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Family Nurse Partnership 'not beneficial' in short term

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A government-backed programme that provides early years nurse support for first-time teenage mothers has not produced the improved health outcomes it was expected to, new research has found.

The Family Nurse Partnership (FNP) programme did not help expectant mothers stop smoking or lower the rates of a second pregnancy within two years, according to an independent study, commissioned by the Department of Health and published in The Lancet.

The author leading the Building Blocks study claimed the programme – originally developed in the US – “cannot currently be justified in the UK”.

“Continued provision of the Family Nurse Partnership programme cannot currently be justified in the UK”

Michael Robling

The programme was introduced in England in 2006 with the aim of improving pregnancy outcomes, child health and development, and parents’ economic self-sufficiency.

The Building Blocks study, which began in 2009, tracked 1,600 young mothers aged 19 or under in England until their child reached the age of two.

Half received support from the FNP programme – which involved up to 64 structured home visits from health visitors, midwives or community nurses during pregnancy until the child reached age two – in addition to accessing normal health and social services.

The other half accessed only the “usual” health and social services available to all mothers. Researchers found four measures of health outcomes were not improved by FNP support.

“Child development and early language…are important [and] they may become more overt as the infant grows up”

Institute of Health Visiting

For both groups, 66% of the mothers had a second pregnancy within two years. Similarly, in both cohorts 56% of the women smoked in late pregnancy.

Meanwhile, 81% of children included in the FNP programme attended an emergency department or were admitted to hospital at least once by the age of two, compared to 77% in the group that did not receive additional support.

The average birthweight of babies born to mothers that received FNP support was 3,217g, compared to 3,197g among those that were not on the programme.

However, some secondary outcomes – inlcuding intention to breastfeed, child cognitive development reported by mothers and levels of social support – suggested “small positive impacts”.

Authors concluded the FNP scheme resulted in “no additional short-term benefit for our selected primary outcomes”.

“The financial return from early intervention comes later in life, often linked to better child development and other longer term measures”

FNP National Unit

Dr Michael Robling, from Cardiff University’s faculty of medicine, who led the research, said: “On the basis of the limited benefit to families seen in the trial, continued provision of the Family Nurse Partnership programme cannot currently be justified in the UK.”

He noted the “substantial” additional cost of the FNP, estimated to be around £1,993 per mother.

He added: “Continued evaluation of families enrolled in the trial will be required to determine whether the programme improves outcomes for mothers and children in the longer term.”

The Institute of Health Visiting said that, while the results “initially appear disappointing”, it noted the study had mainly drawn its conclusions based on outcomes for mothers.

“Secondary outcomes were more child-focused, including child development and early language, which appear to be improved when compared to those in the ‘usual care’ group,” said the organisation.

“This trial assessed short term cost effectiveness based on maternal health outcomes but a much fuller and longer term view is needed”

Family Nurse Partnership National Unit

“These are the ‘building blocks,’ not only in the title of the trial, but also of future learning and development of future cognitive skills, so they are important, as they may become more overt as the infant grows up,” it added.

The institute said longer term studies of the original US programme showed continuing improvement in these areas as the children reached young adulthood.

The DH‘s Family Nurse Partnership National Unit echoed these comments, saying that benefits of the programme in improving early child development may not be felt until children are older than two, which the study did not assess.

Ailsa Swarbrick, director of the FNP National Unit, said: “The financial return from early intervention comes later in life, often linked to better child development and other longer term measures.

“This trial helpfully assessed short-term cost-effectiveness based on maternal health outcomes, but a much fuller and longer term view is needed to understand the overall value for money of FNP,” she said.

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