The health impacts of Sure Start

Over the last two decades, Sure Start Children’s Centres (and their predecessors, Sure Start Local Programmes) have been one of the most important policy programmes in the early years in England. These centres operate as ‘one-stop shops’ for families with children under 5, bringing together a range of support including health services, parenting support programmes, and access to childcare and early education.

While Sure Start itself has seen its budget cut by more than 60% since 2010, the principles behind the programme continue to drive policy. Most recently, the Leadsom Review considering the first 1,001 days of life made the case for early years programmes to offer ‘coherent’, ‘welcoming’, ‘joined-up’ services ‘around the needs of the family’.

Despite Sure Start’s past importance in the early years landscape and its continuing influence over policymaking in this area, surprisingly little is known about how the programme affected families’ and children’s outcomes. In this briefing note (and the accompanying working paper), we extend the evidence from our 2019 report to show how Sure Start has influenced children’s health. Specifically, we extend our analysis to assess Sure Start’s impacts on hospitalisations of very young children, who are still eligible to use its services (ages 1–4), and of adolescents, who may still enjoy medium-term benefits from Sure Start exposure (ages 12–15).

Sure Start’s impacts on hospitalisations

We find strong evidence that access to Sure Start affects children’s hospitalisations. In the earliest years of life, Sure Start increases hospitalisations as families get more support to use health services and as children are exposed to a wider range of infectious illnesses. But after the first few years, Sure Start decisively reduces hospitalisations, with stronger immune systems, better disease management, safer home environments and fewer behavioural problems all potentially playing a role.

These effects are substantial; our calculations suggest that an additional centre per thousand children under 5, on average, generates around 6,700 additional hospitalisations of 1-year-olds each year. But it also prevents around 13,150 hospitalisations each year between the ages of 11 and 15 – meaning that Sure Start averts nearly twice as many hospitalisations among older children as it induces in 1-year-olds.

Our results also suggest that Sure Start had particularly big benefits for some groups of children. The fall in hospitalisations the programme brought about is concentrated among boys and, at later ages, in more disadvantaged neighbourhoods.  

Key findings

1. Sure Start increased hospitalisations among very young children. At age 1, having access to an extra centre per thousand children under 5 increased the probability of a hospitalisation in the neighbourhood cohort by 10%. This translates to roughly 6,700 additional hospitalisations a year.
   
   
2. However, Sure Start’s effects on reducing hospitalisations during childhood and adolescence more than compensate for the increase in admissions at very young ages. At age 5, an additional centre per thousand children prevented around 2,900 hospitalisations a year; for 11- to 15-year-olds, the total was over 13,150 prevented hospitalisations each year.
   
   
3. Sure Start’s impacts on child health last well beyond the end of the programme itself. Indeed, some of the biggest impacts are only felt in adolescence, nearly a decade after children have ‘aged out’ of eligibility.
   
   
4. Sure Start services seem to have affected children’s health through several different channels. At younger ages, large impacts on infectious illness suggest that Sure Start significantly strengthened children’s immune systems. A drop in poisonings in these age groups suggests that advice on child-proofing the home also had an effect. In early adolescence, we see far fewer hospitalisations for mental health reasons. Throughout childhood, we see a bigger drop in admissions for injuries among boys than among girls. These effects point to potential longer-term benefits from Sure Start supporting children’s socio-emotional and behavioural development.
   
   
5. The benefits of Sure Start are not evenly distributed. At most ages, Sure Start had significantly larger impacts on boys than on girls. The programme also had bigger benefits for children in disadvantaged areas, at least from age 9 onwards. This suggests that a model that combines universal services with an area-based focus on disadvantaged neighbourhoods can be a promising approach to early years interventions.
   
   
6. While the full cost of providing Sure Start to all eligible children may not be recouped by including only the health returns, we find that the financial benefits from reducing hospitalisations offset approximately 31% of the cost of Sure Start provision. This figure is likely to underestimate the benefits of Sure Start since the programme may have affected many other outcomes beyond hospitalisations. Future work will study impacts of Sure Start on educational outcomes, use of social care, and offending.
   
   
7. Evidence from Sure Start shows that large-scale, holistic interventions can be effective in improving children’s health. It is particularly exciting to find evidence that the benefits persist (or even grow) after children are too old to attend the centres. The success of Sure Start in promoting child health should inform policymakers’ decisions about the design of and funding for early years programmes. In particular, policymakers should consider the longer-term benefits of these programmes and their potential to reduce inequalities.