“Joined up thinking” and “joined up government” are now familiar phrases. Joined up real life is rarer, with services for children and families frequently fragmented. Sure Start is therefore particularly encouraging as an initiative which will potentially pull together health, education, and welfare services for 0–3 year olds in a coordinated way.

Sure Start is part of the current government's policy to prevent social exclusion, and as such, it is targeted at preschool children and their families in disadvantaged areas. The initiative was the result of a cross cutting review of services for young children chaired by the Treasury.1 The review's conclusions focused on the importance of the early years for child development, and highlighted the problems of multiple disadvantage for young children, the variation in quality of services for children and families, and the need for community based programmes of early intervention.

The cash behind Sure Start is substantial: £540m is to be spent between 1999 and 2002 of which £452m will be spent in England. The policy is being developed in different ways in Scotland, Wales, and Northern Ireland.2 Starting with 60 “trailblazer” schemes selected on the basis of deprivation, geographical spread, and links with other government initiatives to tackle deprivation, there will eventually be 250 local programmes covering up to 150 000 children.3