In her recent GCPH Seminar Series lecture, Anna Coote shared a vision for what could be achieved with the redesign of our public systems and set out a case for Universal Basic Services (UBS). 

“This is about transforming services, not just about having more of them…” 

We are living in a time of profound societal and ecological change. We are seeing the rapid evolution of technologies that are both awe-inspiring and horrifying in equal measure. We are at the precipice of potential irreversible climate change with the urgent need for alternative models that meet the needs of the current generation, while not destroying opportunities for future generations. We have widening health inequalities, with an unequal distribution of power and wealth – with some people having more and more, with others having less. 

Are public systems ‘fit-for-purpose’ to help address these challenges? And if not, what can be done? 

Anna presented an alternative vision for the future. One that involves redesigning the role of public systems, and relationships with communities. One that sees public systems as enablers and facilitators, creating conditions to help people meet their own needs, rather than an exclusive top-down provider that enforces uniform provision. More specifically, Anna argued that Universal Basic Services are an essential part of public systems re-design.   

What are Universal Basic Services? 

This is not about setting up more foodbanks because people cannot afford to buy food for themselves or their families (which, in itself, is a shameful indictment of system failures). 

Anna provided a simple definition of UBS. Universal so that everyone is entitled to access services that are sufficient to meet their need, regardless of their ability to pay. Basic in the sense of being essential to allow people to meet their own needs. Services meaning collectively generated activities aimed at serving the public interest. 

One of the most vivid illustrations of UBS can be found by drawing comparisons between countries with and without universal health provision, free at the point of use. We can see the consequences for some in the United States making an impossible choice between whether to feed their families or pay for essential healthcare. A choice – thanks to the NHS – that families in Scotland need not make. 

Examples of UBS models in other contexts can be found in the recently published book – The Case for Universal Basic Services by Anna Coote and Andrew Percy. It discusses how UBS can (and has been) extended to other areas of public interest such as housing, childcare, adult social care and transport. The format and delivery, however, will need to be bespoke to each area. Regardless, Anna outlined some guiding principles. 

Principles of Universal Basic Services 

It is partly about creating and protecting systems, so profit is not the primary driver in the provision of services and goods that people need. We can turn to health and healthcare to understand the dire consequences where profit becomes a primary incentive. In the United States, despite spending more on healthcare per person than other high-income countries, there are comparably poorer mortality rates and higher rates of premature death (Why do Americans have shorter life expectancy and worse health than do people in other high-income countries?).  

Jones and Kantarjian provide a particularly eloquent articulation of this problem. They talk about the perverse incentive structures that lead to investing in healthcare to maximise profit, instead of investing in healthcare to meet health needs. Public health suffers, with health inequalities widening as a result. Life expectancy of the wealthiest in America is over 10 years more than the poorest.   

Anna argued organisations providing goods or services that serve a public need should operate in accordance with a collectively agreed social license. Such a social licence could be used as a tool for accountability, with contracts removed from organisations should they fail to adhere to the conditions serving in the public interest. Universal Basic Services must be provided that meet sufficient quality.   

Public systems should have a responsibility to ensure equal access, set and enforce quality standards, and facilitate new, innovative models of ownership and control that support and empower communities. 

Are there connections to Scotland’s policy landscape? 

There are important and common principles shared across the UBS model presented  in the lecture and Scotland’s seminal Christie Commission report published nearly a decade ago, that set out the urgent need to transform the delivery of public services. 

In light of rising demand and constrained resources, there was recognition that services could no longer continue to operate as they did. The Commission also highlighted community empowerment and the need for shared or pooled resources across services and systems to facilitate collective responsibility. Participatory Budgeting (PB) provides a powerful example of such an innovative, alternative model which fosters community empowerment. Read a comprehensive overview of PB from What Works Scotland. 

It leads us to ask – with its shared common elements with UBS of community empowerment and collective responsibility – how far have we come since the Christie Commission, and how far have we still to go in the transformation of public systems? 

Next steps 

Crucially, Anna presented the guiding principles for Universal Basic Services. She did not however, provide a detailed blueprint for implementation. That’s on us to explore. We have a responsibility to collectively develop and refine. It’s for us to look at the different parts and think how it might run. So, the question we need to ask ourselves: what are the opportunities and challenges in years to come for a Universal Basic Services model? 

You can read more about Universal Basic Services in the recently published book: The Case for Universal Basic Services by Anna Coote and Andrew Percy.