Family Nurse Partnership: Stockport

Stockport, with a population of approximately 290,000, is one of the healthiest places in the North West England. However, it ranks as the eighth most polarised council in the country, revealing stark health inequalities. The life expectancy gap between the affluent area of Bramhall and the disadvantaged Brinnington is 11 years. While Stockport's overall health indicators are average, the gap in health outcomes is particularly pronounced in its youngest population. For example, white British boys from disadvantaged backgrounds are the least likely to achieve a good level of development by the end of the Foundation Stage.

In 2023-24, despite the growing number of disadvantaged clients, FNP in Stockport achieved a 100 per cent enrolment rate before 28 weeks of pregnancy and a low attrition rate of eight per cent. The team comprises one FNP supervisor (34 hours/week), five band 7 family nurses (4.04 WTE) and one administrator (28 hours/week).

The FNP model is grounded in the belief that fathers play an essential role in the development of children, yet they are often overlooked by services. FNP in Stockport engages fathers, aiming to strengthen the entire family unit. Furthermore, early intervention in family life leads to long-term economic benefits by breaking intergenerational cycles of poor parenting and supporting healthier families.

Stockport’s FNP model has strong evidence backing its effectiveness. It contributes to the Stockport Children and Young People’s Plan by improving outcomes for vulnerable teenage parents and their children. It addresses key areas like smoking in pregnancy, breastfeeding, immunisation rates, safeguarding, and reducing repeat teenage pregnancies, with improved inter-generational health and economic outcomes and reduced long term financial burdens. This includes significant savings in areas such as reduced demand for foster care, residential placements, and healthcare services. (Public Health Agency of Northern Ireland, 2018). Stockport’s FNP results surpass the national average on low birth weight, breastfeeding initiation, children in smoke free homes and immunisation rates at two years. 

Data from the programme also shows that the level of social care need among FNP families decreases as they progress through the programme. This sustained reduction in need is seen in the cohort of children born between April 2019 and March 2020, who showed a reduced level of need at graduation from FNP and beyond.

In 2024, Stockport took the decision to recommission FNP. This followed a review of the financial benefits and return on investment undertaken by the revaluation team in Northern Ireland. By considering ‘paths not taken’ by FNP clients and applying four UK reference costs, the team concluded that the annual cost per client avoided, as a result of FNP, is in the range of approximately £40,000 to £485,000. Most potential savings are from reduction in fostering and residential places and reduced demand on other services. As a minimum, FNP pays for itself financially and is cost effective. (Public Health Agency Northern Ireland 2018). 

Since its introduction in 2014, the Family Nurse Partnership in Stockport has consistently demonstrated its effectiveness in supporting young families, improving health outcomes, and breaking the cycle of disadvantage. Through strong engagement with both mothers and fathers, and a focus on early intervention, the programme has shown long-term positive impacts on both child development and family well-being. Its cost-effectiveness and ability to produce measurable improvements in health, education, and economic outcomes make it a vital service in addressing the inequalities faced by Stockport’s most vulnerable families.

Lessons Learnt

• A strengths-based approach is key.  Nurses that are skilled to engage with young parents provide robust relational and restorative practice that is more likely to sustain engagement to improve both child and parent outcomes.
• Intergenerational dynamics influence parenting. Early intervention in family life through FNP leads to long-term economic benefits by breaking intergenerational cycles of neglect, abuse or trauma thereby addressing health inequalities in the area.
• The importance of engaging fathers / partners. Involving fathers leads to better outcomes for children and families. FNP recognises their influence and actively encourages male involvement.
• Personalisation is crucial.  FNP recognises that ‘one size does not fit all’. Tailoring support to each family's needs and circumstances improves engagement. Effective partnerships with children’s services, education, housing, and health services enhance FNP delivery and ensure effective referral pathways and interventions can be tailored according to the needs of young parents.
• FNP is cost effective. The FNP programme offers a cost-effective approach to public health nursing by consistently demonstrating positive outcomes such as improved infant health and development, reduced need for social work intervention, and enhanced parental self-esteem and confidence.
• High return on investment. Cost analysis shows that Stockport FNP delivers a strong return on investment, with its positive impact on both the child’s immediate development and the family’s long-term outcomes powerfully illustrated below through the lived experience of a young parent.