Evaluating the impact of Sure Start (Northern Ireland) using a naturally occurring experiment and a longitudinal birth cohort

Being born into poverty is associated with educational and health disadvantages from infancy through to adulthood and incurs a considerable expense to the public purse. The Marmot review (2010) - commissioned by the then Secretary of State for Health -- recommended early years intervention as the high priority for reducing health inequalities and other independent reviews have come to a similar conclusion. There have been several initiatives to tackle early years inequalities using place-based interventions such as Sure Start in Northern Ireland: both of which have been expanded since 2020 due to their popularity and perceived effectiveness. These interventions are ambitious and expensive but there is a glaring evidence gap: no one has been able convincingly to demonstrate whether these interventions had any impact. No study featuring these early years interventions has been robust enough to be included in recent evidence reviews of place-based interventions. This is due to selection bias issues: these schemes target the most deprived areas in the UK which make it difficult to create fair comparisons between Sure Start and non-Sure Start areas.

Our project leverages a naturally occurring experiment that occurred when the Department of Education expanded Sure Start to new areas in 2010 and 2017. For each expansion, Sure Start was extended to cover the most deprived areas in Northern Ireland by rank up to a certain cut-off threshold (20% and 25% respectively). This rule created near identical groups of areas which were just included or just excluded in each expansion based on the cut-off threshold. To measure impact, we plan to use the linked administrative data from the Northern Ireland Regional Data Warehouse which contains linked health and education data for every birth in Northern Ireland. This will allow us to compare early years outcomes for birth cohorts in areas which were eligible and ineligible for Sure Start due to the deprivation cut-off threshold rule.

Our primary objectives are to:

Measure the impact of Sure Start on maternal and child health outcomes, and families' access to services
Disseminate our insights to key stakeholders and offer our tools and methods to the wider research community in order build capacity for future evaluation opportunities
Our project addresses a timely issue in Northern Ireland: the Northern Ireland Audit Office has explicitly flagged an impact evaluation of Sure Start as a priority issue. To maximise impact, we are already in correspondence with the Northern Ireland Department of Education and joined by partners who are key opinion-formers and representatives of the wider research community including the National Children Bureau (leading advocates for children in the UK for over 60 years); and the Maternal and Children's Health Network.

In the short term, our study addresses a major accountability gap and helps the Department of Education in planning and delivering Sure Start. In the medium term, evidence of 'what works' in early years are of relevance to other UK nations and internationally as well as the National Children's Bureau who advise on the 'Better Start' programme in England. We are certain that our design (birth cohorts affected by natural experiments) will be of continued relevance and interest to the wider research community for years after project end for studying other outcomes, longer-term impact and linkages to other administrative data.