Naomi Eisenstadt is Designate Chair of Northamptonshire’s Integrated Care Board. Naomi’s career has centred on children, poverty and family policy. She was the first Director of Sure Start, ran the Social Exclusion Task Force, and served as Poverty Advisor to the Scotland’s First Minister. She is a trustee of the Abdrn Financial Fairness Trust and the Education Endowment Fund. In 2019 she published Parents, Poverty and the State, with Carey Oppenheim. Naomi was awarded an honorary doctorate from the Open University in 2002 and became a Companion of the Bath in 2005.
- No history of early years policy and practice covering the last fifty years would be complete without Sure Start. The backdrop to the story will be described in other chapters of this collection. Suffice it to say that many people were involved in convincing key people in the Labour party about the importance of early childhood development before the Labour Party gained power in 1997. Several new Ministers, particularly Margaret Hodge, Harriet Harman and Tessa Jowell were committed to early years provision both as a means to improve child outcomes as well as a crucial component of women’s participation in employment. The Labour Party had signalled its commitment to improved early years provision in its 1997 Manifesto, promising a national childcare strategy and universal free early education for all four-year-olds. Combining early childhood policy with a more general policy about child poverty came later, within a year of Labour taking power.
- Sure Start
- Sure Start was announced as a new programme in Parliament in July 1998. It was born out of a cross government review on investment in early years led by a senior civil servant in the Treasury, Norman Glass. The review identified two main areas of importance. Firstly, several government departments invested in early years. But the government had no overall strategy or goals nor was there cross Whitehall coordination on early years policy. Even within the Department for Education (then the Department for Education and Employment) there was fragmentation between early education, led by the Schools Directorate, and childcare, led by the Women and Employment team. Secondly, evidence from the United States and from continental Europe indicated that high quality early years provision especially aimed at children from low-income families, could improve school readiness and narrow the gap between children living in poverty and their better off peers.[i] After widespread consultation with charities, think tanks, academics and providers of children’s services, a budget was agreed for the first three years of a new programme aimed at children under four living in very poor areas. Sure Start was born.
- Among a proliferation of area-based initiatives set up by New Labour, Sure Start was aimed at local areas with very high concentrations of poverty. Initial funding of £450 million over three years was allocated for 250 Sure Start Local Programmes. Each programme would cover between 400 and 700 under fours living in some of the poorest neighbourhoods in England. Once the geographical area was agreed, the programme services would be open to all families with young children in the catchment. The assumption was that given the level of poverty in the chosen areas, there was no need to target by individual family need. Open access was a key feature, avoiding the stigma that can accompany targeted services. Each programme would deliver some services as well as joining up whatever services were already operating in the area. Required services included: outreach and home visiting, support for parents and carers, play and childcare, health advice, and support for children with special needs. Local Sure Start programme boards were able to decide on any other provision that would be needed to reach Sure Start established goals set out in its own Public Service Agreement. Local programme board membership included representatives from local statutory and voluntary agencies, and local parents.
- Sure Start was seen at the time as a flagship of the New Labour Government. In keeping with the Government’s Modernizing Agenda, Sure Start was meant to be user not provider led, flexible and responsive to local needs, joined up across different agencies, focused on outcomes not inputs, and evidence based. There was and continues to be arguments about the final point. My own view remains that while the importance of early years services was clearly based on years of international research, the actual design of the programme was significantly different from models of provision in other countries. The emphasis on flexibility and local decision making about what was delivered was very different from the structured and manualised programmes that had been evaluated and found to be successful. As discussed later on, this diversity of local approach made the evaluation of Sure Start particularly challenging.
- An evolving policy
- A particular feature of New Labour that had profound impact on Sure Start was the frequency of ministerial changes as well as department reorganisations. Within the first year of Sure Start operating, the lead minister at the Department of Health, Tessa Jowell, was replaced by Yvette Cooper. Jowell’s key interest was in mother infant attachment; Cooper’s interest was in women’s workforce participation. Overall responsibility at the start sat with the Secretary of State for Education and Employment, David Blunkett, who was primarily interested in community development and increasing the role of the voluntary sector. All these interests had to be reflected in the ongoing design and guidance provided to local programmes from Whitehall. The spending review of 2002 agreed a doubling of Sure Start from 250 to 500 local programmes. Barely any services were yet to be set up; there was no evidence from a recently commissioned evaluation. Yet, Government was doubling the programme. Arguments against the rapid expansion were unheeded. Sure Start was already immensely popular with MPs and local people. Every MP wanted one for their constituency. This was probably the first programme set up by Government explicitly aimed at poor areas that everyone wanted. The rapid expansion of Sure Start continued, alongside a major reorganisation of children’s services at local government level. A summary of the key changes to Sure Start over the years is in the box below.
2002 -Comprehensive Spending Review doubles Sure Start from 250-500 local programmes;
2004- Choice for Parents the Best Start for Children: a ten year childcare strategy announces Sure Start Children’s Centres for every local area, 3,500 to be established over three years.
Main control of the policy and funding moves from central Government to local authorities. Sure Start rolled into wider children’s policy of Every Child Matters. Early years funding ring-fenced within local authority settlement;
2011- Coalition Government supports early years but renames ringfenced grant as Early Intervention Grant;
2013- Coalition Government removes ring fence for Early Intervention Grant, rolling all early years funding into Local Government settlement;
2014- By 2014, Sure Start cut in funding by 41%;
2017- 16 Local Authorities closed half or more of their centres. 6 local authorities closed 70% of centres;
2019- continued change in rebadge children’s centres as family hubs. Not just early years but nought to nineteen targeted at families in need of social services interventions. Basic premise of open access in poor areas completely undermined.
- Did Sure Start Work?
The evaluation of Sure Start has been subject to debates over years. The diversity of approach among local programmes meant a randomised control trial wouldn’t work. Ministers also opposed RCT methodology. They considered it unfair to consult with local parents on what they wanted and then randomly refuse some of the access to new services. The continuing expansion of Sure Start presented real difficulties; the researchers were finding it hard to identify poor areas that did not have a Sure Start programme in order to compare Sure Start and non-Sure Start areas. The question is not ‘did it work’, but did it work under what circumstances and for whom? Sure Start was not an intervention. It was an attempt to reform local services so that they would work together at neighbourhood. Level. A consortium led by Edward Melhuish and Jay Belsky at Birkbeck College won the tender to evaluate Sure Start in its initial phases (National Evaluation of Sure Start, NESS). Kathy Sylva and Pam Sammonds at the University of Oxford carried out a subsequent evaluation of Sure Start Children’s Centres (Evaluation of Children’s Centres in England, ECCE). The biggest difference between the two evaluations was that NESS chose families at random from the catchment areas of Sure Start Local Programmes and compared them with children in poor areas that did not have Sure Start. They did not capture service use data. The ECCE study looked at families who actually used Children’s Centres and looked at variety and frequency of services used. Both evaluations yielded valuable and new knowledge about the challenges of delivery at speed and at scale.
|Some early promising results for non-teen mothers, but children of teen mothers living in Sure Start areas doing less well than children of teen mothers in non-Sure Start areas.||Improved child and parent results, and no differences between the children of teen mothers and non teen mothers. Sub group differences disappeared.||Continued improvement in parent results. Some small improvements in child health and immunisations.||Continued improvement in parent results: better home learning environment, less home chaos, better mother life satisfaction. No cognitive or social differences between Sure Start and non Sure Start children.|
Findings from ECCE were similar, but they did find a correlation between service use and better outcomes. In summary ECCE found:
- Greater impact on overall family function and mothers’ well-being; fewer effects on child outcomes;
- Service use and specific characteristics of children’s centres predicted better outcomes;
- An indirect effect of reducing child externalising behaviour via improvements in the home learning environment;
- Children’s centres targeted their high need families for specialised services;
- Children’s centre use helped to reduce but not eliminate the corroding influence of disadvantage on child outcomes;
- Families in poverty benefitted more from children’s centres than families on middle incomes;
- Children’s centres experiencing cuts to funding were less likely to show improvements for families.[iv]
The Institute for Fiscal Studies (IFS) has recently been doing a separate evaluation of Sure Start. A health impact study was published in 2021 with some surprising findings about the medium to long term effects of Sure Start. For very young children, under twelve months, Sure Start increased the likelihood of hospitalisations by 10%. However, Sure Start’s effects on reducing hospitalisations during childhood and early adolescence more than compensated for the increase in hospital admissions for infants. At age 5, an additional children’s centre per 1000 child population prevented nearly 3,000 hospitalisations compared to children living in an area without access to children’s centres. For 11–15-year-olds, over 13,000 hospitalizations were prevented. The effects were particularly strong for boys from low-income families. It is possible that the increase in infancy acute admissions could be explained by more frequent access to primary care professionals who identified serious health problems early. The health effects on older boys could be explained by better self-regulation leading to fewer accidents.[v] Hence the possibility that earlier changes in parenting styles could show later positive behavioural impact.
Both the NESS and ECCE studies point to some similar conclusions. Firstly, a program targeted at poor areas with open access and assertive outreach can mitigate the impact of poverty on young children. Secondly, the Sure Start effects were mainly on parents, not on children themselves. The early guidance of the program emphasised parental involvement and community participation. this was based on the assumption that improving parental well-being and parenting behaviours would improve cognitive and social outcomes for children. In terms of social development, the results were disappointing. However, it is possible, as shown in the IFS study, that the improved parenting and home learning environments would take time to demonstrably affect children and could have positive impact on younger siblings. For cognitive development, neither evaluation found differences between Sure Start and non-Sure Start children. It is possible that the cognitive development gains were masked by the expansion of free early education and care for all three- and four-year-olds. Hence the difference between Sure Start children and their peers was mainly to do with additional support for parents. All children by 2005 were entitled to at least 12.5 hours per week of free early education and take up was very high. The IFS results came as a welcome surprise. The positive health effects were on children themselves. Finally, all three studies found the Sure Start impact was greater for children living in low-income families. Given the original intent of the program, this is an important positive result.
- What we got wrong
Retrospective views of Sure Start vary. The main criticism was that a program designed for disadvantaged families got hijacked by middle class mothers. This was largely a London effect because of the mix of rich and poor families in areas like Camden, Islington and Hackney. These boroughs housed many journalists and senior civil servants, who themselves had young children and were often using their local Children’s Centre. What was particular to one part of the country became an urban myth that was not borne out by the data. Sure Start, before its expansion to all neighbourhoods was successfully serving the poorest families and all studies found that the benefits were accrued mainly to the poorest families and children.
Sure Start did suffer from over ambitious expectations. Cross Government working is extremely difficult. Each Departmental Minister had his or her hopes for what the program would achieve: stronger local communities, better health, education and social development for young children, increased women’s labour market participation, reductions in child poverty. There were tensions to be managed between the DWP’s aim of reducing child poverty by increasing female labour market participation and the Department for Education’s aim of improving school readiness. The former aim is dependent on childcare that is low cost for parents. The latter aim is dependent on high quality provision with at least some graduate level staff. While subsidies were available for low-income families, the funding of childcare was complex and never adequate to ensure provision was good enough. Furthermore, many mothers were keen to work part time, so needed flexibility in the uptake of free childcare hours. Evidence on the impact of early education on child outcomes was largely based on regular four or five days a week attendance, often mornings or afternoons. Regular short sessions across the week are not as helpful for part time working as two or three long days.
A big surprise to the Treasury was how long it took for programmes to actually start spending Sure Start funding. The initial allocation of funding for the first 250 programs was up to one million pounds capital and up to one million pounds per year revenue for three years. Most programs unsurprisingly asked for the maximum amount allowed. The capital allocation meant finding appropriate places in very poor areas on which to commission new builds or refurbishments to existing premises. Each programme board had significant power over the spend, so getting agreement on what and where to spend capital took several months. Deciding on activities, setting up local evaluations, hiring staff all took time. The NESS study found it took three years from agreement to get a fully functioning programme underway. Hence the first few years of Sure Start was significantly underspent. The key lesson is that community engagement and participation in designing both capital investment and a new service structure takes time and skill. Ministers assumed that the announcement was implementation. Civil servants thought it was posting the guidance. The actual task was complex and required a range of soft and hard skills.
Relevant to the above, there was a failure to recognise the skill mix required to set up a local programme involving parents, statutory and voluntary sector partners. There were some excellent examples of what a Sure Start program should look like, notably the Penn Green Centre in Corby and Coram Family in Camden both of which had been running years before Sure Start. But creating such provision at scale was a huge task. We failed to put in place any arrangements for programme manager support and development. Teachers, social workers and NHS staff all have professional bodies and membership organisations that support their development. Nothing really existed for Sure Start managers who largely came from a mix of backgrounds including health, early years, and special needs housing. Margie Whalley from the Penn Green Centre in set up a master’s level programme in interagency working in the early years. This excellent course filled a gap but required significant investment in time and funding for hard pressed managers trying to get new services up and running.
The popularity of Sure Start proved a mixed blessing. In 2004 the Government decided to offer a Sure Start Children’s Centre in every neighbourhood, 3,500 centres in all. However, the generosity of the original funding was reduced; resources were spread more thinly, although Labour continued to fund the centres in poor areas more generously. This differential funding largely disappeared after 2010. Sure Start remained immensely popular. While he was Prime Minister, David Cameron’s mother was on the picket line trying to save the children’s centre in her area. Expansion greatly increased the awareness of and popularity of Sure Start, and opposition to closure It also resulted in a weakening of the original model.
- Where are we now
The Coalition Government in 2010 made commitments to continue with Sure Start, but the removal of the ring-fenced grant for early years services in 2013 was the death knell for the key principles of Sure Start: open access services for families with young children in all areas, with the funding weighted for poor areas. The drastic cuts in local government funding led to severe reductions in Sure Start Children’s Centres. Those in the poorest areas experienced the most drastic cuts. Most were either closed or hollowed out: open fewer hours on fewer days with fewer services. The key feature of a centre open at least 5 full days a week with a range of services on offer was lost.[vi] Closures meant that potential users would have to travel further to attend a children’s centre. Both these features meant the inevitable reduction in demand.
The Conservative Government from 2015 heralded a repurposing of children’s centres as referrals only centres for families deemed to require social work support. The essential features of community engagement, parents involved in centre governance, and the benefits of social mix to community cohesion were all lost.
More recently, Dame Andrea Leadsom argued in her Early Years Healthy Development Review that the first two years of life are particularly critical to future life chances. In October 2021 the Chancellor announced in his budget speech
£500 million over the next three years to transform ‘Start for Life’ and family help services in half of the council areas across England. This will fund a network of Family Hubs, Start for Life services, perinatal mental health support, breastfeeding services, and parenting programmes. It will also expand the Supporting Families programme, providing up to 300,000 with high quality multidisciplinary support. (Autumn Budget and Spending Review 2021)
Leadsom calls for a universal offer of information and advice for parents, probably delivered digitally, as well as an enhanced offer of face to face support delivered from Family Hubs located in lower income areas. She is also allocating funding to build a workforce more prepared for the special skills required to work with pregnant women and families with babies. Given the neglect of early years and young families over the previous ten years, Leadsom is to be congratulated for getting integrated support for young families back on the policy agenda, with funding attached.
As can be seen from the other articles in this collection, early years policy has been on and off the national agenda for decades. The post war assumption of one adult working full time to support a partner and two children has long been dismantled. A social security system that assumed women would stay at home at least until children started school has disappeared. As the economic pressure for both parents to work has increased, so has the social pressure for both parents to spend more time with their children. Successive governments have adopted policies to improve parental capabilities. A rhetoric has emerged concerning the social class gradient that largely blames poor parenting for the difference in outcomes between children from better off and low-income families. Programmes to improve parental capacity are designed to narrow the gap while economic policy continues to increase pressure on families.[vii] Sure Start was one of a number of initiatives designed to improve outcomes for children, including massive investment in education, health services and tax incentives to make work pay. It is now over 20 years since it was announced in Parliament. Hopes for Sure Start were too high, and many mistakes were made. None-the-less it remains one of the most popular of all New Labour initiatives and is still warmly regarded by thousands of families that used Sure Start services as well as the thousands of staff who worked in local programmes and children’s centres. Whatever comes next, and whatever it is called, the basic premise of community-based centres for families with young children that are open to all and offer a range of services must be a good thing. But it must be supplementary to the services that reduce pressure on parents; adequate income supports, parental leave policies, and high-quality public services.
[i] Glass, N. (1999) ‘Sure Start: the development of an early intervention programme for young children in the United Kingdom’ Children and Society, vol 13 pp 257-264.
[ii] Eisenstadt, N (2011) Providing a Sure Start, How Government discovered early childhood. Bristol, Policy Press
[iii] National Evaluation of Sure Start Team (2012) The impact of Sure Start Local Programmes on seven year olds and their families. Department for Education.
[iv] Sammons et al, (2015) The impact of children’s centres: studying the effects of children’s centres in promoting better outcomes for young children and their families. Department for Education.
[v] Cattan et al (2019) The Health Effects of Sure Start. Institute for Fiscal Studies.
[vi] Smith, G et al (2018) Stop Start, survival, decline or closure? Children’s centres in England, 2018. University of Oxford and Sutton Trust.
[vii] Eisenstadt, N and Oppenheim, C. (2019) Parents, Poverty and the State, 20 years of evolving family policy. Policy Press, Bristol.