England’s most deprived areas face about 20 fewer years in good health.

The problem

The attainment gap opens before school, and integrated early-years services have thinned out in many areas.

Who is affected, and where

Children under five and their families in areas with weak access, in England. Territory: England. Sure Start was an England programme; devolved nations run separate early-years services.

Policy status

A funded programme already exists. Best Start Family Hubs are being rolled out to every local authority in England from April 2026, “backed by over £500 million”, with up to 1,000 hubs by the end of 2028 (DfE, July 2025); by March 2026 the stated backing was £900m over three years, including £200m for Healthy Babies services, and on 30 September 2026 the Burnham government said the Healthy Babies programme would reach every hub. They are not automatically equivalent to the 2000s Sure Start centres that were evaluated. The proposal is to hold the hubs to the features that were tested, start where access is weakest, and phase the roll-out so it can be evaluated.

The evidence

What the research found:

Five A*–C GCSEs up 0.9 percentage points; hospital admissions down 8.5% by age 15 (up 10% at age 1); no significant effect on EHC plans; more cautions by 16. Central appraisal: £2.7bn cost per cohort against £5.5bn discounted benefits (£2.4bn to government), 2023–24 prices.

Evaluated on:

Children in England with access to a Sure Start centre, cohorts born around 1990–2007; England, 1999–2010 roll-out

Transfer to this case:

Today’s family hubs differ in services, funding and staffing from 2000s Sure Start.

Our recommendation (separate from the research):

Specify the service mix and outreach first, then fund it where access is weakest, and evaluate cohorts rather than claiming the old results.

Strongest counter-evidence:

Updated methods removed an earlier fall in EHC plans; crime results are mixed (more cautions); benefits are largely modelled lifetime earnings. Wales’s Flying Start raised service contact but found no measurable difference in child development by about age three.

Effects on record

• Five GCSEs at A*–C (or equivalent) at 16: +0.9 percentage points (about 2%) (children without access, before and after centres opened; cohorts born around 1990–2003; quasi-experimental; method update changed some earlier findings). evaluated, moderate confidence; England. 2000s Sure Start, not today’s family hubs.
• Hospital admissions by age 15: −8.5% by age 15 (areas with fewer centres per child; cohorts born 1990s–2000s; admissions rose 10% at age 1 before falling). evaluated, moderate confidence; England. Not a cashable NHS saving.
• Criminal record by age 16: A mixed effect; size not established. evaluated, moderate confidence; England. More young people had a criminal record by 16, driven by an 11% rise in cautions; a fall in convictions was not significant. A trade-off to watch, not a benefit.

Cost and funding

Cost completeness: Published programme envelope; project costs still needed. Funding: Programme funding exists; project allocation unconfirmed.

• Integrated early-years service package and workforce (recurring spending; paid by central government, councils, NHS): Not yet costed. The IFS appraisal of 2000s Sure Start is a benchmark, not today’s rollout price; see the separate appraisal chart.
• Best Start Family Hubs roll-out (programme envelope) (recurring spending; paid by central government): at least £500m in total, Announced 6 July 2025 (“over £500 million”), hubs in every local authority from April 2026 to the end of 2028; fiscal years and price basis not stated in the announcement., price basis not stated by the source. A programme envelope for the hubs, not a costed package of the Sure Start features the evaluation tested; an individual area’s offer is funded only once its allocation and specification are confirmed.
• Best Start Family Hubs: “over £500 million” to the end of 2028: amount not established — not committed (programme envelope, not a project award). Recorded as “at least £500m” in the cost record; the amount is not repeated here to avoid implying a precise figure.

Who pays:

Central government and councils; the NHS for health visiting.

Financing proposed:

Best Start Family Hubs allocations (a programme envelope of over £500m) and public-health and health-visiting budgets; extra coverage or staffing beyond the hubs needs a new allocation or explicit displacement.

Gap remaining:

Unknown until the service package is specified and costed. Lifetime benefits cannot fund upfront delivery.

What delivery needs

Skills:

Early-years practitioners, health visitors, outreach workers.

Operational capacity:

Local commissioning.

Infrastructure:

Accessible buildings.

Permissions:

None.

Law:

None.

Public consent:

Families’ trust and use of services.

First step and stages

First step: Map service access and specify the offer before choosing buildings or branding. (owner: Councils with DfE)

1. Map access and specify services — Councils (proposed stage, not an official timetable)
2. Build provision and track reach — Councils and NHS (proposed stage, not an official timetable)
3. Evaluate cohorts over years — DfE with researchers (proposed stage, not an official timetable)

Depends on: Early-years workforce

Trade-offs

Who gains and who loses:

Largest gains for disadvantaged children; costs fall now, benefits mostly later and partly to other budgets.

What else the money or effort could do:

Funds and staff are not available for childcare places or other services.

Strongest counterargument:

Effects are modest per child and arrive slowly; diluted provision may not reproduce them.

Risks:

Workforce shortages and attributing every childhood outcome to one programme.

How we would judge it

Baseline:

Good level of development at age five (DfE EYFS profile).

Leading indicator:

Reach among families in target areas.

Outcome:

Child development, later attainment and admissions, kept separate from projections.

Continue, adapt or stop:

Expand where reach and early outcomes improve; review where reach is low.

Earlier option on this page

This card replaces the option “Early years services in disadvantaged areas” (operating: Family hubs programme operating in some council areas.). Its evidence: IFS evaluations of Sure Start found fewer hospitalisations among children aged 11–15 in areas with centres, with the largest benefits in the most disadvantaged areas. Effects on adult health are not yet observable. IFS, The health impacts of Sure Start (Cattan, Conti, Farquharson, Ginja, Pecher, 2021)

Sources

• Institute for Fiscal Studies, The short- and medium-term effects of Sure Start on children’s outcomes, Executive summary pp.6–10; Table ES.1 (2025-05-22; full text checked)
• UCL Institute of Health Equity / Health Foundation, Build Back Fairer: The COVID-19 Marmot Review, Executive summary Box 9 (2020-12; relevant passages checked)
• Institute for Fiscal Studies, The short- and medium-term effects of Sure Start on children’s outcomes, Executive summary printed p.8; Section 5.2 (2025-05-22; full text checked)
• Welsh Government (Ipsos MORI and SQW), National evaluation of Flying Start: impact report, Summary pp.5–8 (2013-12; relevant passages checked)

Source published 22 May 2025 (IFS); December 2020 (Marmot); evidence reviewed 2026-10-04. Reconsider if: An evaluation of family hubs or Best Start services; A change in early-years funding.

The problem

No official benchmark says what the basic rate of Universal Credit is meant to cover; it is set by ministers at the annual uprating review and, for 2026–2030, by a fixed path in legislation, without a published comparison with the cost of essentials.

Who is affected, and where

Households on Universal Credit in Great Britain, and people entitled to it who do not claim. Territory: Great Britain. Universal Credit is legislated for Great Britain; Northern Ireland runs a parallel system and Scotland pays some devolved benefits on top (for example the Scottish Child Payment). Equivalent decisions there are not assessed here.

Policy status

Proposed by researchers or others, not government policy. A Joseph Rowntree Foundation proposal, not government policy. The Universal Credit Act 2025 (Royal Assent 3 September 2025) already sets the standard allowance on a path that ends 4.8% above inflation-only uprating by 2029–30; that is a fixed path chosen by Parliament, not a test of adequacy, and it is the baseline any option must be compared with.

The evidence

What the research found:

JRF reports that the standard allowance from April 2026 (about £98 a week for a single person aged 25 or over, £154 for a couple) is below its destitution thresholds (£105 and £160) and below the JRF/Trussell estimate of essentials (£120 and £205). It proposes an independent advisory process but does not cost the body or any change in rates.

Evaluated on:

Not evaluated. JRF compares 2026–27 Universal Credit rates with its own and Trussell’s estimates of essential costs for a single adult and a couple.; United Kingdom, 2026–27 rates

Transfer to this case:

The Low Pay Commission and New Zealand’s advisory group answer different questions; their record is not evidence that a benefits body would reduce hardship.

Our recommendation (separate from the research):

Specify the essentials basket, household types and decision rule first, then publish a distributional costing of named options against the 2025 Act baseline. UK Facts does not set its own adequacy threshold; the JRF/Trussell figures are their estimates.

Strongest counter-evidence:

An essentials basket is a normative choice, and a published benchmark creates pressure for large recurring spending that must be financed by tax, cuts elsewhere or borrowing; higher basic rates also change work incentives at the margin. JRF itself does not cost the change.

Effects on record

• Material hardship among households on Universal Credit: Direction plausible; size not established. plausible spillover, limited confidence; Great Britain. A benchmark changes nothing unless rates change; how much hardship would fall depends on the option, take-up and housing costs, none of which has been modelled here.
• Recurring benefit spending: A cost or harm; size not established. plausible spillover, limited confidence; Great Britain. Shown as a trade-off, not a benefit. The size depends on the option and has not been costed on the current baseline.

Cost and funding

Cost completeness: Not yet costed. Funding: Not yet costed / funding not identified.

• An independent advisory body on benefit adequacy (secretariat, research, consultation) (administration; paid by central government): Not yet costed. JRF does not cost the body. Comparable bodies (the Low Pay Commission, pay review bodies) are small, but their budgets are not a price for this one.
• Any change in Universal Credit rates or deductions following the benchmark (household transfer; paid by central government): Not yet costed. Must be modelled on the current caseload, take-up and interactions with housing support, against the Universal Credit Act 2025 baseline. No older campaign price tag is reused.

Who pays:

Taxpayers, through higher benefit spending (or cuts elsewhere, or borrowing); DWP for the small administrative cost of an advisory body.

Financing proposed:

None. Any rate change would need a recurring tax, spending or borrowing decision matched to a costing on the current caseload and take-up.

Gap remaining:

Unknown: it depends entirely on the option chosen. The advisory body is a small administrative cost; rate changes could be large and recurring.

What delivery needs

Skills:

Analysts able to price essentials by household type.

Operational capacity:

DWP and HM Treasury modelling of caseloads, take-up and interactions with housing support.

Infrastructure:

None beyond existing payment systems.

Permissions:

None.

Law:

A statutory body or duty would need legislation; a non-statutory panel would not.

Public consent:

Agreement on what counts as an essential; public attitudes to benefit spending.

First step and stages

First step: Specify the essentials basket, household types and the exact options to cost against the 2025 Act baseline. (owner: DWP with HM Treasury)

1. Consult on remit, basket and household types — DWP (proposed stage, not an official timetable)
2. Set up the advisory body and publish a first benchmark — DWP; Parliament if statutory (proposed stage, not an official timetable)
3. Annual report, with a published government response at the uprating review — Advisory body; DWP ministers (proposed stage, not an official timetable)

Depends on: A25: higher rates help only people who claim; Housing support (Local Housing Allowance) interacts with any change

Trade-offs

Who gains and who loses:

Gains for households on Universal Credit, largest for those with the least other income; costs fall on taxpayers or on whatever spending is cut. Rates for pensioners and disability benefits are outside this test unless its remit is widened.

What else the money or effort could do:

Money for higher rates is not available for services, employment support or debt reduction.

Strongest counterargument:

A benchmark turns a political judgement into an apparently technical one and builds in pressure for spending that may not be affordable; uprating already follows a legislated path to 2029–30.

Risks:

Basket choices contested as arbitrary; recommendations ignored, eroding trust; higher rates absorbed by rents where housing support is capped.

How we would judge it

Baseline:

Deep material poverty and food insecurity among people in low-income households (DWP Households Below Average Income).

Leading indicator:

The published gap between each household type’s rate and the benchmark.

Outcome:

Material hardship, food insecurity and income after essential costs; employment and caseload effects alongside.

Continue, adapt or stop:

Review the remit if the benchmark is not used in uprating decisions, or if hardship does not change after rates move towards it.

Sources

• Joseph Rowntree Foundation, Independent process to ensure Universal Credit covers essential costs (briefing), Briefing sections 1–3; section 2 (standard allowance against essentials) (2026-01-30; full text checked)
• legislation.gov.uk, Universal Credit Act 2025 (c. 22), Section 1(2) and 1(4) (standard allowance uplifts to 2029–30) (2025-09-03 (Royal Assent); relevant passages checked)
• Joseph Rowntree Foundation, Independent process to ensure Universal Credit covers essential costs (briefing), Section 3 (models for an independent process) (2026-01-30; full text checked)

Source published 30 January 2026 (JRF); 2025 (Universal Credit Act); evidence reviewed 2026-10-04. Reconsider if: A government response to an independent adequacy proposal; The next uprating review; A costed JRF/Trussell essentials-guarantee update.

The problem

Cold, inefficient homes push up bills and can harm health, and poor installations can make homes worse.

Who is affected, and where

Low-income and fuel-poor households in inefficient homes, in England. Territory: England. Warm Homes Plan grants are England-focused; devolved arrangements were to be set out separately; Scotland and Wales run their own schemes.

Policy status

A funded programme already exists. The Warm Homes Plan allocates £4,422m of low-income home grants for 2025–26 to 2029–30. The proposal here is targeting by need plus quality assurance, within that programme.

The evidence

What the research found:

Solid wall insulation cut median gas use by 17% in 2024 for measures installed in 2023 (indicative). The Cochrane review found health improvements “are possible”, clearest where homes were inadequately warm.

Evaluated on:

Homes with measures installed under government schemes (energy); people in improved homes in 39 studies (health); England and Wales, 2023–24 (energy); several countries to 2012 (health)

Our recommendation (separate from the research):

Select homes by need and suitability, fund surveys and post-installation checks, and measure weather-adjusted use and indoor conditions.

Strongest counter-evidence:

Savings vary year to year and include households choosing to heat more; health effects are uncertain and the review is old.

Effects on record

• Gas use in homes after solid wall insulation: −17% median gas use (similar homes without measures; 2024 savings for measures installed in 2023; indicative; varies year to year and includes households choosing to heat more). evaluated, moderate confidence; England and Wales. Observational comparison, mostly from government schemes; savings for cavity and loft insulation are smaller.
• General, respiratory and mental health of residents: Direction plausible; size not established. evaluated, limited confidence; Studies in several countries, searched to 2012. The review says improvements “are possible”, clearest where warmth was inadequate; no current UK estimate and no cashable NHS saving.
• Low-income households counted as fuel poor: Direction plausible; size not established. plausible spillover, limited confidence; England. The fall in the headline count partly follows from the definition. Whether hardship actually falls depends on real bills, heating behaviour and prices, which the count does not measure.
• Damp and mould after poorly specified or installed insulation: A cost or harm; size not established. plausible spillover, limited confidence; England. This is why A18 pairs grants with a survey before work and checks after it. No national rate of defects is published in the sources we checked.

Cost and funding

Cost completeness: Published programme envelope; project costs still needed. Funding: Programme funding exists; project allocation unconfirmed.

• Warm Homes Plan: low-income home grants (capital; paid by central government): £4.42bn in total, 2025–26 to 2029–30, price basis not stated by the source. Grant line only; the plan’s loans and financial transactions are different kinds of money and are not included. No price basis stated.
• Property surveys, installation quality checks, remediation and monitoring (recurring spending; paid by central government, landlords, households): Not yet costed. Use surveyed property-level costs; no invented national average.
• Warm Homes Plan low-income grant allocations: £4.42bn, 2025–26 to 2029–30 — not committed (programme envelope, not a project award). Programme allocation; an individual home or council scheme is funded only once its award is confirmed.

Who pays:

Central government grants; landlords under minimum standards; some households’ own contributions.

Financing proposed:

Warm Homes Plan low-income grants; landlord duties.

Gap remaining:

Unknown for any scheme until surveyed costs, quality assurance and remediation are priced.

What delivery needs

Skills:

Accredited installers and assessors.

Operational capacity:

Council delivery teams.

Infrastructure:

None beyond the homes.

Permissions:

Landlord and occupant agreement.

Law:

Private-rented minimum standards via regulations.

Public consent:

Disruption to occupants.

First step and stages

First step: Select homes by need and building suitability, then secure the award and installer capacity. (owner: Councils with DESNZ)

1. Survey — Assessors (proposed stage, not an official timetable)
2. Install and inspect — Accredited installers; councils (proposed stage, not an official timetable)
3. Monitor over heating seasons — DESNZ and councils (proposed stage, not an official timetable)

Depends on: Installer workforce; Quality-assurance regime

Trade-offs

Who gains and who loses:

Gains for low-income households in the least efficient homes; landlords bear costs and may pass some on in rents.

What else the money or effort could do:

Grant spent here is not available for other energy or housing programmes.

Strongest counterargument:

Savings can be smaller than modelled and poor work can cause damp.

Risks:

Poor ventilation, workmanship, rent increases and installer scarcity.

How we would judge it

Baseline:

Fuel poverty rate in England (DESNZ).

Leading indicator:

Measures installed, defects found and fixed.

Outcome:

Weather-adjusted energy use, indoor conditions, bills and appropriate health outcomes.

Continue, adapt or stop:

Scale where measured savings hold after inspection; stop measures that cause defects.

Sources

• Department for Energy Security and Net Zero, National Energy Efficiency Data-Framework (NEED): summary of analysis 2026, Section 3, Figure 3.1 (2026-06-11; relevant passages checked)
• Cochrane / Hilary Thomson and colleagues, Housing improvements for health and associated socio-economic outcomes (Cochrane Review CD008657); plain-language title 'Housing improvement as an investment to improve health', Abstract (2013-02-28; summary or abstract only)
• Department for Energy Security and Net Zero, Warm Homes Plan (updated 18 March 2026), Funding allocations table (2026-03-18; relevant passages checked)
• Cochrane / Hilary Thomson and colleagues, Housing improvements for health and associated socio-economic outcomes (Cochrane Review CD008657); plain-language title 'Housing improvement as an investment to improve health', Authors’ conclusions (2013-02-28; summary or abstract only)

Source published March 2026 (Warm Homes Plan); June 2026 (NEED); February 2013 (Cochrane); evidence reviewed 2026-10-04. Reconsider if: Devolved and all-tenure allocations are published; A new UK evaluation of health effects; A new NEED release.