Abstract
Historically, clinical public health was called Community Paediatrics and School Health Service and was run by medical officers, health visitors, school nurses and administration staff based in local health clinics. The service was terminated gradually between 1997 and 2000 due to national economic considerations. The main functions of this service for children included intensive child surveillance, immunisation, provision and regular supervision of nurseries as well as care homes, educational difficulties management and finally, to give a fitness-for-appropriate-work certificate to every child when he or she left school. After birth, every child was visited at home by a midwife until they were 15 days old and then visited at home as well as brought to attend child health clinics by a health visitor until they were four years old. Their visits were compulsory, and they supported parent and child. A child aged 4–5 years was supervised in nursery by a visiting medical officer. A child aged between five and 16 or 18 years was supervised by a full-time school nurse who had good liaison and communication with their teachers.
Every child was examined for developmental and health assessment/checks by an independent community medical officer who was not their family doctor in a local child health clinic at regular intervals up to the age of four years and in school at age five, 10 and 15 years. Hence, child care negligence, abuse and sexual abuse were detected early and managed by close supervision from health staff, especially independent doctors and nurses. At school-leaving age, every child was given a fitness-for-appropriate-work certificate, no condition or with a condition, such as to wear glasses. Two copies were kept in his or her file, two were sent to the Home Office and two were sent to the Ministry of Defence.
Every child’s care was 50% shared by parents and 50% by the British Government. This is still the case – family courts deal with litigation cases as they did before as and when required.
Clinical public health was an excellent service which does not exist anymore due to national financial constraints. Today, if a social worker has to visit a family home in a suspected/alleged child abuse case, he or she has to go to their home accompanied by a police officer. No wonder that child neglect, physical and sexual abuse cases are hard to detect and eliminate.
There may be similar problems and solutions in other countries. This issue needs a constructive discussion. I wonder if readers, in Britain and abroad, have any observations and suggestions.