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29 March 2004

A model that could save local democracy

By Jenny Rathbone

Sure Start ought to be one of the government’s rallying cries, and a flagship example of how to renew the meaning of social democracy. Piloted in 1998, Sure Start is now established in more than 500 areas of deprivation. The total spend on the programme is £766m to date, with another £955m allocated for 2004-2006. Each area is allocated about £5m to spend over ten years within a population of roughly 18,000 people. The money is ring-fenced: it can be spent only on families that have children under the age of four.

The purpose of Sure Start is to improve the life chances of babies and toddlers, breaking the cycle of deprivation so that the children of the poor do not become poor in the next generation. The key to its success is that parents lead it and evaluate it.

When the low-paid have babies, the lack of affordable childcare generally means getting the sack. Forget maternity-leave entitlement of up to one year. By the time your child starts school, you are likely to have lost your job, your confidence and your contacts with the working world.

Take Joanne. When she became pregnant, her boyfriend didn’t hang around. She struggled alone with a very needy premature baby, and rarely had the energy to get out of the house, never mind retain a responsible job with a non-unionised and inflexible employer. The overstretched health service failed to notice she was clinically depressed, and offered only Prozac. In desperation, she went to live with a “friend”, who used her rent money to feed a drug habit. The inevitable eviction tipped mother and baby into temporary accommodation.

Fortunately, it was in a Sure Start area. Sure Start pays for advice workers, speech and language therapists, and clinical psychologists, who go where and when families need them rather than being tied to appointments and targets. Joanne got specialist help in a non-stigmatising, non-medical environment. She got people who listened to her problems and therapies to bring down her stress levels. A childcare worker looked after her son for a few hours while she looked for new housing and a new job.

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Sure Start operates where people will find them – in local schools, churches and community centres. Most parents get involved because of what the programme offers their child. Professionally run play sessions help parents and carers understand the importance of play in children’s emotional and language development. And a qualified person looking after your child for a couple of hours makes sorting out housing repairs or debt problems, or filling in a job application form, infinitely easier.

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But what is crucial is that Sure Start trains parents to map the gaps in local services. For example, parents themselves conduct surveys of new mothers so that midwives change their practices.

Parents, elected by all those engaged with Sure Start, constitute at least one-third of the local boards which, in partnership with local front-line workers, decide how to spend substantial budgets of up to £750,000 a year. Front-line workers, in response, try different ways of doing things, discarding old demarcations and sharing their skills. Speech and language therapists are training parents and professionals to screen one-year-olds for development delay; this will enable additional speech and language support to be targeted where it is most needed. The next challenge will be to roll out the lessons learned from Sure Start to reshape mainstream services, so that the needs of all families with young children will be better served, and not just those in Sure Start areas.

The government proposes to bring children’s health, education and social services together into new children’s trusts, but the precise form these will take is being hotly debated. The model developed by Sure Start would acknowledge parents and patients as the engines of change and enable them to take on the managers of statutory services, who can (with difficulty) be persuaded to relax their command-and-control instincts.

It may be the best hope we have not only for improving public services, but for reviving confidence in local democracy.

The author manages a Sure Start programme in north London