Harry Benson: How to make Sure Start achieve what it was meant to do

Harry Benson is the author of “Let’s Stick Together – the relationship book for new parents” and Communications Director of The Marriage Foundation.

There is a fundamental flaw at the heart of current attempts at “early intervention”. Until recently, we used to have a terrific NHS post-natal system run by health visitors. Programmes lasted a few weeks, were preventive, educational, focused, supportive and extremely well-attended by as many as 40% of all first time mothers.

In the last few years, that system has more or less collapsed, supplanted by the broader Sure Start Children’s Centre early years support groups. The problem is that Sure Start is failing to attract anything like the same numbers of parents. Those who do attend tend to stay in their groups for many months in what feels less like early intervention and more like state-sponsored coffee shop.

For the last six years, I and my volunteers have run an early intervention for new parents in both NHS post-natal clinics and Sure Start centres in the Bristol area. We teach couples how to stay together through a single session relationship programme called “Let’s Stick Together”. It’s early intervention, it’s preventive and it’s evidence-based. Once people realise that they’re not being counselled, almost everyone finds it enjoyable and useful. Our programme is short and sweet but it accesses a higher proportion of parents than has ever been achieved in the UK. Over seven years, we’ve accessed 4,000 first time mothers in Bristol. My joint venture with a national charity is currently being evaluated, and funded in part, by the Department for Education.

The flow of our work in Bristol tells the story of early intervention. Within the last few years, we have seen at first-hand the near collapse of the post-natal system. Health visitors have been sucked away from routine post-natal care of new mothers into child protection and paperwork. Most of the post-natal clinics that we used to visit have shut down as a result. In 2008-9, NHS post-natal clinics made up 90% of our work. Today, it’s less than a third.

Sure Start could and should have taken up the slack. In 1999, Sure Start centres were set up “to enhance the life chances for young children growing up in disadvantaged neighbourhoods”. After 2005, centres expanded into all communities. Today there is a 3,500 strong network of shiny new centres, many of which attached to primary schools. The idea is good. As a new parent, you simply wander into your local Sure Start centre and find professionals who can provide you with all sorts of information about being a parent and early years support groups that you can join.

But Sure Start has never really acquired the kind of easy attraction of ante-natal or post-natal. You’re pregnant. So you go to either free NHS or paid NCT ante-natal classes. According to the Millennium Cohort Study, ten years ago 70% of first time mums did exactly that. You’ve just had the baby. So you go on to post-natal clinic. In 2009, when we reckoned we were accessing almost all post-natal clinics in Bristol, we reached 33% of all first time mums. So perhaps 40% of first-time mums used to go on to post-natal.

Sure Start is not taking up the slack. Their frustrated staff – who are definitely not the problem – tell me time and again how hard it is to attract new parents into the centres. The biggest reason why Sure Start doesn’t get the numbers is down to basic social psychology. If a health visitor invites a group of pregnant mothers to come back for post-natal clinic after they’ve had their babies, most come along. The place and faces are familiar. Mums come back because it’s made easy for them and it feels secure.

Asking the same mums to come to a Sure Start early years group, usually in another location and with other group members they won’t know, doesn’t feel so good. In the exhausting and confusing land of new parenthood, the tiniest of barriers is enough to prevent good things from happening. The language of treatment rather than prevention doesn’t help. “It’s for people who need it”.

Perhaps it’s not surprising that the mums who do come along to Sure Start groups tend to stay on for several months. It’s become less “intervention” and more “support”. Our figures bear this out. We are really good at finding new groups. Yet our numbers today are down by nearly half from our peak in 2009. At the NHS post-natal clinics that still operate, we average three and a half visits a year. Programmes roll over every few weeks so we get new mums every time. At Sure Start, we average two visits per year and the groups are smaller. We can’t run more regular sessions because the same mums are there for months.

The different ethos of these two groups – NHS “post-natal” and Surestart “early years” – also has a huge bearing on early intervention. The whole point of going to a handful of post-natal sessions is to learn. Support and friendship with other mums happens. But it is secondary. Post-natal groups are always attentive and always easy to teach as a result. Interventions within this kind of positive environment have the best chance of making a difference. However the primary purpose of going to a Sure Start group is much less obvious. Many mums keeping coming back because they enjoy chatting with familiar faces more than they are there to learn. Running any kind of intervention within this environment is challenging at best and painful at worst.

Sure Start has become a sacred cow, with strong political and individual backing. All parties have bought the concept and many thousands of parents have accessed services at Sure Start Centres. A recent accusation that Sure Start is being cut inspired outrage at PMQs. Yet there is little evidence that the vast expense poured into Sure Start has made much of a difference. The most recent of several official evaluations from University of London, Birkbeck, finds that mums say they have benefited in various ways. However there is “no impact on child outcomes”.

One tiny piece of good news is that we are beginning to see the first hints that the government expansion of health visitors may rebuild the shattered NHS post-natal system. Three health visitors have already hinted to us that their groups may start up again this year. There is a solution to the Sure Start problem. It means taking a leaf out of the NHS post-natal system. Post-natal has been so successful because it feeds off ante-natal and is explicitly a short programme of learning. That’s what needs to happen with Sure Start.

If all ante-natal classes were held in Sure Start centres, mums would be far more likely to come back soon after having their baby. With a far bigger proportion of parents wanting to attend, Sure Start staff will have no choice but to recycle groups quickly and introduce real purpose and focus. Only then might Sure Start begin to achieve what it could and should have been doing in the first place. Early intervention.