In 1965, US President Lyndon Johnson ordered American war planes to bomb north Vietnam. That same year, he set up the Head Start programme to provide intensive support for children under five. Both decisions made history. Only one left a positive legacy. Almost 40 years later, a British Prime Minister followed another US President to war, but parted company with him when it came to young children. While George W Bush has been accused of undermining Head Start, Tony Blair agreed to set up a UK programme inspired largely by the US

model. Launched in 1999 to improve the lives of the under-fours, Sure Start is now an accepted part of the welfare state, with a proposed budget of almost pound;2 billion by 2007-8 and the Government recently announcing an expansion of the scheme into a network of dedicated children’s centres. But critics claim the new proposals will alter Sure Start out of all recognition and undo much of its good work. So what is the future likely to be for the programme that has pioneered joined-up services, paved the way for the Every Child Matters legislation, and challenged traditional patterns of behaviour? As a director of a Sure Start children’s centre says: “When a mother tells me she praises her child instead of smacking him, I know that is the moment when things will change for that family.” But is this also the moment when things will change for Sure Start?

So what does Sure Start do?

All sorts of things. Gathered under a local Sure Start umbrella you could find early-years advisers, health visitors, pre-school staff, outreach workers and counsellors. Also squeezing in could be social workers, playgroup volunteers, midwives, librarians, teachers, nursery nurses, private nursery managers, speech therapists, and even a dental hygienist or two. Working in partnership, often on secondment, they might organise books for babies, advice on child health and giving up smoking, story-telling sessions or swimming lessons. Or they might set up toddler groups, fund playgrounds, organise Jobcentre links, give out information on childcare or provide it themselves. Then again, they might sort out basic skills courses for parents, babysitting, driving lessons, or just an outing to the seaside . The list is long and each programme unique.

Some programmes are set up by social services, some by primary health trusts, and some by education authorities. In others the lead has been taken by charities such as the Children’s Society or the Pre-school Learning Alliance. All are guaranteed funding for 10 years - and are paid to listen. The aim is to give local families what they want, not what officials think they need. So parents are first consulted and then given a strong voice on the board of their local programme. “So, ultimately, the barriers between the ‘provider’ and the ‘provided-for’ are eroded and families slowly gain confidence,” says Margaret Lochrie, director of Capacity, the children’s services think tank.

How it came about: ‘cooking the children’

In 1997 it was decided that MPs would discuss the proposed programme during education question time, but their queries would be answered by a health minister. This esoteric change signalled the start of so-called joined-up, also known as “cross-cutting”, thinking on the early years. Mr Blair’s fledgling government set up six cross-cutting reviews, one of them on services for young children. Eleven departments were involved as well as the social exclusion unit, the women’s unit, the efficiency unit and the No 10 policy unit. Also, unusually, outside experts were invited in.

Experts and officials were brought together at a Treasury seminar in 1998.

Norman Glass, now chief executive of the National Centre for Social Research, but then the Treasury official responsible for Sure Start, describes “the slightly comic atmosphere as the two worlds of children’s services and Gladstonian public finance met face to face”. He says: “The trepidation felt by the early-years community was probably matched only by the bewilderment of the Treasury doorkeepers faced with directing people to a seminar on services for young children. Perhaps they felt, recalling Jonathan Swift’s A Modest Proposal, that the Treasury intention was to find a way of cooking the children and serving them up as a cheap and nutritious diet supplement.”

It can only get better...

The cross-cutters faced an enormous challenge. In 1997 more than one-third of UK children, around 4 million of them, were growing up in poverty.

Without help, they could end up swelling the ranks of the unemployed, disaffected underclass - and costing the state a fortune. Head Start research had shown that every $1 spent on a deprived youngster could save $8 in long-term social costs associated with unemployment, crime and drug addiction. The new Chancellor, Gordon Brown, impressed by the figures, declared that: “As long as there is child poverty, there will be a scar on Britain’s soul.” He resolved to end it by 2020.

Sure Start was, and is, central to this mission. Tackling the disadvantages of poverty could help families feel better about themselves, live healthier lives and find work. Providing them with a holistic package of services could reduce the developmental divide that opens up between deprived and better-off toddlers. Sure Start, described by Professor Glass as “a comprehensive community-based programme of early intervention and family support” aimed to improve services for the under-fours through “local programmes” in the UK’s 20 per cent most deprived wards.

Balancing the books

The initial Sure Start budget of pound;200 million a year is now an annual pound;1.1 billion, rising to almost pound;2 billion by 2007-8. It’s a substantial investment, but only around 3 per cent of the total education budget for England, with its population of almost 50 million. Sweden, on the other hand, with a population of just 9 million, spends about pound;3.5 billion on its pre-schoolers. As children’s minister Margaret Hodge has admitted: “It takes a long time. In Scandinavia the infrastructure was started 30 years ago. We are starting from scratch.”

Small steps

There are no quick or cheap ways round the hurdles Sure Start set out to leap. But after a shaky beginning, there are now 524 Sure Start programmes, the final ones gaining approval in 2003. Each targets about 800 children, meaning that 400,000 under-fours are now being helped. And they need it.

More than 40 per cent are growing up with unemployed parents, almost double the national average, and half are at risk of developing a special need, compared to 16 per cent nationally.

These largely urban programmes reach about a third of deprived under-fours and their families. But almost half of the UK’s poor children live outside the Sure Start wards, scattered in wealthier areas or in the countryside.

And, as Sure Start national director Naomi Eisenstadt has acknowledged, for these families, living among more affluent neighbours, the danger of feeling stigmatised as “in need” is particularly acute.

Striding forwards

If the programme is to have long-term success it must be rolled out across the UK, the Child Poverty Action Group said last year. It must become universal, as much for middle-class families as for their poorer neighbours. Another aim is to standardise what is on offer. Local programmes have been locally grown, but, as Ms Lochrie points out, this means a Sure Start child in one area might get a home visit every week while one somewhere else will have no more than an occasional trip. So how is everyone to access a universal set of child and family services tailored to their community’s needs? By popping down to the local one-stop children’s centre, of course. Sure Start is spreading its wings. The Government recently announced that all early-years and childcare policies, including extended schools, are to bear its name. Neighbourhood nurseries and early-excellence centres, two other Labour initiatives, are being rebadged as the first children’s centres.

Or backtracking?

But while the Government regards this as a huge expansion, others are less convinced. Professor Glass sees it as the death of Sure Start. He says parental involvement, a key to success, but difficult to achieve, will go, and with it the hope of genuinely transformed communities. He also warns that Sure Start is becoming “a new deal for toddlers,” focused on childcare and parental employment rather than child development. Local Sure Starts do not have to offer childcare, but the new children’s centres do, and it must be full daycare, 10 hours a day, 48 weeks of the year. The Department of Health’s involvement has faded, and the Department of Work and Pensions now has joint responsibility with education.

Late last year Mr Brown said he wanted 3,500 children’s centres by 2010, one for every community. There are currently about 70. “My overall position on this is positive,” says Ms Lochrie, “but the definition of community is vague. To have one in every ward would require 8,000, not 3,500.”

Addicted to diversity

Becoming a children’s centre means offering good quality, joined-up services in five areas: early education (employing at least one teacher), daycare, health, family support and help for parents wanting to find a job.

“It’s not easy,” says Sue Clempson, director of a Sure Start children’s centre in the Cotswolds. “Running this place is a bit like having a bad back. You can’t explain what these roles are like unless you’ve had one.

You have be a certain sort of beast to be in charge of such a diverse environment, but I think you get addicted to diversity.”

Mrs Clempson has been in charge of the much-praised ACE centre in Chipping Norton, Oxfordshire, for five years. It grew out of a nursery school and a social services family centre. It still has the school, but has added a day nursery, a drop-in family centre, out-of-school activities, an outreach worker, a computer centre and adult education. Even the local registrar for births, marriages and deaths pops in. It caters for many support groups: the outreach worker, for example, helps 29 early-years groups. Recent proposals to organise a childcare course drew 28 applicants, around three times the expected number. The children also enjoy a Danish-style forest school in some local woods. Unsurprisingly, ACE attracts about 500 adults, including grandparents, and 1,000 young people from an 11-mile radius every week.

The key to success

Such diversity inevitably involves a mixture of staff qualifications and salaries. “Personnel management is crucial to the success of these places,” says Mrs Clempson. “The joined-upness is the biggest hurdle.” When she was building her multi-disciplinary team, she realised the teachers were unhappy, even though they were highly-regarded professionals, working shorter hours and earning up to pound;10,000 a year more than other staff.

She faced the same problem when health professionals came on board, essential for children’s centre status. “I had a eureka moment,” she says.

“I realised what was behind all those tight lips and folded arms: insecurity.” Now, she says, trust and honesty are key. “I make it clear that we are all equal, working as professionals from different angles.”

Is Sure Start working?

In 2001 the Government set up a national evaluation programme run by a team under Ted Melhuish at Birkbeck college, London. Last year it published a summary of its work, heavily underlining that these are early findings and Sure Start needs years to prove itself. (Head Start has been running for four decades.) Nevertheless it is clear, as Mrs Clempson found, that one of the greatest challenges has been to integrate services. Staff from the public, voluntary and charitable sectors have had to work out how to work together - a huge challenge, even given the enthusiasm the programme tends to inspire. The mess of qualifications, poor training, and low pay that bedevils the early-years workforce is another major issue. Local programmes have needed two or three years to get their full range of services up and running. “Joint work is challenging and time-consuming and there is still some way to go,” Professor Melhuish concluded.

Generally, though, the pointers are favourable. Sure Start mothers are more likely to treat their child in a warmer and more accepting manner than those in comparison areas. And evidence of improved childfamily functioning is twice as likely to be found in a Sure Start area. And, everyone loves it. The programmes are popular with parents. Special needs in the areas where they run are on the increase as families gain in confidence and ask for help. Staff, too, are positive. Professor Melhuish is optimistic. “There is widespread support for the philosophy of Sure Start, especially the opportunities to work in multi-agency teams and across professional boundaries, to focus on prevention and early intervention, to involve families and communities and to enhance existing services.”

Main text: Stephanie Northen

Photographs: Getty, Alamy

Additional research: Sarah Jenkins

Next week: the school day