The much-praised Family Nurse Partnership (FNP) programme may not be sustainable, according to a new study, if local concerns about costs are not tackled. The research by Jacqueline Barnes from Birkbeck University comes only weeks after FNP was in the spotlight when it was highly recommended by an independent review into early intervention commissioned by the Coalition government [see: Launch of the Allen review on Early Intervention]

Interim research suggests the programme is making a big difference in the lives of vulnerable families in the UK [see: Research backs work for new parents through Family Nurse Partnership]. But caution stems from the fact that there are problems with local support and willingness to fund the programme - two factors fundamental to the long-term success of a programme. In the 10 UK pilot sites that Barnes studied local support was sketchy. Interviews with administrators, commissioners and professionals from other agencies, showed the willingness to sustain the FNP was blighted with concerns regarding the high costs of the service and worries about the roll-out of the programme depleting the universal workforce, especially in relation to health-visiting.

Some commissioners would like FNP to be watered down to a less intensive service to make the funding go further. The impact of this cannot be predicted with any certainty, as the programme would not be provided as it was intended.

A further concern expressed by commissioners was the fact that the benefits would not necessarily be realized by the health services who currently fund the programme. Benefits would extend to other services such as education, social care and criminal justice. These other agencies would need to be brought on board to provide support and offer funding. This would only come about if there were a proper understanding of the ultimate aims and potential outcomes of the programme for all agencies.

The pilot sites also had difficulty in retaining clients and there were problems about the provision of the expected programme sessions. The UK sites were successful in recruiting families and the proportion of clients retained in the programme was very close to the US guidelines. However, the rate of clients dropping out from the programme varied widely between the ten UK pilot sites. The rate of families leaving the programme when the woman was pregnant, ranged from five per cent to 23 per cent. During infancy drop-out rates ranged from three to 38 per cent.

Barnes suggests the differences reflect the political pressure on some local authorities to recruit families onto the programme quickly, only to find them dropping out almost immediately, whilst other sites were slow to recruit but retained the families more effectively.

Key to a successful roll-out of a programme is ensuring a well-trained and motivated nursing staff. On the whole this seems to have been achieved. Despite the teams of nurses having been trained in a very short time the programme was provided with a fair degree of fidelity. Unfortunately, though the nurses delivered sessions well, in most authorities they struggled with undertaking enough of the expected visits with just under one third of the clients receiving 80 per cent or more of their visits.

The indicators from this study do, however, suggest that many of the implementation problems have been solved in the UK and the initial signs are promising. Central government support remains strong and the current NHS Operating Framework requirement is for local teams to sustain and expand the programme.

A move from central to more local funding is not straightforward, however, and Barnes fears the current expansion and level of central support might be too strong. It may be encouraging a hasty roll-out of the programme without consideration to local issues that might be barriers to successful implementation in the long term.

Furthermore, she urges patience on account of not knowing how the FNP compares with the usual services offered to young mothers until the results from the randomised controlled trials come out in 2012-2013:

“The implementation evaluation is indicative of impacts, not evidence of impacts, a nuance that is not often acknowledged politically.”

References:
Barnes, J. (2010) From evidence-base to practice: implementation of the Nurse Family Partnership programme in England. Journal of Children’s Services. 5(4), 4-17.