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CHAPTER VI
HEALTH
The improved health of
children: value of the School Health Service
Children in this country are physically much healthier than they were in the last century. The School Health Service has done much to bring this about, although when it began its work the worst effects of the industrial revolution had already been to some extent reduced. In the thirty-nine years which have since passed, the death rate of children has been halved; there has been a steady improvement, so that children today are appreciably taller and stronger, and despite the setback during the war, much cleaner in their persons and habits; many diseases, then very common, including tuberculosis, rickets, skin diseases and infections of the middle ear have been rapidly disappearing; deformities have become less common and with early treatment less severe; and many children who would have been prevented by ill-health from taking part in various activities both in and out of school are now able to enjoy them fully.
Despite the improvements the
standard achieved is still far from the modern ideal
Parents and teachers have come to show a much greater interest and sense of responsibility in this matter. The effect of bringing together the doctor, school health visitor, teacher and parent to discuss the health of the child has been to make them dissatisfied with a low standard of health and has convinced them that much ill-health is preventable. Some of the progress has been due to the increasing attention paid to physical training, which has changed from the static drill of the last generation to an education in movement designed to cultivate "poise, strength, mobility and agility". The gain has certainly been considerable: but it must be realised that standards change, and that, in terms of positive health,* the health and physique of children today is quite as far removed from the present ideal, as the state of affairs in the last century was from that of today. Lack of space, of gymnasia and physical training rooms, and of apparatus, still greatly handicaps effective training.
The origins of the School
Medical Service. The first practical step was to provide inspection
The School Medical Service started in November, 1907. The necessity for such a service had long been recognised. In 1861 Sir Edwin Chadwick had said: "A special sanitary service applicable to schools is needed for the correction of common evils of their construction, and the protection of the health of the children therein." Later on public opinion was startled by the low standard of physical fitness among recruits during the Boer War, and in 1904 the Duke of Devonshire's Committee on Physical Deterioration recommended a complete service of medical inspection. It was made clear, when establishing such a service for schools, that the aims were to enable the child to take advantage of the system of state education, to ensure the health of the coming generation by caring for the present one, and
*As discussed in the recent White Paper on a National Health Service.
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finally, to provide health supervision. To carry out the aims, it was necessary "first to improve the health conditions, both personal and in regard to environment, of the children of the nation. A consideration of the gravity of the need led to the conclusion that medical inspection of school children is not only reasonable but necessary as a first practical step towards remedy. Without such inspection we not only lack data, but we fail to begin at the beginning in any measure of reform."* It is still agreed that the health of children must be supervised, and any defect discovered; but it may well be thought that this one side of the work has been too much considered to be all the work, and that other beneficial sides of the service have been virtually excluded.
The increased scope of the medical inspection
To a large extent the School Medical Service is the same today as that introduced by the Act of 1907: its basis is still three examinations of each child during school life, with re-examination and special examination as required. There have been great advances made in the way in which the work is carried out. Special examinations take place more often, and are more thorough, so that extra attention can be given to children found by the school doctor to need observation, and to those referred to him by teachers, parents and school attendance officers. The number of special examinations now almost equals the number of routine inspections; and whereas formerly medical inspection was successful chiefly in detecting early illness, latterly the aim has been to provide a complete audit of a child's health.
Increase in the provision of treatment:
some authorities have already gone beyond statutory requirements
Treatment also has received increasing attention, but it was not compulsory until the 1918 Act,** and has never been interpreted as applying to more than a small number of ailments.*** But many authorities, by going beyond the minimum of requirements laid down, have provided a most efficient and complete service, and have set a standard of treatment which has prepared the way for raising the standard generally.
The next step: to make the service comprehensive
The history of the School Medical Service has been one of "organic development" and expansion. This development was particularly rapid during the fifteen years preceding the war of 1939. The more "positive" outlook in health matters generally demands a further step in the development of the service: designed to meet one set of circumstances, it must now expand and adapt itself to others. The need is for a service which will give attention to the whole development of boys and girls in sickness and in health, at school and at home. Inspection thus becomes but a part of a much wider whole.
*Board of Education Circular No. 576, November, 1907.
**Grant Regulation No. 19 introduced under the 1918 Act.
***Eyes and teeth, minor ailments, and chronic tonsillitis and adenoids.
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The necessary aims for such a service
Though considerable expansion is necessary, its rate must be controlled by seeing that the high standard established in many parts of the service is secured throughout. The aims of the service today should be to ensure:
(i) more comprehensive supervision of children in the schools,
(ii) more and better facilities for treatment in hospitals and clinics,
(iii) the universal maintenance of adequate and continuous child health records,
(iv) an extension of health supervision on similar lines over the early years of employment.
(v) sound and effective teaching of Health in and through the schools.
(vi) suitable provision for all "handicapped" children,
(vii) instruction for teachers of a kind that will enable them to co-operate most satisfactorily with the School Health Service.
(i) The Supervision of Health in Schools
The supervision of health in the school must
be comprehensive and continuous, and should aim at fostering positive health
The supervision of health in school must fulfil three conditions. It should be comprehensive, and continuous, and aim at fostering positive health. First then, medical inspection must be sufficiently thorough to ensure that nothing of importance is overlooked. The school doctor and nurse should have time to inform themselves about the whole life of the child so as to arrive at a full appraisal of his well-being. Detailed enquiries, apart from their value in themselves, should be of very great assistance to parents; through their expert knowledge, doctor and nurse can help parents to carry out the responsibility they feel towards their children.
Comprehensive medical inspection
There must, therefore, be time for the doctor to consult with both teacher and parent, and a three-party conference of teacher, parent and doctor often brings to light aspects of a child's life which otherwise might remain unnoticed. Furthermore, school doctors and nurses should study children in the classroom or at play, where observation often tells them much that a formal medical inspection, however thorough, cannot always reveal. To inspect in this way means spending more time on each child.
Continuous supervision
Secondly, health supervision must be continuous, so that it can at once be seen if any child is not so healthy as he should be, and arrangements can be made for special examination. At present the most notorious "gaps" occur immediately before and after the age of compulsory school attendance, in the health services for children between two and five, and after the age of fourteen. The Act of 1944, by raising the school leaving age to fifteen, and later sixteen, and by extending the School Health Service to county colleges, will, as it is put into effect, close the gap at the adolescent stage; and at the other end, as the supply of nursery schools is increased, so will the number of young children coming within the School Health Service be increased. Meanwhile for children between the ages of five and fourteen
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the present three formal medical inspections during school life, supplemented as they are by valuable special examinations, and occasional visits of a school nurse, do not make the supervision anything but spasmodic. This defect in the system should be remedied. Visits to schools of professional staff should take place more often. Doctors and nurses should be associated with particular schools, so that they can get to know them intimately. and come to be regarded as friends of the school who can advise parents and teachers. The schools, and all who are concerned with the child, must respond by becoming more "health conscious". The teacher, the parent and the school attendance officer should accept it as part of their responsibility to bring to the notice of the school medical department any children who do not thrive.
The need is to
establish a "health" service in the schools
Thirdly, the cumulative effect of a "Child Health Service" should be to instil ideals of positive health. The following comments of the Workers' Educational Association express well this point of view:
"What is wanted is a school health service, positive in conception and thoroughly co-ordinated. As a young engineer puts it 'the service is at present inadequate for the schools of poorer people ... The greatest need of all is not greater medical service but better health services in the form of wholesale extension of school playing fields, swimming pools, fresh milk, fruit, meals. etc.' Another member, a post-office engineering worker, says 'the prevalent idea of health as absence of disease is wrong. There is failure to teach children to reach a higher standard of health by natural means, sleep, fresh air, balanced diet.'"
And to teach "positive health"
This idea of a positive approach to health as distinct from absence of disease, although increasingly understood, is not at present current enough in the schools. It can certainly be best established during school life. But special training of doctors, nurses and teachers is essential, in order that it shall pervade the whole of the work and life of the school. The condition of the school buildings is most important, as is the providing of modern facilities for meals and for activities such as swimming and games. Stress is laid upon this elsewhere.
Difficulties in the way of establishing such a service
with the known shortage of doctors: choice lies between better or
more, medical inspections. The quality of the inspections should be improved
In creating a comprehensive Child Health Service we are at once faced with difficulties. More staff will be needed. In particular, if inspections are to be longer, more doctors will be needed. In face of the known shortage of doctors this raises the question whether it is practicable to increase the number of inspections. There are those who wish to see a yearly medical inspection; this view is expressed by the National Union of Teachers, the National Federation of Class Teachers, the Workers' Educational Association and others. There seems, then, to be a general desire for more thorough and continuous supervision of health. But it is not possible now to increase
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substantially the number of inspections and at the same time greatly to extend their scope. A full and comprehensive examination of the type advocated could not at present be made every year, and the choice must lie between an increase in quantity or improvement in quality. Despite the known gaps in the existing service, and with full appreciation of the fact that some increase in the number of formal inspections is necessary, we believe that the greatest need now is for an improvement in quality. Further, the introduction of some form of continuous supervision, as is suggested below, may be as effective as would be annual formal inspections. When more doctors are available the matter should be further reviewed.
The function of the nurse in
supervising children's health. The work
of the school nurse and health visitor should be amalgamated
The shortage of doctors must also make effective supervision difficult. Nonetheless the ideal of continuous supervision is important. To realise it in practice it will be necessary in the first place to extend the range of the nurse's work. It is already a part of the work of the school nurse to follow up children in need of treatment in their homes; this side of her work is of the greatest value and should be continued and developed. On the other hand much greater use could be made of the health visitor in school.* The first step should, therefore, be to amalgamate the work of the health visitor under the maternity and child welfare authority with that of the school nurse under the education authority. The same nurse will then be both school nurse and health visitor, and will be concerned with the same children both in and out of school. Her influence will be exerted not only at school but also in the home, where many believe that health is best controlled. Her visits to schools should be frequent; weekly, that is, or at an even shorter interval, depending to some extent on the size of the school. In the school she can be made responsible for a number of semi-medical tasks which now fall to the teacher: routine eye-testing, for example. She should be trained to keep proper records of her work, including such details as the weights and heights of children, recorded at short intervals.
The nurse must have a
limited area. More nurses will be needed
If the nurse is to carry out work of this kind, performing her dual function of a school nurse - health visitor effectively, she must have a fairly small area, and a substantial increase in the number of nurses will be needed. While the present shortage lasts this increase may not be practicable, and auxiliary helpers may have to be employed to assist nurses with their routine work in schools. But there is no doubt that if their scope is defined and extended in this way nurses should be invaluable in singling out children in need of special examination, and in co-operating with teachers, school attendance officers and parents, who must also play their part in making supervision continuous.
*The Association of Teachers in Colleges and Departments of Education recommends the "appointment of a school nurse for each school who shall also act as health visitor in the homes".
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A further difficulty: the School Health Service
does not at present offer a satisfactory career. School medical officers
should, by their qualifications and experience, rank as specialists in child health
A further difficulty to be overcome in improving the quality of the service lies in the limited prospects which the career of school doctor offers. In fulfilling the conditions outlined, the training and outlook of the medical men and women in the service will be of paramount importance. In its present form the service does not give the doctor a sufficiently full professional life; it is almost completely divorced from treatment in hospital, the most vital centre of children's medicine and also from other forms of clinical work such as that undertaken in general practice. School medical officers should spend part of their time in a children's hospital, or in some equivalent children's work, preferably of a specialist sort, and they should be required to hold a special qualification in children's medicine, so that their training and work will qualify them to rank as specialists in child health. It is, indeed, most important that the work of the School Health Service should be so organised that it will provide doctors with a career in itself, and not, as is often the case, constitute a stepping stone to an administrative career, or become a backwater without hope of advancement.*
There should be senior posts for child health
officers carrying special duties and responsibilities
There should be senior posts for child health officers employed whole-time by the local authority. These officers could devote their time to more specialised duties; they could be given a limited range of schools over which to exercise general supervision, and be made responsible for directing the work of the nurses whose dual function is outlined above. A most important part of the work of the child health officer would be the careful consideration of all handicapped children, and of the arrangements for them. Greatly increased responsibilities have been placed on local authorities to ascertain and deal with handicapped children of different categories, and the advice of a specialist officer upon the many problems which will arise should be invaluable. The child health officer would also have important clinical functions, for he would be required to see all cases referred for special examination, and to advise upon the adjustments made in school for children not so severely handicapped that they have to be sent to special schools.
*In this connection the Association of County Medical Officers recommends:
"(a) That Medical Officers employed in the general work of the Child Health Service should, as soon as practicable, be required to hold the Diploma in Child Health, or an equivalent special qualification.
(b) That their work in connection with medical inspections, health education, and clinics, should be varied by the allocation of other duties, and by association with the work of local hospitals wherever practicable.
(c) That except for those proposing to take up a public health career the Diploma of Public Health should not be regarded as essential, and the Child Health Service should be regarded as a career in itself, just as the Tuberculosis Service is, and not as a mere stepping stone to an administrative career.
(d) That if the Child Health Service is to be complete, comprehensive and fully effective, it must include the whole field of health education in relation to the child, and also the treatment services in hospitals, voluntary and municipal, in clinics and in institutions for handicapped children.
(e) That if in the future it proves practicable to employ general practitioners in the School Medical Service, it is desirable that they should hold a Diploma in Child Health, or have special post-graduate experience. As part-time officers they would carry out their work under the direction of the Chief Medical Officer of their employing authority."
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These duties should be combined with work in the infant welfare service and in hospital.
The School Health Service
and the specialist in child health
The development of a specialist service for child health in hospitals and clinics should be closely associated with the school service. It would add to both the efficiency and attractiveness of the service if authorities could appoint hospital specialists in children's medicine for part-time work as consultants. They would be invaluable in advising on the more unusual types of disease occurring from time to time in a large school population, and in helping to bring about a close working arrangement between the school and hospital services.
The same doctors and nurses
should serve both M. and C.W. and education authorities
For the sake of continuity within the School Health Service itself, it is most important that the maternity and child welfare and education authorities in all areas should employ the same medical staff as well as the same nursing staff.
Salaries of school medical staff
Reorganisation of the work of school medical officers must inevitably lead to reconsidering their salaries. There should be an improvement in the prospects to which an able doctor can look forward if he adopts the School Health Service as a career. It is understood that this is now being considered.
The need for better
accommodation for school medical work
Finally, evidence from many different sources indicates the great need for better accommodation in school for medical inspections; the existing standards which limit the building of medical rooms to schools with over 300 pupils need urgently to be revised. The services outlined above cannot be properly conducted without space and privacy, and this calls for special provision to be made in every school.
(ii) The Provision of Treatment
Provision for comprehensive treatment, other than
treatment that can be carried out at home, is now compulsory
The 1944 Act has made possible the provision of treatment for all conditions, medical and surgical. The obligation is laid upon local education authorities by Section 48 (3) of the Act to ensure that facilities for free, full treatment, other than treatment at home, are made available for all children on the school rolls. This is as great an advance on the present position as the original step of providing a system of medical inspection for all was on the "laissez-faire" outlook of the 19th century. To inspect all children was a first logical step; to make these inspections sufficiently frequent to ensure that all abnormal conditions are found at an early stage, and to give full treatment without regard to financial circumstances. is the second. It is to be hoped the 1944 Act will be fully implemented.
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The School Health Service and the
National Health Service: some forms of
treatment will still have to be provided by the education authority
Most forms of treatment will presumably come under the National Health Service; but there will be some services, such as those for the handicapped children, which must necessarily be within the province of the local education authority. In this connection the Association of County Medical Officers recommends:
"(a) That the School Medical Service should form part of a wider organisation to be known as the Child Health Service which will deal with the well-being of the child and adolescent in health and in sickness. This Service must in turn form part of a National Health Service.
(b) That there must be full co-ordination between the administration of the environmental public health work of the area and the administration of the Child Health Service of the same area."
(iii) Maintenance and use of complete and continuous records of Health
and
(iv) Health Supervision during the early years of Employment
Health records are at present incomplete
and often not available to the many agencies concerned
It is a great weakness in the present system that health records are so incomplete, and are rarely available to all the many agencies who have a part to play in the care of the child both in school life and during the years of adolescence after leaving school. There is no complete account kept of even the major incidents in the child's health record, and there is little or no co-ordination among those concerned.
In particular the information
accumulated by the school doctor is rarely
available to those who deal with the health of the post-school child
While at school the child may be cared for by the family doctor, by one or possibly several hospitals, and by the medical service of the local educational authority. Each may have vital information which is not passed to the others. When a boy leaves school the family doctor and the hospitals continue to look after him in times of illness, and as he takes up work three other agencies may be concerned with his health: the juvenile employment committee, who advise him about suitable employment, the certifying factory surgeon, who has to examine him if he enters certain types of employment,* and the medical officer of the factory or works if he joins a firm large enough to employ its own doctor. Yet information which the medical department of the local authority has accumulated over the years of school life is rarely available to either the juvenile employment committee, the factory
*Mainly trades which make or mend. A large proportion of children, e.g. those entering the distributive trades, building, transport, agriculture and domestic service, are not so examined.
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surgeon,* the works' doctor, the hospital or the family doctor; and the family doctor's information, even information covering the present gap in medical provision between the ages of fourteen and sixteen, is again available to no one. If the boy leaves his first employment, a common occurrence, the certifying surgeon who is required to make the examination of fitness at the next place where employment is sought, remains without the information gained at the previous examination, unless both factories happen to be in his own area.
Though rightly regarded as
confidential, medical information is at
present withheld to an extent that is detrimental to the child
The situation is confused, and is complicated by the fact that information obtained by a doctor in the course of his profession is regarded, and rightly regarded, as confidential. It is clear, however, that at the present time the withholding of such information from other agencies also concerned with the supervision of adolescents, notably the Juvenile Employment Service, is disadvantageous to the child, and is carried further than necessary.
Moreover the statutory examination
of fitness for employment is purely "protective"
It is also unfortunate that the statutory examination of fitness to enter employment should be purely "protective". If the young recruit is found unfit for a particular industry, nothing is done as a result of the examination to remedy his (or her) disability.
The chief need is to create machinery for
maintaining a complete and continuous record of health
It is clear that the chief need is to create machinery for maintaining a complete record of health, and for using such records to the fullest extent possible in preventing ill-health, and promoting positive health in the school child and adolescent. It seems clear then, that when the child enters school, pre-school records should pass, as indeed they often do, from the maternity and child welfare authority to the education authority; and that hospitals should supply records of children admitted and discharged, with information about the treatment given, and recommendations for future care and supervision. The information must be confidential and should be sent to the school medical officer. This will enable him to take account of all relevant details of a child's health, and also to provide supervision through the nurse. We believe that satisfactory arrangements of this kind have been made in some areas, and it is hoped that hospitals and school medical officers elsewhere will recognise the great advantage of adopting the practice.
The examination for entry into
employment should be extended to all boys and girls
It is evident that when a boy or girl leaves school a thorough medical examination is necessary before he or she is committed to a particular type of work; the stage of entry into employment should, therefore, be regarded as one of the stages when a full examination is carried out. In our view
*The certifying factory surgeon may require the medical department of the local education authority to supply information.
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the justification for confining the examination to certain types of employment no longer exists. It should be extended to all boys and girls, including those who remain at school full-time beyond the age of compulsory attendance, and should be part of the whole scheme which aims at maintaining positive health in the school child and adolescent. Like any other examination it should be followed by treatment and supervision of all who are found to be unfit, and special arrangements are needed to ensure that such boys and girls are advised of kinds of work which are suited to their physical condition.
And should be
transferred to the School Health Service
County colleges are essential to the proper treatment, supervision and guidance of adolescents, since in the extension of the School Health Service to all boys and girls up to the age of eighteen, lies the opportunity to fulfil the ideals we have in mind. As the colleges come into existence some definite action to shape the health service for adolescents will be unavoidable. In order that the examination of fitness to enter industry should take its proper place in the health service, the statutory examination now carried out by the factory surgeon for certain employments should be transferred to the School Health Service, which will of course be extended to the county colleges as they are established. The school medical officer engaged on such work must have special knowledge of factory work and factory conditions; and like the present certifying factory surgeon, who is now generally a medical practitioner in the district, be acquainted with the varying industrial conditions in his area. This work could well be done by the child health officer whose appointment is suggested earlier.
Relevant information about a child's health
must be available to the committees advising juveniles on employment
The findings of the examination on entry into employment as well as relevant information accumulated while a boy or girl is at school must be made available to juvenile employment officers. The committees advising juveniles entering employment cannot do their work adequately unless they are suitably informed on medical matters. This fact has to be faced. There is much to be said for attaching to each juvenile employment office a medical officer, who, with the information contained in the previous records at his disposal, could give the suitable medical advice.
The work of the Juvenile Employment
Service should be carried out by the education
authority, and as far as possible at the county college
We are entirely in agreement with the view expressed in the Report of the Committee on Juvenile Employment Service* that the service "should be closely associated with the county colleges". It should be added that in our opinion the work of juvenile guidance should always be carried out by the education authority, and as far as possible at the county colleges.
*cf. the Ince Report, p. 28, par. 126 and p. 48, par. 226.
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Information accumulated by the education
authority should be passed on to the family doctor and works' doctor
Finally, when the education authority's responsibilities cease, the family doctor is the proper recipient of the information contained in the health record of individual boys and girls, and the record cards should be at his disposal; and if a boy or girl takes employment with a firm large enough to have a medical officer, the school record must be available to him also.
(v) The Teaching of Health in and through the Schools
Various influences have already much
improved the standard of hygiene among children today
As early as 1906 the Regulations for training teachers in training colleges said: "The students ought to have an adequate knowledge of school hygiene ... they should be acquainted with the rules of personal health, and so far as possible, with the physiological principles upon which these are based." This early appreciation of healthy living has had its influence on the teaching profession, and on the steady growth of understanding by successive generations of children of the meaning and importance of health. Many other influences have been at work, not least among them the impression created in the child's mind from regular inspections by school doctors and nurses. The improved outlook of parents who themselves have benefited by state education has also been a powerful factor.
But there is still much to be learned about
the art of healthy living, and much that has to be taught in the schools
Despite the many improvements, most people have still much to learn. There will be times and occasions for specific teaching in the schools;* but the end in view will not be met by a course of lessons dealing with hygiene as an isolated subject, and little good will be done so long as the school buildings make it impossible for the principles of hygiene and the rules of personal health to be observed. During the past quarter of a century, there has been some real progress in the design of suitable school buildings, but less progress when it came to the actual building.
Poor school buildings
make training in healthy living difficult
Schools that are overcrowded, poorly ventilated, dimly-lit and without washing facilities, up-to-date sanitary arrangements, dining-halls, gymnasia or adequate space for outdoor recreation, wherever they remain, do not teach children by example that the basis of health is organised living, with attention to cleanliness of the body, clothing, and surroundings. Poor conditions in the schools suggest rather that the way of living seen by many
*In this connection the Society of Medical Officers of Health recommends:
"(a) That there should be at least one teacher in every department specially interested in hygiene. Every education authority should have specialist teachers who are qualified and responsible for the teaching of hygiene ...
(b) That there should be Inspectors specially qualified to encourage and supervise the teaching of hygiene.
(c) That at parent-teacher meetings every opportunity should be made to interest the parents in the hygiene of the school and in its application in the home."
We are in general agreement with this, provided (again) that "specialist" treatment of hygiene does not come to mean merely "subject" treatment.
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in their own homes is the better way. The art of healthy living largely depends upon habit formation, and obsolete school buildings place great obstacles in the way of teachers who seek to change the habits of the young. At the same time, although it is difficult for teachers to make their training fully effective until school buildings are brought up to the standard of the new Building Regulations,* they can do much to set a good standard of hygiene in the schools, and to see that their pupils live up to it in practice.**
The value of the School Meals Service
One of the habits upon which health depends is that of proper feeding. This involves not only taking an adequate and well-planned meal, but deriving full value from the school dining-room as a social institution. The need for school meals was recognised even before that of school inspection, but although authorities had statutory powers as far back as 1906, the progress up to 1939 in providing school meals to any but necessitous children, or sometimes to those attending school from a distance, was negligible; and it was not until the war that the Government adopted a comprehensive policy for the extension of the School Meals Service. The numbers now taking a mid-day meal at school amount to more than 40 per cent of the school population, and though this is still well below the figure aimed at, competent authorities now generally recognise that the school meal is a valuable institution.
The benefit to children of even one well-planned meal a day has been so startlingly demonstrated that it can only be hoped that before long all children at school will be provided with a mid-day meal. prepared by competent cooks, and supervised by those who have an expert knowledge of diet.
The service of the meal
In the matter of the service of the meals there is much less cause for satisfaction. Many of the present arrangements are improvised, and with the numbers now taking the meal, may be in some ways even worse than when handfuls of children brought a meal with them and ate it in the classroom or playground. To be properly conducted a meal must be eaten in a hall or room set apart for the purpose, and the school must accept responsibility for training the young in the dining-room as in the classrooms. As the conditions are now in many schools this is a hard saying; but as proper amenities are provided it should be possible for the mid-day meal to become a social function in all schools.
Social education. The aim should be the planning
of a comprehensive course which would make separate instruction in sex unnecessary
There is a branch of health teaching which is often referred to as social education. It is concerned with the life of the future citizen, especially with the technique of living in the home and community, and with the relationships that arise in the family and between one person and another in
*Regulations Prescribing Standards for School Premises, 1945.
**The communal towel is a grave source of infection in schools, and a very poor object lesson for the teaching of hygiene. Some solution of this difficult problem - such, for example, as the air dryer - is urgently needed.
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society. The teaching of hygiene, in its widest sense, has an obvious place in such education, and so has instruction in Homemaking, and Mothercraft. Whether or not it should include sex instruction as a separate item of the curriculum for boys and girls at school, and if so at what age, is far more controversial. There are two parts to the question: the scientific explanation of the facts of reproduction, and the ethical side, which is a much more difficult problem. The first is a part of the knowledge of the body as a whole, and from the earliest such knowledge should be given in answer to the questions that arise quite naturally from children's desire to have explained to them the "how" and "why" of everything they become aware of. There is also a need for more systematic teaching. It should be possible to devise a comprehensive course for boys and girls, beginning with simple studies of the body and all its functions, and directed later to the study of health in the home and in the community. If, as a part of the whole study of living, the course includes reproduction, boys and girls will come to know, and accept, this function of their bodies, and separate sex instruction will be unnecessary. This is the end to be aimed at. But for a time at any rate such instruction may be needed by some boys and girls at school, and careful attention should be paid to giving it in the right way. When the county colleges are in operation there will be opportunity to investigate the whole question more thoroughly, and this should certainly be done.
The use of films in social education
As an aid to social education generally, mention may be made of the use of films. Good films on such topics as care of the baby, preparation of foods, the value of breast-feeding, the care of the feet, have already been made, and films illustrating various aspects of healthy living should be of particular value at the stage of further education.
The school health service
has a part to play in organised research
There is still a great deal to be learned about common disabilities among school children, such as defects of posture and sight. Much else that very closely concerns school health, such as the elimination of dust-borne infections, and the sterilisation of air, awaits careful scientific investigation; a good deal of accepted health practice is based on very slender evidence. In this, as in many other directions, there is need for more research, and also for more co-operation between the many agencies engaged in the service of health. Departments of Preventive Medicine, Medical Faculties of Universities, the School Health Service and hospital services have now a joint field that is not at present being effectively cultivated.
(vi) Special Provision for "Handicapped" Children
Early efforts to provide for
handicapped children. The Act of 1944
imposes the duty of dealing with every kind of disability
Special educational treatment for handicapped children was first provided by voluntary effort, and more than half the existing residential schools are still run by voluntary bodies. Great credit is due to the many agencies that have made a study of the complicated problem of dealing with handi-
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capped children, and have developed schemes for their special treatment; and to persons such as Dr. Bishop Harman, whose enterprise and foresight developed the treatment of the partially-sighted in the early part of this century. Such pioneering efforts have made the public see the need for special provision for a variety of different disabilities; and for certain serious types of disability provision had already been made compulsory before the institution of the School Medical Service: for the blind and deaf, that is, in 1893, and for the mentally defective and epileptic in 1899. But the growth of understanding of what is needed has been slow; and behind the provision of special education for handicapped pupils has always lain the belief that a small fraction of the total school population (possibly not more than 5 or 6 per cent) should not receive preferential treatment before the lot of the many has been alleviated. Only under the recent Education Act has the duty of ascertaining, and providing treatment for, the less obvious handicaps been imposed.
For most kinds of disability the arrangements
are very incomplete. Practical experiment is needed
to evolve the best arrangements for the partially deaf and the partially-sighted
Today the ascertainment of the blind and deaf is, generally speaking, efficient, and more complete and suitable provision is made for the blind and deaf both in special institutions and otherwise, than for the partially-sighted, the partially deaf, the delicate, the epileptic, the rheumatic, the physically handicapped, the educationally subnormal and the maladjusted, for whom the arrangements are very incomplete. The measures for finding out children who are partially-sighted, or partially deaf, to an extent which affects their ability to profit by normal education, are wholly unsatisfactory; boys and girls who are so discovered represent only a proportion of those needing special attention. And even for those boys and girls who are ascertained to be partially-sighted, or partially deaf, the existing facilities are inadequate. The time has arrived for a number of deliberate experiments, and until genuine attempts are made to deal in practice with the great problems which attend upon the education of a child whose fundamental senses are defective, more deliberations will be of little avail.
The shortage of accommodation in special schools
For epileptics the provision is so poor that children placed on the waiting list for the few institutions that exist may wait for as long as two years for admission. The delicate child for whom convalescent home, and day and residential open-air schools, are needed is still fortunate if he receives such attention; for England and Wales together there are less than 5,000 places in residential open-air schools. There is a great shortage of places for educationally subnormal children. Special schools for rheumatic children, often in need of prolonged rest in bed, but not requiring continuous treatment in hospital, are still a rarity; these children often either attend school by day to their great physical disadvantage, or at times remain away from school with grave disadvantage to their educational progress. Places for the physically handicapped (cripples), particularly the severe cases with paralysis, for whom an ordinary school is quite unsuitable, are also insufficient. The maladjusted children who are in need of understanding and treatment, whether in special clinics or at the hands of the school teacher in the ordinary school, or as is most desirable in many cases in special schools, have so far
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had insufficient attention from education authorities. Lastly there are many children who show a combination of these disabilities, and there is a great lack of special schools for children with more than one defect.
The time has now come to make the
provision complete. Less severe disabilities can
be overcome by suitable adjustments in the school
There can be no doubt that the education provided for handicapped children is generally speaking much below what is needed, and this is serious both for the individual child suffering from the disability, and often for the other children in contact with him. The time has now come to provide what the findings of the past forty years have shown to be necessary. The Society of Medical Officers of Health makes the following comment:
"The requirements of the Education Act with regard to handicapped children have tremendous possibilities. All classes of handicapped children will need not only careful selection by the school medical officer, in conjunction with the teachers, but also observation by him in conjunction with the specialist, and the skilful blending of medical treatment with educational guidance. The number of special schools, day and residential, hospitals and convalescent homes will be greatly increased as at the present time for most conditions they are grossly inadequate in number. In addition much more attention will be required for these handicapped children retained in the ordinary schools."
Teachers should be enabled to deal suitably
with the less severely handicapped children in school
Many children, notwithstanding their disability, can continue to be educated in the ordinary way, if some adjustments are made in school to enable them to overcome their special difficulties. Obvious examples are children with slight defects of sight and hearing who, given an advantageous place in the classroom, can quite well keep up with their own group. Such children are far better left in the ordinary schools; but special account has to be taken of them by the teachers, and suitable adjustments made. In the course of their training teachers should be given the knowledge which will fit them to deal appropriately with the handicapped children who remain in the ordinary schools. It should also be recognised that teachers have an important part to play in bringing handicapped children to the notice of the school doctor.
(vii) The teacher and the School Health Service
Teachers should understand what is meant
by "positive health" and know about the work of the health service
Finally, it should be emphasised that the School Health Service demands much of the teacher. The idea of positive health has little chance of general acceptance until teachers have themselves understood and adopted it and are prepared to teach it. Again, teachers have in the past often been insufficiently instructed in the details of the working of the health service, and thus have been unable to co-operate with the school doctor and nurse to the extent that is desirable.
Specific instruction of a kind that will enable teachers to contribute most effectively to the success of the health service should be extended, wherever possible, to teachers in active practice.
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CHAPTER VII
THE MORAL FACTOR
This chapter contains the Council's attempt to deal with an aspect of our main subject which most of us regard as vital to it, but on which there is a wide divergence of conviction. As the attempt proceeded we realised that this divergence coloured both our interpretation of history and our estimate of the present situation. The result, therefore, does not fully satisfy any member of the Council. Indeed a number of members have strong reservations, but felt that to express them as individual statements would be out of place. At the same time it was felt that the Council was not justified in avoiding altogether a problem which daily confronts all those who have to do with the bringing up of children. We would ask, therefore, that this section of the Report be regarded not as an attempt to prescribe, but as an effort by people whose own views considerably diverge, to analyse the factors in the present situation with which they, like others, are faced.
Education has always
been related to the needs of society
Anyone eager for the growth of education is faced by the difficulty of deciding what sort of society we are educating for. Education cannot be carried on in a void; it is part of a general culture, a common way of living. It has always, for obvious reasons, been to a high degree vocational, lending itself to the progressive needs of society. Thus very early in our civilisation the country required people who could read and write; then it wanted those who could do accounts and understand the law; lately the demand has been for technically trained men and women.
But within the social framework the
object of education is always to teach man, as man, how to live
But always, within this framework, we have expected schools to indicate, indeed, to drive home, the moral values without which no society can exist; a set of customs, a pattern of recognised behaviour, a way of life in regard to which the purely practical things are merely means. After all, the object of education is to teach man how to live as an individual and in a community: the part religion has always played in our schools is proof enough of that.
The change of ideals in this century
During the last hundred years ideals have changed a good deal; latterly our notion of how man should live, what he should aim at being, has been challenged by other notions from outside our country, notions which have been echoed within it. These currents of opinion, which seriously threaten civilisation itself, and of which two shattering wars are the symptom, run very deep and go far back into history.
The change in ideas is more marked
on account of the acceleration of technical change
But it is only in recent history that the change in ideas has become marked, because the change in moral outlook has been made much quicker by the rapid changes in our industrial methods and our social structure. About a hundred and fifty years ago our tools, which for thousands of years had remained practically the same, were revolutionised by the use of new sources of power; populations increased enormously; there was a great
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drift to the towns. We began to enter a phase of civilisation that was new - not because change itself was going on, there was nothing new in that - but because the rate of change was so rapid. It is this bewildering speed of change which made, and still makes, our moral as well as our physical adjustments extremely difficult.
The individual in a machine-age society
Men and women seem, even to themselves, to be more and more becoming cogs in some huge impersonal machine, so that the ordinary man finds it increasingly difficult to discover either a purpose in his work or a meaning in his existence. As far as he can judge, the value of the individual, his own value, seems to be declining; yet the whole of our civilisation for some centuries has ever more clearly insisted on the value of a person as such: that, indeed, has been the whole meaning of our democratic development. Our professions seem to fly in the face of facts, and this contradiction is one of the main sources of a widespread sense of frustration.
The breakdown, since the
Middle Ages, of a common framework of belief
It is evident also that large numbers of men and women no longer feel that they share common beliefs, or are agreed on any set of permitted actions based on those beliefs; and this process has been going on increasingly for about four hundred years. From the time that Christianity first spread in Europe, men on the whole thought and acted on the basis of a broadly accepted idea of what life was about. They saw man's place and destiny as part of a divine plan and felt that man's conduct was subject to moral laws which were part of God's will. They might keep or break the laws, but they recognised that observance or breach of these laws was something more than a matter of private taste or social convention.
The search for something
to take the place of the former acceptances
This framework of religious belief, together with the moral authority which it carried, have now largely disappeared; and now, without a generally accepted standard by which to test their own views and conduct, men are apt to feel an undue strain. This is not to imply that a mere uniformity of belief or practice based upon convention or tradition can ever be a proper substitute for freedom in thought and choice. It is simply to affirm the commonplace that individual thinking and living in any epoch depend upon the comparatively stable framework, social, cultural and religious, which is part of its inheritance. When this framework becomes insecure, men have to look again into its foundations and may even look for something new to take its place. That is obviously happening at the present time in the attempts which are being made to find a basis for moral standards in "the good of the community" or "the progressive development of scientific enlightenment". Whether these can provide the required foundation is a matter for honest difference of opinion. What is really urgent is that the individual should not be left indefinitely without the support which he needs. For to leave him without it is to open the door either to moral irresponsibility or to acute moral tension. This is par-
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ticularly true of the young. As things stand they are being asked to shoulder what is at their age an unfair measure of responsibility in moral choice. The engine is being raced when it ought to be undergoing a careful "running-in".
The present confusion
Thus the characteristic feature of the present situation is a greatly increased moral perplexity and confusion; and it is essential that there should be an understanding of the different ways in which this affects people. The first and most obvious is that a great number no longer feel sure that the division between right and wrong which they were brought up on was always a strictly moral one; they are inclined to think that it was to some extent drawn according to social or class conventions, influenced by a false emphasis on the rights of property as against the rights of personality. They feel that a more honest moral judgment might well mean revising some of our traditional standards. More dangerous still: the fact that men find it hard always to tell what is right and what is wrong may lead them into a doubt as to whether there is any absolute distinction between the two.
The need for clear thinking
There is need of clear and honest thinking if an accurate estimate is to be made of the actual moral situation. There are those who criticise the old standards because they want to see a better type of conduct, more freely chosen, and for the right reasons. This is based on a genuinely moral feeling, and must be given its full value. But on the other hand, care must be taken not to allow the use of such criticism to excuse irresponsibility. Because it is difficult to decide, that is no argument for giving up the attempt, or for refusing to commit one's self to any definite position or way of behaving.
The nature of the
traditional ideal under Christendom
Whether this diagnosis of the situation is right or not, it is of the first importance to examine again the tradition which grew up in England, a tradition which is part of the heritage of European civilisation. It was in part the result of forces which were beyond men's control. But it was also largely the result of intention and will, as vital traditions always are. Men knew what they wanted to be, and what they wanted their society to be like, and in their vision of these things they were deeply influenced by the values of what they called "Christendom". There was a tradition of a certain type of character, the "God-fearing" man - honest, just, brave, charitable, merciful. The customs of society, the institutions it threw up, were shaped, in part at least, by the desire to make it possible for men and women to be just that. Out of this there grew a sense of moral responsibility. Men knew that they were answerable to God or to their fellow-men, or to both, for trying to maintain and to hand on a humane way of living. The intention was never more than partial, and the achievement was imperfect; but what is significant is that there was a real element of deliberate intention in it.
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What is the ideal to be today?
The real question, then, which confronts our generation, and especially all those concerned with education, is: What kind of person do we want the child to grow into? What kind of beings would parents wish the school to help their children to become? Both want, first of all, to see children grow up with strong healthy characters, independent, reliable, able to cope with the responsibilities of life. They want children who will both carry on and critically reshape the way of life which in this country we have built up for ourselves.
The child as a moral being is moulded by society
Children learn from what grown-ups say and do, and from the kind of life they see led around them; they are moulded by the influence of home, of school, and society. All three are part of our English tradition, part of what we love, and have so lately fought for. The child when born is outwardly just a young animal; what makes him different from other animals, what he is taught as he grows older, is that "memory, merit, and noble works are proper to men", in short that he has a moral being as well as a body. The shape that his moral being takes depends upon what he sees and hears, what he is told, what he is asked or made to do, and all that far from simple tissue of customs in which he finds himself caught.
An accepted ideal
of behaviour still exists in society
Our customs, the way we behave and the way we look at things, have, as already suggested, been hammered out through ages of experience. Everybody expects men and women to have, and each individual aims at having, certain moral qualities, some of them belonging to man as an individual, and some belonging to man as a member of the society which gives him opportunities, but which expects certain duties in return. These are the foundations of our way of life; they imply certain ideas about our country, about our homes, about behaviour, and about social responsibility. It is the business of education, by teaching, by example, by preserving and renewing and adapting customs, to see that these ideas take firm root in the minds of the young, without impairing their freedom of thought; in our civilisation men must be able to judge for themselves what is good and what is evil, and be able to choose the good.
The tradition has various sources
On what grounds are they to choose the good? This is where some points of real difficulty occur. The "tradition" has been spoken of, but when it comes to be examined it appears that it is a fabric into which a number of different strands have been woven. There is, too, a further complication. For in the course of history, especially in the last three or four hundred years, the strands have drawn apart; so that today the different influences which have shaped our common life seem to pull against each other, and men are in doubt as to what they ought to preserve and develop, or what the relations of the various parts should be.
The "classical" tradition
Over a period of centuries European culture flowed from two main sources. There was the great classical culture, with its literature and art, inherited
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from the civilisation of Greece and Rome. These dwelt upon the dignity or man, upon his duty to live 'humanely', upon courage, self-control, and loyalty; they contributed to our idea of man's worth, and from these we drew also much that has shaped our institutions, the ideas of justice, order, and law.
The Christian tradition
The second main source is the Hebrew-Christian tradition which comes to us through the Bible, and in the history of the Christian Church. It was this tradition which, by absorbing and assimilating much of the classical culture, and by supplying a new purpose and a renewed sense of direction, provided the impetus which has carried European civilisation forward to our own day. One might say that its essence lies in its insistence upon the reality of God as determining factor in man's understanding of his life.
The rise of the scientific tradition
But within the last three or four centuries, and at a rate rapidly increasing in the last hundred years, both these ancient traditions have been challenged by the enormous growth of the experimental sciences, which have in many ways revolutionised both our life and our thought. There is no need to emphasise here the material benefits man enjoys as a result of discovery and invention, nor the tremendous changes made in man's ideas of the universe and of himself by modern scientific ideas of space, by the theory of evolution, and by explorations into the nature of man's mind. Nor is there need to stress the contribution made to the ideals of integrity of thought, exactness of reasoning, and devotion to new truth. One result, however, has been that for a large number of men and women science has been enthroned as the authority and hope for man's future; for them, science has displaced God, and the scientific tradition has eclipsed both the Christian and the classical lights.
The result is a divergence
of view about the basic sources of belief
Thus when one comes to consider the basic convictions on which the teaching of moral standards is to rest, there is a real divergence of view. To many, the Christian beliefs which in the past supported our moral teaching no longer make sense, although the moral values still make a strong appeal. To insist upon the beliefs appears an affront to the intellectual integrity of such men and women. On the other hand we are faced with an equally sincere assertion that if our moral standards are to be maintained it is essential to preserve Christian beliefs. This is the situation described in some of our earlier paragraphs.
All three sources should
be given due place in education
There is no quick and easy solution of the problem; what must be assured is that children are given the opportunity to see the value of the various threads which made up our tradition, and absorb, as part of their moral inheritance, the virtues of each. A historical sense, and fairness of intellectual judgment demand that due place be given in our education to all three elements. Above all we must insist that whatever choice is made must be a matter which allows for the exercise of intellectual and moral freedom. The beliefs must be honestly held, the way of life freely chosen.
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Education has also the task of
adapting the tradition to changed circumstances
It must not be thought that the stress laid upon tradition means simply pointing men back to the past, or suggesting that a tradition is something to be followed blindly. A tradition, to be any use, must be living; it is not kept alive by an attitude of reverent conservatism, but by constant examination, criticism, re-interpretation and development. A vital tradition must be lived into, perhaps moulded and made richer by experiment. The educational system of our country, indeed the whole country, must face the challenge imposed by the need to adapt our tradition to changed circumstances. It is evident that this makes the educational task as it faces us now different in form from that which would face a society built upon a universally accepted belief, or code of conduct.
The tradition has constantly
to be evaluated in new circumstances, and renewed
Moreover it is plain that under the conditions of our emerging civilisation, account will have to be taken of other codes of conduct resting upon different beliefs, expressing different scales of moral values. Some are older than our own, others newer and backed by powerful forces. One cannot but hope that the British tradition of life and conduct will not only continue to operate strongly among ourselves, but also influence other peoples in a greater or less degree. Yet if we are to continue as free people, rival codes are bound to find adherents in our own country: and though this need not lead to open conflict, it makes it all the more clear that our tradition cannot operate automatically. It must always be borne in mind that no moral standard will run, so to speak, of its own accord: it has constantly to be thought about, to be consciously lived up to. It requires, in fact, a continual social and personal effort.
But our more complex
society requires fresh access of moral energy
Two strong reasons can be added why the old codes of thought and behaviour need to be looked at afresh. The first is that our technical advance, making organised life so much more complex, demands new things from our moral resources. Failure to rise to the demand may look like moral decline, but does not prove that it exists. Moral resources which may be enough for a simpler age are not enough for our own much more complex one. New demands upon the moral capacity of man can be met only by a fresh accession of moral energy.
And the code has to
include loyalties wider than purely national
Secondly, it must be taken into account that our code has now to be applied over a far wider area. The answer to the question, "Who is my neighbour?" has become enormously wider. To talk of "world citizenship" may or may not be premature; but it is certainly not premature to reconsider our code in relation to the larger sphere, since any conception of "world citizenship" British people arrive at must be strongly coloured by the prevailing code.
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The quality of the individual life
depends upon freedom. Education must fortify freedom
The reason why such stress has been laid on the need for a clearly conceived code of moral duty is that the central concern through the whole of this report is the quality of the individual life. Here the ultimate problem is to guarantee, as far as may be the conditions of positive freedom, that is, freedom not only from restrictions, but freedom to do and to choose. But are the conditions of today favourable to the maintenance and growth of positive freedom? There are some tendencies which suggest the answer "yes"; but there are others, perhaps even stronger, which not only obstruct this positive freedom, but which may even, in insidious ways, stifle the very desire for freedom. Against such a danger, education can and must provide the necessary fortifying influences. Perhaps, at this point in our history, this is its hardest task: and if it is whole-heartedly accepted it will mean not only the surrender, perhaps the painful surrender, both in school and out, of some carefully cherished traditions, but a considerable revision of certain attitudes and practices current in the outer world.
The solution is not here. It can only be
found through patient and honest statement and discussion
The preceding paragraphs will have illustrated a fact which is familiar enough to all who are concerned with the upbringing of the young, that the task of giving moral and religious guidance is one of great difficulty. The solution must be sought by the patient and honest statement and discussion of divergent views by those who sincerely hold them. It is a long term, not a short term, problem.
CONCLUSIONS
CHAPTER I. THE SCHOOLS AS THEY ARE: THE CONTRAST BETWEEN THEORY AND PRACTICE
It was impossible to deal with our subject - the transition from school to life - in a practical way without some study of actual school conditions. The evidence collected on this point left no doubt that there cannot be a substantial advance in education until:
(a) the number of pupils per teacher has been reduced to a point which makes modern methods of education possible in all schools;
(b) unhealthy and unsuitable school buildings have been replaced.
The two problems are closely related, but as (a) has been fully explored by the McNair Committee we concentrated on (b). Our investigation shows that a great many schools are obsolete and should be replaced as soon as possible. This leads to the next conclusion, namely:
(c) improvement of unsatisfactory school buildings should not wait for the completion of long-term projects.
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Developments in the past have tended to benefit a limited number of older children, and primary schools have had a raw deal. As the earlier stages of education are an important influence in shaping both society and individual character:
(d) more attention should be paid to primary schools. i.e., the nursery, infant and junior stages; the practice of authorising larger classes for infants and juniors than are authorised for seniors should be discontinued. Schools for young children should be kept small.
Many schools now classified as "secondary" under the Education Act (1944) are such in name only, and fall far short of requirements in staffing, premises, and equipment. The majority of children will continue to be denied adequate secondary education, and the harmful struggle for admission to the relatively few well-provided schools will persist until:
(e) good secondary schools are available for all.
In technical education there should be:
(f) intimate relationship with managers, foremen and other workers in industry; willingness to spend on premises and plant on a much higher scale; the inclusion of adequate provision for women and girls.
Obsolete schools cannot be replaced and new secondary schools provided without heavy capital expenditure. The postponement of necessary projects in the past has been largely due to the apathy of public opinion. The strongest public support is essential if all schools are to be brought up to standards appropriate to a modern society. Thus:
(g) priority should receive urgent consideration, and existing financial arrangements with local authorities be revised at the earliest possible date:
(h) vigorous efforts should be made to stimulate a widespread interest in education.
CHAPTER II. HOME AND SCHOOL
Only by close co-operation with each other can parents and teachers do their best for children, and avoid the frictions that arise from different standards in home and school.
Co-operation can be secured only by the deliberate effort of both parents and teachers, especially during the day-to-day life of the school, as well as through associations and otherwise.
There are certain ways in which the school can meet children's needs as even the good home cannot: e.g. through nursery schools, through playing fields, camps, visits and journeys abroad:
(a) a nursery school should be within reach of every parent who desires it, wherever this is practicable;
(b) school camps, visits, and journeys abroad should be promoted;
(c) for normal children whose home circumstances are difficult or unhappy, generous residential facilities should be provided during the school term;
(d) much more should be done to provide adequately for the activities of children under fourteen out of school hours. Properly trained leaders must be provided, and if school premises are to be used, they must be suitable.
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Today the schools have to assume a larger part in the life of the community than has hitherto been required of them, e.g. in providing certain social services, such as school meals.
Services so provided are not meant to lessen the parents' responsibility; nor, in general, do they do so. What the schools do for the children enables parents better to carry out their own share in the care and training of children.
(e) The part the schools now have to play as social agents in the community should be recognised. The staff of schools should be increased so that teachers can fulfil their wider functions effectively without loss to their other work.
CHAPTER III. NEIGHBOURHOOD AND SCHOOL
Every school should take account of its environment. Particularly a school should (1) explain its environment, (2) compensate as far as possible for its deficiencies, (3) establish standards by which it can be judged.
To do this means:
(a) sizing up the environment as a whole;
(b) acquiring the knowledge needed to explain it;
(c) developing a technique for using the environment to give children firsthand experience;
(d) planning the school course so that children can, while they are at school, experience something of what is lacking in the environment: e.g. a town child can be taken to camp in the country;
(e) making the school itself a place where children have educative experiences they might otherwise lack: e.g. a place rich in whatever of colour and variety good taste can introduce.
The approach to knowledge on more frequent occasions from the concrete to the abstract - beginning, that is, with knowledge about things at first hand - not only gives environment its proper place in the field of learning, but also conforms to good current practice:
(f) the training of teachers should fully prepare them to organise local studies;
(g) schools should have a wide discretion to arrange for their work to take place off school premises.
The theme "man and his ways of living" will give unity to the study of environment. "Wholeness" should be the dominating idea in planning the experience that the schools can give children.
CHAPTER IV. EMPLOYMENT AND EDUCATION
The main conclusion is that the purely educational aim comes first, and that the schools should not attempt to prepare their pupils for particular types of employment.
Nevertheless, the educational system can serve the needs of industry, and the chief benefit it can confer is to carry the general education of all as far as practicable.
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(i) The Schools and Employment
Industry benefits, and so does education, if:
(a) children acquire at school the maximum degree of skill of which they are genuinely capable in Reading, Writing, Arithmetic and use of English;
(b) some of the instrumental skills called for in industry, such as the reading of graphs and the use of the slide rule, are included in the later stages of the curriculum;
(c) full use is made of any facts about industry (including agriculture) likely to interest boys and girls, especially towards the end of the school course;
(d) concrete examples from local industry and common occupations are used in teaching;
(e) handicrafts are linked with local crafts and industries;
(f) children learn to appreciate good industrial design, and to prefer well-designed goods.
Of particular value in employment are the personal qualities that a sound general education develops: a sense of responsibility, initiative, adaptability, persistence and accuracy.
(ii) Further Education and Employment
Further education is particularly needed to "compensate" the effects of the routine work performed by a large proportion of workers.
In the development of compulsory further education:
(a) experiment should be encouraged and watched;
(b) the course at a county college should not be devoted to training for specific employment;
(c) works schools have a valuable function of their own, but they should not be regarded as substitutes for county colleges.
The Council supports the general trend of the recommendations of the recent Report on the Juvenile Employment Service, particularly the recommendation on vocational guidance:
(d) local education authorities should exercise their powers of administering or continuing to administer the Juvenile Employment Service, and the work of the Service should, as far as possible, be carried out at the county colleges;
(e) the schools should make information about a boy or girl available to the Juvenile Employment Service in the form in which it will be of the greatest use for guidance into employment.
In the present situation it is strongly in the interest of employers to see that their young recruits are given not merely a sound initiation into the process they are to engage in, but a sympathetic introduction to the world of employment as a whole.
The training of skilled craftsmen will be of particular importance in view of the needs of British industry in the immediate future. It is essential that training arrangements should be such as to ensure adequate variety of experience for young recruits.
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CHAPTER V. THE YOUNG WORKER
In attempting to meet the needs of young workers through the Youth Service, education authorities and voluntary organisations have evolved a new form of partnership for providing a social service.
Principles and methods are still being worked out. But two principles in particular seem now to be established; first, that membership of clubs and similar organisations must be voluntary, and second, that the young people must be given all possible responsibility in carrying on the activities of their clubs.
The clubs themselves show a healthy variety of organisation and method.
Important lines of advance are:
(a) extension of the present age-range both upwards and downwards, so as to meet the proved social needs of many now falling outside its limits;
(b) the development of a form of relationship between youth clubs and community centres for adults, which will most satisfactorily meet the needs and preferences of each;
(c) further experiment with "mixed" clubs, and with affiliation between clubs for boys and for girls;
(d) recruitment and training of "youth leaders" to meet a wide variety of needs and conditions, and to set standards likely to attract suitable men and women to the service;
(e) provision of attractive premises, and good facilities for friendly intercourse, and for the pursuit of a diversity of interests.
CHAPTER VI. HEALTH
Since the last century the health of the children in this country has very much improved, largely because of the School Health Service. Today the aim should be to secure a high standard throughout the service, and in particular to ensure:
(i) more comprehensive supervision of children in the schools,
(ii) more and better facilities for treatment in hospitals and clinics,
(iii) the universal maintenance of adequate and continuous child health records,
(iv) an extension of health supervision on similar lines over the early years of employment,
(v) sound and effective teaching of Health in and through the schools.
(vi) suitable provision for all "handicapped" children,
(vii) instruction for teachers of a kind that will enable them to co-operate satisfactorily with the School Health Service.
The prevailing idea in the School Health Service should be "positive health" as distinct from absence of disease. It should govern the attitude towards health of all concerned with the care of children.
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(i) Improving the supervision of Health in the Schools
(a) While the known shortage of doctors exists there must be a deliberate choice between increasing the number, or improving the quality, of medical inspections. The quality of medical inspections should be improved. The time allotted should be increased to allow doctors to make inspections more thorough, to observe children in normal conditions, and to consult with parents and teachers.
(b) At the same time as far as possible the number of visits to schools by doctors and nurses should be increased, and greater use made of the school nurse in arranging for continuous supervision.
(c) There should be a considerable increase in the staffs of doctors and nurses in the School Health Service.
(d) The School Health Service should be made to provide a satisfactory career for a medical officer.
1. All medical officers entering the Service should be required to hold a special qualification in children's medicine, and to undertake some duties in the treatment and care of children in specialist clinics, hospitals or other institutions.
2. There should be senior clinical posts for more highly qualified and experienced officers, with a wider range of work and responsibilities, and with a salary appropriate to the high quality of the work demanded.
(e) The hospital children's specialist (the paediatrician) should be brought into the service as a consultant on the more unusual types of disease.
(f) The same medical and nursing staff should serve both the maternity and child welfare and education authorities.
(g) The work of the school nurse and of the health visitor should be amalgamated. The combined work should be so organised that nurses can, with the co-operation of parents and teachers, carry out effective supervision of children's health.
If necessary, auxiliary helpers should be appointed to assist nurses with their routine work in schools.
(h) Proper accommodation for medical inspection must be provided in all schools. The existing standards, prescribing a medical room only for schools with over 300 pupils, should be revised.
(ii) Treatment
(a) Local education authorities should press forward with their arrangements for providing treatment in accordance with the 1944 Education Act, keeping in close consultation with others concerned with providing treatment.
(iii) Health records
(a) The School Health Service should have at its disposal information obtained (1) by the maternity and child welfare service, (2) by family doctors and (3) by hospitals.
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(b) The family doctor and the works' doctor should have access to the accumulated information about children while at school and when they leave the care of the School Health Service.
(c) In order that guidance may be effectively given in relation to health and physical capacity (see (iv) (a)), the Juvenile Employment Service should have all relevant information about health.
(iv) The supervision of Health during the early years of employment
(a) Medical examination upon entry into employment should be the rule for all boys and girls up to the age of eighteen entering employment, and should lead to treatment, supervision and guidance for all children found to be unfit.
(b) To give effect to this the duty of making such an examination should be transferred to the School Health Service which should also be responsible for treatment and supervision.
(c) (see Chapter IV, Conclusions (ii), (d).)
(v) The teaching of Health in and through the schools
(a) Hygiene and the requirements of healthy living should be treated as part of a wide course in social education.
(b) Sex education should not be treated as a separate subject. The course in social education should, throughout, be sufficiently comprehensive to make unnecessary separate sex instruction for adolescents.
(c) Parents and teachers should be encouraged and enabled to acquaint themselves with up-to-date views on such matters as methods of preventing infection and what is meant by "positive health".
(d) In schools not likely to be housed in up-to-date buildings within a short interval, all practical improvements should be carried out which do not call for large-scale structural alterations.
(e) The School Health Service should play an active part in research, in close co-operation with other bodies, such as the departments of universities, engaged in research upon children's health.
(vi) Provision for "handicapped" children
Effect should be given with the least possible delay to the provisions of the 1944 Education Act concerning handicapped children.
(a) Immediate improvements are possible in the following directions:
1. the ascertainment of handicapped children,
2. carrying out experiments in the normal education of children whose defects are partial.
(b) The shortage of accommodation for all types of handicapped children, excepting the blind and the deaf, is so serious that it calls urgently for remedy.
(c) In the course of their training teachers should be given the knowledge which will fit them to deal appropriately with the handicapped children who remain in the ordinary schools.
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(vii) The teacher and the School Health Service
(a) Students in training, and practising teachers, should acquire an understanding of what is meant by "positive health". This should make them alert to detect signs of ill-health or disability in children, so that they can bring to the notice of the doctor at the earliest possible stage any of their pupils who may require special examination. Teachers and students should also be adequately informed about the working of the School Health Service.
CHAPTER VII. THE MORAL FACTOR
This chapter should not be read as an attempt to prescribe, but as an effort made by people whose own views differ widely to arrive at all estimate of the situation, and in this way to face the difficulties confronting those who have to put moral values before children and justify them.
Rapid social changes bring bewilderment; despite assertions of the value of the individual, ordinary life seems less and less to give reality to the idea.
The break-up of commonly accepted beliefs and standards increases the confusion; extra strain is, therefore, thrown upon the individual. Although there is still widespread acceptance of the traditional virtues, there is variety of opinion about the grounds for recommending them to the young.
The impact of scientific thought upon the older classical and Christian tradition has been the chief cause of the moral perplexities of our day.
A living tradition is always being thought out afresh. The educational task is to mobilise fresh moral resources to meet increasing demands, as well as to maintain good standards. The essence of the task is to develop the sense of personal responsibility, and to strengthen the individual's instinct for freedom against influences that tend to stifle it.
(Signed)
F. CLARKE (Chairman)
MARGARET F. ADAMS
MARJORY ALLEN OF HURTWOOD
ARTHUR BRISTOL
FRASER BROCKINGTON
HAROLD E. CLAY
HENRY CLAY
BONAMY DOBREE
CLAUDE GIBB
RONALD GOULD
|
WILLIS JACKSON
ANTONY L. MILBANKE
P. R. MORRIS
R. A. B. MYNORS
MARJORIE E. REEVES
W. O. LESTER SMITH
JAS. A. S. WATSON
JOSIAH WEDGWOOD
ROSE YOUARD
J. F. WOLFENDEN
M. S. SMYLIE (Secretary) |
December, 1946.
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APPENDIX
LIST OF WITNESSES AND ORGANISATIONS CONSULTED
Ministry of Education (Inspectorate)
Sir M. P. Roseveare
Senior Chief Inspector
Miss D. M. Hammonds
Chief Inspector
Mr. E. J. W. Jackson, M.C.
Chief Inspector
Mr. C. A. Richardson
Chief Inspector
Mr. H. J. Shelley, O.B.E.
Chief Inspector
Miss F. M. Tann
Chief Inspector
Mr. R. H. Charles, C.B.E.
Formerly Chief Inspector for Secondary Education
Mr. W. Elliott, C.B.E.
Formerly Chief Inspector for Technical Education
Ministry of Health and Ministry of Education
Sir Wilson Jameson, KC.B., M.D., F.R.C.P.
Chief Medical Officer
Ministry of Education
Dr. J. E. A. Underwood, M.B.
Senior Medical Officer
Mr. J. Lumsden
Staff Inspector of Special Schools
Ministry of Labour and National Service
Mr. H. M. D. Parker
Mr. R. J. T. Card
Miss F. I. Taylor, O.B.E.
Senior Deputy Chief Inspector of Factories
Dr. Stuart Horner
Medical Inspector
Ministry of Fuel and Power
Dr. T. W. Howell
Deputy Chief Mines Medical Officer
Sir Peter Innes
Chief Education Officer, Birmingham
Society of Medical Officers of Health
Dr. A. A. E. Newth
School Medical Officer, City of Nottingham
Dr. J. D. Kershaw
Medical Officer of Health and School Medical Officer for the Borough of Accrington
Association of County Medical Officers of Health
Dr. Wyndham Parker
County Medical Officer of the Worcestershire County Council
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Association of Assistant Mistresses in Secondary Schools.
Association of British Chambers of Commerce.
Association of County Medical Officers of Health.
Association of Directors and Secretaries for Education.
Association of Education Committees.
Association of Head Mistresses.
Association of Head Mistresses of Recognised Independent Schools.
Association of Municipal Corporations.
Association of Principals of Technical Institutions.
Association of Teachers in Colleges and Departments of Education.
Association of Teachers in Technical Institutions.
British Association for Commercial and Industrial Education.
British Psychological Society.
County Councils' Association.
English New Education Fellowship.
Federation of British Industries.
Headmasters' Conference.
Incorporated Association of Assistant Masters in Secondary Schools.
Incorporated Association of Head Masters.
Industrial Welfare Society.
National Association of Head Teachers.
National Association of Inspectors of Schools and Educational Organisers.
National Association of Juvenile Employment and Welfare Officers.
National Federation of Class Teachers.
National Federation of Women's Institutes.
National Institute of Industrial Psychology.
National Organisation of Parent-Teacher Associations.
National Union of Teachers.
National Union of Townswomen's Guilds.
Trades Union Congress.
Society of Medical Officers of Health.
*Standing Joint Committee of Working Women's Organisations.
Youth Leaders' Association.
Workers' Educational Association.
*Incorporating Co-operative Women's Guild.