On leaving FNP

Ailsa Swarbrick, former Director of the FNP National Unit (2012-2020)

This week we published our report about how we have learned from evidence and changed FNP.  This also marks the end of my eight years as Director of the FNP National Unit.

It’s hard, right now, to think beyond the immediate pressures and fears of coronavirus, and the unimaginable new normal it produces each day, and I’ve wondered if it’s appropriate to do that.  But against the backdrop of the global crisis, the public health and economic emergency and the policy responses, there are people’s lives, loves and hardships, and it is what we and future generations do which will take us through this time and into the future.  So these things, and the contribution FNP has made, still matter.       

The FNP story is about improving outcomes for both babies and their parents over their whole lives.  It’s also about the delicate balance between the human, personal and relational, and the scientific, the structured, the social and the political.  It’s about exploring complexity, listening and learning, and making hard and pragmatic choices to move things forward.  Finally, this has all shaped me personally, and so it’s also my story.

I was introduced to FNP in 2006, overwhelmed on return to work as a civil servant after having my fourth son, trying to pick my way to being both the mother I wanted to be and also to do meaningful professional work, well.  FNP’s combination of a frank recognition of emotion and love (with fluffy pink hearts and all), alongside a robust evidence base, and a focus on real world delivery spoke to me.  I spent a few months helping to introduce it to the UK, before moving on to something else.

Fast forward a few years and I took on the role of Director, taking the FNP National Unit into the NHS, the Tavistock and Portman, home of attachment theory.  I have loved this job, and here are a few things I have learned and which I will take with me to pastures new.   

  • You need data, science and evidence to do things well – and this takes many forms. They inform good decisions, show what’s working, and test improvement.  FNP has an extensive evidence base of RCTs, programme data and an upcoming English RCT follow up and a data linking study.  But data is not necessarily neutral, and can privilege certain groups.  Chimamanda Ngozi Adichie brings this home in her wonderful TED talk, the danger of the single story, as do books like Invisible Women and Disappearing Acts.  Evidence is also not always linear, or objective, or even of good quality.  So people, their perspectives and their stories are also necessary to illuminate and challenge.  As we took forward the ADAPT project to change FNP, we therefore tried to listen to many voices, including those of FNP clients and nurses, to help interpret the data we were seeing.   
  • There’s a gap between strategy and reality, and lots of the best work is done by carefully and thoughtfully muddling through. I’m convinced it’s virtually impossible to design a strategy for change, and then to make it happen as planned.  Change is in fact dependent on many, many responses to small acts, or gestures.  Ralph Stacey, whose theories of complex responsive processes I was privileged to learn about as part of the Health Foundation Generation Q programme, taught me that.  It follows that it’s important to try to be a learning organisation, noticing and learning from each small step taken; and also to pay attention to thoughtful communications, to engage those involved in the work and support delivery.  That doesn’t mean structures and plans aren’t valuable.  In the FNP National Unit we are also enthusiastic about Agile project management and implementation science, but this is to help manage and monitor work rather than to reach a pre-determined outcome.      
  • Finally, the personal and the political can’t be separated. Change in FNP is generated through individual relationships, histories and motivation. But that rarely happens in a vacuum, and is also shaped by the wider determinants of health.  I’ve written before about how hard it is for a mother to support her child’s development when she’s living in poor, unsafe housing for example, and the links between poverty and mental health are well documented

What I’ve learned most of all is about the value and the beauty in the so-called small things, and the place of humanity in work.  I’d like to thank all the many people I’ve worked with, talked with, laughed with, or been inspired and supported by during my time leading FNP – colleagues, nurses and clients who have let me into their lives and sometimes their homes.

This poem by Simon Armitage says it all, especially these final two verses:

I have not toyed with a parachute cord
while perched on the lip of a light-aircraft;
but I held the wobbly head of a boy
at the day centre, and stroked his fat hands.

And I guess that the tightness in the throat
and the tiny cascading sensation
somewhere inside us are both part of that
sense of something else. That feeling, I mean.


(Extract from the poem It Ain't What You Do It's What It Does to You)