Reimagining early years services to address childhood inequities

‘A Better Start’ was a 10-year (2015–2025), £215 million initiative funded by the National Lottery Community Fund, supporting five areas in England to address inequalities in the early years of life across socio-emotional development, language and communication, and nutrition outcomes. It aimed to provide a place-based, test-and-learn model, putting parents at the heart of design and delivery. As a result, each of the five sites developed and implemented distinct local programmes. The Better Start Bradford programme delivered multiple preventative interventions across the outcome domains. Bradford was the only site to embed a research partner - Born in Bradford - from the very beginning. This enabled a fully resourced research hub – the Better Start Bradford Innovation Hub, including the world’s first interventional birth cohort, Born in Bradford’s Better Start (BiBBS), designed to efficiently evaluate multiple interventions simultaneously. This evaluation has provided in-depth learning about the inequalities faced in contemporary urban populations and evidence of the implementation and impact of multiple early years interventions. In this review, we reflect on our ‘decade of discovery’: what worked well, what we have learned about evaluating and delivering early-years prevention at scale, and what we would do differently if we had the opportunity again. Examples of what worked well include the place-based model, the test-and-learn approach, a robust evaluation infrastructure and community empowerment. Our learning has evidenced important changes for future programmes and for commissioners, chief among them: complex inequalities cannot be resolved through the delivery of individual or scattered interventions. This collective learning points to a clear call for change to create a jointly commissioned, appropriately funded, and continuously evaluated early-years system, underpinned by a long-term commitment to prevent inequity in the early-years before it becomes entrenched.