Sure Start: Combined forces

Professionals working with Sure Start schemes are truly helping families in deprived areas to help themselves, as Anne Wiltsher reports

Sure Start is a 'very exciting way to work', according to Lynda Hassall, team member of the programme which has been operating in Barrow in Furness, Cumbria, since February last year. 'I spent ten years as a social worker being constrained by resources and asking how on earth can we manage to help people? Now we can say, "What would make a difference to you?"', she says.

It's rare for those at the coalface to praise Government initiatives, but the enthusiasm for Sure Start among those involved is palpable. 'The best public health initiative this country has ever done,' says one consultant in public health medicine. 'I'm 100 per cent hooked,' says an ex-health visitor who has reduced her hours as lead officer of a health improvement programme to act as advisor on 12 Sure Start programmes.

The reasons for their passion are easy to understand. Public money to support early parenthood is at last here to help parents bond with and enjoy their babies and toddlers; to show how to play with them, keep them healthy and give practical help. This is what Sure Start tries to do.

Couple this with the fact that Sure Start programmes require public sector agencies and voluntary organisations to liaise not just with each other, but with local parents and you have a genuinely new way of working that can shake the cobwebs out of tired services that have failed families in the past.

Innovative services
In Barrow in Furness, for example, Sure Start has set up a 'Chatterbox' scheme to help parents communicate with their children to prevent language delay.

Health visitors and playgroups refer children identified as being at risk. 'It's a different way of working from the traditional speech and language therapy service,' says Lynda Hassall. 'The parents work in groups supported by extra therapists who are employed by Sure Start. The outcome is that the groups continue to meet and support each other. It's very important to facilitate this. It's what we're about.'

The Barrow in Furness programme, which supports 1,000 children, has set up 50 projects run by local people - either on their own or in conjunction with the team - to meet the Sure Start objectives (see box below). It has also trained 20 local parents to act as community support workers. 'Co-ordinated by the team, they help with craft activities at Chatterbox. They also give family support in a crisis, when a child is ill or a mother is stressed, or if a child is re-introduced to a family after being in care,' explains Lynda Hassall.

'They play with the children, pass on ideas for activities and take them out to give parents some time alone.' Matched to the families by the Sure Start team, and paid on an hourly basis, these community workers are seen as less threatening than social workers.

Services staffed by parents are also being planned in Chesterfield Sure Start, which is only a few months old and works with 823 children. Kimberly Bennett, who has two children under five and is expecting her third, is the parents' representative. She became involved when Sure Start organised a coach outing for everyone at her son's nursery. 'When asked, the parents all saw the cause of problems the same way,' she says. 'For example, they thought children got on the at-risk register because social services did not have the resources to get involved earlier and because of lack of family support. Low self-esteem also played a big part.

'It's the same with post-natal depression. If you've very little family support just being lonely can be a trigger for PND. What parents want is practical support - someone to come in and take the kids off their hands, do the washing or just take them out of the four walls!'

Now health visitors and midwives in the area are training parents to deliver PND and breastfeeding support. The courses will be accredited to enable those taking part to access other education and work opportunities.

Change in focus
Each of the four waves of Sure Start programmes has learned from the previous ones, but a major change of focus came after the Government's pledge in 1999 to end child poverty by 2020. 'It changed the focus from ameliorating poverty to asking, "How do we make families unpoor?"' says Naomi Eisenstadt, Sure Start director.

After a second Government Comprehensive Spending Review (the first, in 1997, was the catalyst for Sure Start - see box), the programme was doubled in size and a major new objective added.

'We added the target of reducing the number of nought to three-year-old children in Sure Start areas living in households where no one is working,' says Naomi Eisenstadt. 'This was contentious because children would be outside parental care. But nothing gives you choice like money in your pocket.

'Adult literacy and other courses should be available to parents through Sure Start during the first year or two of parenthood, so that when they go back to work it is with better prospects. It's also about getting the childcare strategy right, about improving transport - all sorts of practical issues that create barriers to people working. But it's not about making parents work.'

Programmes now also have to link up with Employment Service Jobcentres and narrow the childcare gap between Sure Start areas and other parts of the country, which means working closely with their local EYDCP and perhaps setting up a neighbourhood nursery.

Parental involvement
Involving parents is central to Sure Start's ethos, but this is not always easy and success has varied. Part of this is scepticism, according to Linda Asquith, a parent representative and vice chair of Sure Start Bramley in Leeds, who has three children aged under five. 'On some estates so much has been promised, mountains and mountains, and not even a pebble...' she says. Nevertheless, she told an audience of Sure Start teams at a recent conference organised by the Local Government Association not to under-estimate the impact programmes can have on parents. Those involved were applying for jobs they would not have dreamed of before, she said.

However, Naomi Eisenstadt says Sure Start must combine what the parents want with what children need. 'They're not always the same. The parents may want a drop-in with coffee, but if the childcare is crummy that's no good,' she says. There also has to be a balance between community and professional leadership. 'We don't want Sure Start to be a knowledge-free zone. We rob the community if we don't give professional expertise.'

Sure Start basics

Aim: To improve the health and well being of children under four in deprived areas, by pioneering new ways of delivering services.

History: Emerged from the Government's Comprehensive Spending Review (CPR) in 1997, which reviewed the services available for young children.

Targets: Each programme must:

• Contact new parents within two months of a birth to give support and information.
  
  
• Reduce, by specific amounts, the number of children on the at-risk register, speech and language problems, post-natal depression, smoking in pregnancy and under threes admitted to hospital as an emergency with gastro-enteritis, a respiratory infection or severe injury.
  
  
• Give guidance on breastfeeding, hygiene and safety.
  
  
• Ensure access to good quality play and learning opportunities.
  
  
• Encourage parents to use libraries.
  
  
• Have 75 per cent of families reporting personal evidence of an improvement in family support services.
  
  

The CPR 2000 added the targets of reducing the number of 0 to 3-year-olds living in households where no one is working; linking with employment centres and increasing childcare.

Organisation: A board with representatives from the statutory and voluntary services, plus parents. Some programmes have their own centres.

Cost: A total of 452m for 1999 to 2001; 580m for 2001 to 2004.

Numbers: 128 programmes running, 66 on the way and 66 announced this year - 260 towards the 500 in deprived areas planned by 2004, reaching about one third of under-fours living in poverty. Each programme covers 400 to1,000 under-fours.

Duration: From seven to ten years. Innovations will eventually be adopted by mainstream services.