If you are a community paediatrician, involved in safeguarding and a champion of social paediatrics your debt to James (Jim to his familiars) Appleyard may be greater than you are aware.
The early ‘80s UK paediatric establishment may have found it difficult to contemplate a district hospital paediatrician as a British Paediatric Association (BPA) senior office holder. The post of Treasurer (and, in those days, de facto Vice President) had been held previously by distinguished teaching hospital luminaries. It was the astute thinking of two Presidents of those times (Komrower - a former Treasurer - and Tizard) which led to Jim’s election. They recognised that while British paediatrics was gaining an academic reputation, slower progress was being made to find its place in political circles, which meant recognition, acceptance and support within the British Medical Association (BMA). Jim had already made his mark there as a junior doctor and was held in respect (but not always affection) not only by the medical politicians at Tavistock Square but by his paediatrician chiefs. In a piece about the revered Dr Philip Evans of Guy’s and Great Ormond Street hospitals, Dr Michael O’Donnell wrote: “in the 1960s he sometimes stayed on duty for extra hours at Guy’s covering for one of his juniors, James Appleyard, when he was out making political speeches about the way senior doctors exploited their juniors.”
Jim therefore was well placed to influence BPA policy and politics and he threw himself into it (but always aware that as a “jobbing generalist” - his words - there were sick children in East Kent for whom he was responsible). His greatest achievements were to yoke the two organisations together in the campaign to promote community paediatrics and paediatricians. These ideas and proposals did not have universal support: they challenged territory holding. At his persuasive best Jim, with his Presidents (Tizard and Forfar), changed attitudes in medical and other political circles, always centring on the due north of Jim’s compass: that the wellbeing of children and families should come first. The diagnosis of child sexual abuse occupied his time, dealing with the BPA/BMA politics when its scale became known and when diagnostic signs were being established. In this, he was a force for unity between paediatricians and police surgeons. When the Cleveland sex abuse controversy became national news, Forfar and Appleyard led the BPA’s involvement and response, Jim giving evidence on its behalf to the subsequent enquiry.
His day job for the BPA was, of course, to oversee its finances and budget. No treasurer is popular with members when it comes to annual subscriptions, nor staff making requests for equipment. Jim managed to maintain financial prudence: I cannot recall retrenchment, austerity or profligacy - nor hard feelings. It was on his watch that the costs of the headquarters move from Queen Square to the St Andrew’s Place precinct were met and resources found to mark the BPA Diamond Jubilee.
His term of office complete in 1988, he handed over to the late Dr James Partridge and directed his hard work and energy to promotion of children’s health services, and their interests, within the BMA and beyond, together with whole-person medicine - a touchstone of paediatric practice.
Jim’s final significant BPA activity was as a backbencher in the early 1990s when the longstanding debate about where paediatrics should sit academically - a separate College or an entity of the Colleges of physicians - came to a head. Temperamentally a remainer, seeking unity over Balkanisation, he favoured staying with the physicians and was a vigorous and outspoken campaigner in its support. The outcomes of such events and controversies are seldom clarified by randomised trials: Jim’s later views were Delphic rather than Delphi.
James Appleyard served the BPA well; British families and children, and their doctors, owe him much - as does British medicine.
Dr Timothy Chambers
From when I first knew Jim as a new consultant at the Kent and Canterbury Hospital in January 1971, he fought all his working life for the good of children’s health and paediatrics in the hospitals, and the wider community in East Kent. From the start locally he needed an excellent Special care baby unit (SCBU), staff and more paediatricians, as he was possibly the sole full time paediatrician for the whole of East Kent at the time. He finally got his excellent new SCBU along with staff. He was always there for the babies where junior staff were concerned, whether he was on duty or not. ’Whatever it takes’. His mantra for students was ‘listen to the mother’ and ‘look at the children at their eye level’.
His next vision was for a unique type of children’s development centre, which opened within two years (October 1972). This eventually encompassed diagnostic, assessment, treatment, therapies, support services for the family, educational services and aa nursery playgroup all in a child-friendly setting. He broke down barriers between staff from different professions for the benefit of the child on the ward, getting the staff to work together even though they were funded from very different sources at the time eg social workers, nurses, therapists, and doctors. He also persuaded different branches of the same profession ie paediatrician in hospital (himself) and paediatrician in the community (my superior) to agree to having both my posts in hospital and the community fused into one with funding. This became the template for his campaign for acceptance of community paediatricians into the BPA.
As he acquired more paediatric staff locally, he was able to spend more time at national level, fighting in his BMA Treasury role for more funding for junior staff, and paediatrician’s share of the national ‘cake’. He later became Treasurer of the BPA. Much later, when he had handed over his Head of Paediatric department role, his vision led him to an international role as President of the World Medical Association, so he visited impoverished nations to persuade health leaders that children were ‘not third class citizens and just bread-winners’ but were ‘their country’s future’ and needed their share of funding. Even then he still campaigned on local East Kent health issues when necessary.
Throughout his time as a paediatrician in hospital, it gradually became clear to Jim that people who came into hospital as patients with symptoms in a particular system, could be referred to among the staff looking after them, for example ‘a cardiac patient’ which dehumanises ‘the person with a health problem’ in staff’s minds. The College of Person-Centred Medicine has the same philosophy that all doctors/medical students should think of their patient as a person first, be they adult or child, who has a health problem(s). Good general practitioners in UK still think and treat each person on their list as an individual with their own health problems.
Jim believed this essential concept should be taught to future generations of medical students. In his last year, he hosted a conference, wrote a chapter for the College and gave an annual essay prize on Person-Centred Medicine to a student at the recently opened Kent and Medway School of Medicine. He presented the first of these prizes to a medical student at this Medical School here in December 2021. The legacy of this remarkable paediatrician, visionary, politician and philosopher will live on.
Dr Barbara Armstrong
A memorial will be held for Dr James Appleyard in the Quire of Canterbury Cathedral on Thursday, 23 June at 14:00.