Hansard

I congratulate Jim Eadie on securing the debate. I also congratulate NHS Lothian because Edinburgh is, I think, the first city in the world to offer the family nurse partnership programme to all eligible mothers—in this case, teenage mothers.

The programme started five years ago. It was, in a sense, part of a wider movement towards focusing on investment in the early years as part of the preventative spend agenda. The idea is that, by investing a lot of money in the early years, some of the problems that children face growing up and later in life will be avoided.

As Jim Eadie said, the family nurse partnership programme is based on a programme from America, which is well-evidenced by randomised controlled trials. We know from Professor Olds and the evaluation in America that the programme’s outcomes include better pregnancies, improved child health and development, and improved parental life course. Of course, that does not automatically mean that the outcomes in Scotland would be the same. For a start, we have a national health service: clearly, there is nothing like that in America. Therefore, it is important that we do separate evaluations in Scotland. I have read NHS Lothian’s latest evaluation, and I will obviously draw on that in my speech.

Like Jim Eadie, I am very enthusiastic about the programme. However, others have been more sceptical. For example, I am told that a recent parliamentary question suggested that breastfeeding rates for mothers on the programme were 5 per cent only. We should not be so starry-eyed that we do not focus on areas where the outcomes are perhaps not so outstanding. However, in general, I am positive about the programme.

The programme appears to be tightly controlled and prescribed—everyone must follow the procedures and protocols that were laid out by the programme’s founders. However, in reading the evaluation, I see that, in a sense, part of the prescription is to be flexible; there is flexibility to meet individual clients’ needs.

The training of the nurses is important. I was struck and impressed by mothers being involved in the selection of the nurses. The key issue seems to be the quality of the relationship between the nurse and the mother, and the consistency of that relationship over a significant period, with regular visits. It seems to be a non-judgmental approach. The nurse can say to the mother, “Take this on board if you want to.” In addition, the small attrition rates suggest that the programme is valued highly by the mothers who receive it.

The basic idea is to give mothers the support that they need, to help children to get the best possible start in life and to prevent the problems that might otherwise arise. We should not just look at the programme from a public expenditure point of view, because the programme is quite expensive in the short run. However, the belief in America and the evidence from there are that it saves money down the line, because some of the children do not have the problems in later life that they might otherwise have had.

The whole programme is underpinned by attachment theory and recognition of the mothers’ strengths, which is a part of the assets-based approach that we sometimes hear about.

The evidence is that the programme is a good one. The Scottish Government has been doing some worth while and innovative work on the early years. Alongside the family nurse partnership, we could look at the early years collaborative. Sometimes, those are set against each other as alternative ways of pursuing a preventative spend agenda. I prefer to see them as complementary initiatives. Indeed, I certainly do not see any contradiction between them.

I welcome what has happened here in my city, and I am glad that the programme has been extended throughout Scotland. Clearly, we must keep on evaluating the programme. If there are weaknesses in the outcomes, we must address those. I commend all the work that has been done here in Edinburgh and I commend the Scottish Government for supporting the programme.