Paul Rayner (M 1960)
Former reader in paediatrics and child health University of Birmingham, and honorary consultant paediatrician Birmingham Children’s Hospital (b 1936; q Birmingham 1960; BSc ,(FRCP), died from aspiration pneumonia associated with Parkinson’s disease on 26 April 2010.
Paul H.W. Rayner pioneered home care for children with diabetes. Many children throughout the world now benefit from the adoption of Paul Rayner’s philosophy of the management of diabetes, whereby all but the most serious aspects of the condition can generally be managed at home. The provision of effective home care services reduces the stress to affected children and their parents, particularly at the time of the initial diagnosis and during inter-current illnesses. It also greatly reduces the need for hospital admission and allows diabetic children to lead a more normal life. At Birmingham Children’s Hospital he worked as registrar and then lecturer in paediatrics and child health with Professor Hubble, who stimulated and encouraged Rayner’s interest in growth disorders and paediatric endocrinology.
He also gained experience in laboratory methods and hormonal assay procedures in the Department of Clinical Endocrinology under the direction of Professor Wilfred Butt, and in the Institute of Child Health, where he established a longstanding research collaboration with Dr Brian Rudd.
After Hubble’s retirement in 1968, Rayner became senior lecturer with honorary consultant status to Hubble’s successor, Professor Charlotte Anderson, and took over the clinical service for children with growth and paediatric endocrine disorders. He later became the honorary consultant paediatric endocrinologist to the whole of West Midlands Regional Health Authority (population some 5.5 million people).
As one of the first paediatricians specialising in endocrinology in the UK, Rayner participated in the early studies of growth hormone treatment. His endocrine clinic was designated an investigation and treatment centre for children with growth hormone deficiency by the Department of Health, and he personally supervised this work. In the latter years of his career he had almost 200 patients under his care who were receiving growth hormone. In the 1970s the treatment of diabetes often entailed repeated and prolonged admission to hospital. Rayner was concerned by the disruption that this caused to the children’s lives, which included emotional stress to the child and parents, loss of schooling, and financial problems for the family.
In 1967 Rayner had been awarded a James Smellie Bursary from the University of Birmingham to allow him to study the community care services for children with long-term disorders in Edinburgh.
In 1981, inspired by this experience he set up a Diabetic Home Care Unit (HCU) for children, based at the Children’s Hospital. The HCU was to become the first such facility in the UK and probably in the world. The aims were to reduce the emotional impact caused by the onset of diabetes, by undertaking as much as possible of the initial and subsequent investigation and treatment at home. This would entail enrolling the family in delivering the child’s treatment from the start, and creating liaison between the hospital staff, family doctor, community health services, and schools. The HCU provided a domiciliary visiting service and was able to undertake the care and treatment from the time of diagnosis of diabetes, including the management of many inter-current illnesses, and teaching the children, their parents, and carers to inject insulin and monitor blood glucose concentrations. The HCU nurses also discussed at home any behavioural or emotional problems affecting the children.
Towards the end of his career, which was tragically curtailed by increasing disability from Parkinson’s disease, Rayner was promoted to reader. He took early retirement in 1994 and died in 2010, leaving a widow, Elaine; three children; and five grandchildren.
Jillian R. Mann, A.S. McNeish