We believe it is important to invest in the first few years of life.

It is important to address the root causes of social disadvantage by ensuring additional support is available for those that need it most early on. The Family Nurse Partnership (FNP) aims to enable young mums to reach their full potential and prevent the use of costly interventions later down the line, such as children going into care.

A good fit with national and local priorites

The FNP programme is a good fit with national and local priorities. It:

  • Provides prevention and early intervention for some of two vulnerable populations (teenage mothers and their children)
  • Works to improve access and engagement with other services (e.g. social care/children's centres)
  • Works to improve child health and development (e.g. school readiness) so that this population develops in line with expectations for this age group
  • Works to improve the life chances for mother and child by breaking cycles of disadvantage (e.g. focussing on supporting mothers to get back into education, employment or training)
  • Delivers the Healthy Child Programme to first-time teenage mothers
  • Addresses the six early years high impact areas - transition to parenthood, maternal mental health, breastfeeding, healthy birthweight and nutrition, managing minor illness and reducing accidents, and supporting child development
  • Invests now to save in the future.
Money matters

The average local cost per FNP place is approximately £3,200 a year. The minimum size for a FNP team is four family nurses, a supervisor and a Quality Support Officer that offers approximately 100 places at any one time, based on full-time equivalents. A supervisor can manage up to eight family nurses.

Cost benefits

US research has shown that FNP can results in positive economic returns to the Government, to individuals and to the wider society. They suggest:

  • A net economic benefit of between $18,000 - $34,000 per participant, $3 - $5 for every $1 invested by time child reaches adulthood (This was reported from the Nurse Family Partnership Programme)
  • The greatest returns in the longer term are through programme costs which are recovered by the time the child is aged four
  • From welfare savings alone, the Government recovers the costs of the programme by the time the child is aged 12
  • The greatest economic returns come from increased employment, welfare savings, a reduction in crime, and reduced child protection costs. [1, 2, 3]

The Dartington Social Research Unit’s Investing in Children site suggests there is potential for positive returns on investment in UK and estimate that for every £1 invested in the programme, society obtains £1.94 at an annual rate of 6% return on investment. This is quite a cautious estimate based only on a small number of outcomes which have been monetised so far in UK.

Costs avoided

Another way of looking at the financial benefits of FNP is to consider the costs of services avoided by not having to spend as much on support and services for families with complex needs. Potential service costs avoided through FNP include:

Social care [4]

 

Foster care (Local authority) 

£636 per child per week

 

£16,500 for six months

 

£33,000 per year

Residential care (Local authority) 

£2,964 per child per week

 

£77,050 for six months

Child In Need (CIN) - aged under six

£5,729 for six months

 

 

Education, training and employment [5]

 
8-24 year old not in education £4,528 average cost per year
One Employment Training (NEET) Income support to employment NVQ level 3  £7,744 saved (by DWP) per year per claimant
  £545 saved per year (to HM Treasury in tax receipts from increased earnings)
Improved school readiness  £1,023 saved per child
   

 

The US evidence base

The FNP programme, known as Nurse Family Partnership (NFP) in the US, was originally developed by Professor David Olds and colleagues at the University of Colorado, on the basis of over 35 years of extensive research.

Three large scale randomised controlled trials (RCTs) have tested the programme with diverse populations in different contexts in Elmira, New York (1977), in Memphis, Tennessee (1988) and Denver, Colorado (1994). The programme has also been adapted and evaluated for at-risk mothers in the Netherlands and in Germany. These studies have highlighted a range of benefits for children and mothers over the short, medium and long-term.

NFP has one of the best evidence bases for preventive early childhood programmes. It has been repeatedly identified as a programme with the highest quality of evidence and best evidence for effectiveness. The Early Intervention Foundation Guidebook gave it their highest rating, as did the Coalition for Evidence Based Policy and the Blueprints for Healthy Youth Development. [6, 7]

Achieves results

The US and Dutch RCTs identified evidence for a range of positive effects from the Nurse-Family Partnership programme. The effects with the strongest evidence (those found in at least two of the four trials) are:

  • Improved prenatal health
  • Fewer childhood injuries and reduced child neglect and maltreatment
  • Fewer subsequent pregnancies
  • Greater intervals between births
  • Increased maternal employment
  • Improved school readiness.

Many of the outcomes were strongest for, or restricted to, the most vulnerable sub-groups, e.g. women who were on low incomes, young and unmarried mothers/families, or those who had low psychological resources at intake to the programme. The effects on child and maternal mortality, children’s emotional and behavioural development, and criminal behaviour became apparent in the longer term, and as a result have only been reported in findings from trials which have continued to follow families and children through childhood into their teenage years. [8, 9, 10]

 

References

[1] Olds, D. L. Kitzman, H. J., Cole, R.E. et al (2010) Enduring Effects of Prenatal and Infancy Home Visiting by Nurses on Maternal Life Course and Government Spending – Follow up of a Randomized Trial Among Children at Age 12. Arch Pediatr Adolesc Med. 2010;164 (5):419-424.

[2] Lee, S., Aos, S., Drake, E. Pennucci, A., Miller, M., & Anderson, L. (2012). Return on investment: Evidence-based options to improve statewide outcomes, April 2012 (Document No. 12-02-1201). Olympia: Washington State Institute for Public Policy.

[3] Karoly, Lynn A., Peter W. Greenwood, Susan S. Everingham and others. 1998. Investing in Our Children. Santa Monica, Calif.: RAND Corporation.

[4] Curtis, L., 2013. Unit Costs of Health and Social Care 2013. PSSRU, University of Kent. (was 5)

[5] The Cost of Troubled Families, 2013. Department for Communities and Local Government, London. (was 6)

[6] Social Programs That Work - Family Nurse Partnership. Social Programs that Work

[7] Intervention Summary - Family Nurse Partnership. National Registry of Evidence-based Programs and Practices

[8] Olds, D. L. et al. Effects of Nurse Home-Visiting on Maternal Life Course and Child Development: Age 6 Follow-Up Results of a Randomized Trial. Pediatrics 114, 1550–1559 (2004).

[9] Olds DL, Eckenrode J, Henderson CR, Jr & et al. Long-term effects of home visitation on maternal life course and child abuse and neglect: Fifteen-year follow-up of a randomized trial. JAMA 278, 637–643 (1997).

[10] Olds, D. L. et al. Effect of Home Visiting by Nurses on Maternal and Child Mortality: Results of a 2-Decade Follow-up of a Randomized Clinical Trial. JAMA Pediatr. 168, 800 (2014).

Other useful publications

[1] The Family Nurse Partnership Information Leaflet – The Department of Health

[2] Karoly, L.A., Kilburn, M.R., Cannon, J.S., 2006. Early Childhood Interventions: Proven Results, Future Promise. Rand Corporation.

[3] Lee, S., Aos, S., Drake, E., Pennucci, A., Miller, M., Anderson, L., 2012. Return on Investment: Evidence-Based Options to Improve Statewide Outcomes (Update No. Document No. 12-04-1201). Washington State Institute for Public Policy.

[4] Apteligen, 2013. A Study into the Local Costs of the Family Nurse Partnership Programme in England, Summary Report. Department of Health, London.

[5] Social Research Unit/Aldaba. 2014. The economic case for the Family Nurse Partnership (FNP) programme. Summary of publicly available information for decision makers in the UK

[6] Curtis, L., 2013. Unit Costs of Health and Social Care 2013. PSSRU, University of Kent.

[7] The Cost of Troubled Families, 2013. Department for Communities and Local Government, London.

[8] Mental health promotion and mental illness prevention: The economic case, 2011. Personal Social Services Research Unit, London School of Economics and Political Science, Department of Health, London.

[9] McCrone, P., Dhanasiri, S., Patel, A., Knapp, M., Lawton-Smith, S., 2008. Paying the Price. King’s Fund, London.