- It has improved outcomes for clients against a backdrop of increasing vulnerability.
- Training packages have disseminated knowledge to practitioners outside the scheme.
"Change takes time," explains Ailsa Swarbrick, national unit director of the Family Nurse Partnership (FNP). It has been more than a decade since FNP launched and this is one of the reasons Swarbrick gives for the "very positive movement" her team is seeing in its outcomes recently.
"FNP is quite a complex programme to deliver, with an enormous amount of knowledge but also new practice - and that takes time to embed," she explains. "Most people who come from other forms of public health nursing attest to the difference between being an FNP nurse and being a health visitor or midwife. We've now been delivering FNP for nearly 12 years and I think we have all gained more experience."
FNP works with parents aged 24 and under, partnering them with a specially trained family nurse who visits them regularly, from early pregnancy until their child is two, and supports them in making positive decisions about their lives and the life of their baby. The programme is built around the six key domains of personal health, the maternal role, life course development, family/friends, environmental health, and health and human services. FNP is structured in that the tools it uses - and the nature and number of visits - is prescribed. However, its rigidity is a misperception, says Swarbrick, and its nurses deliver a highly personalised intervention based on the needs of each client, known as agenda matching.
"We have always had a rolling programme of review and change to keep up with new clinical knowledge," says Swarbrick, adding that ADAPT (Accelerated Design And Programme Testing) has increased the pace of that change. ADAPT launched in 11 local authorities in April 2016 with the aim of rapidly adapting, testing and improving FNP to make it more flexible. Now at 20 sites, it completes in September this year, with its final report due to be published after that.
Although it's too soon to know what structural changes will be rolled out as a result of the ADAPT pilot, some of its clinical adaptations have already been implemented across the wider FNP programme. These include new materials on quitting smoking, which open up the discussion about smoking in pregnancy, as well as highlighting the impact it can have, and new resources on increasing child attachment. There's also the New Mum Star, which enables family nurses to the plan the content of the programme and the frequency of visits with input from their clients.
The Knowledge and Skills Exchange, which launched in October 2016, is another development in FNP. It aims to share the key theories and concepts that underpin the programme with the wider workforce through training packages. Swarbrick explains: "FNP is a targeted service; that level of intensity, that relationship and that structure isn't necessarily what every young family needs, but there's a lot that can be used by other services."
The exchange initiative has seen 2,658 health and social care professionals in England, outside of FNP, attend sessions in the nine months from April to December 2018 alone. Feedback from participants suggests these sessions have been helpful for practitioners' work with children and families, FNP states.
FNP has seen positive movement in its outcomes in the areas of breastfeeding and smoking cessation, although Swarbrick makes clear that there is no direct comparison group. The programme's most recent data revealed that the breastfeeding rate among FNP clients at six weeks was 63 per cent, compared with a national average of 55 per cent. The programme's smoking cessation rate has also been increasing regularly over the last two years and is more than double that of 16- to 24-year-old women who quit smoking in England in 2017.
"It's particularly positive because we're also seeing quite a significant increase in vulnerability for FNP clients," says Swarbrick. "Forty per cent had one main adverse childhood experience in 2017, compared with 28 per cent in 2009. Against that backdrop, we're seeing improved outcomes."
Where FNP really makes a difference, however, is not in specific results but in its strengthening of the relationship between young parents and their children, which enables them to better understand their child's needs and make the right choices to give them the best start in life. "These," says Swarbrick, "are long-term outcomes."