Meeting of the Parliament 25 June 2015
I am delighted to be asked to congratulate NHS Lothian on Edinburgh becoming the first city in the world to offer the family nurse partnership programme to all eligible women in the programme’s fifth anniversary year. I welcome the speeches that members have made and I thank Jim Eadie for lodging the motion.
In 2010, NHS Lothian was the first board in Scotland to deliver the programme. It has been clear in its commitment to the programme from the outset. Evidence from the evaluation that was carried out over three years demonstrated that the programme could be implemented with fidelity to the original research model.
NHS Lothian has worked closely with the Scottish Government, using a co-production model, to ensure that learning is embedded in wider policy rather than just in the programme. The lessons that can be learned from the family nurse partnership are being applied in the wider health visiting community. Learning has been shared with other universal services, including maternity services and health visiting, and I commend them for their continuing commitment to the programme.
The commitment has been demonstrated further by expansion to other parts of NHS Lothian, including West Lothian, East Lothian and Midlothian, which will also have the opportunity to benefit from the programme. There are also the other health boards that Jim Eadie mentioned. The programme has started in NHS Grampian and will start in the Borders later this year, so it will cover 10 boards.
This is the first time that the Scottish Government has implemented a licensed, evidence-based programme at scale. Further expansion of the programme has to be agreed with the licence provider, Professor Olds, to maintain the quality of the implementation. The programme’s success so far has been demonstrated through the recruitment and retention of clients, as well as the dedication of the nursing teams that support them. NHS Lothian has an average uptake of 81 per cent, with only 9.6 per cent leaving the programme before their child reaches the age of two. That is well within the fidelity targets that are set in the licence, and that has been maintained throughout the implementation.
The achievement was recognised at the recent event that the First Minister hosted at Edinburgh castle to celebrate with NHS Lothian and bring a message of continuing support from Professor Olds. I was delighted to have the opportunity to attend that event and was struck by the family part of it. That involved not just mothers and their children; partners, boyfriends and husbands were also really enthusiastic and involved in the upbringing of their children. I was struck that their relationships with the nurse partnership were strong. NHS Lothian’s experience and learning have been used to inform how the programme can be rolled out across Scotland and how other health services can use it.
In her former role as the cabinet secretary for health, the First Minister visited a clinic in Harlem, New York, in April 2009, where she first recognised the strength of the programme’s evidence base and how it could contribute to giving all our children the best start in life. The programme supports first-time young mothers from early pregnancy until the child reaches two and it aims to improve maternal and birth outcomes, child health and development, and the family’s economic self-sufficiency. We have also noted a reduction in the number of children’s injuries; less neglect and abuse; and less criminal behaviour in other children and mothers. The investment is showing wider dividends.
The Scottish Government has invested £15.5 million in the programme since 2010. That has allowed dedicated nursing teams to be put in place in nine health boards. I stress again that the family nurse partnership teams are an addition to the existing community nursing workforce, which supports families who do not receive the family nurse partnership programme. We are not taking away from existing services.
The investment has also supported the infrastructure in NHS boards to allow the programme to be supported in the local context. An emphasis is placed on data collection at each visit, and the data is used to inform continuous quality improvement at each level of the programme, whether that be nurse-client, team or NHS board.
The sub-group of the population that is served by the family nurse partnership programme was recognised as a vulnerable group in the National Institute for Health and Care Excellence guidance on pregnancy and complex social factors that was published in 2010. It recognised that young women under the age of 20 should be supported through the provision of tailored advice and support that recognises their specific needs. The family nurse partnership programme goes further than that; it also recognises the strengths in that population and where there are opportunities to work with them to help them to make good choices for them and their children.
The group’s vulnerabilities must not be underestimated. According to the most recent Information Services Division teenage pregnancy report, which was published in June 2014, those who are most deprived are 4.6 times more likely to have a teenage pregnancy. The report states that, in the group of under-20s from the most deprived areas, the rate of those who go on to have their babies is almost 12 times greater than that in the least deprived areas. We also know that levels of poor health behaviours, such as smoking, are highest in that group.
The strength of the programme is that it has generated transformational change in the partner organisations outwith the national health service—particularly in housing—and helped them to recognise how to realign their services to meet the particular needs of young mothers and their families. That insightful learning was first gathered by NHS Lothian and has led to a much greater understanding by all services of what it takes to support the population group well. NHS Lothian has provided guidance and support to the other NHS boards to help inform them of how to work in an integrated way with other service providers who might not immediately recognise the importance of their role.
I recognise the achievements of nurses and families from the NHS Lothian area in successfully implementing a social intervention as complex as the family nurse partnership programme.