I've researched the importance of Sure Start - here's a five-point plan to bring it back properly in Yorkshire

What was lost is harder to cost: an anchor of community life and, according to the strongest evidence yet assembled, one of the few public services that reliably narrows the gap between Yorkshire’s haves and have-nots.

That evidence is the subject of my latest BMJ research, the largest and most comprehensive analysis of the Sure Start programme conducted since the programme’s 1999 birth. Three themes light up the data.

First, physical health. Local authorities that kept centres open saw a 15 per cent fall in emergency admissions for accidental injury among under-fives and a two-percentage-point drop in Reception-year obesity.

One supplementary study shows that adding a single centre per 1,000 toddlers cuts hospital admissions at age five by seven per cent.

Second, school and social function. Children growing up near vibrant centres arrive at Year 1 phonics checks with measurably stronger literacy and are less likely to be excluded: a point of no small resonance in a region where permanent exclusions have climbed by a quarter since 2019.

Third, neurodevelopment. Data reveals improvements of ADHD and conduct-disorder symptoms over the long-term, benefits that persist into adolescence and lighten the load on over-stretched CAMHS teams.

Add these strands together and a compelling picture emerges: healthier bodies, readier minds, calmer classrooms. The economics are just as striking. Once reduced healthcare spending, higher earnings and lower welfare dependency to age thirty are included, the programme returns £4 for every £1 invested: hard to match in any Treasury spreadsheet.

Nowhere is that bargain more needed than here. More than one in four Yorkshire and the Humber children lives below the poverty line, a rate that has risen faster than the national average. Yet council spreadsheets tell a different tale: Little Owls nurseries in Leeds have closed; North Yorkshire has trimmed village childcare to the bone; parents from Gipton to Great Ayton describe hour-long bus journeys for breastfeeding support.

Every shuttered door shifts cost upstream: to A&E, to pupil-referral units, to youth justice.

The irony is brutal. Ministers preach “levelling up” while peeling away one of the few schemes that actually does that.

When Sure Start flourishes it does so because it is rooted. In Keighley, the centre that survived austerity sits beside a primary school and a GP surgery; parents leave with a library card, a healthy-start voucher and, crucially, an open invitation to return. In Thirsk, health visitors conduct home-safety checks that have halved under-five burn admissions.

The principle is “progressive universalism”: everyone is welcome, but the greatest effort follows the greatest need.

That model fits a county of seamed inequity. Wharfedale’s stone terraces and Wakefield’s ex- pit villages share little except the fact that early struggles, left unchecked, shadow children for life. Sure Start intercepts those struggles at their source.

Opponents of revival point to empty coffers. Yet hospitalising a toddler after a fall costs around £2,000; a year’s worth of home-safety visits delivered via Sure Start costs a tenth.

Treating childhood obesity in Leeds Teaching Hospitals swallows £1.3 million annually; a two-point regional fall, in line with programme effects, would erase the waiting list.

Excluding a teenager with unmanaged ADHD carries a lifetime fiscal shadow of £370,000 once lost earnings and justice costs are counted. Good economics, like good medicine, starts with prevention.

So here is a five-point Yorkshire plan:

1. Enshrine a spending floor. Parliament should legislate for a statutory minimum early-years spend per child, weighted for deprivation and indexed to inflation. For Yorkshire that equates to roughly £120 million – less than one per cent of the regional NHS budget.

2. Reopen closed doors. The quickest impact will come from re-establishing hubs in areas of highest exclusion and highest A&E attendance – Gipton, Dewsbury West, Hull’s Orchard Park, Scarborough South Cliff.

3. Measure what matters. Publish quarterly dashboards tracking five sentinel indicators: under-five emergency admissions, EYFS “good level” scores, BMI at Reception, ADHD/CD referrals and Sure Start take-up. Transparent data stiffen political resolve.

4. Back the workforce. Yorkshire has lost a quarter of its health-visitor team since 2010. A national pay spine, protected professional-development pots and research-in-practice fellowships would stem the bleed and root expertise locally.

5. Tie success to school readiness. Require councils to link Sure Start attendance rates to Year 1 phonics scores in public reporting. If literacy stalls, the remedy sits upstream in parenting programmes, not cramming classes.

Seventy-five years ago Beveridge named ignorance and disease as giants stalking post-war Britain; in 2025 their heirs are vocabulary gaps, widening waistlines and neuro-developmental diagnoses creeping up classroom registers.

The data say we already possess a shield: a restored, universal Sure Start. For Yorkshire: for Rotherham’s terraces, Harrogate’s crescents, Filey’s fishing lanes; the decision is ours.

Either we reinvest now, securing healthier bodies, sharper minds and calmer communities for the next generation, or we keep paying later in ambulances, exclusions and court summonses.

History will record which path we took. From cot to classroom, Yorkshire’s children deserve no less than a Sure Start that truly lives up to its name.

Dr Jatinder Hayre is a medical doctor and public health academic. He is the author of ‘The Lost Generation of COVID-19’.