Observations BMJ Confidential

John Appleby: Hoping for the “Appleby paradox”

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h107 (Published 14 January 2015) Cite this as: BMJ 2015;350:h107


John Appleby is 56 and practises the science of economics with a cheerful demeanour. As chief economist at the King’s Fund since 1998 he often has to spell out gloomy news about financial dangers and missed targets, as a barometer of the NHS’s financial and organisational health. Given politicians’ propensity for putting the best complexion on whatever muddle they find themselves in, Appleby provides a much needed reality check. Before joining the King’s Fund he worked for the NHS in Birmingham and London, as well as the NHS Confederation’s predecessor body, the University of Birmingham, and the University of East Anglia. He is a visiting professor at City University and Imperial College, both in London.

What was your earliest ambition?

Aged 5, to earn a dolly mixture from the arts and crafts teacher at Stanley Road Infants, as a prize for my bent biscuit tin lid model radar station. I didn’t get one.

Who has been your biggest inspiration?

Tony Harrison, erstwhile King’s Fund colleague. A generous, smart, and kind man, from whom I learnt that, if you haven’t found a solution to a problem, you should think harder.

What was the worst mistake in your career?

A (genuine) spreadsheet error that eventually led to a letter of apology to the Welsh nation (in the form of the then health minister, Lesley Griffiths).

What was your best career move?

Coming to the King’s Fund. Fantastic colleagues and a great place to work.

Bevan or Lansley? Who has been the best and the worst health secretary in your lifetime?

Bevan was before my time but surely the best; the first top-down organiser of the NHS. It’s hard to pick a loser out of the subsequent 28 (re)organisers.

Who is the person you would most like to thank and why?

Joy Townsend, a teacher at university who encouraged me in 1979 to apply to the new masters course in health economics at York. Also, Richard Smith, past editor of The BMJ, who encouraged me to write about health economics issues for a wider audience.

To whom would you most like to apologise?

As John Wayne said in the film She Wore a Yellow Ribbon, never explain, never apologise. Except for spreadsheet errors, I guess.

If you were given £1m what would you spend it on?

Honestly? Probably 90:10 altruism:selfishness.

Where are or were you happiest?

As a small boy with my mum, as she lit the candles on her piano on Christmas Day with the house smelling of food, chocolate, and bay leaves.

What single unheralded change has made the most difference in your field in your lifetime?

Not exactly unheralded, but the creation of NICE [the National Institute for Health and Care Excellence]. This is health economics in institutional form, an organisation that has done a remarkable job of tackling the wicked but fundamental—and unavoidable—task of rationing in a rational and transparent way.

Do you support doctor assisted suicide?

It already happens as part of the private decision between the clinical professional and the patient. I think that, on balance, I would keep that private rather than try to legislate.

What book should every doctor read?

It’s a paper, not a book, and not just for doctors but for policy makers and others too: Reforms as Experiments by Donald T Campbell.1 That paper said it all about the need for evidence based decision making.

What poem, song, or passage of prose would you like mourners at your funeral to hear?

Robert Wyatt’s wordless piano version of [Buddy Holly’s] Raining in my Heart, then Dean Fraser’s Dick Tracy.

What is your guiltiest pleasure?

That’s a question for puritans. Why feel guilt about pleasure?

If you could be invisible for a day what would you do?

Levitation tricks with Derren Brown.

Clarkson or Clark? Would you rather watch Top Gear or Civilisation? What television programmes do you like?

Both of those. Plus Breaking Bad, Parks and Recreation, and, latterly, Detectorists.

What is your most treasured possession?

They’re not possessions, of course, but my children.

What, if anything, are you doing to reduce your carbon footprint?

Too little, too late, probably.

What personal ambition do you still have?

To have an eponymous “law” or “index” . . . or better still, the “Appleby paradox”!

Summarise your personality in three words

Critic (not good), humorous (good), curious (neutral).

Where does alcohol fit into your life?

Probably a little too easily.

What is your pet hate?

People who don’t understand that it’s more efficient and equitable to have a single queue for multiple tills, check-ins, etc.

What would be on the menu for your last supper?

Whatever the Del Parc café on Junction Road [London N19] had on the menu on that terminal day. Something like: Padrón peppers, mojamo [wind dried tuna] with pickled pear, wasabi, pomegranate, caper berries, black olives, and mint.

Do you have any regrets about becoming a health economist?

Whatever I had done or not done the outcome would be the same—some unquantifiable regretful opportunity cost of the things not done. But regretting those lost opportunities seems pointless to me; the same is true, I think, for regretting the things I have done.

If you weren’t in your present position what would you be doing instead?

An artist, or a guitarist in a north London prog rock jazz fusion five piece band . . . probably.


Cite this as: BMJ 2015;350:h107


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