Sure Enough?

It’s early days, but
how well are the local roots put down by Sure Start doing? Jane Tunstill
describes the findings of the implementation team’s study of 118 Sure Start

Start has so far had the highest profile of the government’s community-based
initiatives. This is because most of its goals are fundamental to the
government’s drive to tackle child poverty and social exclusion. It aims to
improve the health and well-being of families and young children under-four so
that children have greater opportunity to flourish when they go to school.
These aims are addressed through 
community-based programmes serving 400 to 800 children. Starting in
1999, the first 260 programmes have been rolled out in stages – each “round”
has 60-70 programmes.

The implementation
study discussed here looks at the policy and practice characteristics of the
118 Sure Start programmes. Three other areas of research are running in
parallel: an impact study, a local context analysis, and a cost-effectiveness


There is a broad
range of representatives in the management structures of most programmes,
including the main statutory agencies, voluntary sector, parents, and other
members of the local community.

The level of parental
involvement in Sure Start is generally high, with parents contributing to the
management of every programme but one. These were overwhelmingly mothers rather
than fathers, although almost half of programmes do have fathers on the
management board. Most programmes provide practical support such as child care
and transport, to enable parents to be involved in management meetings, and
some provide other types of support such as confidence-building courses. Almost
all programmes have parents of children under four working as volunteers in
their programme.

The voluntary sector
is well represented, and only five Sure Start programmes have no voluntary
sector representative. The four voluntary organisations with the greatest
operating presence in Sure Start areas are Pre-School Learning Alliance,
Home-Start, Citizens Advice Bureaux, and the National Childminding Association.

The main statutory
agencies – health, education and social services – are represented in the
management of most programmes. Health agencies have the highest number of
representatives, with an average of three per programme.

Working in
multi-agency partnerships, developing collaborative relationships and joining
up with partners and other relevant groups form among the most important tasks
facing programme managers. The survey found that, although a quarter of
programmes are finding ways to join up with their partners, most programmes, at
this early stage, still have a long way to go.


Sure Start programmes
are becoming significant employers in their area, employing both professionals
and members of the local community. Although some programmes are working
towards ensuring their staff’s ethnic profile reflects that of the local
population, others have considerable work to do. More than half of programmes
have a system in place to monitor the ethnicity of their staff.

Volunteers are an
important resource in terms of delivering services in almost all Sure Start
programmes, though the number of volunteers varies widely. Where volunteers are
used, the average voluntary input is 98 hours per week.

Providing services

Programmes are making
efforts to maximise access to services, from publicising the programme, to
engaging hard-to-reach groups and tailoring the provision of service delivery
to groups with particular needs. They are adopting many ways to publicise their
service, including social events, visits by health visitors or midwives, and
press coverage. Programmes try to make all materials available to the whole
community, including the use of translation and interpreting services.

Discovering where
families with young children live is a complex task, carried out by using
health information systems and health professionals, who introduce families to
Sure Start. Knocking on doors is also used. Health visitors and midwives are
very important in this. They often make the initial contact with families and
encourage them to use services. Schemes are also making similarly good use of
community and social workers.

Most programmes make
special provision for hard-to-reach groups such as  parents under 20, ethnic minorities, families with literacy
problems, fathers, families with mental health problems, traveller families,
refugees and asylum seekers.

The size of outreach
teams varies enormously across programmes, as do programmes’ policies on
routine home visiting. Most programmes planned at least one routine visit to
children under the age of one year with a quarter of programmes providing two
visits. Two-thirds planned routine visits to 13-24 month olds, while around a
half planned routine visits to 25-48 month olds. Many programmes stated they
visited “as needed”.  

The main ways in which
Sure Start programmes support families are through extending existing home
visiting and family support services, providing parenting programmes, drop-in
centres, and a dedicated Sure Start centre. Three-quarters of programmes have
specific provision for supporting fathers and most programmes (85 per cent)
have introduced specific services for families with children with special
educational needs and disabled children. More than 50 per cent of programmes
have specialist parenting programmes for parents with disabled children,
travellers’ families and asylum seeking families.

Most (90 per cent)
programmes have or plan to have links with local educational institutions to
encourage parents to take up training or education.

Health and
child care

Home visiting,
antenatal services, access to specialists and services for children and parents
with special needs were regarded as the most important health services for Sure
Start programmes. Almost all programmes are developing a range of new or
extended antenatal services, including home visits by midwives. Most programmes
hold antenatal clinics and classes in their local area, screen new mothers for
postnatal depression, and provide support for those mothers diagnosed with it.
Most (89 per cent) provide breastfeeding advice, information and support. Those
programmes that are not yet providing these services are planning to.

Other health-related
work includes smoking cessation and healthy eating advice – important aspects
of almost every programme. Most programmes (70 per cent) provide home safety
equipment to parents, although less than one half offer home safety checks, and
80 per cent do not monitor housing quality.

The provision of
child care, play and learning services varies considerably between programmes
as some areas already had good services before the implementation of Sure Start
in the locality while others had little. Three-quarters of programmes are
providing new child care places in either crèche, childminder or group
settings. Many programmes are not yet able to deliver day care due to lack of
buildings, but most programmes are setting up between two and nine new play,
learning and child care services.


The highest spending
programmes are spending six times more per child per full year than the lowest
spending programmes. This reinforces the point that Sure Start is not a uniform
programme and that a range of services are being provided at different levels.

Programmes have been
slower than expected in getting off the ground, which is evident in the
proportion of their allocated grants that have been claimed in their first
year. Two-thirds of programmes receive some resources from other government
initiatives although less than half receive cash from other sources.

The challenge

There is strong evidence
that progress is being made towards developing the services parents want and
need, and that parents have a strong voice in shaping these. However, the
survey highlights the challenges facing Sure Start programmes:

• It is difficult and
time-consuming to join up and work in partnership with other agencies and

• Working in
multi-disciplinary teams is a tough task and new to many staff.

Some areas of
activity appear to pose special challenges. These include:

• Ensuring that the
main statutory agencies are represented in every programme.

• Getting local
evaluations started.

• Facilitating
greater involvement of the private sector.

• Initiating systems
for monitoring the ethnic representation.

• Achieving a higher
level of involvement of fathers in management.

Jane Tunstill is a
member of the National Evaluation of Sure Start Implementation Team

The article is based on the report,
Early Experiences of Implementing Sure Start.

See the full
report at  Further information at

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