SURE Start was a terribly good thing for countless numbers of children and its decline at the hands of the vicious Tories and their austerity has been a national disaster. Of course it has – just see all newspapers and broadcasters last week.
You may remember that Sure Start was launched by Tony Blair and Gordon Brown 20 years ago, with the aim of improving the health and development of pre-school children. It was one of New Labour’s signature ideas, with money to match. By 2010 there were 3,300 Sure Start children’s centres run by local councils, at a cost to taxpayers of £1.8billion a year, providing childcare, health checks, advice and information for parents in one convenient place.
The cruel Tories have cut that budget by two-thirds since 2010 and councils have closed 500 children’s centres, most of them in more affluent areas.
Last week the Institute for Fiscal Studies (IFS) produced a report which examined exactly how much good Sure Start centres did in their first decade of operation. https://www.ifs.org.uk/publications/14139 It found, according to the BBC, that there had been ‘big benefits for children’s health’ and ‘a positive impact from the scheme’.
The Times said that ‘health risks among poorer children have been reduced‘. The Guardian said the centres ‘delivered major health benefits for youngsters in the most deprived areas, reducing the number of people taken to hospital and delivering millions of pounds in savings to the NHS.’
It was all so convincing that the Anglican Bishop of London, the Right Reverend Dame Sarah Mullally, tweeted that ‘Sure Start centres played a critical role in children’s health.’ And she should know, because she is a former Chief Nursing Officer at the Department of Health.
When I see a lot of talk about major benefits and critical role and positive impacts, I think it’s worth asking, how big? The bottom line, follow the money, and all that. So, shall we?
Fortunately, some way towards the back of its 100-page report, the IFS has worked out some answers.
It says that the health benefit of Sure Start was that it had reduced hospital admissions for young children, so that if there was one Sure Start centre for every 1,000 children, there would be 5,500 fewer hospital admissions of 11-year-olds each year.
The financial gain for the NHS from this reduction in hospital admissions, the IFS said, has been £5million a year. There’s the Guardian’s millions for you.
This saving amounted to 0.4 per cent of spending on Sure Start.
Let me guide you through the arithmetic. What that figure means is that for every £1billion of public money sunk into Sure Start, the NHS saved £4million. Or, on a Thatcher-style household budget scale, the Health Service was saved £1 for every £250 that went into Sure Start.
All of this gain, all of it, was in the poorest third of districts. There were no gains for the NHS from the many Sure Start centres in the rest of the country.
There must have been other benefits from Sure Start, surely?
No. The IFS looked for evidence that the centres had reduced child obesity among five-year-olds, or improved the mental health of mothers. It found none. The IFS report assured us that this unfortunate gap ‘should not be taken as evidence that there is in reality no effect’. Well, only if you place your trust in wishful thinking.
Using the same kind of analysis, the report reckoned that if you look at the health improvements produced by fewer hospital visits for those 5,500 kiddies across their whole lifetimes, then the value to the NHS of Sure Start rose to a whole six per cent of Sure Start spending. I am no statistician, but I suspect there is some extrapolation going on there.
The trouble with these nasty figures is that they chime with one or two official signs that perhaps Sure Start was never the wonderful boon to children and families that it was made out to be.
The first Government-sponsored inquiry into the success of Sure Start, published in 2006, said its impact was ‘small and limited’ and that deprived children in Sure Start areas actually did worse than those outside them. This finding was not repeated in subsequent Whitehall assessments of the Sure Start network.
However, earlier this year the National Audit Office, the Whitehall spending watchdog, said that the closure of 500 Sure Start centres since 2010 does not appear to have resulted in harm to children.
It said – and please bear with the jargon because for once it means something – ‘stakeholders and academics have suggested that closing children’s centres would result in increased, and more expensive, statutory child protection work. We tested the hypothesis that closing these centres has, by reducing preventative services, increased the need for statutory intervention, measured through increased child protection plans.
‘The closure of these centres has not resulted in increased statutory children’s social care activity. Indeed, for those local authorities which had closed centres there was a slight fall in the number of child protection plans.’
I do not think you need an especially cynical mindset to come to the view that a great deal of the spending on Sure Start has been wasted.
If you were the Bishop of London, you might wonder if it would not have been better to give that £1.8billion a year direct to the NHS.
Last month the IFS proposed a local income tax to raise more money for councils. If you read both IFS reports, you might wonder if the money sunk into Sure Start could be diverted to councils to pay for more social care for the old and vulnerable.
My view, for what it’s worth, is that the bright and frequently ideologically-driven ideas that governments come up with in the name of helping children and families are almost always misconceived. But once politicians have poured money in, it becomes impossible to stop them. Sure Start continues to soak up £600million a year. David Cameron’s pet Troubled Families Scheme, long since exposed as a shambolic failure, has cost over £1billion and still Theresa May’s ministers have lacked the courage to kill it off.
If the new Prime Minister turns out to be a tax and spending cutter, this is my advice: start here.
