Evaluation of the Family Nurse Partnership Programme in NHS Lothian, Scotland - Late Pregnancy and Postpartum

7 IMPLEMENTING FNP IN LOTHIAN

7.1 A key purpose of this evaluation is to help distil and disseminate key learning from the first Scotland FNP test site in NHS Lothian, Edinburgh. The following chapter draws together wider lessons and conclusions from this report as a whole, while this penultimate chapter focuses specifically on Family Nurse and stakeholder perspectives on key areas of potential learning from the experience of delivering FNP in NHS Lothian, Edinburgh in the last year. It is hoped that future reports will be able to consider this issue from the perspective of non-FNP professionals (particularly midwifery and General Practice).

Learning from FNP in Scotland

7.2 The first Scotland evaluation report (Martin et al, 2011) identified some initial concerns around how easy it would be to share learning from a licensed programme, which specifies that the detailed materials and manuals cannot be disseminated beyond trained FNP teams. While this report cannot comment on how the wider NHS and other services view this issue, the views of Family Nurses and FNP stakeholders interviewed for this evaluation suggest that in practice this has not been a major barrier to sharing learning. It was felt that discussions about shared learning had been less focused on what could not be shared in terms of details of the manual, and more focused around what can be learned in terms of, for example, different approaches to engaging those less likely to access universal services. Good practice was shared within Lothian via the local FNP lead and Nurse Supervisor's contact with wider NHS and non-NHS services (for example, via the CHP Clinical Nurse Manager structure) and by the Family Nurses themselves via day-to-day contact with other services. More widely, both the FNP team in Lothian (and now Tayside) and the FNP National Unit (Scotland) shared learning via their involvement in both FNP specific and more general conferences and away days. A recent example was an away day convened at the request of the Chief Nursing Officer to look at what the Modernising Nursing in the Community programme can learn from FNP and vice versa. At the same time, there was also a perceived need to balance sharing learning about what appears to be good practice, with a recognition that FNP is still being evaluated in the UK, and that it cannot be a panacea solution for all the problems teenage mothers might face.

Learning from Lothian for other FNP sites

7.3 The experience of introducing FNP in Lothian was seen as having highlighted the central importance for other sites of early engagement with other local stakeholders and services, particularly local authorities, maternity services and general practice. Building relations with Housing and the third sector was also seen as key. Scottish Government recognition of the importance of building these relationships has been reflected in the establishment of strengths-based leadership courses for key stakeholders working with FNP local teams in Scotland (including senior social workers, child protection leads and child health commissioners). The skill of the Nurse Supervisor and local lead and the close support of strategic leads within NHS Lothian were viewed as key factors that had facilitated good engagement with wider services in Lothian.

7.4 At the same time as recognising the importance of building these relationships to the success of FNP, however, it was also suggested that a key learning point from the experience of delivering it in Lothian was that 'the programme will sell itself'. As people see changes 'in people they thought it wasn't possible to change', appreciation of FNP was seen as naturally increasing.

7.5 A final learning point for other sites related to the importance of building in time for consolidating learning from FNP training. This was identified as a key challenge in the early stages of the NHS Lothian, Edinburgh programme in the first Scotland evaluation report (Martin et al, 2011), and it was noted that more time for this was being built into Supervisor schedules for new sites in Scotland.

Learning from Lothian for wider services

7.6 Interviewees also reflected on the ways in which they felt the first FNP test site in NHS Lothian, Edinburgh might have influenced thinking in the wider NHS and in other services. It was suggested that FNP NHS Lothian, Edinburgh may have had an influence in three key areas:

• Engaging clients. It was noted that the strength-based philosophy of FNP chimed well with a number of other recent developments in the NHS (in particular, the renewed focus on an assets-based approach). However, although such approaches are not necessarily unique to FNP, Family Nurses in NHS Lothian, Edinburgh believed that they had seen changes in the way other NHS and non-NHS services speak to their clients as a result of their explaining and modelling a strengths-based approach.

I think (it) has had a rippling type of effect in many ways because … you hear examples you know about how … the way we might focus on strengths … you hear other agencies maybe do more of that and they feel that that's probably come from us. (Family Nurse 6)

Learning from FNP in this respect was not necessarily confined to young mothers and children - for example, FNP (Scotland) contributed to national conference on coproducing services for older people, illustrating how learning from FNP approach may be transferrable to other areas, with potential positive impacts for understanding how to bring about change within communities.

• How to support Nurses working in high pressure roles. There was a perception that the wider NHS was being encouraged to think about its own models of supervision, training and support for Nurses in the light of the positive experiences of the NHS Lothian, Edinburgh FNP team. The low levels of sickness and retention of Family Nurses within the NHS Lothian, Edinburgh FNP team, in spite of the demands of the Family Nurse role was seen as an indication of the benefits of the FNP supervision and support model. At the same time, it was suggested that the investment in Nurses' training and supervision associated with FNP might be boosting the morale of the wider nursing community by conveying the importance the Scottish Government attaches to the profession.
• Specific approaches to assessing clients. While some of the tools used by FNP are covered by the license and cannot be shared more widely, the programme also makes use of standard tools and assessments that may be useful for other services. For example, dissemination by the FNP team in NHS Lothian, Edinburgh of their use of the Ages and Stages Questionnaire (ASQ) child development questionnaire had led to this potentially being trialled in universal services in Lothian.
• Services for teenage parents who are not eligible for FNP. The experience of delivering FNP was also viewed as having acted as a 'prompt' for NHS Lothian to think about services available to teenagers who are not eligible for FNP, and to start developing a 'pathway' for teenager's health.

Key points

• Perceptions of key learning from the experience of delivering FNP in NHS Lothian, Edinburgh for other FNP sites include:
• The importance of early engagement with local stakeholders and services
• Learning that 'the programme will sell itself' as people see the changes it can effect, and
• Building in time for consolidating learning from FNP training from the start.
• Perceptions of the potential influence the NHS Lothian, Edinburgh FNP programme may have had on the wider NHS and other services focused on learning about:
• How to work with those less likely to access universal services
• How to support Nurses working in high pressure roles
• Specific approaches to assessing clients, and
• Thinking about services for teenage parents who are not eligible for FNP.