 The next item of business today is a member's business debate on motion number 13494, in the name of Jim Eadie, on the fifth anniversary of the family nurse partnership programme in NHS Lothian. This debate will be concluded without any questions being put, and I would invite those members who wish to speak in the debate to please press their request to speak mutton's now or as soon as possible. I would also invite those members who are leaving the chamber to do so quickly and quietly, and indeed members of the public who are leaving the chamber to do so in the same way. I now call on Jim Eadie, Mr Eadie, of seven minutes to open this debate, please. Thank you, Presiding Officer. It is a real privilege for me to be able to bring this debate before the chamber this afternoon, and I am most grateful to all those members who have supported the motion in my name. This debate is an opportunity to recognise the innovative work that has been undertaken by family nurse partnerships across Scotland. However, I am particularly pleased, as an Edinburgh MSP, to be able to recognise the fact that Edinburgh has become the first city in the world to offer the family nurse partnership programme to all eligible women on a sustained basis. What that means is that every first-time mum in our capital city, aged 19 or under, will now benefit from this programme. In total, more than 2,000 mothers have already benefited from the programme, more than 600 of them are here in Lothian. The service first began as a pilot project in January 2010, and it has made a real and lasting impact so much so that it is now being rolled out across the whole of Scotland. There are already teams in place across eight health board areas—Lothian, Tayside, Fife, Greater Glasgow and Clyde, Ayrshire and Arran, Forth Valley and Lanarkshire—and plans to extend coverage into borders and grampain later this year. I want to thank the Scottish Government for the political leadership that it has shown, the Minister for Public Health, as well as the current and previous First Ministers. Sometimes it requires leadership to say to the sceptical voices within the civil service and the vested interests that this is the direction in which we are going to go and this is what needs to happen. I also want to thank NHS Lothian and, in particular, his director of nursing, Melanie Johnson, for the clinical leadership and the commitment that she and the health board have shown to the pilot project, which has now proved to be so successful. Most of all, I want to pay tribute to the nurses, the highly skilled and empathetic healthcare professionals and the young mums who have made the programme work. What is the family nurse partnership programme? It is an intensive, preventative, one-to-one home visiting programme for young, first-time mothers from early pregnancy until their child reaches the age of two. Mums are visited by a specially trained nurse every one or two weeks during pregnancy and throughout the first two years of their baby's life. It was first developed in the United States by Professor David Olds, Professor of Pediatrics at the University of Colorado and is delivered in this country under licence. Its main aims are threefold, to improve pregnancy outcomes, to improve child health and development and to promote the economic self-sufficiency of the family. The programme aims to introduce a new approach to nursing, working with the parent to help them build up their own skills and resources to parent their child well but also to think about their own future and future aspirations. The programme is intended to offer targeted intervention in addition to Scotland's universal health visiting services. However, it is important to put the family nurse partnership programme into its wider strategic and policy context. It is part of a wider approach that recognises the importance of targeted interventions, particularly in the early years of life. There has been the development in the United States of the concept of the social womb, the environment in which a baby experiences after birth, and Jai Ronald Lally, the co-director of the Centre for Child and Family Studies at West Ed in the USA, has stated that, be it at home or in childcare, what happens during infancy is too eventful to leave to chance. This wider approach also requires paid parental leave so that parents can spend critical bonding time with their baby, the provision of high-quality affordable childcare and it sits alongside and complements well-resourced universal provision of health visitors, which this Government is committed to. However, we should not lose sight of the unique and innovative contribution that family nurse partnerships can make. The Scottish Government's own data clearly shows that women aged under 20 in the most deprived areas, the target client group for the family nurse partnership, are around 10 times more likely to have a child than those women of the same age in the least deprived areas. We also know that other issues that are impacting negatively on the wellbeing of mums and babies are also higher in areas of multiple deprivation. For example, nearly 31 per cent of women in the most deprived areas self-report as smokers at the time of their first antenatal visit compared to just 6 per cent in the least deprived areas. This is a stark reminder of why the approach that is embodied in the family nurse partnership programme is so necessary in targeting vulnerable mums and babies and offering them the intensive support that they need. When you take the time to examine the benefits from the programme, it becomes clear why the Scottish Government and health boards are right to make this investment. Nurses support mums to make positive choices in areas such as child development, preventative health measures, parenting skills, breastfeeding, better diet information and offer practical support on education and employment opportunities. All of that leads to improved pregnancy outcomes and improved child health and development. I want to refer to an article that appeared in the Observer newspaper in March of this year. It will not be possible for me to quote extensively from it, but I want to refer to the fact that the journalist spent three months in Manchester and Portsmouth observing what the impact of family nurse partnerships had been for the women and babies who participated in it. She concluded that this was to witness how this extraordinary intervention achieves little short of miracles. There is one personal story that stands out, and that is of a young woman called Sarah, not her real name, whose father had hanged himself when she was nine, her mother had died of an age-related disease when she was thirteen, she had been in and out of care, had a badly scarred face from a dog bite and her boyfriend, a user of drugs, was in prison. Her nurse said that, as a result of the programme, she had twin girls, she breastfed, she dumped the boyfriend, she had her scars fixed, so her self-esteem has risen, she is at college and has a part-time job and her own tenancy. Her two little girls are doing so well. We tell our girls again and again, you can be different if you choose to be. As well as those anecdotal personal testimonies, it is also important to observe that the programme is one that is underpinned and supported by extensive research. That includes the findings from the three US-based randomised controlled trials, drawing on the experience of the programme over 30 years. Here in Scotland, there have been four detailed evaluation reports which explored the experience of delivering family nurse partnership in the first Scottish test site in NHS Lothian. In addition, it will be important to understand, in the UK context, what added value family nurse partnerships deliver over and above universal service provision, where the NHS already offers midwifery and health visiting support. The randomised controlled trial, the building blocks trial, which is evaluating the family nurse partnership programme in England, will be instructive in that regard. There is growing evidence from the United States and from England of what the real benefits of this programme have been. There is evidence from an evaluation carried out in England by the University of Nottingham of the benefits of early intervention for fathers involved in a home visitation service delivered by the family nurse partnership. Quoting from that evaluation, it states that the early nature of the help was crucial to its success because of how it is so effectively tapped into the men's redefinition of themselves as caring fathers during pregnancy and following the birth. In conclusion, when it comes to family nurse partnerships, we should celebrate them, we should invest in them, we should continue to evaluate their impact and we should implement their roll-out across the country. This is an investment like no other. It is one that is not only changing lives but transforming the lives of young mums and babies for this and future generations. Giving vulnerable children, in some of our most deprived communities, the best start in life and the greatest chance to succeed as they grow and develop as adults, what better legacy for our society could there be than that? Many thanks. I now call on Malcolm Chisholm to be followed by John Mason. I congratulate Jim Eadie for bringing forward this debate and I would also like to congratulate NHS Lothian for being the first city in the world to offer this programme to all eligible mothers, in this case, teenage mothers. It started five years ago and in a sense was part of a wider movement towards focusing on the early years and looking at investment in the early years as part of the preventative spend agenda. The idea is that, if you invest a lot of money in the early years, you are going to avoid some of the problems that children growing up would face in later life. It is based, as Jim Eadie said, on a programme that has been well evidenced from America by randomised controlled trials. Professor Olds and the outcomes from America, we were told, were better pregnancy outcomes, improved child health and development outcomes and improved parental life course. Of course, it does not automatically mean that there would be the same in Scotland. For a start, we have an NHS in Scotland. Clearly, we do not have anything like that in America. It is very important that we do separate evaluations in Scotland. I have read the latest evaluation from NHS Lothian and I will obviously draw on that now, but I think that I am very enthusiastic about the programme, as is Jim Eadie, but others have been more sceptical. I am told, for example, that there was a PQ recently that suggested that breastfeeding rates for mothers on the programme was only 5 per cent. I do not think that we should be so starry-eyed that we do not focus on perhaps areas where the outcomes are not so outstanding. In general, I am certainly very positive about the programme. It appears to be a very tightly-controlled and prescribed programme. Everyone has got to follow the procedures and protocols that are laid out by the founders of the programme. However, in reading the evaluation, I can see that, in a sense, part of the prescription is to be flexible. There is flexibility to meet the specific needs of individual clients. Truly training of the nurses is very important, and I was struck by the fact that young mothers are involved in selecting the nurses. I was quite impressed by that. The key thing seems to be the quality of the relationship between the nurse and the mother, the consistency of that relationship over a significant period of time with regular visits. It seems also that it is a non-judgmental approach. The nurse can say, take this on board if you want to. The fact that there are very small attrition rates suggests that this is a programme that is certainly 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 arise. I do not think that we should just look at it from a public expenditure point of view, because it is actually quite expensive in the short run. The belief and evidence from America is that it will save money down the line, because some of those children may not have the problems in later life that they would otherwise have had. The whole programme is underpinned by attachment theory and the recognition of the strengths of the mothers, which is a part of the assets-based approach that we sometimes hear about. The evidence is there that this is a good programme. The Scottish Government has been doing some very worthwhile and innovative work. In the early years, alongside the family nurse partnership, we could look at the early years collaborative, and they are sometimes set against each other. As alternative ways of pursuing a preventative spend agenda, I would prefer to see them as complementary. I do not see any contradiction between them. I certainly welcome what has happened in my own city here. I am glad that it is extended throughout Scotland, but clearly we have to keep evaluating it. If there are weaknesses in the outcomes, we have to try to address those. I am certainly very pleased to welcome and commend all the work that has been done here in Edinburgh. I congratulate NHS Lothian. I commend the Scottish Government for supporting the programme, and I thank Jim Eadie for bringing forward this debate. Many thanks. I now call on John Mason to be followed by Jackson Carlaw. I thank Jim Eadie for bringing forward this important subject, which is highly important in its own right, but in many ways is symbolic of the whole area of preventive spend, which is what I would like to concentrate on. As a Glasgow MSP, I do not always support motions that start with the words that the Parliament congratulates Edinburgh. However, I will make an exception today. There are obviously different angles to come at this subject from, be that health-focused or Edinburgh-focused. However, I would like to come at it from a finance angle, not least because the Finance Committee, of which I am a member, has spent a considerable amount of time thinking about preventive spending. Whenever we talk about that subject, one of the most common examples that is given is family nurse partnerships. Just recently, the Finance Committee took part in a round-table event at Edinburgh University, and this was the major topic that we focused on. If we as a Parliament and we as a country are serious about spending money in the earlier years to save money later on, then family nurse partnerships is exactly the kind of thing that we need to be doing. If, as has been said by both speakers so far, a child gets a better start in life, they are not so far behind when they start school, they are less likely to be in trouble as they go through their teenage years, and they are more likely to do well in later life. I think that we are all signed up to this concept, and certainly when we as MSPs are in committees and in smaller groups in behaving perhaps more sensibly, I sense that we have a lot of agreement on that issue. As I understand it, this FNP programme has very tightly defined rules, albeit with the flexibility that we heard about earlier, and deals with a very specific group of young mothers and has been well analysed, especially in the United States. However, one of the challenges that we face is to see if we can move more resources into early years, see that family nurse partnerships or other programmes, because that means that we need to move resources away from more reactive forms of expenditure. Thus, in the health field, we might think of moving resources away from hospitals and more into community and preventative programmes. That is where it all becomes more difficult to gain consensus, and especially when we are together in this chamber in a combative atmosphere, are we really happy to see some hospitals closed that would free up resources for young families in the community? Are we happy to let A and E waiting times rise in order to let GPs have more time with their patients? I thank the Royal College of Nursing for their briefing for today's debate, because they also have raised the tension between where resources should go. They particularly highlight resources staffing in the professional backup that is required for the FNP programme, and their particular concern is that the wider health visiting service is stretched and is competing for the same resources. I think that they have raised a valid question in the final paragraph of their briefing, which says that, so that no children fall through the gaps, the RCAN believes that the Scottish Government should ensure that Scotland has adequate health visitors in addition to FNP nurses. I think that we would probably agree with that. We should put more emphasis on both the FNP nurses and health visitors, both of which are very much based in the community. Where are those resources to come from, presumably by reducing resources for hospitals? In the statement that we previously debated in this place, building a more sustainable NHS in Scotland, health professionals lead the call for action. Again, there was a quote in their statement from the RCAN, which said that the focus has remained firmly on the traditional model of hospitals as the mainstay of the health service needs to change. As the motion says, we congratulate Edinburgh and commend the valuable work undertaken by the family nurse partnerships in Lothian and across Scotland. I very much hope that we can continue building on this example by disinvesting from our more reactive services so that we can invest more at the preventive end. I support the motion in Jim Eadie's name on family nurse partnerships. I wish to raise some concerns that I have about the consequences that arise from the contribution that John Mason made in which I very much share. I support the family nurse partnership because it is focused on the preventive agenda. All the evidence suggests that if we are going to see real savings in our health service so that we are able to cope with the wider challenges that we know it will face with an ageing population, we have to start becoming much more successful in the preventive agenda strategy that we have. He is right. The family nurse partnership, the track record in the United States that Malcolm Chisholn has alluded to and in England, has shown dramatic results, but it is very neatly targeted and focused on young mothers under the age of 19. It has a consequence, I believe, for the wider health visiting strategy. Scottish Conservatives expressed concerns about our approach to health visiting. We have 14 health boards who are each able to determine their own approach to this issue and the resource that they put towards it. We moved away from a nationally GP-attached service to one that works in teams. The consequence of that was that the skillset that previously existed in individual health visitors being attached to GP practices was slightly diminished by a range of skillsets within the broader teams that were then brought to bear. Some of those skilled health visitors have applied to be the family nurse partnership specialists, which has further diminished some of the skillsets within the health visiting service. Moreover, the family nurse partnership has over 40 per cent of its staff aged 50 or over, and there was a significant age issue arising within national health visiting as well. Scottish Conservatives support family nurse partnerships. We believe that that targeted and focused assistance to that particular group is important, but we also now believe in a universal GP-attached health visiting service, taking children through to the age of seven, because there is a lot of compelling evidence to suggest that trends that develop in young children beyond the age of two, at three and beyond, which lead to obesity, potential future addictions or even offending rates, can be dealt with with that degree of intervention and support. We believe in that universal service so that all children have access to it, but we also believe that particular areas of concentration should be in areas where there are high levels of health inequality and deprivation, because that is where it is needed most. The reality is that there are young mothers who are vulnerable and who are deprived, who are over the age of 19, who are not going to have the benefit of a family health nurse partnership, but who need the support of a well-resourced health visiting service if we are going to be successful in the much wider spectrum of prevention on young persons' issues. I fully support the family nurse partnership, which I would like to see it rolled out further. In the whole wider debate that we are having—this is no criticism, I hope that the minister accepts—it is part of what we hope is a constructive approach to the shape of the health service going forward, because I do not necessarily believe that it is, as John Mason said, a question of hospitals closing down. The whole point about health prevention strategy is that we can, with a different model of GP facilities and with a successful health prevention strategy, reduce the incidence of people presenting it at accident and emergency, and potentially the cost burden to the health service, for example, of type 2 diabetes, because we could prevent that with a better approach to young people's health and avoiding issues of obesity. I hope that the minister accepts in the spirit in which I say that I am concerned that we need, in the next Parliament, as we look to how this new model of healthcare develops to ensure that family nurse health partnerships, which I believe are successful, are in conjunction with a wider availability of service to a much wider target group of people universally and particularly where vulnerabilities in health inequalities exist. Many thanks. I will now move to closing speech for the minister Maureen Watt. Minister, seven minutes are thereby pleased. Thank you very much, Presiding Officer, and I am delighted to be asked to congratulate NHS Lothian on becoming the first city in the world to offer the family nurse partnership programme to all eligible women in its fifth anniversary year. I also welcome the contributions that have been made by members during the debate, and I would like to thank Jameedy for tabling the motion. NHS Lothian was the first board in Scotland to deliver the programme in 2010. They have been clear in their commitment to the programme from the outset. Evidence from the evaluation carried out over three years demonstrated that the programme could be implemented with fidelity to the original research model. NHS Lothian has worked closely with the Scottish Government using a co-production model to ensure that the learning is embedded in wider policy rather than just this programme. I think that the lessons that are in the family nurse partnership and can be learned from them are being used in the wider health visiting community. That has included sharing with other universal services, including the maternity service and health visiting, and I would like to commend them for their continuing commitment to the programme. That has been demonstrated further by expanding to other parts of NHS Lothian, including West, East and Mid Lothian, who will also have the opportunity to benefit from the programme. The other health boards that Jameedy mentioned have already started up in Grampian and Borders later this year, so there will be 10, including the Borders. That is the first time that a licence-evidence-based programme has been implemented at scale by the Scottish Government. Further expansion of the programme has to be agreed with the licence provider, Professor Olds, to ensure that the quality of the implementation is maintained. The success of the programme so far has been demonstrated through the recruitment and, more importantly, the retention of clients, as well as the dedication of the nursing teams who support them. NHS Lothian has an average uptake of 81 per cent, with only 9.6 leaving the programme before their child reaches the age of 2. That is well within the fidelity target that is set within the licence and has been maintained throughout the implementation. That achievement was recognised recently at an event hosted by the First Minister at Edinburgh Castle to celebrate with NHS Lothian and to bring a message of continuing support from Professor Olds. I was delighted to have the opportunity to attend that event and was really struck by the family part of it. It was not just mothers and their children, it was partners, boyfriends and husbands as well who were really enthusiastic and well involved in the upbringing of their children. The relationship with their nurse partnership was really strong and I was quite struck by that. Their experience and learning, as I said, has been used to inform not only how the programme can be rolled out across Scotland but how other health services can use it. Indeed, it was the First Minister in her then role as Cabinet Secretary for Health, who, on her visit to a clinic in Harlem, New York in April 2009, first recognised the strength of the evidence-based base of the programme and how it could contribute towards giving all our children the best start in life. The programme supports first-time young mothers from early pregnancy until the child reaches two and aims to improve maternal and birth outcomes, child health and development, and the economic self-sufficiency of the family. We also note that there are reductions in children's injuries, neglect and abuse, and a reduction in the rest and criminal behaviour of other children and mothers. There is a wider investment that is showing dividends. The Scottish Government has invested £15.5 million in the programme since 2010, and this investment has allowed dedicating nursing teams to be put in place across nine health boards. The family nurse partnership teams are, and I stress this again, in addition to the existing community nursing workforce that supports families who do not receive the family nurse partnership programme, so we are not taking away from existing services. The investment has also supported the infrastructure in NHS boards to allow the programme to be supported within the local contexts. There is an emphasis placed on data collection at each visit, and that is used to inform continuous quality improvement at each level of the programme, be that either nurse client, team or the NHS board. The subgroup of the population served by the family nurse partnership programme was recognised as a vulnerable group within the nice guidance on pregnancy and complex social factors published in 2010. It recognised that young women under 20 should be supported through the provision of tailored advice and support that recognises their specific needs. The family nurse partnership programme goes even further than that and also recognises the strengths within this population. Others have already mentioned that and where there are opportunities to work with them to help them to make good choices for them and their children. However, the vulnerabilities of this group cannot be underestimated. According to the most recent ISD teenage pregnancy report published in June 2014, we know that those from the most deprived are 4.6 times more likely to have a teenage pregnancy. It also states that, in the under-20s group from the most deprived areas, the rates of those going on to have their babies is almost 12 times greater than the least deprived. We also know that poor health behaviours, like smoking, are highest in the group. The strength of the programme is that it has generated transformational change in the partner organisations outwith the NHS, particularly housing, to help them to recognise how to realign their services to meet the particular needs of young mothers and their families. That insightful learning was first gathered by NHS Lothian and has provided a much greater understanding by all the services of what it takes to support this population group well. NHS Lothian has provided guidance and support to the other NHS boards to help to inform them of how to work in an integrated way with all the other service providers who may not immediately recognise the importance of their role. In closing, I would like to recognise the achievements of both nurses and families from NHS Lothian to successfully implement a complex social intervention, such as the family nurse partnership programme. Many thanks and thank you all for taking part in this important debate. I now suspend this meeting of Parliament until 2.30.