b.2 August 1936 d.26 April 2010
BSc Birmingham(1957) MB ChB(1960) MRCP(1964) FRCP(1978)
Paul Rayner was prominent among the UK’s first generation of paediatric endocrinologists. An essentially modest man whose professional life was cruelly cut short after many years of Parkinson’s disease, his lasting legacy lies in the (now common) home care service for children with diabetes – a service which he conceived of and pioneered in Birmingham, and which has since been copied throughout the UK and far beyond. He achieved this while offering, singlehanded, a tertiary service in paediatric endocrinology and growth disorders for the West Midlands, based at Birmingham Children’s Hospital, and while pursuing significant laboratory-based research, in a long-term partnership with Brian Rudd, into the physiological control and clinical disturbances of growth and pubertal development in childhood.
Rayner was a man of the Midlands: brought up in Coventry, he won a scholarship to Bablake School, where he excelled both academically and on the sports field. He entered the medical school of the University of Birmingham in 1954 and graduated in 1960. Almost all of his early training, as well as the entirety of his substantive career, was centred on Birmingham and the West Midlands.
The development of clinical subspecialisation within paediatrics was largely unplanned in the early days and tended to depend upon the interests and energies of individuals. Thus it was that, at Birmingham Children’s Hospital and in Birmingham University’s department of paediatrics and child health, it was (later Sir) Douglas Hubble [Munk’s Roll, Vol.VII, p.280] who drove the early specialist interest, both clinical and academic, in paediatric endocrinology. Rayner was a beneficiary, in that he received superb training in the discipline as a registrar and later a lecturer in Hubble’s department. However, his legacy was to have to take on singlehanded, as a senior lecturer/consultant, the continuation of the referral services in endocrinology and diabetes when Hubble retired and was replaced by Charlotte Anderson [Munk’s Roll, Vol.XII, web], a gastroenterologist. At the time of Rayner’s retirement in 1994, he was responsible for approximately 180 new referrals and 1,300 follow-up patients a year, together with the continued supervision of 190 patients with growth hormone deficiency as head of a Department of Health designated centre. As so often seems to happen when singlehanded, exceptional people retire, Rayner was replaced immediately by two full-time consultant paediatric endocrinologists, and four years later by a third.
In 1967, Rayner was awarded the James Smellie bursary from the University of Birmingham to study, in Edinburgh, their approach to community care for children with chronic handicap. The seeds sown there germinated in Birmingham in 1981 when he, in partnership with his long-term nurse colleague Adele McEvilly, set up a home care unit (HCU), based at the Children’s Hospital. The aim was to reduce the emotional upset associated with the onset of diabetes in childhood by undertaking as much of the initial management as possible in the home. Additional difficulties arising from separation and travel would also be reduced. By involving the family directly from the beginning, it was hoped that the relevance of treatment and its relation to everyday activities would be more easily appreciated, that confidence and self reliance of child and parents would be promoted, and that liaison between hospital staff, family practitioner and community health services would be improved. In addition to undertaking the initial treatment of the newly presenting diabetic children, the HCU provided a domiciliary-visiting service which dealt with the management of intercurrent infection, which otherwise would have required hospital admission, instruction and support for children to self inject insulin, assistance with management during illness of a parent, and discussion in the home of emotional and psychological problems: in all, truly pioneering work.
In addition to Rayner and McEvilly, the HCU employed a further nursing sister, and a half-time senior dietitian. Funding support came, as so often was and is the case in new developments within the NHS, from the strenuous efforts of the ‘onlie begetter’ (in this case Rayner) to galvanise parental fund raising and obtain short-term grants from charitable bodies and from the pharma industry. Attempts during 1984 (by which time bed days for diabetic children had been reduced to 25% of the pre-HCU levels) to persuade the West Midlands regional health authority to take over funding the unit failed. Only a few weeks before the forced closure of the HCU seemed inevitable, intervention by the local MP, Clare Short, resulted, as reported in the press, in ‘senior officials at the DHSS expressing concern about the future of the unique diabetic HCU in Birmingham’. The outcome was that the regional health authority agreed to fund the senior nursing sister (McEvilly) and dietitian on condition that the HCU trained nurses and other staff to undertake similar work across the whole of the five million population of the West Midlands region.
By the time Rayner retired in 1994 the HCU was looking after some 230 families. (By 2011, the unit had further grown to 10 members of staff, responsible for 300 families.) The ‘management of diabetes’ course burgeoned, such that applicants came not only from the West Midlands, but from other regions of the UK and from abroad. The course became accredited by Birmingham City University and subsequently an e-learning resource was established, giving global reach to the concepts and practicalities of home care for diabetic children and their families originally conceived by Rayner and McEvilly. For this work Adele McEvilly received a lifetime achievement award from the Department of Health in 2001, and was honoured with a CBE in 2004. When helping the present author to prepare this appreciation, she said, and wished it to be said, that ‘Paul never received the recognition that he deserved’.
There is always another strand to personal reminiscences, even about a devoted clinician and scientist. In this case it was to be found in Paul as a party animal! In the right setting, at the Children’s Hospital Christmas show, or at the parties that tend to occur at the end of scientific conferences in the UK or Europe, colleagues remember that ‘it took very little to get Paul up on to the stage’. His singing, while accompanying himself on the piano, was excellent, even legendary, as, for example, his impersonation of Elton John, which lives on in the collective memory. In addition, a European colleague had ‘very happy memories of Paul on the dance floor’.
In 1994, because of increasing disability, Paul Rayner retired to Suffolk to be near his family, supported, as always, by his devoted wife, Elaine. He and Elaine celebrated their golden wedding surrounded by their family only two weeks before he died of aspiration pneumonia at the age of 73.
Alexander S McNeish
(Volume XII, page web)
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