Early intervention, lasting change: Why Sure Start matters

Since 2010, austerity has cast a long shadow over Britain’s children, hollowing out many of the supports that once shielded families from hardship and leading to a rise in child poverty with a widening of health inequities. Today, one in three children in the UK lives in relative poverty. Yet the very programmes meant to break this cycle, chief among them Sure Start, were dismantled at the time of greatest need. At their peak in 2010, 3,620 Sure Start centres were in operation; austerity has led to the closure of over 1,400 of them, with most closures in the poorest areas. 

With rising child health inequality across the UK, the health impacts of the Sure Start programme in children from disadvantaged backgrounds represented a vacuum in the literature. Our systematic review is the first comprehensive investigation into the health impacts of the Sure Start programme. The study represents a timely investigation amongst the socio-political landscape. Methodologically, our study yielded the inclusion of nine studies and three grey literature reports. Our study devised three themes: physical health, social functioning, and neurodevelopmental health.  

Growing up in poverty is hazardous to a child’s health. It dramatically raises the risk of chronic illness, hospitalisation, obesity, and even early death. Sure Start was built to sever the link between poverty and poor health, and our review indicates the programme performed effectively on selected outcomes. Within the measured outcomes, children in Sure Start areas experienced significantly fewer hospital admissions as they grew older (after an initial uptick – likely due to the synergistic effect of enhanced detection of illness and heightened infection risk from children’s interactions in Sure Start centres). Additionally, childhood obesity was affected; when Sure Start funding was reduced, childhood obesity rose: a 10% budget cut led to 4,500 additional children becoming obese. Furthermore, there was a decrease in accidental injury amongst children utilising Sure Start services versus non-Sure Start users. Finally, Sure Start interventions aided breastfeeding amongst neonates. Early intervention yields real health benefits, while cutting those services costs lives. 

School budgets have been squeezed and youth services reduced. In England alone, more than one million vulnerable children have seen their life chances reduced since 2010 with spending on preventive children’s services cut by over 50%. This has left many without the basic building blocks of development that wealthier peers take for granted. Sure Start provided integrated support, parenting classes, playgroups, health advice and helped parents create nurturing environments at home. Children from Sure Start areas arrived at school more ready to learn and achieved higher test scores. Removing these supports is a false economy.  

A consequence of pulling back support is a rise in children’s mental health issues left unaddressed. Diagnoses of ADHD and conduct disorders have climbed, but accessing help has become increasingly difficult. Many families now wait over a year, sometimes even several, for a child psychiatry appointment. Sure Start’s preventive approach offered support here as well. Through early screening and parenting programmes, potential problems could be spotted and addressed in the preschool years. One trial found over half of children with conduct problems showed major improvements in behaviour after parents received Sure Start support. Similarly, early interventions at Sure Start significantly reduced ADHD symptoms, delivering help long before a child would ever reach a years-long waiting list. 

We cannot afford to continue down this path of inadequately supporting children from disadvantaged backgrounds; political short-termism is the antithesis of lasting population health and wellbeing. Sure Start’s integrated, locally tailored, universally accessible model is exactly what early years support should look like: effective and cost-saving, easing strain on schools and hospitals while investing in futures. We must restore and expand Sure Start, reopen centres in the communities that need them most, and fund them to provide the full spectrum of proven early years services: to act as an agent of health equity and justice for all.