Delivered! Economic policies that worked: Sure Start
Infographic by Holly Moeller at Kettle & Quill Illustrations
By Tim Thorlby
5 min read
This is the second blog in a short series highlighting some of the UK’s most effective economic policy interventions of the last 25 years. It is a blog about how big changes can be achieved.
As noted in the last blog, and an important starting point, is the old and wise saying in policy circles which goes like this:
We tend to overestimate what we can achieve in one year and underestimate what we can achieve in ten years
Projects and interventions may not always look obviously successful in the short term but sometimes impacts can build over time. This second blog takes a look at a major early intervention programme, Sure Start, which took a long term view. Did it work? What can we learn? And what have pre-schoolers got to do with economic policy anyway?
What is Sure Start?
In 1999, the New Labour Government launched something of a novelty for the UK – a pioneering early intervention initiative which sought to integrate a whole bunch of health and education services into one place for young families. The aim was to improve the health and wellbeing of young children living in England’s most deprived neighbourhoods (the 20% most deprived).
These ‘Sure Start’ centres were designed to bring together a wide range of services for families with children under the age of 5 to help new parents navigate pregnancy, parenting, childcare, early learning and even how to find a job. The services were delivered from a network of 500 Sure Start centres across the country – ‘one stop shops’ for families with pre-school children. They provided an integrated mix of antenatal care, childcare, family health support, parenting advice, early learning, support for children with special needs and links to Jobcentre Plus to help with training and employment.
The service was a key part of the Government’s ambition to tackle poverty and social exclusion and change the trajectory of disadvantaged communities. It was led by a new Sure Start Unit, jointly owned by the Departments of Education and Health. Delivery in each community was led by local government.
Initially targeted at the most deprived areas, the programme was expanded in 2004 to cover a much wider range of neighbourhoods, with the aim to have a centre in every community. These rebranded ‘Sure Start Children’s Centres’ grew to become a network of over 3,000 service points across England by 2010, accounting for one third of all public spending on under 5s and costing £2.5 billion per year (2023 prices)[1].
In 2010, it was estimated that the 3,290 Sure Start Children’s Centres had a wide reach, with 83% of the nation’s 4 year olds living within 2.5km of their local centre.
Sure Start has not fared particularly well in the Age of Austerity. From 2010 to 2022, nearly half of these centres closed and funding overall fell by 75%, so the original service is no longer recognisable. As we will see, this may be a significant missed opportunity.
Did it work? Educational achievements….
A number of long-term national evaluations have been conducted on the Sure Start service, together with additional studies more recently. We are now in a good position to see what worked.
We can now see what happened to those cohorts of children using Sure Start centres in the early 2000s. Where are they now?
Academic achievement
A 2024 IFS report[2] evaluated the impact of Sure Start on the academic achievement of children at age 5, 7, 11 and 16.
It showed that, for children who had access to Sure Start before the age of 5, there was “strong evidence” of a significant improvement in their academic achievement at the age of 11 and 16 in particular. It helped to lay stronger foundations for these children to achieve well at school, with an average increase of 0.8 GCSE grades per child overall. That means a child who might have otherwise got a ‘5’, got a ‘6’ instead (in old money: going from a high ‘C’ to a ‘B’).
The evidence also suggests that children from lower-income households (those who qualified for Free School Meals) benefited the most. At age 16 these children showed improvements in academic achievement, on average, equivalent to 3 GCSE grades higher than expected. That is a huge difference.
How did it happen? The impact of Sure Start is considered to arise primarily as a result of the development of the children’s personal, social and emotional skills, communication and language skills and mathematics and reasoning skills.
The particular success of the programme with lower-income families is likely to be because centres were physically located in more deprived neighbourhoods and they used active local outreach to engage parents.
The study suggests that providing good antenatal and postnatal services in Sure Start centres, together with high-quality childcare and support for parenting to enable better and more nurturing home environments are probably the key drivers of impact. Plenty of studies support the idea that educational attainment is supported by the healthy cognitive and social and emotional development of children which is itself more likely in “a home environment which is safe, stimulating and nurturing”. Sure Start seems to have been particularly effective at supporting this, with a key impact being the development of improved communication skills in children in particular, proving helpful throughout their school career.
Special needs
The same IFS report also identified that Sure Start made it more likely that any special needs in children would be identified and addressed at an earlier stage, with the result that the incidence of more severe special needs amongst these children by the age of 16 was actually lower than previously reported.
Did it work? Health and behaviour…
Earlier evaluation reports highlight other benefits of the Sure Start programme.
Health
A 2021 report[3] explored the long-term health benefits from children and their families engaging with Sure Start and produced some quite staggering numbers.
The study showed that hospitalisations of very young children (those aged 1) in areas with Sure Start centres actually increased by 10% - i.e. they were more likely to go to hospital when they had a health issue or an accident, and may have been more likely to catch bugs through socialising with a larger number of children. However, by the age of 5, and even more so as teenagers, the rate of hospitalisations reduces substantially.
Young people who benefited from Sure Start through stronger immune systems, better advice on healthcare, safer home environments and stronger mental health, were less likely to go to hospital each year when they were aged 11-15. The study showed that the initial increase in hospitalisations amongst babies was more than offset in later years by substantial long-term decreases. They estimated that over 13,000 hospitalisations per year were prevented amongst those 11-15 year olds. The financial ‘saving’ from this alone would have covered 31% of the total cost of running Sure Start each year at its peak.
Offending
Another 2024 study[4] looked at the impact of Sure Start on the behaviour of children. It also offers some striking results. The evidence suggests that children who engaged with Sure Start before the age of 5 were significantly less likely to be involved in serious offending. The evidence showed they were 13% less likely to receive a criminal conviction and 20% less likely to receive a custodial sentence by the age of 16.
The study also suggested that children were less likely to spend time in care. In a sign that impacts can be complex, there was also some evidence that low level misbehaviour, resulting in unauthorised absences from school (truancy) may actually have increased among some groups.
Overall though, the report highlighted that the substantial savings in criminal justice costs would have been sufficient to cover 20% of the costs of Sure Start at its peak.
Show me the money!
At an annual cost of £2.5 billion in 2010, some might say that this is an expensive programme. Although, when you consider that it was an almost universal service within reach of over 80% of the nation’s pre-school children, the unit costs seem rather low. The IFS estimate that in 2010, at its peak, Sure Start’s overall costs amounted to an average of £1300 per child.
The IFS even did a cost-benefit analysis. These can be slippery things, but what is interesting is that even just considering one outcome alone – educational achievements – and not including health or offending or other outcomes, the cost-benefit analysis shows a positive benefit. For every £1 invested in Sure Start, they estimated £1.09 in benefits.
This is a result of both actual cost savings to Government from reduced special needs expenditure (because more of these needs were identified and addressed earlier) as well as the expected benefits from higher earnings of children who secured better qualifications when they left school and would be likely to pay more tax over their working lifetime.
In other words, even on one narrow calculation, Sure Start looks like a good investment for the taxpayer. Not just a ‘cost’, but an investment which reduced some future public costs (SEN) and increased the earning potential of young people as they entered their careers.
When you take the savings identified for the health service (31% of the cost of Sure Start) and the savings identified for criminal justice (20% of the cost of Sure Start), and add them together with the benefits of improved educational outcomes, it does not seem fanciful to suggest that this programme represents a solid investment and pretty good value for money.
One other interesting note about money is that those Sure Start centres which were better resourced throughout their lifetime, usually the earliest centres launched, tended to produce better outcomes than the centres launched later on more of a budget. Bigger, better resourced interventions produced bigger, better impacts. In public services, it seems that you get what you pay for.
*Cough*…sorry, why are we talking about children in a blog about economic policy?
Our economy’s greatest asset is the people who work within it. There is a rather unlovely phrase - ‘human capital’ – which sums up the knowledge, skills and experience that each person brings to work. The more we invest in our human capital, the better our economy will work. The better educated and skilled our workforce, the more they can do and the more they can earn.
Many of our economic issues today are about people. We need more workers with higher qualifications. We need more workers who are currently unwell to get better and go back to work. We need more workers with the confidence and creativity to start their own businesses. You get the idea.
Sure Start was a programme aimed at new parents, babies and young children, seeking to support the development of children so that they would start primary school, at the age of five, healthier, happier and more equipped to learn. It was an early investment in ‘human capital’.
It worked.
Although these children left their Sure Start Children’s Centres at the age of 5, clutching a balloon and an ice cream, and probably never set foot in the building again, the combined effect of their, and their parents’, experiences in these centres had an enduring impact on their health, education and behaviour. It impacted their whole school career. This in turn has impacted their first steps onto the careers ladder. Early intervention produces benefits for decades afterwards.
The evidence suggests that Sure Start paid for itself in health, education, economic and offending outcomes. An investment in the future, not just a cost.
The programme was particularly effective in deprived areas, where the UK has wasted a huge amount of human potential through decades of neglect. Our economy will never fire on all cylinders until every community participates fully in the labour market and achieves its best.
This is why Sure Start, with its particularly strong effect on educational outcomes in deprived areas, is one of the most effective economic policies any UK Government has ever delivered.
Lessons for future interventions?
This is what I take away after reflecting upon this intervention:
Visions should be audacious – I love the bigness of the Sure Start vision. It was not afraid to try joining up public services (difficult), targeting deprived areas (difficult) and seeking to shift big outcomes like health and education (difficult). If you are going to work up a vision then make it a big one, or go home. I think people respond well to big, worthwhile ambitions. They are less excited by tinkering at the margins.
Deprivation is no excuse for failure – Some people use deprivation as an excuse for why things don’t work or will never work or why lower standards are acceptable in those places. I don’t buy this at all. Sure Start shows that significant impacts can be delivered in deprived areas if there is the will and the resources to make it happen. We don’t have to accept the world as it is today, we have the capability to make changes.
Investing in healthy, happy families is a smart thing to do – Sure Start showed that supporting new parents pays dividends. Being a good parent is one of the toughest challenges going, and everyone benefits from a bit of help. Bringing new parents into contact with public services and also social networks where they can find more help and support is a good thing to do. There is much more we could do on this as a nation.
Benefits arising from early interventions take time to unfold – It has taken nearly 20 years to see the hard benefits of Sure Start, evaluate them and make them known. We cannot expect impacts to be delivered in a year or two if we are doing difficult things. Sure Start also shows us that investing in children is surely one of the best investments we as a country can make – the benefits continue to unfold and deliver results for decades afterwards. Investing in children is a no-brainer.
Austerity is the dumbest policy ever devised – The conception of programmes like Sure Start as a ‘cost we cannot afford’ is shown up as a short-term false economy, because a decade later we are paying more for health services, more for youth offending and custody services and we have a less well-educated workforce. It is much cheaper to prevent problems than fix them afterwards. Public sector spending needs to be evaluated on its long term investment value not just its short term costs.
Local government can deliver transformative services – The idea and funding for Sure Start came top-down from Westminster, but the entire national programme was planned, managed and delivered by local government in partnership with local communities. This approach successfully delivered measurable results on some of our most intractable social challenges. We need to do this more often.
Conclusions
Our national economic policies must include a healthy level of investment in children who are today holding balloons and eating ice creams on a far flung housing estate and tomorrow might be leading the businesses and industries of the future.
It’s amazing what we can do.
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The infographic for this blog was created by Holly Moeller, a watercolour and pen artist who creates bespoke illustrations for companies, charities and private clients in her signature vibrant style at Kettle & Quill Illustrations. You can see some of her portfolio here. If you want to discuss a design possibility, get in touch!
Foot Notes
[1] Data drawn from: Cattan, S et al (2024) The short- and medium-term impacts of Sure Start on
educational outcomes, IFS | Access here: https://ifs.org.uk/publications/short-and-medium-term-impacts-sure-start-educational-outcomes
[2] Cattan, S et al (2024) The short- and medium-term impacts of Sure Start on
educational outcomes, IFS | Access here: https://ifs.org.uk/publications/short-and-medium-term-impacts-sure-start-educational-outcomes
[3] Cattan, S et al (2021) The health impacts of Sure Start, IFS | Access here: https://ifs.org.uk/sites/default/files/output_url_files/BN332-The-health-impacts-of-sure-start-1.pdf
[4] Cattan, S. et al (2024) The effect of Sure Start on youth misbehaviour, crime and contacts
with children’s social care, IFS | Access here: https://ifs.org.uk/news/sure-start-reduced-likelihood-ending-youth-custody-fifth