The short-term and medium-term effects of universal early childhood interventions: evidence from Sure Start
Case study details
| Metadata item | Details |
|---|---|
| Publication date: | 14 August 2026 |
| Owner: | Office for National Statistics (ONS) |
| Contact: | SRS.Impact@ons.gov.uk |
The UK government’s Sure Start programme
Research from the Institute for Fiscal Studies (IFS) examined how the Sure Start programme affected children’s outcomes from early childhood through adolescence. Sure Start was introduced in 1999 and expanded across England during the 2000s. It was designed as a large‑scale, area‑based programme with centres offering integrated services’ support for families with children under the age of five, including health, education, and parenting and family support.
The study assessed impacts across health, education, behaviour and interactions with public services. It used administrative data to trace outcomes well beyond the period when children were eligible to attend Sure Start centres.
Use of powerful administrative data
Analysts used a range of administrative datasets accessed securely through the ONS Secure Research Service (SRS). Health outcomes were analysed using Hospital Episode Statistics (HES), covering inpatient admissions for children born between 1993 and 2006, with follow‑up records available into adolescence.
Educational outcomes, school absences, exclusions, special educational needs and interactions with children’s social care were analysed using linked records from the National Pupil Database and associated administrative sources. These data were combined with detailed information on the opening dates and locations of more than 3,300 Sure Start centres.
Additional contextual information was drawn from the Index of Multiple Deprivation and from national longitudinal surveys, which were used to explore self‑reported health and wellbeing in adolescence.
The analysis compared children born in different years who grew up in the same neighbourhoods, taking advantage of the fact that Sure Start did not open everywhere at the same time. This staggered rollout created variation in access across birth cohorts within the same local areas.
Findings
Access to Sure Start changed the timing and nature of children’s interactions with public services in the early years, alongside longer‑term improvements in outcomes.
Health
Greater access to Sure Start increased hospital admissions during infancy. These admissions were mainly related to infections and conditions where earlier engagement with services could support detection and treatment. From school age, hospital admissions declined steadily through childhood and adolescence for preventable conditions, injuries and later mental health‑related admissions, with effects strongest in more disadvantaged neighbourhoods. By early adolescence, admission rates were around 8 to 10 per cent lower in areas with greater Sure Start provision.
Education
Children with greater early access to Sure Start achieved higher test scores at primary and secondary school and were more likely to meet GCSE benchmarks. Sure Start was also associated with fewer school absences and exclusions. The programme increased identification of special educational needs at school entry but reduced the proportion of children requiring less intensive support later in childhood.
Survey evidence supported these findings, showing better self‑reported physical health and fewer emotional difficulties among adolescents with greater early exposure to Sure Start. Together, the results suggest that integrated early years services influenced children’s development, home environments and engagement with services in ways that persisted into adolescence.
Policy influence
The findings provide strong evidence that integrated early childhood services can generate sustained benefits across multiple domains, even in settings where healthcare and schooling are already universally available.
The research continues to guide discussions on early intervention across the UK and internationally. For example, the research has influenced the design of Family Hubs in the UK and the future of place‑based early years support in England. Findings have been shared with:
- the Department of Health and Social Care
- the Department for Education
- NHS England
- a range of parliamentary and cross‑government groups
Local authorities have used the evidence to inform early years strategies, service integration, and commissioning decisions.
A comparison of programme costs with downstream savings and benefits shows that Sure Start recouped a substantial share of its cost through reduced use of public services and increased lifetime earnings. This remains true even when considering only a subset of measured outcomes. This suggests the overall economic case for integrated early years provision is likely to be considerably stronger when wider social benefits are taken into account.
About the ONS Secure Research Service (SRS)
The ONS Secure Research Service is an accredited trusted research environment providing secure access to de‑identified, unpublished data following the Five Safes Framework.
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About the analysts
Dr Sarah Cattan is Associate Director at the Institute for Fiscal Studies. The project was supported by the Nuffield Foundation, the Economic and Social Research Council, the European Research Council, and the NORFACE consortium.