Ailsa Swarbrick: A significant step for evidence in England

The Family Nurse Partnership (FNP) trial report published today is hugely significant. Here are just a few reasons why. First, it demonstrates real bravery and honesty across the board. The young mothers, often feeling judged, often wary and sometimes even scared of public services, committed not only to a relationship with a family nurse for over two years but also agreed to their experience being observed, monitored, noted, discussed with a research team and then published. Family nurses and supervisors will see the work they do with passion, skill and commitment laid out over 500 pages of close analysis, and then discussed both nationally and internationally. Government, and politicians from all parties, made a commitment to evidence and early intervention and to honestly understanding what works. These people and many others form a remarkable partnership, working to get it right for vulnerable young mothers, fathers and their babies, and to improving their life chances.

Secondly, the report shines a light on the challenges that some of the most vulnerable in our country experience. When they joined the trial, 46% of young mothers had been suspended, excluded or expelled from school, 71% had truanted and 35% had been arrested. 40% went on to experience domestic abuse, 30-35% experienced depression and 56% smoked throughout pregnancy. In our rich and developed society, in the 21st century, we must do better. We must do more to transform the life chances of young women and their babies, who have so much to offer, and we will.

Thirdly, the report gives us a basis for change. Few similar services have had the benefit of this level of scrutiny and research. It’s now our responsibility to use this wealth of information well. We should build on what works, be honest in accepting what didn’t, and commit to improve. This is what being evidence based really means, and it will be hard, complex and I hope enriching work.

I’m pleased the report recognises family nurses’ skills in being able to develop a trusting and enduring professional relationship with young mothers. This is a crucial first step to improving outcomes. Some findings are positive. In particular, FNP appears to have had a positive impact on child development and early language development - these are important indicators of later school readiness and academic achievement. There are also signs of benefits around early identification of child abuse and neglect – it’s obviously so important to prevent children “slipping through the net” – we need to see how this develops in the follow up study at age six.

Other areas are more challenging. Levels of smoking in pregnancy are worrying, and we need to accept and understand this, and do something about it. Stopping smoking means overcoming an addiction to nicotine at a stressful time of life and FNP needs to help women to do this within a few weeks of the programme starting, and before the relationship between the nurse and the mother has fully developed. So we need to think differently and learn from new evidence, from what works well elsewhere, to develop new approaches and to rapidly and rigorously test them. I am clear this is one of our top priorities.

Another priority is to address cost effectiveness. The report says FNP is not cost effective to the NHS at this stage, based only on the mothers’ health outcomes. This is only focused on the costs to the NHS and doesn’t take the child’s outcomes into account. However, if a mother smokes, her health at this stage of life (and that of her baby) can be best improved by stopping smoking, so tackling this is doubly important. We also need to assess over time the impact on cost effectiveness of any improvements in child health and development, of safeguarding benefits (it was interesting that 18 mothers and children were taken into foster care in the control group but only nine in the FNP group), and of other longer term benefits. The trial tells us that FNP costs just under £1,000 extra per mother per year – we may find this is good value when we take a longer term view.

So, there is lots of potential, and we now have plenty of evidence to help us adapt and improve. My colleagues and I will share our initial thinking and plans in future blogs and I welcome the input of everyone with a stake in this - young parents, nurses, service leaders, local authorities, CCGs, academics, professional experts and others.