The case for universal basic services

by Hannah Brunton and Scott Faulds

There are longstanding debates around what should be included in the provision of public services, and this issue was central to the discussion at a recent Glasgow Centre for Population Health (GCPH) Seminar (series 16: lecture 2), at which Dr. Anna Coote presented her proposal for ‘Universal Basic Services’ (UBS). The need for public services like healthcare and education is widely recognised, but services such as adult social care, housing and transport remain largely privatised. As poverty, inequality and environmental issues become increasingly prevalent, could UBS be what is needed to transform public service provision to tackle such problems?

What are universal basic services?

The basic premise of UBS is the idea that public services should be improved and expanded to sufficiently cover all of life’s everyday essentials, for everyone who needs them, irrespective of their ability to pay. One of the main principles identified by Dr. Coote was the idea that public service provision should be guided by the shared basic needs which are common to all in society, such as food, shelter, housing, transport, information, education and healthcare. By combining existing resources and taking collective responsibility for meeting these needs, Dr. Coote proposes that UBS would be a sustainable system that would also allow future generations to manage their own continually changing needs.

A core aspect of the proposal is the idea of the “social wage” whereby all members of society receive a ‘virtual income’ via collective public services, topped up by income support for those who need it, to ensure that everyone’s income is sufficient and that everyone is able to afford the essentials that they are expected to pay for themselves.

How would UBS work in practice?

The proposal involves expanding the variety of public services offered, as well as improving those which exist already, such as education and healthcare. Dr. Coote argues that public services should be broadened to include childcare, adult social care, transport, housing, and information services, universally available to all, and free at the point of use.

However, as Dr. Coote acknowledges, this is easier said than done. The implementation of UBS would mean a major transformation of public services and would require a great deal of investment in social infrastructure, as well as the establishment of clear entitlements to ensure everyone has an equal right to access the services they need.

In practice, Dr. Coote proposes a bespoke approach for each area of need, based on case studies from a range of European countries. For example, the proposal recommends a universal childcare scheme based on Norway’s childcare system, and a free bus system based on transport schemes in France and Estonia.

Benefits of UBS

While Dr. Coote acknowledges the potential difficulties in implementing a system like UBS, her talk outlined the broad range of potential benefits which such a system could bring about, in terms of equality, efficiency, solidarity and sustainability. In terms of social and economic inequality, Dr. Coote argues that UBS could tackle this by reducing income equalities by 20%. The proposal also argues that efficiency would be improved, as investment in public services would deliver more social and economic value than the current market system does. Furthermore, Dr. Coote argues, taking collective responsibility, combining resources, and sharing risks would help to build solidarity and empathy. Finally, with regard to sustainability, UBS could help to tackle the climate crisis by reducing carbon emissions and protecting natural resources, while also improving public health and wellbeing and boosting employment.

Universal basic income

Recently, there has been a spate of trials of what is known as universal basic income (UBI), a form of cash payment paid to every citizen regardless of income or employment status. The concepts of UBS and UBI are in some sense relatively similar: both involve providing some form of statutory support to all citizens. However, Dr Coote, argues that the provision of UBS with a sufficient UBI would be fiscally incompatible. Instead, she suggests implementation of UBS in tandem with a generous, guaranteed income protection scheme. This would include:

  • restoring child benefit to 2010 levels in real terms;
  • swapping the tax-free personal allowance for a cash payment for all but the richest;
  • improving social security payments by 5% for all;
  • removing caps and reduceing rates at which benefits are withdrawn.

The combination of this scheme and UBS have been estimated to cost 5.8% of GDP. By comparison, the provision of a sufficient UBI alone would cost between 20% to 30% of GDP. Dr Coote, invokes the work of Luke Martinelli, who concludes: “an affordable UBI would be inadequate, and an adequate UBI would be unaffordable”. In short, Dr Coote, believes that the provision of a sufficient UBI is unaffordable and that the delivery of UBS, whilst not perfect, avoids the ineffective use of huge amounts of public money which could instead be used to improve and expand upon collective public services.

Additionally, Dr Coote, states that even from an ideological standpoint UBS and UBI are incompatible, arguing that UBI is: “an individualistic, monetary intervention that undermines social solidarity and fails to tackle the underlying causes of poverty, unemployment and inequality”.

For example, proponents of UBS argue that providing people in poverty with a UBI to fend for themselves within an inflated housing market is an inefficient use of public money and contend that it would be more effective to provide quality housing. Research conducted by Oxfam has found that the “virtual income” provided by the provision of universal public services helps to reduce income inequality in OECD countries by roughly 20%. Therefore, it could be argued that by deploying UBS, and substantially enlarging the social wage, people will need less disposable income to meet their needs and flourish.

Final thoughts

At its very core, the concept of UBS can be seen as a desire to create more and better collective services, available as a right, rather than by an individual’s ability to pay. Throughout the seminar, Dr Coote was clear in her belief that UBS is not a silver bullet.  Instead it should be viewed as a principled framework that challenges conventional economic thinking and provides a vision of a better future. In short, UBS can be seen as an attempt to reclaim the collective ideal and as a desire to extend the ‘social wage’ to best meet the collective needs of everyone in society.


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Writing and recovery: creative writing as a response to mental ill health

 

“You don’t put yourself into what you write, you find yourself there.”
Alan Bennett

Mental illness, for so long regarded as secondary to physical health, is now being taken more seriously. Media stories about loneliness, anxiety and depression have highlighted increasing concerns about mental ill health, and the issue has also been rising up the political agenda.

In 2017, a survey by the Mental Health Foundation found that only a small minority of people (13%) reported living with high levels of good mental health, and nearly two-thirds of people said that they had experienced a mental health problem.

Prescribed medication is one response to mental health problems, and it’s been reported that the NHS is prescribing record numbers of antidepressants.  But while psychiatric drugs can be of real value to patients, especially those whose condition is very severe, the mental health charity Mind has suggested that alternatives, such as physical exercise, talking therapies and arts therapies, are often more beneficial.

Last month, a conference at the University of Glasgow explored ways in which creative writing is being used to respond to mental ill health, and discussed what makes writing interventions helpful for coping and recovery.

Voices of experience: coping and recovery through writing

“Making and consuming art lifts our spirits and keeps us sane”.
Grayson Perry

Several speakers at the Glasgow conference testified to the effectiveness of writing in dealing with mental ill health and in finding a way to recovery.

In 2012, James Withey experienced a set of circumstances which brought him close to taking his own life. In the darkness of his depression, James felt that he might never recover. But after spending time at Maytree, the UK’s first “sanctuary for the suicidal”, he found that writing about what he was going through offered an antidote to the lies being spun by his depression.

He started a blog, and when he posted a letter to himself, beginning “Dear You.” James found that writing the letter gave him space to express his feelings and to listen to himself.

Before long, readers of James’s blog were responding with their own “Dear You” letters. The word spread that the letters offered a different perspective on recovery, and in some instances, had prevented suicide.

Today, The Recovery Letters project is still going strong, with a website, one published book and another in the pipeline. James is realistic about the project:

The letters are not a cure for a chronic illness, but they do provide support in helping sufferers of depression accept where they are.”

Policy positions: the view from Wales

“If poetry and the arts do anything, they can fortify your inner life, your inwardness.”
Seamus Heaney

Another speaker at the conference was Frances Williams, a PhD candidate at Manchester Metropolitan University, where she is studying arts and health. In her presentation, Frances explored some of the policy frameworks and public discourse surrounding the field of therapeutic writing in Wales.

She highlighted a recent report, Creative Health, The Arts, Health and Well-being, which  makes a case for the healing power of the arts in many different healthcare and community contexts.  In this report, a creative writing tutor explained some of the ways in which writing can help people experiencing bereavement, including keeping a journal, writing unsent letters, describing personal belongings and resolving unfinished conversations:

“Writing can be a valuable means of self-help, with the page as a listening friend, available any time of the day or night, hearing whatever the writer wants to say. The results of this can be powerful, and include people being able to return to work and adjust more effectively after their loss, acquiring skills for their own self-care which will serve them through the rest of their life.”

Frances also noted that the battle of priorities between impact and value-for-money has driven advocates of arts therapy programmes to defend them in terms of cost effectiveness and social value.

A mapping project by the Arts Council of Wales has taken this to heart, producing in 2018 an audit of the principal arts and health activities currently taking place in Wales.

Writing to the rescue

“By writing, I rescue myself”
William Carlos Williams

The Glasgow University conference underlined the health-giving properties of creative activities and the potential for creative writing to support people suffering with mental ill health. There was no pretence that writing offers a quick-fix solution. As James Withey noted, “…writing is just one element in a toolkit of responses to mental ill health.”

The All-Party Parliamentary Group on Arts, Health and Wellbeing fully supports this concept, and has recommended that policymakers recognise its importance:

“…the arts can make an invaluable contribution to a healthy and health-creating society. They offer a potential resource that should be embraced in health and social care systems which are under great pressure and in need of fresh thinking and cost-effective methods. Policy should work towards creative activity being part of all our lives.”


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Planning healthy cities … integration is key

Image from Flickr user Sebastian Niedlich, licensed for reuse under a Creative Commons License

Image from Flickr user Sebastian Niedlich, licensed for reuse under a Creative Commons License

By Dorothy Laing

“The environment in which we live, work and spend leisure time – both the physical nature of places and the social environment of communities – has an enormous impact on our health and wellbeing. Health problems such as obesity, chronic heart disease, stress and mental health issues are intricately linked to the environments in which people live and work”. (RTPI, 2014)

Earlier this month the RTPI published Promoting healthy cities: Why planning is critical to a healthy urban future, the third in a series of Planning Horizons papers launched to mark the RTPI’s centenary. The report looks at how planning can help to create healthy cities – one of its main arguments being that health and wellbeing need to be at the core of city design and development.

With a growing number of people living in urban areas, and health problems such obesity and diabetes on the rise, planning for healthy cities is vital. And interest in the links between planning and urban health is nothing new.

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