Evaluation and value of Sure Start.

A decade ago, the Cross-Departmental Review of Services for Young Children concluded that disadvantage among young children was increasing and it was more likely that poor outcomes could be prevented when early intervention was undertaken.1 The review also noted that current services were uncoordinated and patchy, and recommended that there should be a change in service design and delivery. It suggested that programmes should be jointly planned by all relevant bodies and be area based, with all children under 4 years old and their families in an area being clients. In July 1998, the then Chancellor of the Exchequer, Gordon Brown, introduced Sure Start, which is aimed at providing quality services for children under 4 years old and their parents.2 The original intent of the programme design was to focus on the 20% most deprived areas, which included around 51% of children in families with incomes 60% or less than the national median (offi cial poverty line).3 Over 3 years, £542 million was made available, with £452 million designated for England. In England, 250 programmes were planned by 2001–2002 to support 187 000 children, 18% of poor children under 4 years old. Typically, a programme was to include 800 children under 4 years old, with £1250 per annum per child at the peak of funding. Programmes were to run for at least 10 years with funding peaking at year 3 and declining from year 6 to none at year 10. Some funding would fall to local authorities, made available by “reshaping” services. This investment utterly transformed early-year services while representing a relatively small contribution from the perspective of treasury— just 0.05% of public expenditure. In this brief summary, we cover the history and impact of this ambitious initiative. While more than 40 reports and peer-reviewed publications have documented the different phases of the National Evaluation of Sure Start with the corresponding fi ndings, this report provides an overview of the evolution and impact of the Sure Start programme. As individuals involved in the evaluation of the overall initiative, we attempt to provide a summary of what has been learnt thus far. Community control was exercised through local partnerships, comprising everyone concerned with children, including health, social services, education, private and voluntary sectors, and parents. Funding fl owed from central government directly to programmes, which were independent of local government, although local departments of education, social services, etc, and health trusts would typically be part of the partnership. All programmes were expected to provide (1) outreach and home visiting; (2) support for families and parents; (3) support for good quality play, learning and childcare experiences for children; (4) primary and community healthcare and advice about child health and development and family health; and (5) support for people with special needs, including help getting access to specialised services but without specifi c guidance as to how.4 While evidence derived from programmes with clear unambiguous protocols for services were used to justify Sure Start, Sure Start programmes did not have a prescribed “protocol” and had freedom to improve and create services as they wished.5 This was in contrast to examples of interventions with clear models of provision and demonstrable effectiveness used to justify Sure Start.6–8 The speed of funding was often overwhelming in a sector previously starved of support. Only 6% of the 1999 allocation was spent in that year. Despite this slow start, and without any information on the success of the initiative, the treasury expanded Sure Start from 250 by 2002 to more than 500 programmes by 2004, thereby more than doubling expenditure to almost £500 million by 2003–2004. Thus, Sure Start became a cornerstone of the campaign to reduce child poverty. The National Evaluation of Sure Start (NESS) was commissioned in 2001. Programme diversity posed challenges in that there were not several hundred programmes delivering one intervention, but several hundred unique interventions. The early evaluation protocol to 2005 has been summarised,9 and detailed reports are available at http://www.ness.bbk. ac.uk, with some fi ndings summarised here. Government decisions effectively ruled out a randomised controlled trial; hence, a quasi-experimental design was used with its consequent limitations to compare Sure Start populations with equivalent populations not receiving Sure Start. An independent review of early fi ndings of the evaluation work and a critique of the methodology is available.10