MV Non-executive Professor Donna Hall argues that early intervention must be a priority for a new government and makes the case that a revived, improved version of Sure Start is the place to begin.
Of all the myriad policy initiatives of previous governments, probably the most frequently discussed, and for me the most effective, is Sure Start.
Introduced in 1999, two years into a new Labour government, Sure Start was an evidence-based, preventative national programme designed to improve the life chances of babies and children under the age of five, particularly focussing on areas with the highest levels of poverty.
The American Head Start Programme provided an evidence platform to show that targeting babies and young children with support with parenting, attachment and speech and language skills had a lifelong impact on their well-being and long-term life chances.
The energy and ambition behind the programme was huge, with 250 local place-based projects set up in the first few years.
The latest evaluation of Sure Start by Pedro Carneiro, Sarah Cattan and Nick Ridpath at the Institute of Fiscal Studies, showed indisputably the positive impact of Sure Start. Language, speech development, communication skills, numeracy and social and emotional development all improved measurably as a result of Sure Start.
We also know from the work of Michael Marmot and other public health experts that investment in the first 1,000 days of life and brain development has the most impactful result on life chances in the long term. We know that if we get the first 1,000 days right it improves attachment, relationships, ability to do well at school, to get and retain employment etc.
In 1999 I was lucky enough to be working at Salford City Council in a team of innovators; a genuine “rebel alliance” of people who were excited to implement such a ground-breaking project as the first Sure Start pilot in an area with high levels of deprivation, Seedley and Langworthy.
We worked alongside our local MP Hazel Blears, local GPs and health visitors, midwives at Hope Hospital and local communities to set up the first Sure Start right in the heart of one of the poorest parts of the City of Salford.
The main problem from my perspective was the heavy proportion of national funding from the Treasury that was capital. This meant that we had to buy land and build a building. So rather than focus on outreach, data sharing and building a model of relational working, we put a disproportionate amount of effort into the building. The Cornerstone in Salford is still there; it’s now a community hub with loads of activities run by local people.
But in 2010 Sure Start became one of the first victims of austerity when two thirds of the funding was cut nationally. To me this was and is a huge social and economic policy act of self-harm. The costs of Children’s Services in 2024 are spiralling out of control with many councils on edge of declaring bankruptcy; some saying they are two or three children being taken into care away from issuing a Section 114 Notice. So why cut a preventative programme to support parenting and child development?
In Greater Manchester as The Mayor Andy Burnham’s lead for Public Service Reform, I worked with NHS and council colleagues to implement the first 'early years new delivery model’ as part of our integrated place-based teams; based on the principles of Sure Start but without the additional money and in the middle of enormous funding cuts.
Despite this the programme showed a significant increase in school readiness within the first few years. This was part of the Combined Authority’s Strategy of “Growth and Reform” The links between early years and the economic health of a place are well-proven. This is the way to truly level up.
Local authorities were unable to find the missing money for Sure Start as they too had to make huge savings as a result of funding cuts which were more intense in areas of deprivation, especially in the North.
Local freedom to innovate with pilots was restricted and many Sure Start programmes were halted. This meant local communities were all treated the same when they were very different.
Paul Johnson, Director of the Institute of Fiscal Studies, wrote in The Times in April 2024
“Sure Start achieved its aims and then we threw it away. We know that children grow up with poor life chances. We know how to ameliorate that. The choice is ours”
Paul is right. The choice is ours. To give our babies and children the best start in life and to truly level up areas with the highest level of poverty Sure Start in 2024 would need to be:
Implemented as part of a 'total place' funding settlement from Treasury for all other services in both the NHS and local government.
The proportion of capital should not outweigh revenue, so that people locally can focus on what’s needed in a bespoke programme designed for the specific circumstances of their local area rather than focus on building a centre as we did in 1999.
There should be a national public services outcomes framework, which includes Sure Start but with maximum implementation flexibility at the local level.
Community and voluntary organisations need to play a much stronger role in the design and local delivery of a new Sure Start. Local family support groups like Homestart, Pause and the Family/Nurse Partnership need to be at the centre of the relational service design.
Sure Start should not be a stand alone programme but needs to be integrated within multiagency place based teams as families shouldn’t need to navigate the complexity of silo services and their multiple assessment and referral procedures.
A wider package of support needs to be available including housing. Its pointless providing developmental support if a child doesn’t have a safe home to live in.
One of the criticisms of Sure Start over the years has been those accessing support have been middle class families for whom it was not designed. Deploying multiagency risk stratification to target specific families who need additional support would ensure this isn’t repeated.
Rather than spending an increasing proportion of limited public money on picking up the results of crisis in Children’s Services and to truly level up our poorest areas we know what we need to do.
One of the themes Mutual Ventures has been exploring as part of our Prioritising Public Services campaign is children’s health. Children’s physical and mental health is a growing national problem but there are examples of good practice, including in Leeds where Chief Executive Tom Riordan and his team are taking an innovative approach to tackling childhood obesity. You can view our recent webinar on the topic and read more about our work here.
Professor Donna Hall CBE is a non-executive director at Mutual Ventures and former Chief Executive of Wigan Council.
Comments