Improving early years outcomes through data linkage.
Family nurses are experienced, qualified nurses and midwives who deliver a structured programme to support young parents to build the confidence and skills they need to provide the right support for their baby and give them the best start in life.
Scottish Government commissioned Cardiff University to carry out a natural experiment approach (observational study) to assess the impact of FNP over a 10 year period.
The study population included all young women 19 years or younger, eligible for the FNP Programme from 1st January 2009 to 31st March 2016 and their first-born child(ren).
Centre for Trials Research, Cardiff University with support of The Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, carried out the study. They were commissioned by Scottish Government.
The cost of the research was under £200,000. This is much lower than for the equivalent study in England that collected new data rather than reusing existing datasets. The English study cost over £5,000,000.
In Scotland, we have a wealth of high-quality administrative data that is collected throughout the course of people’s lives.
Making the best use of this data by linking it maximises the insights that can be gained, which in turn enables patterns and relationships within the data to become clearer.
This study demonstrates the value of using linked administrative data to a programme such as the FNP.
This programme makes use of datasets on use of healthcare services (including prescriptions) for both children and mothers, the child health surveillance programme that runs from birth into school, education including qualifications and where young people move on to after school, experiences of looked after children, and where the family lives. These were all linked to give a picture of a child and their family. This allowed researchers to measure 54 outcomes of a child and family wellbeing.
The research found that the programme is targeted well with the majority of young parents that enter FNP having had significant complex challenges. For example, FNP clients are young first time mothers, many of whom have experienced anxiety and depression (63%), social deprivation, parental separation and a high proportion have been care experienced or on the child protection register (22%).
• 80% of FNP clients completing the programme.
• 20% of FNP clients are in work and/or education at 6 months post-birth to 40% at 24 months post birth.
• There is an improvement over time in breastfeeding initiation and duration of feeding among younger mothers.
• Fewer FNP children have a concern recorded about communication/speech and language at 14 months (1.0%) compared to Scotland as a whole (4.2%) at 13-15 months.
FNP has been expanded over the last 10 years and is now delivered in all mainland health boards in Scotland. Over 10,000 families have received the programme, and 6,000 have graduated from the programme. The FNP reaches over 3,000 families at any one time.
The Family Nurse Partnership was developed at the University of Colorado, Denver, USA, where it is known as the Nurse-Family Partnership (NFP). Over 40 years of research, the programme has been shown to produce many benefits, including:
• improvements in antenatal health
• improved early language development and academic achievement
• reductions in children's injuries, neglect and abuse
• improved parenting practices and behaviour
• fewer subsequent pregnancies and greater intervals between births
• increased maternal employment and reduced welfare use
• increased involvement from fathers
This project used traditional routes of applying for data linkage with multiple approvals panels, multiple research identifiers and data classed as personal in the Safe Haven. This meant that the length of time taken between application and receiving access to the data for the study was approximately two and a half years.
This (not uncommon) wait period for a data linkage project means studies aren’t timely enough to answer pressing policy questions: the most up to date data is often excluded and the findings from the data are already outdated.
Research Data Scotland (RDS) exists to make it faster and simpler for researchers to access public sector data. We are starting to make the cycles of innovations faster.
Through the Researcher Access Service, we enable streamlined access to data for research in the public benefit, reducing the time and resources required to undertake projects that can provide evidence for FNP and speed up research with data access in weeks and months rather than years. Launched in April 2024, the service initially enables access to nine of Public Health Scotland’s most frequently requested datasets through a streamlined pathway, where previously complex approvals and information governance processes are standardised using the Five Safes framework.
We are also working with Scotland's National and four Regional Safe Havens to simplify and streamline common systems, processes and services, making it easier for researchers to access data which falls outside of the Researcher Access Service. For projects, which require researchers to obtain individual approvals through several local health boards, our work to federate processes will further improve the data access journey. Find out more about our work with the Scottish Safe Haven Network.
Find out more about the Scottish Government programme here.
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