Sure Start had major health benefits for children in poorer neighbourhoods

One of Sure Start’s original aims was to improve the health of, especially, disadvantaged children. A new IFS study, funded by the Nuffield Foundation, is the first of its kind to follow children who had access to Sure Start right through to the end of primary school.

The IFS find that it did indeed have a big positive effect on children’s health, reducing hospitalisations. That positive effect was concentrated on children living in disadvantaged areas.

The Sure Start programme – now known as Children’s Centres – is a major source of government support for families with young children. First established 20 years ago to serve disadvantaged neighbourhoods, Sure Start was later expanded across England. Providing health, education and childcare services, spending peaked at £1.8 billion a year in 2010 (in current prices) but has been cut by two thirds since then with the closure of more than 500 centres and service cuts affecting many more sites.

The main findings of the research include:

  • Sure Start significantly reduced hospitalisations among children by the time they finish primary school.These effects build over time: while we find no significant effect at age 5, by age 11, greater Sure Start coverage (one more centre per thousand children aged 0-4) prevents around 5,500 hospitalisations per year (18% of the pre-Sure Start baseline).
  • Sure Start’s benefits are strongest for children living in disadvantaged areas. Indeed we find no effect on the hospitalisations of children living in the richest 30% of neighbourhoods.This means that providing access to Sure Start at the level of the programme’s peak closes about a half of the gap in hospitalisation rates between the 30% poorest and 30% richest areas by the end of primary school.
  • At every age in primary school, Sure Start reduced hospital admissions for injuries. At younger ages, injury-related hospitalisations fell by around 17% of their pre-Sure Start (1998) baseline; at ages 10 and 11 they fell by 30%. 
  • Our results are robust and hold up against a variety of checks. Our findings account for differences between neighbourhoods and nationwide differences across years. As expected we find no impact of placebo treatments or on outcomes which Sure Start can’t influence (like genetic defects). This gives us additional confidence in the findings.
  • The direct savings to the NHS from fewer hospitalisations at ages 5-11 amount to about £5 million per cohort, or just 0.4% of average annual spending on Sure Start. Including the longer-run savings from fewer injuries as well, the financial benefits reach around 6% of Sure Start’s budget. However, a full cost-benefit analysis is not possible since we only investigate Sure Start’s impact on health outcomes.
  • Between 2011 and 2017, over 500 centres have officially been closed. While closures have been more concentrated in richer areas, about 100 of those closures have been in the poorest 20% of neighbourhoods. There has been a lot of variation between councils. Some local authorities have closed the majority of their centres, while others have chosen to keep centres open but reduce the services on offer through them.

With its newly announced review into Children’s Centres, as well as the upcoming Spending Review, the government has a chance to assess the impacts that Sure Start has had and decide on its vision for the future of the programme. While the review will be national, the government has been clear that it believes that decisions about Sure Start should be taken at the local level. It is crucial that both local authorities and central government consider the effectiveness of Sure Start for different groups when deciding how services should be delivered going forward.

At least when it comes to health outcomes, the research provides strong evidence that the Sure Start model has worked better in poorer neighbourhoods, reducing health inequalities. Unpicking to what extent this is driven by choices these centres make or the characteristics of the families they serve should be a top priority for future research into Sure Start. For now though this does suggest focussing limited resources on poorer neighbourhoods rather than spreading more thinly.

UCL Associate Professor and IFS Research Fellow Gabriella Conti said: “Access to Sure Start has had big benefits for children’s health during primary school. Relative to not having Sure Start, opening one centre for every thousand children prevents 5,500 hospital admissions of 11-year-olds each year. Since the benefits are biggest in the poorest neighbourhoods, access to Sure Start can help close around half the gap in hospitalisations between rich and poor areas.”

IFS Research Economist Christine Farquharson said: “Sure Start has had a turbulent history, with a fast rollout followed by deep spending cuts. But these decisions were not always based on thorough evidence about the programme’s impacts on children and their families. Ahead of the Spending Review and the government’s new review of Children’s Centres, it’s crucial that both central government and local authorities use the best evidence available to decide on their vision for Sure Start as the programme turns 20. Our findings suggest that limited resources are best focussed on the poorest areas.”

Related


Explore our projects

New

Education | 2025 - 2026

Investigating performance across Key Stage 2 maths topics

View project
Teacher with secondary pupils
New

Education | 2024 - 2028

Teaching improvement through data and evaluation (TIDE)

View project
New

Welfare | 2024 - 2027

Gypsy, Roma, Traveller Youth: mitigating exclusions using the digital?

View project
A front view of a father and his two children. He is carrying his young son in his arms and his daughter is riding her scooter along the footpath as he pushes his son's scooter along the way.
New

Justice | Welfare | 2024 - 2026

Challenging justice inequalities with children in conflict with the law 

View project
New

Education | 2024 - 2026

Long-term outcomes of high-achieving disadvantaged children

View project
New

Education | 2024 - 2026

Exploring academic selection and grammar schools in Northern Ireland

View project
New

Education | 2024 - 2026

Pupil school mobility: types, pathways and implications for education

View project
New

Education | 2024 - 2026

Can digital parenting interventions benefit early language development?

View project
New

Welfare | 2024 - 2027

Performance Tracker 

View project
Little girls in primary school uniform

Education | 2024 - 2026

Developing a classroom intervention to improve conversation skills

View project
New

Education | 2024 - 2026

Vocabulary for Reading: the power of words

View project
Mother wearing hijab holding her toddler son on her knee, smiling at each other
New

Welfare | 2024 - 2025

Afghan resettlement in England: outcomes and experiences 

View project
A front view of a father and his two children. He is carrying his young son in his arms and his daughter is riding her scooter along the footpath as he pushes his son's scooter along the way.
New

Justice | Welfare | 2024 - 2026

Challenging justice inequalities with children in conflict with the law 

View project
New

Education | 2024 - 2026

Pupil school mobility: types, pathways and implications for education

View project
Teacher with secondary pupils
New

Education | 2024 - 2028

Teaching improvement through data and evaluation (TIDE)

View project
Secondary school music teacher smiles at students working together at a keyboard.
New

Education | 2024 - 2025

Teacher recruitment & retention challenges in England

View project
New

Welfare | 2024 - 2027

Gypsy, Roma, Traveller Youth: mitigating exclusions using the digital?

View project
New

Education | 2024 - 2026

A feasibility and pilot trial of the Early Years Library

View project
New

Welfare | 2024 - 2027

Performance Tracker 

View project
New

Education | 2024 - 2026

Can digital parenting interventions benefit early language development?

View project
Mother wearing hijab holding her toddler son on her knee, smiling at each other
New

Welfare | 2024 - 2025

Afghan resettlement in England: outcomes and experiences 

View project
New

Education | 2025 - 2026

Investigating performance across Key Stage 2 maths topics

View project
three women walking along street laughing and smiling
New

Welfare | 2023 - 2025

Revealing social capital

View project
New

Education | 2024 - 2026

Vocabulary for Reading: the power of words

View project
In progress

Education | 2023 - 2024

Artificial intelligence and education

View project
A woman is sat on the edge of a bed staring at her phone while her daughter is in the background.
In progress

Welfare | 2023 - 2025

Virtual parent support portals: a new research and practice agenda

View project
Two little boys and a little girl, all wearing primary school uniform, work together to solve a puzzle in their classroom.
In progress

Education | 2023 - 2025

What has ‘Free School Meals’ measured and what are the implications?

View project
Teenager hugging their mother
In progress

Welfare | 2023 - 2026

The long-term effects of being a young carer

View project
Elderly woman and adult daughter out shopping
In progress

Welfare | 2023 - 2026

Connecting pensions, health and care

View project
Father and daughter having fun at home
In progress

Education | 2023 - 2024

Optimisation and feasibility of Triple P parenting programme for remote delivery

View project
Early years professionals playing with children
In progress

Education | 2022 - 2024

Understanding the take-up of early education entitlements

View project
Primary school children using a microscope during a lesson outside at school
In progress

Education | 2023 - 2025

Purposeful and effective practical work in primary school science

View project
Male and female apprentices looking at car engine
In progress

Education | 2022 - 2025

Work or study? Gender and the transition from school to work

View project
Mother, father, son and daughter standing in front of their house
In progress

Welfare | 2023 - 2025

A regional regeneration index to track socioeconomic ‘Levelling Up’

View project
Two teenage male pupils study a science lesson as part of their post-16 options
In progress

Education | 2019 - 2024

Post-16 pathways: the role of peers, family background and expectations

View project
Man working on a laptop using sign language on a video call
In progress

Welfare | 2023 - 2024

Designing inclusive remote and hybrid working to support disabled workers

View project
Secondary school music teacher smiles at students working together at a keyboard.
New

Education | 2024 - 2025

Teacher recruitment & retention challenges in England

View project
New

Welfare | 2024 - 2027

Gypsy, Roma, Traveller Youth: mitigating exclusions using the digital?

View project
New

Education | 2024 - 2026

A feasibility and pilot trial of the Early Years Library

View project
New

Welfare | 2024 - 2027

Performance Tracker 

View project
New

Education | 2024 - 2026

Can digital parenting interventions benefit early language development?

View project
Mother wearing hijab holding her toddler son on her knee, smiling at each other
New

Welfare | 2024 - 2025

Afghan resettlement in England: outcomes and experiences 

View project
New

Education | 2025 - 2026

Investigating performance across Key Stage 2 maths topics

View project
three women walking along street laughing and smiling
New

Welfare | 2023 - 2025

Revealing social capital

View project
New

Education | 2024 - 2026

Vocabulary for Reading: the power of words

View project
New

Education | 2024 - 2026

Spending across different stages of education

View project
New

Education | 2024 - 2026

Exploring academic selection and grammar schools in Northern Ireland

View project
A middle-aged man sat at home is looking at this phone while sorting pension paperwork.
New

Welfare | 2023 - 2025

Collective defined contribution pensions with investment choice

View project
Reception class children using a parachute in a PE lesson
Reported

Education | 2022 - 2023

A movement and story-telling intervention for reception children

View project
Grandparents having fun outdoors with their granddaughter, who is eating an apple and laughing: Understanding family and community vulnerabilities in transition to net zero
Reported

Welfare | 2021 - 2023

Understanding family and community vulnerabilities in transition to net zero

View project
Side view of two female high school students in classroom working on laptops social distancing. Student in foreground is in focus and student in background is blurred
Reported

Education | 2021 - 2022

COVID-19 and disadvantage gaps in England 2020 and 2021

View project
Close up of a young girl and her father wearing protective face masks during the COVID-19 pandemic outside.
Reported

Welfare | 2021 - 2023

The Economy 2030 Inquiry: navigating a decade of change

View project
Young boy draws and plays with a globe as part of nursery education
Reported

Education | 2020 - 2022

COVID-19 and childcare: local impacts across England

View project
Reported

Justice | 2020 - 2022

When is a wedding not a marriage? Exploring non-legally binding ceremonies

View project
Reported

Education | 2020 - 2022

Ethical principles underpinning co-production with young people

View project
Reported

Education | 2020 - 2021

COVID-19 mitigation measures: education provision and access to special schools

View project
Young-boy-uses-tablet-with-mother-for-maths-learning-Can-maths-apps-add-value-to-learning-PROJ
Reported

Education | 2020 - 2022

Can maths apps add value to learning?

View project
Toddler-gleefully-eats-baked-beans-How-COVID-19-is-affecting-food-security-proj
Reported

Welfare | 2020 - 2021

How the COVID-19 crisis is affecting food security

View project
Male secondary school student working at home on laptop
Reported

Education | 2020 - 2021

The impact of COVID-19 on mainstream schools in England

View project
Teenage-girl-looks-at-smartphone-next-to-laptop-Growing-up-under-COVID-19-PROJ
Reported

Education | Welfare | 2020 - 2022

Growing up under COVID-19

View project
Search projects

We improve people’s lives by funding research that informs social policy, primarily in Education, Welfare and Justice. We also fund student programmes that give young people skills and confidence in science and research.

We offer our grant-holders the freedom to frame questions and enable new thinking. Our research must stand up to rigorous academic scrutiny, but we understand that to be successful in effecting change, it also needs to be relevant to people’s experience.

Profile