This volume provides a most valuable, thoughtful account of both the origins of Sure Start Local Programmes (SSLPs) and what they have achieved so far. My assignment was to provide an independent assessment of the initiative as a whole, insofar as it can be judged at this rather early stage. I approach that task wearing the hat of a clinician who has throughout his career been concerned with preventive and therapeutic interventions, that of an epidemiologist concerned with the study of risk and protective factors for psychological outcomes, and that of a methodologist concerned with the critical examination of the efficacy and effectiveness of interventions. I examine the need for such an initiative, the evidence for this, the content of the provision, the design of the programme and the research evaluation and design, and conclude with an overview; during this critique I bring out positive elements of the initiative, as well as making critical comments.

Was there a need for a new initiative?

It is appropriate to start with the basic question of whether there was a need for a major new initiative. Of all the questions to be considered, that is the easiest to answer. Clearly, there was a huge need. The recently published UNICEF comparison of the well-being of children and young people in 21 industrialised countries (UNICEF Innocenti Research Centre, 2007) provides the stark conclusions that, despite being one of the richest countries, the UK is ranked bottom in terms of well-being assessment. Questions can be raised about the concepts and measures but the facts are indisputable. The UK is one of the worst countries with respect to child poverty, the proportion of children continuing in education and the rate of infant mortality, to mention but three relatively objective, quantifiable indices. The measures of children's social relationships and general well-being are inevitably rather ‘softer’ but they provide the same negative picture. The UK's bad international position is very similar to that of the US – again one of the richest countries in the world (see Fitzgerald et al, 2006; Freeark and Davidson, 2006; Villaruel and Luster, 2006; Watt et al, 2006).