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Today we’ve published the results of an opinion poll of over 300 NHS leaders about prevention. We commissioned this research as part of FPH’s larger project examining the role of the NHS in ill-health prevention.

With this poll we wanted to explore with an NHS audience several of the key issues that have emerged from our project’s extended consultation so far with predominantly a specialist public health audience. We were interested to see if the opinions, perceptions, and priorities of these two (sometimes overlapping, but often distinct) groups diverged or were in general alignment.

We explored the following six main issues:

  1. Do NHS leaders consider prevention to be part of their job, e.g. is it a core, large, or small part of their departmental work?
  2. Prevention priorities now and for the future – which approaches to prevention delivery (e.g. addressing common risk factors or targeting specific populations) is their local NHS currently prioritising and which approaches do they think their local NHS should be prioritising?
  3. The effectiveness of NHS prevention activity – how effective or ineffective do they think their local NHS is at delivering its current prevention priorities?
  4. Prevention budgets – on average, what percentage of their budget do they currently spend on prevention and what percentage do they think they should be spending? Do they think the NHS should reallocate its budget away from treatment and towards prevention?
  5. The top barriers to NHS prevention activity – what is getting in the way of their department doing more or more effective prevention?
  6. NHS advocacy for prevention – which taxes and regulatory measures do NHS leaders think would most benefit the health of their local population?

You can learn all of the answers to these questions and with some very brief analysis in our short summary paper here.

We think these results provide a useful (and much needed) benchmark for the current state of what the NHS does, spends, values, prioritises, and would like to do more of (or better of) when it comes to prevention. We also think they can help our members and others working on the frontline of healthcare delivery ‘do’ more prevention. Additionally, we also think they can inform the ongoing debate around the implementation of the prevention aspirations laid out in the NHS Long Term Plan.

But we’d really like to know what you think.

Please do take 10 minutes and have a read-through and then let us know what you make of our findings by emailing policy@fph.org.uk or tweeting us @FPH using #NHSprevention

Thank you so much in advance for taking the time to read and share.

Lisa Plotkin
FPH Senior Policy Officer

Richard LilfordOn 13 February 2019 I visited Balukhali refugee camp (Camp 18 in the Kutupalong refugee camp) near Ukhia, a sub-district of Cox’s Bazar in South East Bangladesh. I travelled with my colleagues Dr Sam Watson and Ryan Rego as the guests of Drs Sirajul Islam and Mohammed Yunus from the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). Our purpose was to set up a study to test the utility of stool pathogen screening, rather than diarrhoea rates, as an outcome of choice in the study of Water, Sanitation and Hygiene (WASH) interventions. 

Rohingya

I had watched and read news reports about the plight of displaced Rohingya people, and as I travelled towards the camp I imagined that I would encounter a scene of squalor and desolation, reminiscent of the most extreme among informal urban settlements. 

What I found was completely different to my mental image. We drove into the camp along a pristine brick road. Dwellings were mostly made of bamboo, and were nicely laid out as in a French campsite. There were regular bore-hole outlets providing safe water at source, numerous advanced pit latrines, and no unpleasant smells. Many of the adult inhabitants were hard at work making a concrete drainage system in preparation for the coming monsoon. Children were in school. They looked healthy and were well-groomed. There were football pitches and plants growing in the many parts of the camp. 

Four things seem to have come together: 

  1. The government in Bangladesh, after some hesitation, decided to accommodate the refugees – a country of 170 million can absorb another 1 million, said the Prime Minister. 
  2. UN agencies, such as the High Commission on Refugees, were available to supply logistics and know-how. 
  3. Money was provided on the back of the many NGOs that gravitated to the area. At the peak, over 150 NGOs had a presence in the camp. 
  4. The effort was co-ordinated by the Office of Co-Ordination of Humanitarian Affairs. There was no ‘free-for-all’. 

Too good to be true? Yes, I am afraid so. If you look at “Open Street Map” (OSM) you will see that we visited a well laid out, orderly part of Ukhia. There is another section where the dwellings are much more closely packed among narrow lanes laid out in a disorderly way – much like a slum. Apparently, this was where the Rohingya settled following the initial, unanticipated influx that we all watched on our television screens. What lessons can I draw, tentatively, from my visit? 

First, what I observed is a good news story on balance – a tiny proportion of the worlds resources were harnessed and focussed on a real and present need, and the majority of the camps in Ukhia appeared to be in good order.  

Second, it is amazing what moderate resources can achieve, given an organising hand. I think there may be an important lesson in the contrast between the orderly, planned part of the Ukhia, and the disorderly sector where I understand WASH is less developed and intrinsic violence is prevalent. I hypothesise that planning for an influx of people lends itself to a favourable environment, whereas, once an urban area has developed in a disorderly way, it is much harder to remedy. 

Third, service provision in slums could learn a lot from refugee camps. Bamboo could be provided free of charge by NGOs to provide better insulated, more attractive accommodation. I fancy this would be a big improvement over corrugated iron shanties that are hot by day and freezing by night. Advanced pit latrines I observed in the camp would be a big advantage over the facilities usually provided in slums and their marginal cost is modest. Above all, a centrally co-ordinated approach is essential. I think cities that harbour slums should appoint officials with responsibility for informal settlements and a responsibility to co-ordinate investments and community engagement. 

Fourth, the problem for the Rohingya people is averted not solved – a long-term, sustainable solution is required and a return to Myanmar does not seem to be that solution. 

Written by Richard Lilford, Professor of Public Health at the University of Warwick. You can follow Richard on Twitter @rjlilford

Johningown

President’s end of term report – Part one: Professional public health development

As my term of office comes to an end, I have been reflecting on our major achievements over the last three years. You can read some of these in our latest annual report, which does, I think convey the spirit of work over a much longer period. I hope it presents a view of a Faculty in a respected position, ready to build further to create an organisation of which our members can be confident and proud. So, I won’t reflect on all of the business I have been involved in, but rather give my personal top ten things I’ve most appreciated. All of them reflect extraordinary team effort on the part of our members, our officers, our Board and our partners, and I am extremely grateful to all of you.

  1. FPH as a trusted source of public health advice

The Faculty is now respected and restored in the public health lobby and in advice to government in the four nations. We are seen as the trusted, authoritative voice for public health by ministers, chief medical officers, public health agencies, civil servants and partners. We are in the tent. We are in the room, speaking truth to power. When we disagree, we are not disagreeable. Good public health practice has been very helpful to me in shaping the behaviours we need to demonstrate. Patience, courtesy, authority. We should hold to our professional independence, but we must ensure it is not personal prejudice, party politics or preaching we are beholden to. And we must speak well of our colleagues, having our disagreements in private and a united front in public. Our policies are written to a tone of voice policy, our behaviours are conditioned by codes of conduct for staff, members and Board trustees.

Our members should be confident that our voice and our concerns are being heard in the places that matter.

  1. Contributions to national policy making

Over the last three years we have made substantial contributions to national policy making – more behind the scenes and under the radar than shouted from the rooftops. Among these, our responses to the NHS long term plan; the Call to Action Scotland; the Brexit ‘Do no harm’ campaign and work on healthy trade; our strategic case for funding for prevention and public health including the role of NHS in prevention. Our special interest groups and committees have contributed to 29 position statements and consultation responses. I am grateful to Sue Lloyd for her fantastic work this year as Board lead for policy.

  1. Training offer

I am always impressed by the quality of our new registrar intakes each year. I am also heartened that they are all finding consultant jobs on leaving the scheme. We have undoubtedly improved the training offer through the curriculum review 2015 and will do so again through the review starting this year. I am grateful to Brendan Mason, Samia Latif, Suzanna Mathew and the staff team for their considerable work in raising our standards through the curriculum, the education committee and related bodies. It is our lifeblood. I am particularly delighted by the scheme we have for Specialty Registrars to undertake national project work with us. So far 18 registrars have been involved in project work on funding for public health, Brexit, FPH strategy, ethics and values work and other special interest groups.

  1. FPH governance and strategy

Our business in support of workforce, training, standards, membership and governance has been substantial and puts us in a good place as we seek to build a new strategy to 2025. Outstanding elements of this work have been the Workforce strategy; our work with PHE on quality standards for public health teams; our Board membership development group led by Sue Atkinson; our new website; our revitalised attention to Equality and Diversity, thanks to Harry Rutter and Megan Harris; and our new governance committee. Our members supported 171 advisory appointments committees in 2018, a record in my memory. Employers value our advice on the role of public health and making these vital appointments. Our Registrar, Maggie Rae has been the key driver of this work and I am most grateful to her for all she has done in this most unsung, essential but unexciting area of our business. Our finances, thanks to Ellis Friedman and the staff team are better placed than in previous years, with a balanced budget planned for 2019. I am also grateful to Ted Schrecker and Eugene Milne for the awesome job they have done in making the journal the successful, authoritative, international journal it is today.

  1. Wales: a beacon for the public’s health, and future generations

I was heartened by my first official visit to Wales in January 2017. I was inspired by the potential of the Wellbeing of Future Generations Act and the central role for Public Health Wales in taking forward the health in all policies approach and the sustainable development agenda. In two further visits I have watched the confidence grow in Welsh colleagues taking up this baton, and believe it is where we all need to be. I am also profoundly grateful to Angela Jones for revitalising the work of the Faculty in Wales.

  1. Health come all ye! Scotland

The Committee of the Faculty of Public Health in Scotland, led by Julie Cavanagh, have also grown their influence and made themselves the go to voice for public health in Scotland. I’ve spoken at two Scottish conferences, met with two health ministers, given my support to the development of the Call to Action, and the work of the CFPHS on Scottish Public health reforms. The UK Public Health Network was impressed with Scottish leadership on health as a human right, the theme of the 2018 conference and the launch pad for FPH’s Nanny State report.

  1. Public Health walk, Belfast

David Stewart’s Walk in Belfast recounting the stories of the public health of the city he served as DPH was fascinating and inspiring. After our productive meetings with colleagues in Belfast in November 2016, the government collapsed and colleagues in the north still find themselves in difficulty getting policy agreed and services developed. I have been made very welcome in visits to Irish colleagues in Belfast and Dublin and we will build on these relationships for the future.

  1. British public health in demand abroad.

Colleagues in other countries value and seek to emulate the British system of public health. Thanks to the dedicated work of our international registrar, Neil Squires, FPH continues to be involved in work with a wide range of international partners in the lexicon of public health acronyms. Among them, the International Association of National Public Health Institutes (IANPHI), the Association of Schools and Programmes of Public Health (US), the Association of Schools of Public Health Africa (ASPHA) and the Association of Schools of Public Health in the European Region (ASPHER). The European work is glued together by the World Health Organisation European office’s Coalition of Partners and through them we held productive meetings at Imperial College and the London School of Hygiene and Tropical Medicine last year. Our country-based special interest groups for Africa, India, Pakistan, Yemen and Sudan have been active. The India SIG have scored a significant result in getting a public health curriculum approved nationally, based on pioneering work by Sushma Aquila in the FPH Odisha community health workers training pilot.

  1. Great public health hiding its light under a bushel

I have been privileged to observe just a few of our brilliant colleagues work first hand and heard about very much more in conferences over the last three years. I have been involved in business meetings and conferences in all regions of England, in Scotland, Wales and Northern Ireland and also in the European Public Health conferences and the World Federation of Public Health Associations in Melbourne, 2017.

Great public health goes unsung in the Inter-island public health forum, which I’ve seen in Jersey 2017 and Gibraltar 2018; thanks Susan Turnbull and Vijay Kumar; David Ross and colleagues gave a great series of presentations on the work of the Defence Forces public health service in February 2018 in Lichfield. I’ve visited DSPH in Newcastle, Herefordshire, Knowsley, Sefton, Wakefield, Wolverhampton as well as attending ADPH regional committees across four nations. I was humbled and inspired by the work of the University College London Pathway Homeless health care team ward round, which has led to some collaboration with Alex Bax of the Faculty of Homeless health and inclusion.

  1. Stand together, or fall, apart.

Partnership is a vital element of what we do.

FPH has been active as a key partner in forums, such as the United Kingdom Public Health Network. We are respected members of the Academy of the Medical Royal colleges. We have developed partnership agreements with the paediatricians, emergency medicine and dentistry. The Public Mental Health conference with the psychiatrists was outstanding. We have also restored our partnership with the British Medical Association and other health unions representing public health colleagues, through the Public Health Medical Consultative committee. We have been active in enhancing academic public health and its partnership with service public health, through our academic and research committee through the Academy of Medical Sciences, ‘2040’ report, the National endowment for Science Technology and the Arts (NESTA) for the Alliance for Useful Evidence and our Bazalgette lecture 2019.

The future

After a lifetime in service public health making partnerships work, I believe we need to see more progress on partnership at the national level. I am surprised at how little government departments and other national leaders think partnership. In an increasingly complex and inter-related world, it is essential that partnerships work at all levels, across all disciplines, and interests private public, user and community. Our FPH strategy 2025 seeks greater and more effective partnership working. It is crucial that we work together or divided, we fall. I urge everyone in the public health community to come together to explore better ways of working together.

Many thanks for all your support and interest in the work of the Faculty during my time in office. Please continue to give your support to my successor, Maggie Rae.

Yours in health,

John Middleton

Written by Professor John Middleton, outgoing FPH President

 

Networking and working in partnership is second nature to me; however, the Synergy Award I received in 2018 helped me realise that these things take insight, creativity, knowledge, effort and time to be successful and have an impact. It was a huge surprise and accolade to be recognised for my partnership work aimed at addressing a range of deep-seated health inequalities challenges. Like many of you I have long recognised that multi-agency relationships and inter-professional approaches are required and that increasingly we need different skills and viewpoints to address significant public health issues.

It was motivating to be noticed for my innovation and integration of public health approaches across different areas of multiple vulnerability. It was most excellent to be commended for my collaboration with the voluntary, sector where, in partnership, I have highlighted health inequalities and social issues for the most vulnerable and It is more than rewarding to be valued and recognised for my contribution in developing these trusted relationships.

The FPH Special Interest Groups have provided further impetus and demonstrate commitment to working collaboratively in a range of exciting and challenging areas impacting upon the public’s health.  The SIGs have been an important vehicle to enable me to develop further shared commitments for children and young people; housing and arts and health – particularly the use of film as a powerful and impactful medium to raise awareness and promote public health approaches.

I wish the next winner of the Synergy Award success and use the opportunity to build on what you have achieved and to continue to extend the reach and impact of the FPH in addressing public health priorities.

Written by Karen Saunders, Public Health Specialist, Public Health England (West Midlands) .

What do you do on a Saturday morning?  Ah, Saturday morning. The weekend has just begun. 48 hours of freedom. Maybe you’re working this weekend, maybe you’ve got plans with friends, or maybe you’re tackling the chaos that is the Tupperware drawer. We might spend the first portion of the weekend with some housework, homework or, maybe if you’re a student, a hangover. However, there are roughly a quarter of a million people across the world who participate in a Saturday morning parkrun. And believe me, it feels amazing.  

What is parkrun? 

parkrun is a weekly, free timed 5km held in parks worldwide and completely led by volunteers. Simply put, you pitch up to your local park at 9.00am, and at the sound of “go!” you walk, jog or run to the finish line. Operating in 20 countries, there are over 3.5 million parkrunners who have collectively run 221 million km (a gentle jog to and from the moon 285 times). 

Paul Sinton-Hewitt, who was awarded an MBE for his positive contribution to society, set up the world’s first parkrun in London back in 2004. (You can read the story behind parkrun written by Paul himself via this link.) From there, an increasing number of people joined. parkrun’s positive impact on public health is undeniable – we all know the mental and physical benefits of exercise – and so it follows that parkrun’s mission statement is “creating a happier, healthier planet.”  

Essentially, parkrun is a dream public health campaign, but what has facilitated its growth? Why does parkrun work so well? And what can we learn from its success?  

The Three Cs 

I like to summarise the fundamental aspects of parkrun’s success in three simple words, all starting with C. And no, sadly, the first word is not ‘Cake’ (heavily associated with the post-parkrun coffee and cake situation I seem to end up in each week).  

First, consistency. Consistency is key. Consistency helps people find a routine that works for them, and when something becomes normalised within a routine, it is never nearly as arduous as first perceived. For some, the idea of waking up before 9am on a Saturday and running 5km is an unbelievable idea, ludicrous in fact; but do it one week and you’ve pushed yourself out of your comfort zone. Return the following week, and the next, and next after that, you soon find yourself enjoying the regularity. It becomes habitual. And for any social change we may want to make – changing habit is certainly a good place to start.

Consistency is also seen at an individual level as people aim to improve their times each weekHaving the times documented pushes people to try harder. It gives us something to work towards. A target to smash. A small win that just makes your day. parkrun is rewarding.

Secondly, we have community. One of the best things about parkrun is its inclusivity – regardless of your age, fitness or previous running experience, everyone is welcome to join in and become a parkrunner. With a truly welcoming atmosphere and complete absence of judgement, combined with the genuine desire to celebrate each other’s achievements, parkrun successfully creates a feeling of unity between runners. This enables people to feel positive, building confidence and encouraging them to return. Parkrun provides a sense of belonging.

Finally, collaboration. There is an idea of collective interest which runs deep within the roots of parkrun. Inclusive of both the volunteers (without whom parkrun would simply fail to exist) and the runners, everyone invests their time in making it work. parkrun defies popular theories of social change, such as top down and nudgeas it began with one initiator event which “snowballed” into something much bigger. This snowball effect would be lost without collaboration between individuals with a collective interest to improve our society. parkrun encourages people to work together.

Generating positive social change is a process, not a project. It can start with one idea that becomes habit. One idea that helps to grow, develop and empower people. One idea that acts as a catalyst for people working together. As the saying goes, ‘a journey of one thousand miles begins with a single step.’ While the effects of this saying may be lost from slight overuse (and the fact that it is completely cliché), its words stand nothing less than true. When looking at public health initiatives, we must try to think almost in reverse – what can we do to make this change normal and routine for people? How can we engage groups and build that sense of teamwork? What will allow this initiative to erupt and become the social change which we so wish to see? 

Written by Steph Pitt, a final year student at the University of Bath studying for a BSc Honours degree in Natural Science with a year in Industry.

Each year at FPH in Scotland’s Annual Conference, the Littlejohn Gairdner prize is awarded to a public health trainee judged to be showing “outstanding potential in making a contribution to public health in Scotland.” The prize was first instituted by Dorothy Hedderwick to commemorate the centenary of the appointment of her father, Sir Henry Duncan Littlejohn, as Medical Officer for the City of Edinburgh, and of his friend, Sir William Tennant Gairdner, as Medical Officer of Health for the City of Glasgow.

In November 2018 it was awarded to Rachel Thomson, Specialty Registrar in NHS Ayrshire and Arran, for her work on a national needs assessment of gender identity services. In this blog she tells us about the project, why she thinks its important, and what she’s learned from it.


I was both surprised and delighted to be awarded this year’s Littlejohn Gairdner prize, and wish to extend my sincere thanks to the Faculty of Public Health (FPH), the judging panel and, of course, Dorothy Hedderwick. As a relatively small registrar group in Scotland we’re always aware of the impressive range of work others are involved in, and so to have our needs assessment of services for Scottish transgender (trans) people singled out made me very proud.

Any success is absolutely not just mine though. This piece of work was the result of a significant co-production effort between the Scottish Public Health Network (ScotPHN) and several LGBTQ+ third sector bodies (the Scottish Trans Alliance, LGBT Health & Wellbeing and Stonewall Scotland). The prize should really be considered a shared one, because without them there would be no report and I wouldn’t be writing this.

Since beginning the project I’ve always known it had real potential to effect change for trans service users if done well, and so I acutely felt the pressure to try and make sure the final product realised that potential. Waiting times for gender identity clinics are lengthy across the whole of the UK, and we know that those who are waiting are often at an extremely vulnerable point in their lives. There is often little in the way of support services offered by the NHS, with this gap either being filled by grassroots and voluntary organisations or not at all.

In our report, we hoped to provide evidence of the good practice in both the NHS and third sector that was already happening in some areas, and make recommendations for how services could both reduce waiting times and more appropriately care for those who were in this limbo period. We also wanted to better understand how trans people were using existing services, and whether the way that NHS gender identity services currently operated mapped well to the level of need we were seeing in Scotland. Most importantly, we wanted to elevate the voices of trans service users, and use previously untapped data sources to better understand the population that the services were actually for.

This meant a mammoth piece of work involving interviews, data analysis and stakeholder engagement, which took several months to complete. However, by the end of the process we were able to draw some solid conclusions about the population presenting to gender identity services services, how this had changed over time – with numbers of referrals increasing but potentially approaching a plateau, and more people being referred with non-binary gender identities – and how services could adjust in order to meet this need. We were able to feed our work back to the National Gender Identity Clinical Network for Scotland, who welcomed the findings and plan to discuss and take forward our recommendations, which you can read about in full in the published report.

This could not have been achieved without the co-production element of the work, in particular the involvement of the third sector – the range of perspectives and voices involved throughout the process benefited it at every stage, from design to completion. Equally importantly, it meant that the final report was something both the NHS and third sector partners were proud of and happy to disseminate, describing it as something they actively wanted to use to try and positively influence services for trans people in Scotland. I think that’s a real achievement, and would recommend similar co-production approaches to anyone considering such work in future. To have that achievement very kindly recognised with the Littlejohn Gairdner prize is just the icing on top of an already very pleasant cake.

Written by Rachel Thomson, Specialty Registrar in NHS Ayrshire and Arran. You can follow Rachel on Twitter @rachel_thomson. To read the Health Care Needs Assessment of Gender Identity Services written by Rachel and her colleagues Jessica Baker and Julie Arnot, click here. If you want to follow in Rachel’s footsteps, applications for this year’s Littlejohn Gairdner Prize are open until 1 August 2019. If you’re a specialty registrar undertaking public health training in Scotland and have delivered a significant piece of substantive work that clearly contributes to learning outcomes, like a Board-level paper or a needs assessment, consider entering via this link. 

Photo to support Donald Lovett blog

Dr. WCD Lovett, OBE, BSc, MBBCh (Wales), MD (London), DPH, DTM&H, FFPH. 

Donald Lovett died on 7 July 2018 at the age of 100 years. He qualified at the Welsh National School of Medicine, Cardiff in 1942 (and from London University as an external student in the same year). He served in the RAMC in Nigeria, Kenya and Somaliland and the experience gave him a taste for medical administration. 

Consequently he took the Diploma of Public Health at Queen’s Square, London in 1948, whilst in passing obtaining a Doctorate in Social Medicine from London University by examination in 1947. He impressed the viva examiners with his knowledge of the public health risks of the Haj that he had gained in Somaliland.

After a short spell as an Assistant County Medical Officer he joined the Colonial Medical Service and took up a posting in Somaliland as specialist in public health. The range of his responsibilities there was very wide, taking in inspecting abattoirs and a tuna canning factory, selecting land fill sites for refuse, planning and building a new hospital at Hargeisha, drawing up ‘standard architect drawings’ for housing (to ensure conformity with public health regulations), and mosquito and insect control. As part of the latter he carried out a successful relapsing fever eradication campaign, which he believed earned him the O.B.E. in 1958. He ran a vaccination and immunisation clinic and dealt with the medical aspects of famine relief, as well as dealing with a smallpox epidemic (alastrin). He drew up ration scales for prisons, schools and troops and revised the regulations for running medical services within the Protectorate. He assisted in the establishment of a system of tribal dressers, an intervention that would later be called ‘barefoot doctors’.

Whilst on home leave he studied for and obtained the Diploma in Tropical Medicine and Hygiene. In 1957 Donald was promoted to Senior Medical Officer in Tanganyika taking up his first position in Mtwara, Southern Province. There he was responsible for the medical services for a population of one million. This involved the services provided by Christian missionaries as well as those run by the colonial government. He set up a TB domiciliary treatment scheme relying on the admixture of methylene blue to isoniazid tablets to facilitate monitoring of   patient treatment compliance. Those who took the tablets passed blue urine. Interestingly the provincial Senior Medical Officer was regarded as the local expert opinion on all clinical matters so Donald had to personally manage some challenging obstetric emergencies. 

Donald’s second Tanganyika posting was to Northern Province based in Arusha. His time there was however quite short as in 1959 he was promoted to Assistant Director of Medical Services based in Dar- es- Salaam. In that capacity he was involved in facilitating the transition to Independence with Africanisation of the administration. He also served as Director of the Dar-es-Salaam Red Cross running a scheme assisting local Asian young women to train as nurses in the UK. After Tanganyika’s independence, Donald remained and was particularly proud of his role with Maelor Evans, CMO, in setting up a Medical School in Dar-es-Salaam with a curriculum directed at public health training and clinical practice in rural conditions with limited facilities. He ended his Colonial service in 1963 as Acting Chief Medical Officer. 

Upon his return to the UK Donald embarked upon a new career in public health becoming Assistant Senior Administrative Medical officer with the Welsh Hospital Board in 1964. He remained in Cardiff for the rest of his life finally retiring in 1983 from his post as Principal Medical Officer at the Welsh Office. During this time he was in 1974 made a Member of the Faculty of Community Health(later the Faculty of Public Health Medicine ) and in 1976 elected to a Fellowship. He found being a medical administrator in the UK rather more constraining than in the Colonial Medical Service but did comment that managing a meeting of Welsh hospital group secretaries was little different to negotiating with Somali tribal elders under a village meeting tree.  

Donald’s colonial experience was made use of by his participation in two working parties under the aegis of first the Colonial Office and then the Ministry of Overseas Development, advising on the development of Health Services in two newly independent states, firstly in Guyana in 1965 and then in the Northern Trucial States (now the United Arab Emirates) in 1969.  

Throughout his career Donald was ably supported by his wife Mary whom he had met in 1939 when he was a medical student and she was starting as a nurse.  Mary died in 2002 and they are survived by three sons, eight grand-children and twelve great grand-children.  

Written by Donald’s son, Dr Jonathan Lovett.