The short-and medium-term effects of universal early childhood interventions: Evidence from Sure Start

Author: Dr Sarah Cattan, Institute for Fiscal Studies 

Date: August 2026

Research summary

This research examined the long-term effects of the Sure Start programme on children’s outcomes across health, education, behaviour, and public service use. Sure Start centres offered integrated support for families with children under five, including health services, parenting support, early learning activities and links to childcare and employment support. Using linked administrative data, the study tracked outcomes from early childhood through to adolescence. 

The findings show that greater access to Sure Start was associated with earlier engagement with health services and identification of additional needs, alongside longer-term improvements including higher educational attainment, fewer hospital admissions, reduced school absences and lower demand for less intensive special educational needs support. The benefits were particularly pronounced for children in disadvantaged areas, demonstrating the lasting value of integrated early years services.

The findings have been shared with a range of UK Government departments and parliamentary groups, and have informed local authority strategies and commissioning decisions. 

The project was supported by the Nuffield Foundation, the Economic and Social Research Council, the European Research Council, and the NORFACE consortium. These funders enabled long‑term analysis of linked administrative records across multiple policy domains.

Data used

To study the effects of Sure Start, the research used a range of administrative datasets accessed securely through the ONS Secure Research Service. Health outcomes were analysed using Hospital Episode Statistics, covering inpatient admissions for children born between 1993 and 2006, with follow‑up records available into adolescence. This allowed hospital use to be tracked before, during and after the national expansion of Sure Start provision.

Office for National Statistics; NHS Digital, released 03 July 2023, ONS SRS Metadata Catalogue, dataset, Public Health Research Database - England and Wales, doi.org/10.57906/b8zx-6x19

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. A bespoke education and justice linked dataset was also used to track criminal behaviour, specifically focusing on crime committed up to the age of 16. 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.

Methods used

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.

The study used a difference‑in‑differences approach with fixed effects for neighbourhood and birth cohort. This allowed the researchers to isolate the impact of access to Sure Start from systematic differences between families accessing the programmes in different areas and broader changes affecting children over time. For most outcomes, access was defined as living within close proximity of a Sure Start centre during the first five years of life. For health outcomes, access was measured using local authority‑level provision, reflecting the structure of the hospital data.

The researchers tested whether trends in outcomes were already changing before Sure Start centres opened and conducted robustness checks using outcomes that should not have been affected by the programme. Survey data was analysed using sibling comparisons, allowing outcomes for children within the same family who experienced different levels of early exposure to be contrasted.

Research findings

Sure Start was designed as a large‑scale, area‑based programme bringing together health, education and family support services for families with young children. The research shows that 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.

In health, greater access to Sure Start increased hospital admissions during infancy, driven mainly by infections and conditions where earlier engagement with health services  can support detection and treatment. From the point of school entry onwards, hospital admissions declined steadily through childhood and adolescence. Reductions were observed for preventable conditions, injuries and later mental health‑related admissions, with effects strongest in more disadvantaged neighbourhoods. By early adolescence, admission rates were around 8–10 per cent lower in areas with greater Sure Start provision.

In education, children with greater early access to Sure Start achieved higher test scores at primary and secondary school and were more likely to meet key 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 supports 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.

Research impact

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 contributes to ongoing discussions about the design and future of place‑based early years support in England.

The results have been shared with the Department of Health and Social Care, the Department for Education, NHS England, and a range of parliamentary and cross‑government groups. Local authorities have used the evidence to inform early years strategies, service integration and commissioning decisions, through the implementation of the Family Hubs and Start for Life programme.

A comparison of programme costs with later savings and benefits for the public shows that Sure Start recouped a substantial share of its cost through reduced use of public services and increased lifetime earnings, 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.

Research outputs

Publications and reports

• IFS Report (2025): The short‑ and medium‑term effects of Sure Start on children’s outcomes
• Working Paper (2025): The Health Effects of Universal Early Childhood Interventions: Evidence from Sure Start
• Policy Briefing (2026): Early years services and long‑term outcomes

Blogs, news posts and videos

• IFS Blog (2025): What Sure Start can teach us about integrated early years support
• Podcast Interview (2025): Evaluating early years policy

Presentations and awards

• ADR UK Annual Conference (2025): Plenary presentation
• Government Social Research Awards (2025): Shortlisted for Excellence in Use of Data

About the ONS Secure Research Service

The ONS Secure Research Service is an accredited trusted research environment providing secure access to de‑identified, unpublished data using the Five Safes Framework.

If you use ONS SRS data and would like support developing a future case study, contact SRS.Impact@ons.gov.uk. Please also report outputs using the Outputs Reporting Form.