Written evidence submitted by Sebastian Kraemer (CYP0082)
• After nine years of cuts to Sure Start children’s centres, major research by the Institute for Fiscal Studies in 2019 showed, despite equivocal findings in previous outcome studies, a highly significant impact on the health and resilience of the poorest children, an effect increasing at least up to secondary school transfer.
“we have uncovered a robust causal effect of Sure Start on hospitalisations“ p 51
Furthermore the most striking effect was a reduction in hospital admissions following head injury and fractures.
“preventing head injury will also generate savings to the public purse in the longer term” p 71
• What has this to do with child mental health?
How does attendance at a local children’s centre with access to health visitors and other experienced professionals make such a difference? Parents and other caregivers can meet others like themselves. Everyone looking after toddlers knows the relief they experience when they can take their child (or children) out of the home and go to a nearby place where they are welcomed, and where they can make friends. If they need professional help they can ask for it but simply being in a neighbourhood group on a regular basis gives the parents confidence, and reduces loneliness.
A unique innovation in human evolution was collaborative care. There is no such thing as a prehistoric single parent.
As the distinguished anthropologist Sarah Blaffer Hrdy says “Allomaternal support whether from a grandmother in the same household or just transient visits by “as-if” supportive kin accelerates and enhances social awareness and an infant’s sense of security. This holds for infants born to young inexperienced or unmarried mothers who might otherwise be at risk of insecure attachments’ (2016)
The IFS researchers write: “socio-economic characteristics such as the mother’s age at birth, maternal education, maternal work status and household net earnings are neither as statistically significant nor as consistent a predictor of injuries as externalising behaviour.
This result supports the hypothesis that a Sure Start-induced change in child behaviour is a plausible mechanism for the big and growing reduction in injury-related hospitalisations.” (2019, p. 90)
• Self-regulation of children is the holy grail for developmental clinicians and scientists.
It means that the child can contain his or her emotions, can concentrate on the task in hand, can think about what impact his or her actions have on others, can ask for help rather than demanding it through bad or dangerous behaviour, and make friends rather than driving other children away.
“Kindergartners with better emotional regulation and social skills had better later life outcomes, including a reduced likelihood of criminal activity at 25 years old”.
• Note that this effect is not necessarily the result of specific interventions with children and/or their caregivers. A Children’s Centre is a social resource, available without stigma, where parents can simply go and have a cup of tea and a chat. What they are doing is what parents have done for hundreds of thousands of years, which is to share the care of tiny children, to everyone’s benefit.
Parents in need of expert help have access to staff, including Health Visitors who can visit the homes of those unable to attend. Again this is a resource that is without stigma. Every new parent has a health visitor.
• “the effects we estimate may understate the impact Sure Start has on those who use Children’s Centres.”
This is a very cautious piece of research from a highly regarded source yet it comes up with a finding that should change the landscape of early years provision. It is ‘the tip of an iceberg of socially promoted resilience’.
Dr Sebastian Kraemer FRCP FRCPsych FRCPCH Hon Consultant Tavistock & Portman NHS Trust www.sebastiankraemer.com
(Cattan et al, 2019)
 Sarah Cattan, Gabriella Conti, Christine Farquharson and Rita Ginja (2019) The health effects of Sure Start, London: Institute for Financial Studies https://www.ifs.org.uk/publications/14139
 Hrdy, S. B. (2016) Development plus social selection in the evolution of “emotionally modern” humans. In (eds.) C. L. Meehan & A. N. Crittenden. Childhood: Origins, Evolution, and Implications. Albuquerque NM: University of New Mexico Press, pp11-44.
 Music, G. (2017) Nurturing Natures: Attachment and Children’s Emotional, Sociocultural and Brain Development. Abingdon: Routledge, p. 256
“the unique predictive nature of early social competence on important outcomes in late adolescence and early adulthood” Jones, DE, Greenberg, M, Crowley, M. ( 2015) Early Social-Emotional Functioning and Public Health: The Relationship Between Kindergarten Social Competence and Future Wellness
American Journal of Public Health 105,2283-90 https://doi.org/10.2105/AJPH.2015.302630
 Kraemer, S (2021) Children’s centres are the foundation of social regeneration. British Medical Journal 372:n41 http://dx.doi.org/10.1136/bmj.n41 https://www.bmj.com/content/372/bmj.n41.full?ijkey=tAzV7QzwxmY3XQE&keytype=ref