected in concerns over drugs, sex and weight.

The Scottish Office wants school health professionals to move into preventative work, health promotion and support for the rising numbers of children with special needs who attend mainstream schools.

The report accepts that routine medical examinations of children entering primary school should continue. Thereafter the emphasis "should be shifted away from the routine examination of all children irrespective of needs to a more focused service".

The review found that some health boards continue to examine all children at the ages of 11 and 14, despite national guidance issued 16 years ago urging a shift to a more selective approach.

Studies, albeit limited, "suggest that the yield of significant previously undetected abnormalities is very low and that many of the problems which are detected are ones which would have been more appropriately dealt with by the general practitioner".

Some duties in schools should be dealt with by nurses rather than doctors. These include measurement of pupils' weight and height, eyesight tests and immunisations.

The review also covers the school dental service and stresses the importance of early identification of potential problems. Close collaboration between medical staff in and out of school is constantly stressed to ensure pupils' records do not get lost.

The Scottish Office review echoes many of the points made in the Audit Commission's report in 1994 on child health services in England. The commission found a lack of clarity about what the school health service should be doing, insufficient co-operation among professionals, and poor information systems.

"It appears that these problems also exist in Scotland," the review concludes.

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