Silent night

 National Unit Director, Ailsa Swarbrick talks about the silent voices we should seek to find. 

I was incredibly privileged to spend time last month in the Austrian town of Salzburg, meeting European leaders in health and care. We had space to learn from each other and to challenge our views, from different national and professional perspectives.  All the while, the snow fell softly; and in the main cathedral square I listened to a choir singing Silent Night, composed there in Salzburg 200 years ago. I felt moved and stimulated, and brought home thinking which is already influencing my work in the Family Nurse Partnership (FNP) National Unit as we seek to enhance the life chances of vulnerable families and babies.

This space, and silence, also made me think about what we lose in the noise and rush of the day-to-day. That feels particularly acute now as we hurtle into winter with the challenges that always brings for the people health and care systems serve, in the frenzy of the festive season, and amidst the overwhelming political noise of Brexit. Whose voices do we not hear? What do we not give time for? When we are so focused on the present, are we losing the chance to shape the future well?  Here’s my perspective, as I reflect on what 2018 has meant for us in the FNP National Unit. 

Silent voices

First, the voices and experiences of young children and their parents remain silent all too often in public debate, particularly if they are vulnerable, or considered “hard to reach”. I’m pleased they’ve had more attention  in 2018, with a new Task Force on the early years and two Parliamentary Select Committee inquiries, into evidence based early intervention and the first 1000 days of life, both of which we were delighted to give evidence to. We welcome the recent recommendations of the Science and Technology Committee’s inquiry, including its endorsement for the work we are doing in FNP. And internationally, it’s great to see G20 interest this year in early childhood development.

However, there’s still a long way to go.  This exchange at the recent Health and Social Care Select Committee hearing about the first 1000 days sums it up. Childhood and babyhood is still relatively low on the political and funding agenda, despite clear evidence of their impact on long-term health and happiness, and that investment in the early years reaps an economic payback many years into the future.  We know from our own data that FNP clients, young first-time parents, have become increasingly disadvantaged over the last decade; and a recent report from the Children’s Commissioner highlights worrying cuts to targeted preventative services, “removing vital safety nets for some very vulnerable children”. We need to listen carefully to these often unheard voices, and do more to act on what we hear.   

Speed and space

Secondly, speed is often important. Acute needs require a rapid response, people have higher expectations of all services in the 21st century, and the good enough now is often better than gold standard too late. So, we are planning to use tech better to meet client needs, and our ADAPT report published last spring discusses early progress using rapid cycles of design, implementation and testing to change FNP. But I also think an important leadership responsibility is to hold a space for what takes longer, despite the demands of a febrile political cycle and the many other pressures we can face. 

Where does it pay to slow down?  Certainly as we build relationships. We are social beings (and the impact of loneliness on physical health is stark), and many successful services are powered by human connection.  FNP is relational to its core, focusing on the developing relationship between babies and their parents, as well as strengthening relationships between parents, and between families and their communities. Crucially, this is all delivered through a trusting, respectful and consistent relationship between a client and a family nurse, developed over more than two years. 

It’s also often important to think long-term when designing, funding and evaluating services. Our experience tells us that good service design needs time, to build partnerships, to ensure real collaboration with those who will use and deliver services, and to refine and even switch course on the basis of data and experience. We know that benefits of public health interventions accumulate over a life-time; and, as the Early Intervention Foundation recently noted, “short-termism” can often produce approaches which are “unlikely to deliver sustainable improvements or to make the best use of available resources”

…and a happy new year

Where does this leave us for 2019? I’m hopeful. Global events and the wider environment may feel intractable, but we each have some power, some agency, and can take small steps that make a difference. I see this every day in the stories FNP clients tell, I see it in the hard work and huge dedication of all those who work in health and care, including of course family nurses. I see it in the refreshed policy interest in the first 1000 days, in patient-centred care and even in kindness in public policy.   

So as we rush noisily towards the end of 2018, let’s resolve to pause, listen, and hold some space to address the important things in life which have sometimes been silent for too long.