Sure Start

Sure Start Local Programmes (SSLP) aim to support young children and families in disadvantaged areas through integrated early years education, healthcare, child care, and other support services tailored to local needs.

Sure Start was developed because investment in the early years of childhood is likely to be more effective in improving long-term outcomes than at any other stage in a child’s life.1 The Sure Start Programme was adapted from the US-based Head Start program because early studies suggesting beneficial outcomes. Many of the later evaluations of this programme have shown benefit, but there have been some mixed results. It is not likely that the findings of Head Start evaluations will be usefully generalizable to UK-settings, so they will not be detailed here.

The Government has no stated policy to cut Sure Start, indeed David Cameron has pledged to protect the service. However cuts of local authority funding may affect Sure Start, either through direct cuts or changes such as transfer of services to private or voluntary providers.  A survey by children’s charities has suggested that 250 Sure Start centres will close, with 2000 further centres reducing services, 3100 having reduced budgets, and 1000 centres to lose staff.2,3

Evidence of beneficial effects of Sure Start programme:

There is evidence that many positive effects are associated with SSLPs when compared with similar areas without the programme.

• Children in Sure Start areas are less likely to be overweight
• Children are more likely to experience better physical health
• Families provide a better learning environment at home for their children
• Home environments are less chaotic
• There is greater life satisfaction in families
• Families use less harsh means of discipline
• More families in Sure Start areas progress to having someone in the household in employment by the time the child is 5 years old

Evidence of possible harm or lack of benefit from Sure Start programme:

• Mothers in Sure Start areas reported more depressive symptoms than mothers in comparison areas
• Parents in Sure Start areas were less likely to attend parent-teacher meetings at schools – however the number of visits was low in both groups and so difference between groups was small

Any implications for health and well-being

Children who live in Sure Start areas show better social development, and greater independence, than those in areas without such services. Families in Sure Start areas use less negative parenting styles and provide better home learning environments, and used more services for supporting child and family development than those in non Sure Start areas.4

Evaluation of Sure Start5 has shown more positive findings than negative ones. However also a large number of non-effects were found. While this might suggest that the programme may make no difference one way or the other, some of these findings may simply be related to the way measurements and comparisons were done.  Although evaluation of Sure Start has been challenging, the balance of evidence suggests that families benefit from the programme.

The Sure Start programme is directly supported by the Marmot Review, with a strong recommendation by the report that the programme is sustained over the long term and given even greater priority in investment.1

The support given by Sure Start may become of even greater value as the Government’s plans for the economy are implemented. Family debt, unemployment, child poverty, and other family stresses are predicted to increase.6

Author: Ingrid Wolfe, Child Public Health Research Fellow and General Paediatrician, London School of Hygiene and Tropical Medicine and Whittington Hospital

UK area affected: All areas may be affected

Further Reading:

OECD Social Policy Division. OECD Family Database. CO2.2: Child poverty. Available at www.oecd.org/els/social/family/database

OECD Social Policy Division. Doing better for families United Kingdom. 2011. Available at: http://www.oecd.org/dataoecd/61/32/47701096.pdf

References

1. Fair Society Healthy Lives, The Marmot Review. Strategic Review of Health Inequalities in England Post 2010. February 2010.

2. 4Children website.  www.4children.org.uk

3. Daycare Trust. www.daycaretrust.org.uk

4. Melhuish E, Belsky J, Leyland AH, et al. Effects of fully-established Sure Start Local Programmes on 3 year-old children and their families living in England: a quasi-experimental observational study. Lancet 2008; 372: 1641-47.

5. The impact of Sure Start Local Programmes on five year olds and their families. The National Evaluation of Sure Start (NESS) Team.  Research Brief. Available at www.ness.bbk.ac.uk

6. Child Poverty Action Group. www.cpag.org.uk