Meeting of the Parliament 25 June 2015
It is a real privilege for me to be able to bring this debate to the chamber. I am most grateful to all the members who have supported the motion in my name.
The debate is an opportunity to recognise the innovative work that has been undertaken by family nurse partnerships across Scotland. As an Edinburgh MSP, I am particularly pleased to recognise the fact that Edinburgh has become the first city in the world to offer on a sustained basis the family nurse partnership programme to all eligible women. That means that every first-time mum in our capital city who is aged 19 or under will benefit from the programme. In total, more than 2,000 mothers have already benefited from it—more than 600 of them here in Lothian.
The service began as a pilot project in January 2010 and has made a real and lasting impact—so much so that it is now being rolled out across the whole of Scotland. Teams are already in place in the Lothian, Tayside, Fife, Greater Glasgow and Clyde, Ayrshire and Arran, Forth Valley and Lanarkshire health board areas, and there are plans to extend coverage to the Borders and Grampian later this year.
I thank the Scottish Government—the Minister for Public health as well as the current and previous First Ministers—for the political leadership that it has shown. Sometimes leadership is required to say to the sceptical voices in the civil service and the vested interests, “This is the direction in which we are going to go and this is what needs to happen.”
I also thank NHS Lothian—in particular, its director of nursing, Melanie Johnson—for the clinical leadership and commitment that it has shown in the pilot project, which has proved to be so successful. Most of all, I pay tribute to the nurses, the highly skilled and empathetic healthcare professionals and the young mums who have made the programme work.
The family nurse partnership programme is an intensive preventative one-to-one home-visiting programme for young first-time mothers from early pregnancy until their child reaches the age of two. Mums are visited by a specially trained nurse every week or two weeks during pregnancy and throughout the first two years of their baby’s life.
The programme was first developed in the United States by Professor David Olds, who is a professor of paediatrics at the University of Colorado. It is delivered in this country under licence, and it has three main aims: to improve pregnancy outcomes; to improve child health and development; and to promote the economic self-sufficiency of the family. It aims to introduce a new approach to nursing that involves working with the parent to help them to build up their own skills and resources to parent their child well, and to think about their own aspirations for the future. The programme is intended to offer targeted intervention in addition to Scotland’s universal health visiting services.
It is important to put the family nurse partnership programme into its wider strategic and policy context. It is part of a wider approach that recognises the importance of targeted interventions—in particular, in the early years of life. In the United States, there has been the development of the concept of the social womb—the environment that a baby experiences after birth. J Ronald Lally, who is co-director of the centre for child and family studies at WestEd in the USA, has stated:
“Be it at home or in childcare what happens during infancy is too eventful to leave to chance.”
That wider approach also requires paid parental leave so that parents can spend critical bonding time with their baby, and it requires the provision of high-quality and affordable childcare. It sits alongside and complements well-resourced universal provision of health visitors, to which the Government is committed.
However, we should not lose sight of the unique and innovative contribution that family nurse partnerships can make. The Scottish Government’s own data clearly show that women aged under 20 living in the most deprived areas—the target client group for the partnership—are about 10 times more likely to have a child than women of the same age who live in the least deprived areas.
We also know that other problems that impact negatively on the wellbeing of mums and babies are more prevalent in areas of multiple deprivation. For example, nearly 31 per cent of women in the most deprived areas self-report as smokers at the time of their first antenatal visit, compared to just 6 per cent of women in the least deprived areas. That is a stark reminder of why the approach that is embodied in the family nurse partnership programme is necessary in order to target vulnerable mums and babies and offer them the intensive support that they need.
When we take the time to examine the benefits of the programme, it becomes clear why the Scottish Government and health boards are right to make that investment. Nurses support mums to make positive choices in areas such as child development, preventative health measures, parenting skills and breastfeeding, and offer better diet information and practical support on education and employment opportunities. All that leads to improved pregnancy outcomes and improved child health and development.
I refer to an article that appeared in The Observer in March of this year. It will not be possible for me to quote it extensively, but I point out that the journalist spent three months in Manchester and Portsmouth observing the impact of family nurse partnerships on the women and babies who participated. She concluded that she witnessed
“how this extraordinary intervention achieves little short of miracles.”
The personal story in the article that stands out is that of a young woman, Sarah—not her real name—whose father had hanged himself when she was nine and whose mother had died of an AIDS-related disease when she was 13. She had been in and out of care, had a badly scarred face from a dog bite and her boyfriend—a user of drugs—was in prison. Her nurse said that as a result of the programme:
“She had twin girls; she breastfed. She dumped the boyfriend. She had her scars fixed, so her self-esteem has risen, she is at college and has a part-time job and her own tenancy. Her two little girls are doing so well. We tell our girls again and again: ‘You can be different if you choose to be.’”
As well as considering those anecdotal personal testimonies, it is important to observe that the programme is underpinned and supported by extensive research. That includes the findings of the three US-based randomised controlled trials, drawing on the experience of the programme over 30 years. Here in Scotland there have been four detailed evaluation reports that explored the experience of delivering the family nurse partnership in the first Scottish test site in NHS Lothian.
In addition, it will be important to understand in a United Kingdom context what added value family nurse partnerships deliver over and above universal service provision, where the national health service already offers midwifery and health visiting support. The randomised controlled trial—the building blocks trial—which is evaluating the family nurse partnership programme in England, will be instructive in that regard.
There is growing evidence from the United States and England of the real benefits of the programme. There is evidence from an evaluation that was carried out in England by the University of Nottingham of the benefits of early intervention for fathers who are involved in a home-visit service that is delivered by the family nurse partnership. The evaluation states:
“The ‘early’ nature of the help was crucial to its success because of how it so effectively tapped into the men’s redefinition of themselves as caring fathers during pregnancy and following the birth.”
We should celebrate family nurse partnerships—we should invest in them, we should continue to evaluate their impact and we should roll them out across the country. This is an investment like no other. It is one that is not only changing lives but is transforming the lives of young mums and babies for this and future generations, and is giving vulnerable children in some of our most deprived communities the best start in life and the greatest chance to succeed as they grow and develop as adults. What better legacy could there be for our society?
12:44