Housing to be included on health and wellbeing boards, says Jack Dromey

Shadow minister Jack Dromey said the decoupling of housing and health in public policy has been a mistake. Photograph: Bob Fallon/guardian.co.uk

Housing representatives will be given a seat at local health and wellbeing boards under Labour plans to improve the integration between housing, health and social care, according to shadow housing minister Jack Dromey.

Speaking at the Labour conference at a Guardian fringe event sponsored by Moat housing association, Dromey said the decoupling of housing and health in public policy had been a mistake as good quality housing was "arguably the greatest contributor towards public health".

Local health and wellbeing boards were introduced in 2012 to bring together senior council staff, elected members and NHS staff to build partnerships, tackle health inequalities and improve how the sectors work together.

The announcement follows former health minister Paul Burstow's call for the housing minister role to be relocated to the Department of Health.

Dromey also announced a Labour government would scrap the "affordable rent" programme which determines the funding and rent levels of social housing, and would subsidise housing providers with grant funding and investment. But he added that a Labour government would be "very demanding" of how housing providers used the funding.

Moat chief executive Elizabeth Austerberry said reduced funding housing associations receive under the affordable rent programme had constrained the development of new affordable homes.

Opposition leader Ed Miliband said in his conference speech that Labour would introduce a use-it-or-lose-it ultimatum to developers to prevent land banking. Charles Seaford of the New Economics Foundation welcomed this but added: "You also have to be willing to designate land for housing that doesn't currently have planning permission.

"It's not up to people to apply, they just get it. You don't have a free market when it comes to land, essentially."

Photograph: Bob Fallon/guardian.co.uk

Former deputy prime minister John Prescott proposed a land-sharing agreement between local authorities and developers, in which councils retain ownership of the land but permit developers to build on it to reduce house prices by removing the land value from the total cost.

"Why don't [local authorities] keep the land?" said Prescott. "The building costs are say 50%, so let that be the mortgage. That's a £60,000 house. That's the rate of a deposit now in London."

The announcement that a Labour government would double the rate of housebuilding to 200,000 homes a year was warmly received, but Austerberry said less restrictive regulation would be required to increase the number of homes housing associations can build.

Austerberry called for more flexible tenures within the social housing sector: "Not only do we need to be building more units, we need to think of more ways that people can occupy those units depending on their financial circumstances and their lifestyle at any particular time," she said.

Dromey also repeated Labour's pledge to abolish the under-occupancy penalty, or bedroom tax as its known to critics.

"Once every generation there comes a tax so bad that the next generation looks back and asks the question 'why the bloody hell did they do it?'," he added.

Jack Dromey, Charles Seaford and Elizabeth Austerberry were speaking at the Labour party conference Guardian fringe event on 24 September. Read the housing cliff report here.

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Can foundation trusts survive and where do their loyalties lie?

A gap in areas lies between the governors and the non-executive directors of foundation trusts, writes David Walker. Photograph: Martin Argles for the Guardian

The polite word is 'hybrid'. The less polite is 'incoherent'. Either way, NHS foundation trusts are based on two contradictory visions of how they should operate and who should call the shots, and the 2012 Health Act is increasing the tension between them.

Ten years ago, Labour had a wacky idea. Instead of making primary care – the part of the NHS closest to people — more accountable, it would inject democracy into the providers of healthcare in the hospitals, ambulance, and mental health services. They, not the GPs, would have elections. The notion is now looking odder and odder, partly because of the competitive pressures stoked by the Cameron coalition's health act and partly because it's commissioning that needs accountability most.

No wonder, then, you start to overhear backstairs conversations asking whether the foundation trust (FT) model can survive. One half of the hybrid is the community, the people using the service, staff and patients themselves and it is they who elect FT governors. Alan Milburn, the Labour health secretary, dreamily talked of mutualism – but then set up a regulator, Monitor, to enforce strict business principles on FTs.

So the other half of the FT model is hardheaded commerce, profit and loss and earnings before interest, depreciation and amortisation. FTs are meant to behave like businesses, going for growth and profit. How are governors meant to square their desire for a local service with the FT board's concern to balance the books by closing a clinic here or a much-loved ward over there?

Democracy and profitability may be fated to war. Paul Hackett, director of the Smith Institute, notes 'all public institutions face tensions between representation and effectiveness', including school governing bodies and councils themselves. Smith, a centre-left thinktank, has just teamed up with the Association of Chartered Certified Accountants to paint a picture of FT governance.

It's healthier than might have been thought, confirming surveys by Monitor. Total numbers involved have actually been growing though FT governors tend to be older and retired; half their elections are not contested. Still, many thousands of people, embedded in local areas across England (the experiment did not extend to the rest of the UK), contribute vast amounts of time and energy to their mental health, community and hospital services through membership of a trust.

The Smith report warns against generalisation – FTs vary widely in their levels of activism, and in how close governors get to board decision-making, especially in matters of finance. A yawning gap in many areas lies between the governors and the non-executive directors, who are not representative of the area but on the board to ensure trusts operate efficiently and effectively.

The Tories, embarrassed at the complete absence of accountability from their original ideas for clinical commissioning by GPs, inserted more powers for FT governors in the 2012 act; they now shadow many of the decisions taken by FT boards, without being paid and without the support apparatus boards tend to have.

Ahead lie problems. Governors are the public and want to operate in the open.

But how can FTs compete with private providers if their cost schedules and profit assumptions are declared in advance? Virgin of course has no governors. Its shareholders are institutional investors who play no part in executive decision taking unless profits go down. What if governors, responsive to staff and patients, opt for a lower rate of return than the board, mindful of competitive pressures? Who should have the last word?

If governors represent one area, what role should they play if an FT acquires healthcare responsibility in another area and the notion of 'local' gets stretched? In London, the executives of better-performing FTs are supposed to lend a hand to trusts in difficulty (most of them still in the notional pipeline to becoming FTs): governors might object to 'their' managers being distracted from serving the local area.

Do governors have any role in bidding for contracts from clinical commissioners? Or from councils? Now that public health has shifted to councils, some FTs are fighting for contracts from the town hall: is the local authority or the FT governing council more 'representative' of an area? The better FT governing councils are those that include elected councillors, but where now do their primary loyalties lie?

David Walker is a non-executive director of a foundation trust; the views expressed here are his own

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A day in the life of ... a second-year student nurse

No two days are the same for student nurse Alex Collyer who used to work for the ambulance service. Photograph: University of Southampton

Life as a student nurse means that no two days are the same, whether it's clinical placements, lectures, presentations or simulated practice. It's varied and challenging but that's why I enjoy it.

I am currently studying for a bachelor degree in child and adult nursing at the University of Southampton. I have just finished my first year and I am about to begin a placement in the neonatal unit at the Princess Anne hospital. This is the start of my nursing adventure, after four years in the ambulance service.

My first placement was at the children's assessment unit (CAU) at Queen Alexandra hospital in Portsmouth, which deals with children referred by GPs, ambulance crews, community nurses and has open access for families with children who suffer from long-term conditions.

It is a 24/7 unit with nurses and doctors on 12-hour shifts starting at 7.30am. My day on CAU started with the night team bringing us up to speed with those patients already in the unit. The mornings there could be a bit of a whirlwind – assessing, treating, playing, talking to families, observing and dispensing medication – as we attempted to get as many children as possible to the point where they could be safely discharged home. For the children who were not well enough to go home, we arranged for them to be admitted to either a medical or surgical ward. And, seriously ill children were stabilised before being transferred to the paediatric intensive care unit at Southampton general hospital.

Working in a children's unit was fast paced and you deal with the full spectrum of medical conditions. It was also rewarding as children tend to bounce back quite fast and you see their personalities return. I also had a placement in the community working with a health visiting team where I had the opportunity to study child development.

I have been lucky enough to get a place on the National Junior Leadership Academy (NJLA), a pilot project set up by Stacy Johnson, a lecturer at the University of Nottingham, to identify nurse leaders at an early stage. So far we have spent three days in Nottingham discussing what change could mean in healthcare and how to lead that change. All the NJLA students have now returned to their local areas to try and create improvements in their healthcare localities and we meet again in December.

It is opportunities like this, and going on placement, that ensure nursing students are learning from the people who are delivering healthcare, as well as academics and researchers at universities. Both aspects allow nursing students to have a well rounded training programme that prepares us for life in healthcare.

The nursing degree offers 50% clinical placement time and 50% university study and I have been able to take what I have learnt in the classroom on to the wards. During the next few years, my placements will rotate around the various wards and departments in different NHS organisations to gain a wide range of clinical experience. After qualifying, I am hoping to start in an intensive care unit or an emergency department to build on my experience with the ambulance service.

Student nursing is time intensive, we work nights and weekends and, when we're not on the wards, we have essays to write and pharmacology and anatomy exams to get ready for. Due to the nature of the course, student nurses rapidly form a close community. We all have a common goal of helping others and caring for those in need.

When I'm not in hospital or at the university, I am a combat medical technician in the Territorial Army and I have previously served in Iraq. To de-stress I go running with the University of Southampton athletics team, which is my only break from healthcare.

Before drifting off to sleep I normally have a slight moment of apprehension when I realise I have to be up in five hours to get back to the ward. But I don't mind; there is nothing else I would rather be doing. Working in healthcare can be relentless but you're constantly motivated by your colleagues and the interactions with patients to provide the very best care the public deserves.

If you would like to feature in our 'day in the life of series', or know someone who would, then let us know by emailing healthcare@theguardian.com

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