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Sure Start delivered long-lasting health benefits for children

The Sure Start Programme has delivered long-lasting health benefits for children through their teenage years, with the savings from reduced hospitalisations up to age 15 offsetting around 31% of spending on the programme.

Sure Start Children’s Centres, which were established in 1999, brought together health, parenting support, childcare and parental employment services into a one-stop shop for families with children under five years old.

While greater access to Sure Start initially increased hospitalisations for children aged one, these early increases are more than outweighed by longer-term effects, which reduced hospitalisations through childhood and adolescence, according to research by the Institute for Fiscal Studies.

Maud Pecher, a co-author of the report, said: “By bringing together a wide range of early years services for children under 5, Sure Start centres dramatically improved children’s health even through their teenage years. Children who had greater access to Sure Start in their early years were far less likely to be hospitalised later on – at its peak, Sure Start provision prevented over 13,000 hospitalisations of 11- to 15-year-olds each year. These benefits were particularly long-lasting for boys and children in disadvantaged neighbourhoods.”

The research, funded by the Nuffield Foundation, builds on previous IFS analysis and provides the first evidence of how this major initiative affected children’s health up to age 15.

The report found:

  • Greater access to Sure Start initially increased hospitalisations at age one, which is most likely due to the programme’s role in referring parents to appropriate healthcare for children’s illnesses, and greater exposure to infectious illnesses from group settings.

  • However, these early increases are more than outweighed by longer-term effects, which reduced hospitalisations through childhood and adolescence.
  • Sure Start provision at the level of its peak (in 2010) reduced hospitalisations at age 5 by 7% which translates to around 2,800 fewer hospitalisations a year.

  • These long-term benefits persisted as children got older. Peak levels of Sure Start provision during childhood prevented over 13,150 hospitalisations of 11- to 15-year-olds each year (an 8% reduction on pre-Sure-Start hospitalisation rates).

“This means that Sure Start had long-term benefits for children’s health, lasting almost a decade after children have ‘aged out’ of eligibility,” said the report.

The research also highlighted that the benefits for child health come from several different channels, including:

  • Stronger immune systems
  • Less risky environments
  • Improved mental health
  • Potentially better behaviour during adolescence.

There was, however, no evidence that Sure Start affected mothers’ employment.

Furthermore, boys enjoy longer-lasting benefits from Sure Start than girls, reflecting their greater sensitivity to disadvantage in the early years. After the end of primary school, the impact of Sure Start on girls’ hospitalisations fades out, but the benefits for boys continue to grow. By age 15, an extra Sure Start centre per thousand children during childhood prevents over 3,200 hospitalisations a year among boys but has no effect for girls.

The benefits of Sure Start were also longer-lasting in more disadvantaged neighbourhoods, suggesting that Sure Start provision helped to reduce health inequalities.

Going forward, an important lesson for services such as Family Hubs is that a model combining universal services with an area-based focus on disadvantaged neighbourhoods can be a successful approach to early years interventions, said the IFS report.

Sarah Cattan, IFS Associate Director and a co-author of the report, said: “The savings from reduced hospitalisations up to age 15 offset around a third of the cost of the Sure Start programme – and that’s before considering any potential benefits in education, social care or crime. Ahead of this autumn’s tight Spending Review, these results are a reminder that policymakers should consider a programme’s potential for long-term savings, not just its up-front costs.”

The health impacts of early childhood interventions: evidence from Sure Start

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