Leila Lessof: public health leader and trainer whose farsighted ideas came to the fore in the HIV/AIDS epidemic

Public health

As teenagers, her children required less of her time and with their encouragement she took up the opportunity to retrain in public health, which meant working full time. As director of Public Health Islington and of Parkside Health Authorities from 1991 to 1995, Lessof was a very capable manager, highly regarded by her colleagues and able to secure backing from her organisation for public health priorities. She was superb at leading her team, recruited intelligently, and was always generous with her time and skills to develop both individual and team strengths as well as wide networks. Her final major NHS contribution was as chair of Moorfields NHS Trust. She gained huge respect for the quality of the teams she built and sustained, and the high quality of training she offered.

HIV/AIDS

In Islington, she was one of the first to recognise the importance of HIV and the role of public health in health promotion and prevention. Her former colleague, David Panter, AIDS information officer with Islington Health Authority from 1986 to 1988, recalled, “Leila demonstrated the full spectrum of effective public health practice. She worked from a strong value base and was always alert to the changing health needs of her community.

“In the early 1980s the world was beginning to get to grips with a new transmissible disease—AIDS. While no one was immune, its initial grip was on the gay male community and as a consequence much public hysteria was generated with the announcement of the ‘gay plague.’ In 1985, 58 deaths were recorded in the UK caused by the virus that, by the end of 1986, was identified as HIV. AIDS caused great fear and anxiety among health professionals, politicians, and the public and, although the focus at the time was on identifying the cause and finding appropriate treatments, little focus was placed on prevention. Leila, the then director of public health at Islington Health Authority, thought differently. Inspired by gay community activism in both the US and UK, she applied her public health lens and set out to persuade Islington Health Authority to identify a small amount of funds to create the position of AIDS information officer. No easy feat given the gay plague rhetoric, systemic denial of the matter, and a risk averse health board. Leila’s determination and clear logical rationale won the day and in the late spring of 1986 this post, the first of its kind in the NHS, was established. The role was embedded in the broader health promotion team and had a specific brief to work with the gay male community, providing preventive advice as well as information on the subject to wary medical and nursing staff. In addition to this local service the position was also to form links with other key parties—for example, the newly established Terence Higgins Trust—to develop public health campaigns to tackle the matter and raise awareness well beyond the boundaries of Islington. Leila had no truck with HIV being a ‘gay issue.’ She saw it for what it was—a virus whose transmission could be stopped with a solid public health approach. Leila’s innovation opened the door for this role within the NHS and within 12 months more than a hundred similar positions existed across the country. This early action meant that when the government eventually launched its own scaremongering and disastrous public information campaign—‘Don’t Die of Ignorance’—in early 1987 the NHS already had a swathe of dedicated and informed health promotion staff to pick up the pieces.”

Another former colleague, Sarah Price, chief officer for population health and inequalities and deputy chief executive at NHS Greater Manchester Integrated Care, recalled, ‘‘Leila changed public health, not by publishing academic papers and speaking at conferences, but by raising its profile within the NHS and developing a cohort of professionals who have gone on to key roles in the advancement of the specialty and in health services research. Leila could spot talent, nurture it, and get the best from people. Many of us owe our success to the start she gave us, her boundless encouragement, and the pride she took in what we achieved. She was unique, a wonderful person, and is much missed.’’

Lessof’s former trainee, Mary Piper, a retired public health physician for people in prison in England and Wales, said, “On becoming a public health trainee, mid-career, I asked Leila if she would be my trainer, for I had learnt that in addition to her remarkable health and clinical skills, she was a force for good, a champion of the underdog, never shy of speaking truth to power.”

Naomi Fulop, professor of healthcare organisation and management at University College London, recalled, “I began working with Leila at Islington Health Authority in January 1989 and subsequently moved to continue working with her at Parkside—which then became Kensington Chelsea and Westminster Health Authority—until she retired in 1995. She was my first boss, the best I’ve ever had, and she had a profound impact on my career and my life, as she had on so many others. Leila showed us what women could achieve in a then male dominated environment with passion and commitment to both public health and the staff she recruited and supported. Leila remained an important mentor and friend to me throughout her life and I miss her hugely.”

Jonathan Koffman, professor of palliative care and associate director of the Wolfson Palliative Care Research Centre, said, “I met Leila when I started my first job in 1991, a very junior researcher working in the Department of Public Health at the newly formed Parkside District Health Authority. This was a pivotal moment for the NHS when health authorities were mandated to assess the health needs of the populations they served and purchase healthcare for them that would contribute to health gain. Public health was critical in this equation, making use of new approaches (epidemiology, health economics, medical demography, social science, and health services research) to examine needs and also evaluate the contributions of services in terms of their effectiveness and quality. Leila had recently moved from the then Department of Community Health and Islington District Health Authority and brought with her two highly talented researchers she had already mentored. I was an early career researcher, and even though she was my ultimate line manager, Leila became my unofficial critical friend. My research brief was principally focused on mental health and ageing. Both these groups were described as ‘Cinderella’ populations, largely ignored and underserved. Leila encouraged me to become part of what she referred to as the ‘disturbance business’ and to advocate for these groups on a foundation of rigorously acquired evidence that could be robustly defended. She accompanied me to mental health units, showing me, by example, how to ask searching questions of those delivering care to those in the margins—how could we be the better society for these people? Leila shared great practical wisdom and learning with me. Her copy of Epidemiology—Principles and Methods sits proudly on my bookshelf and is still used when teaching. She demonstrated to me that women could ascend to important and high ranks within the health service without having to resort to being aggressive. She was all too often the only woman in a room of grey haired men wearing grey suits, but her presence was enough. She was the diplomat extraordinaire and led by example with four often absent qualities—integrity, authenticity, honesty, and humility. Leila supported and mentored a new generation—women as well as men—and helped to give non-medics in public health the recognition they deserved. She leaves a palpable legacy; at least five of her former staff are now world leading professors working in public health or closely related areas.”

Her former colleague Bobbie Jacobson said, “We see few all round physicians today. Leila was one. Not only did she bring her strong grounding in radiology to the table, but also her prescient insights into population health and general management at many senior levels in the NHS. She set a new benchmark for what a woman doctor could achieve in a male environment. Above all, her authoritative blend of pragmatism and support for junior doctors in training was a model for other medical disciplines. Her leadership and steadfast loyalty to public health trainees across London attracted many talented public health physicians who themselves went on to make enormous contributions to public health from prevention through to care.”

Leila Lessof was awarded an OBE for her services to public health on the Queen’s Birthday Honours list in June 2000.

Lessof had a strong network of friends and was devoted to her grandchildren. In retirement, she enjoyed playing bridge and her reading group. With Maurice Lessof, her husband of 62 years (see obituary: doi:10.1136/bmj.p2254), she enjoyed travelling and both were keen on opera, theatre, and cinema.

She was utterly devoted to her husband as he became older and developed dementia. They remained at home together throughout with the support of carers and family, and sat for hours together until her very last days. He outlived her by barely five months.

She leaves her three children, Nick, Carli, and Suszy; her grandchildren, Noa, Gabriel, Maya, Ila, and Louis; and her younger sister, Carmel.