SHA Vice Chair, Dr Jatinder Hayre, explains why Sure Start still matters.
Britain’s political stage often swings between the ideal of comprehensive early-years provision and the pressure for immediate, visible results. Sure Start emerged as a beacon of possibility—local children’s centres designed to support families in underprivileged areas. Yet, tightening budgets loom, programmes delivering long-term benefits are often first to face cuts. My recent BMJ Open study highlights the danger of such short-termism, showing how diminishing early-years initiatives deepen inequalities well beyond childhood.
What was Sure Start and why did it matter?
Sure Start was built on the conviction that early intervention can disrupt entrenched disadvantage. Informed by the Acheson Report, it merged healthcare, parenting advice, and educational support under one roof. Early evaluations noted improved child development and fewer hospital admissions. However, austerity led many centres to close or reduce services. The BMJ Open paper affirms that weakening this infrastructure stalls progress and magnifies social disparities—exactly what Sure Start was intended to counter.
Critically, the study underscores how timely help reduces downstream costs. Areas that protected Sure Start funding recorded fewer paediatric hospital visits, stronger educational achievement, and lower childhood obesity. Conversely, scaling back budgets undermined families at the earliest point, enabling minor challenges to swell into heavier burdens on schools, social care, and the NHS. Rather than view children’s centres as expendable, the BMJ findings suggest they should rank alongside other vital social infrastructure.
From Hayre et al, BMJ Open 2025;15:e089983. doi: 10.1136/bmjopen-2024-089983
Hurdles, obstacles and barriers
A persistent hurdle is the mismatch between political calendars and the slower process of child development. Politicians favour quick policy gains, yet improvements in literacy or mental health may emerge only over years. Critics sometimes dismiss Sure Start as expensive or too diffuse, but the study indicates that every pound cut now can lead to multiple pounds spent later on remedial interventions. Chronic poverty, poor school performance, and intergenerational disadvantage all worsen when early support is withheld.
An added obstacle is limited public awareness. If voters do not see how crucial the earliest years are, they may not defend programmes like Sure Start when budgets tighten. The BMJ research provides robust data for policymakers while arming communities with the evidence to demand consistent funding. In regions that maintained Sure Start centres, positive outcomes have continued: better speech and language development, stronger family resilience, and enhanced emotional wellbeing.
Morally, a fair society ensures every child has an equal start.
Economically, it pays dividends: well-supported children typically thrive at school, leading to higher earning potential and reduced reliance on state assistance. By contrast, repeated underfunding of Sure Start keeps low-income families trapped in deprivation. The BMJ Open paper thus serves as a stark reminder that cutting early-years provision stores up problems for the future—both financial and social.
Notably, the study outlines clear measures for success. Stable, multi-year budgets allow local authorities to retain skilled staff and refine programmes—like parenting workshops or breastfeeding support—over time. Collecting and integrating data from health, education, and social services can highlight patterns, fine-tune interventions, and reveal where extra resources are most needed. Such a coordinated approach underscores that Sure Start’s broad scope is its greatest strength, enabling a multiplier effect for vulnerable families.
From Hayre et al, BMJ Open 2025;15:e089983. doi: 10.1136/bmjopen-2024-089983
Public funding and provision of Sure Start recompense local authorities and central government through long-term socio-economic returns. This success evidences the BMJ Open findings: early intervention can reorient life trajectories, reduce dependency, and strengthen social cohesion. Indeed, it is far from being a drain on public finances; robust early-years programmes ultimately recoup their costs by preventing more expensive crises.
What often stands in the way is the lure of short-term political wins. Policymakers may be reluctant to invest in projects whose full returns appear beyond the next election cycle. Yet if society aims to narrow inequalities, improve public health, and cultivate a more resilient populace, investing in early years is among the most effective levers available. By the time negative outcomes arise, it is generally too late for economical fixes.
Ultimately, sustaining Sure Start requires both political vision and well-informed public advocacy. While cutting children’s centres may seem to ease immediate budget pressures, it pushes heavier costs into the future. The BMJ Open paper shows that early intervention is not only ethically justified but also fiscally prudent. If Britain wishes to tackle inequality at its roots, it cannot afford to dismantle programmes with a proven record of success.
Consistent support for Sure Start generates benefits that ripple across generations.
Children entering formal education better prepared are more likely to progress to higher education or stable employment. Families gain in confidence and community ties, reducing reliance on crisis services. The evidence is unequivocal: short-term cuts sabotage long-term gains, at the cost of children’s wellbeing and the nation’s collective progress.
Dr Jatinder Hayre is a medical doctor and public health researcher, with an interest in health equity and the social determinants of health. He is an established health campaigner and Vice Chair of the SHA.
References
Hayre J, Pearce H, Khera R, et al.
Health impacts of the Sure Start programme on disadvantaged children in the UK: a systematic review. BMJ Open 2025;15:e089983. doi: 10.1136/bmjopen-2024-089983