Meeting of the Parliament

Meeting date: Thursday, October 6, 2011

Official Report 1106KB pdf

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Scottish Executive Question Time

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Health, Wellbeing and Cities Strategy

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NHS Workforce Reduction (Patient Care)

1. To ask the Scottish Executive how it will maintain levels of patient care in the face of staff reductions across the national health service. (S4O-00248)

As I have said in the chamber on many occasions, quality of care and patient safety are my top priorities and will always come first. Decisions that are being made by NHS boards are subject to on-going scrutiny by me and by local and national partnership bodies. I have made it clear to all boards that projected staff changes will happen only if boards can demonstrate, in partnership with staff, that they flow from service redesigns that do not compromise quality or safety.

NHS Lothian has confirmed to me that it lost 734 posts in 2010-11 and that it will lose a similar number in 2011-12, with half of those being nurses. That comes at a time when complaints about understaffed wards are increasing, the Royal College of Nursing has complained about stress levels among staff and the Edinburgh royal infirmary is yet again under criticism for problems with cleanliness. Does the cabinet secretary seriously expect the public to believe that front-line patient care will remain unaffected when more than 700 nursing posts have gone?

My job as health secretary—it is one that I never shy away from—is to ensure that patient care is protected and that we deliver quality health services. For all the pressures on Scotland’s health service and its staff—I do not underestimate them for a second—it is performing better than it has done at any time in its history. We have the lowest waiting times on record, radically reduced hospital infection rates and a patient safety programme that is delivering significant improvements. I will continue to support our NHS staff to deliver those improvements.

Patterns of patient healthcare are changing. We have shorter lengths of stay in hospital, higher rates of day surgery and improvements in patient safety, all of which mean that the shape and size of the NHS workforce will change. We must ensure, however, that as it changes quality and safety remain the top priorities.

The chair of NHS Lothian wrote to the member after he put out a press release that was in a similar vein to his question. The letter pointed out that the figures that the member gave in the press release were inaccurate. Probably more interestingly, the chair said that, although the member claimed to get those figures from a meeting with NHS Lothian, the member actually left that meeting before the agenda item on workforce. It is one thing for the member to come to the chamber to raise issues, as he is perfectly entitled to do, but perhaps he should show more interest in the meetings with NHS Lothian.

While we are talking about patient care in Edinburgh and elsewhere in Scotland, I want to raise the issue of cancer care. Surely our hard-working NHS staff are to be commended for their success in achieving the 62-day cancer waiting time target, a target that Labour failed to achieve when it was in power. Does the cabinet secretary acknowledge that, in meeting the new 31-day target for the time from urgent referral to treatment, the NHS is ensuring that many more patients in Scotland receive the care that they are entitled to expect?

I strongly agree. I never underestimate the pressure that our NHS staff work under. Being a doctor, nurse or any other member of the NHS team is a tough job in the best of times and it is even tougher in the challenging times that we face today. The achievements that I mentioned in my earlier answer and the specific achievements on cancer waiting times that Annabelle Ewing cites are testament to the hard work of our NHS staff. It is our duty to thank them for that and to support them in the work that they do.

The cabinet secretary will know that, in addition to the job reductions that have been referred to, newly qualified nurses and doctors are struggling to find employment. Before the election, the SNP promised that it would cut management costs in the NHS by 25 per cent to free up resources to spend on the front line, which is a welcome commitment. What progress is being made on that and what is the target date to complete the reduction?

Not only can I tell Murdo Fraser about the progress that is being made; the progress was published just a couple of weeks ago. I will send him a link to that after question time.

The target was to cut the number of senior managers by 25 per cent over the parliamentary session, and the most recent figures to be published show that we are more than on track to do that. That commitment is important, as it allows us to ensure that we get as much of the NHS budget as possible to the front line to support point-of-care services. I will continue to strive to do that.

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NHS Greater Glasgow and Clyde (Meetings)

2. To ask the Scottish Executive when the Cabinet Secretary for Health, Wellbeing and Cities Strategy last met the chief executive of NHS Greater Glasgow and Clyde. (S4O-00249)

Ministers and Government officials regularly meet senior management from national health service boards, including NHS Greater Glasgow and Clyde.

When the cabinet secretary met managers last week, did she discuss NHS Greater Glasgow and Clyde’s position on the prescribing of eculizumab? The National Institute for Health and Clinical Excellence recognises that drug for the treatment of severe blood disorders and it is widely available in England and Wales and, indeed, in health boards throughout Scotland.

The cabinet secretary will be aware of my representations on the fairness of NHS Greater Glasgow and Clyde’s policy on behalf of my constituent Mrs Joyce Juszczak, who is with us in the chamber. Mrs Juszczak has a life-threatening blood disorder and would greatly benefit from the prescription of that drug. It seems that only bureaucracy is preventing her from getting the treatment that she deserves. Could the cabinet secretary assist us to ensure that we get through that bureaucracy and that Mrs Juszczak is given the treatment for the benefit of her quality of life and, more important, for her life itself?

I fully understand the sensitivity of the issue and the personal distress that has been caused to Mrs Juszczak as a result of the circumstances. I welcome her to the chamber and look forward to meeting her later this afternoon.

I am committed to improving the availability of and access to all drugs for all patients who would benefit from them. We debated that in the Parliament last week.

Decisions on what drugs are recommended for general use are taken by the Scottish Medicines Consortium independently of ministers. If a drug is not generally recommended, it can be considered on an individual patient basis on clinical grounds. I am sure that the member will understand that I cannot directly intervene in individual decisions that are based on clinical reasons. However, I will meet the member and Mrs Juszczak later this afternoon and will be happy to discuss her case in general terms with NHS Greater Glasgow and Clyde to satisfy myself that it has taken into account all the relevant factors in her case in reaching its decision.

There is another point that I would be happy to discuss with Mrs Juszczak later. Decisions to do with individual patient treatment requests are never once-and-for-all decisions. If any patient’s condition changes or deteriorates, it is possible to ask for a decision to be looked at again. Perhaps we could usefully discuss that later this afternoon.

The cabinet secretary will be aware that the issue of increases in car parking charges at Glasgow royal infirmary has not yet been resolved and that it is still causing great financial hardship to staff. I have written to the various organisations concerned, including NHS Greater Glasgow and Clyde, but have not yet received a reply. Can the cabinet secretary give me an update or any information that she has received that may help to alleviate the hardship that the staff and people who visit the infirmary face?

I understand and share the concerns of staff about the increase in car parking charges. As Sandra White is aware—and this is a matter of regret to me—the issue is not within NHS Greater Glasgow and Clyde’s control, as we are talking about a private car park. It is one of the private finance initiative legacies that the previous Administration left to us. However, I am happy to discuss matters further with the member and with NHS Greater Glasgow and Clyde to see whether we can bring to bear any further influence. That said, I want to be clear that the decision is not an NHS decision; it is a decision by the company that owns and runs the car park in question.

Further to the question from my colleague Duncan McNeil, the cabinet secretary will be aware that I have had two constituents who have suffered from PNH, one of whom, Mr Devine, has now died. I was delighted to hear that the cabinet secretary will meet Mrs Juszczak this afternoon. I believe that she will be aware of correspondence from me requesting a meeting with the PNH Alliance to discuss a way forward so that we can resolve the issue of access for patients to the most effective medicines and tackle the whole issue of a postcode lottery across Scotland with regard to this drug. Will she agree to such a meeting?

I hope that the member will convey my condolences to the family of his constituent. I would be happy to consider such a meeting—the member should get in touch with my office. I hope that all members, regardless of their genuine concerns and sincere representations on behalf of constituents on these issues, will understand that no health secretary of any party in this chamber can get directly involved in individual clinical decisions. However, we debated these issues only last week and we all have a desire to increase the availability of and access to clinically beneficial drugs. I would be happy to meet any interested group to discuss how we can build on the work that we have already done in conjunction with the Public Petitions Committee to further improve such access.

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Myalgic Encephalitis-Chronic Fatigue Syndrome

3. To ask the Scottish Government what action it is taking to raise public awareness of myalgic encephalitis or chronic fatigue syndrome. (S4O-00250)

In September 2010, we published the “Scottish Good Practice Statement on ME-CFS” for use by general practitioners as part of the process of ensuring that people get better and more consistent standards of care, including quicker and more reliable diagnosis.

The good practice statement is accompanied by a patient guide that sets out what someone should know if they or their doctor think that they might have ME. The statement has been issued to GP practices and consultants across Scotland to help raise both public and professional awareness of the condition.

In addition, Action for M.E has been awarded some £42,000 from the self management fund to set up an online information and support hub for people living with ME, their carers and their families.

Constituents of mine suffering from ME often tell me that their condition can make the complex, drawn-out process of trying to access support from public services too daunting to complete. The United Kingdom Government’s Department for Work and Pensions is among the most frequently cited obstacles in that respect, but it is not the only one. Are there any measures under consideration to improve support for ME sufferers in that respect?

As I said in my previous answer, we as a Government are committed to ensuring that there is an improvement in the standard of care and services that people who suffer from ME receive. The member will appreciate that the DWP is a reserved area, although some of us feel that it would be better if it were responsible to this Parliament. However, I expect public agencies to be sympathetic to individuals who have conditions that might compromise their ability to make claims for benefits, for example. I hope that, in recognition of that, the DWP will take action in order to ensure that Mr Torrance’s constituents are given the assistance that they require in order to make their relevant benefit claims.

One of the fundamental problems relating to ME-CFS is that research funding still tends to be made available to those who believe that it is a psychological disorder, whereas the World Health Organization and other similarly highly respected organisations now recognise that it is a biological condition. What will the minister do to ensure that research is carried out into the biological rather than psychological causes?

The member might not be aware of this, but the chief scientist office in the Scottish Government has already provided some £400,000 for the promoting action on clinical excellence—PACE—project that looks at cognitive behavioural therapy alongside exercise therapy as a mechanism for treating people with ME.

The Medical Research Council has also indicated that it will provide some £1.5 million towards further research on ME and it expects bids from research practitioners in relation to how they can provide more treatment for people who suffer from ME.

Research is being undertaken and the PACE programme is already showing some very encouraging signs of the benefit that that approach can have. I have no doubt that as the programme goes forward we will be able to look at its results to see what further lessons can be learned about the treatment of ME sufferers in Scotland.

In improving services for people with ME or chronic fatigue syndrome, will the minister encourage the NHS to implement the healthcare needs assessment that was carried out by the Scottish public health network so that health boards can further develop appropriate services for people with ME or chronic fatigue syndrome and thereby provide rapid and accurate diagnosis and assessment, supportive care and treatment, and access to wider support when that is appropriate, for people who have that debilitating condition?

We are generally supportive of the assessment of needs that was published last year. We recognise that it contains a number of recommendations that must be taken forward by individual health boards to ensure that they have the right service model at local level to meet the needs of those members of their population who suffer from ME.

It is important to recognise that progress is starting to be made in that area. I understand that Lothian NHS Board has reviewed the clinical pathway for people who are diagnosed with ME to ensure that they are referred back to their general practitioner at an early stage so that they receive the clinical and wider support that they require. I expect boards across the country to use the good practice statement that was issued to look at how they provide services for sufferers of ME with a view to improving the level of service at local level.

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Defibrillators

4. To ask the Scottish Executive what plans it has to extend the provision of defibrillators. (S4O-00251)

Making further cuts in the number of deaths from heart disease is a key theme of the “Better Heart Disease and Stroke Care Action Plan” that was published in June 2009. We have therefore provided some £7.5 million of funding to the Scottish Ambulance Service for state-of-the-art defibrillators for all its ambulances to ensure that they are properly equipped to deal with sudden cardiac events.

A defibrillator can literally mean the difference between life and death. Does the minister share my view that we need a comprehensive, cross-Government risk assessment of the placing of defibrillators in areas of high incidence of cardiac arrest and areas where ambulances cannot respond quickly, such as rural areas, as well as on long-distance trains, buses and ferries?

I know from the range of parliamentary questions that the member has asked in recent times that he has a particular interest in the provision of defibrillators. I am sympathetic to what he has proposed and am more than happy to go away and look at that option. I know that the Scottish Ambulance Service is working with organisations such as Scotmid to look at the location of defibrillators in shops and other premises in rural areas that could be used for that purpose. I will happily look at the initiative that the member has suggested to see whether there is more progress that we can make on the issue.

Would the minister like to take the opportunity to congratulate the pupils of Portree high school and the people from the Lucky2BHere charity foundation who gave a demonstration of community defibrillators in the Parliament yesterday?

I am more than happy to congratulate them. The school environment provides a good opportunity to work with young people to provide them with some of the life-saving skills that may be of use to them and to people in their communities. We are working in partnership with the British Heart Foundation and Lucky2BHere to create a case-study resource that can be used in schools across Scotland. Last night’s demonstration by Portree high school is a good example of how that resource can be used to the benefit of pupils across Scotland.

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Monklands Hospital (Staffing)

5. To ask the Scottish Executive what action it is taking to ensure that there are sufficient staffing levels at Monklands hospital. (S4O-00252)

NHS Lanarkshire has plans in place to ensure quality of care and patient safety across its board area. It is for each NHS board to decide how best to utilise funding and staff, taking account of national and local priorities, to meet local health needs.

As the cabinet secretary knows, I welcomed her decision to retain full accident and emergency services at Monklands, which I campaigned for, but A and E must be more than a name over the door. In light of the cabinet secretary’s answer, is she aware of the worrying situation whereby there were only six consultants available in Monklands A and E department this August, when NHS Lanarkshire’s aim is to have at least 10 consultants available there? Will she intervene so that our A and E department can operate at the safe level my constituents need and expect?

I thank Elaine Smith for her question and note that, as she mentioned, she supported the retention of Monklands A and E service; in that regard, she was an honourable exception in her party.

She raises an important issue. NHS Lanarkshire has had recruitment challenges and is working to manage those and ensure the safety of services.

It is worth noting—I am sure that Elaine Smith is aware of these figures—that in NHS Lanarkshire more medical and dental staff and more consultants are in place than has previously been the case. There are 22 whole-time equivalent consultant vacancies across all specialties. Of those, five relate to emergency medicine, paediatrics and general medicine. There are no vacancies in anaesthetics. NHS Lanarkshire will continue to work to ensure the sustainability and safety of care provided at Monklands A and E department.

Finally, I give Elaine Smith an assurance that Monklands A and E department, which would no longer exist if another party had been in charge, will not be only a name over the door; it will be a fully functioning accident and emergency department.

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National Health Service Boards (Budgets)

6. To ask the Scottish Executive when it last wrote to national health service boards about their budget allocations for 2012-13. (S4O-00253)

The acting director-general health and social care and chief executive of the NHS in Scotland wrote to NHS chief executives on 21 September 2011 about their budget allocations for 2012-13.

The letter of 21 September to health boards showed that 80 per cent of the uplift allocated to them is, in fact, already committed to things such as waiting times and prison services, and is therefore not new money available for general use. Is it not therefore the case that, when the spin is stripped away, there is a real-terms cut in health spending?

Let me spell it out in simple terms to Jackie Baillie, because that question demonstrates that she perhaps does not fully understand NHS board funding.

First, this Government is passing on all the consequentials for health to the health service. That is £1 billion extra for health over the life of the spending review. We are prioritising front-line services. Budgets for health boards will increase, in real terms, in every year of the spending review.

It is important to note that that increase in funding would not have happened had Labour won the election in May. Jackie Baillie might like to forget about it, but the rest of us remember Iain Gray’s “Newsnight Scotland” interview when he said that Labour would not protect the health budget. Jackie Baillie’s hypocrisy is rather breathtaking.

Finally, on the specifics of Jackie Baillie’s question, she demonstrates her lack of understanding of health board budgets, because the money that she talks about was previously ring fenced. In other words, it was previously earmarked but it is no longer ring fenced or earmarked, so it is available for general allocation by boards.

Let us take waiting times funding as an example. Because of the progress made by NHS boards in reducing waiting times over the period of the last Government and this Government, that money can now be spent on other things, as long as the waiting times stay at the level that they are at.

That is what happens when there is success in the NHS such as we have had under this Government. This Government will continue to protect our national health service.

If we can have brief questions and answers, we will get more members in.

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Health and Social Care (Integration)

7. To ask the Scottish Government what steps it is taking to introduce an integrated system of health and social care, in light of the report by the commission on the future delivery of public services. (S4O-00254)

We are committed to integrating adult health and social care during this session of parliament. Better integration can—and I believe does—improve outcomes, accountability and financial sustainability, which are all critical to patients, service users and carers. We have been engaging with a wide range of stakeholders from the national health service, local government and the third and independent sectors to inform our proposals. I intend to make a statement to Parliament later this year on our final proposals for consultation.

In the light of that, does the cabinet secretary agree that preventative spending will be a major contributor to ensuring that public services can deal with the demographic challenges that lie ahead?

Yes, I agree strongly. Preventative and anticipatory services, when they are coupled with effective support for rehabilitation and reablement and are supported by appropriately targeted spending, play a major role in ensuring the provision of quality services and care for older people. The change fund for older people’s services provides financial support for reshaping care for older people. That is enabling partnerships to shift spending and activity into services that are focused on prevention, which is exactly what we need to do.

The cabinet secretary will be aware of the progress that is being made in integrating health and social care services in Orkney, through Orkney health and care. I know that she is very much looking forward to visiting my constituency next week. Will she confirm her willingness to meet representatives of Orkney health and care during her visit, to discuss how the model can be further developed to improve the service to patients, the vulnerable and indeed the wider community in Orkney?

I am very much looking forward to my visit to the member’s constituency next week for the annual review of NHS Orkney. My office is seeking to schedule that meeting. If it is humanly possible, that meeting will happen and we can discuss then the progress to date and how it can be built on in future.

Can the cabinet secretary give us a general update on her thinking on the integration of health and social care, particularly whether she still favours a lead commissioning model; whether she would prefer a reformed community health partnership, with or without dedicated budgets; whether she has some other model in mind; or whether she wishes to allow areas to have freedom and flexibility to develop their own arrangements?

I referred earlier to a statement later in the year, which is when I will answer that question in detail. I appreciate that members, as well as people in the health service, local government and other sectors, are anxious for details of precisely how we will take forward our ambition to integrate health and social care. We are taking a bit of time to ensure that we get that right.

On lead commissioning, I would want to ensure that nothing that we do gets in the way of the very good work that has been undertaken in Highland at the instigation of the national health service and local authorities.

Desperate though members are for further details now, I have to keep them waiting a wee bit longer, until the statement later in the year.

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Familial Hypercholesterolaemia

8. To ask the Scottish Government what progress has been made in treating familial hypercholesterolaemia since the publication of the “Better Heart Disease and Stroke Care Action Plan” in 2009. (S4O-00255)

The genetic cascade testing of family members of people who are known to have FH is progressing well. Once people living with FH have been identified, NHS Scotland has an effective process in place to screen their relatives. To date, more than 1,000 people have been tested and 252 individuals with FH have been identified. However, we accept that more can be done in that area. We expect NHS boards to act on the findings of Healthcare Improvement Scotland’s heart disease report, which was published in September, to ensure that people living with FH are identified as soon as possible and treated appropriately in order to minimise the risk of complications. The national advisory committee on heart disease will monitor their progress closely.

The minister will be aware that there are potentially huge savings to the NHS as a result of early detection of FH. Given the Scottish Government’s moves towards preventative spending, does he agree that detection of FH should be considered as part of our preventative spending proposals? Is he willing to meet me and representatives in the field of FH to discuss how progress can be made in detecting and treating the condition?

Absolutely. Once FH is diagnosed, it is very treatable. That is a good example of where we can make progress in preventing people from developing the complications that may come from having FH. We expect NHS boards to recognise that investing in screening activity for FH can have a preventative spend aspect to it and can reduce the chances of someone developing heart disease or other associated complications.

Regarding the member’s request for a meeting to discuss the matter in more detail with other parties, if he contacts my office, I will be more than happy to look at making arrangements for such a meeting.

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Health Services (Rural Communities)

9. To ask the Scottish Government what importance it attaches to the provision of health services to rural communities. (S4O-00256)

We have made a significant commitment to the provision of health services to rural communities through the work of the remote and rural steering group, which was established to identify a strategy for sustainable healthcare in remote and rural Scotland. The steering group undertook the delivery of 63 commitments and 20 forward issues between 2007 and 2010. Although the steering group has completed its work, support continues to be given to all NHS boards to implement the actions and further recommendations that are contained in its final report, which was published in October 2010.

As the local MSP, I recently attended the 50th anniversary of the Queen Mother wing of Arbroath infirmary, which delivers a range of health services to the town. However, 12 miles or so from Arbroath lies the thriving village of Letham which, by some historical quirk, has no on-site general practitioner provision. Will the cabinet secretary join me in encouraging the health authorities in Tayside to look favourably on the local campaign to address that situation and deliver appropriate locally based health cover for the village?

I am aware of that issue and I know that NHS Tayside and Angus community health partnership are working together closely with a sub-group of Letham community council members to achieve a satisfactory solution, including testing the feasibility of running satellite clinics from the Academy medical practice in Forfar. I also understand that the member has asked for a meeting with the general manager of Angus CHP to discuss the issues in more depth. As talks are on-going, I do not want to comment in more detail, but I am pleased to say that a genuine attempt is being made by all parties concerned to find a solution. I am happy to keep in contact with the member as things progress.

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East Ayrshire Community Hospital (Dental Facility)

10. To ask the Scottish Executive when the dental facility at East Ayrshire community hospital will be built. (S4O-00257)

NHS Ayrshire and Arran has confirmed that, although the development of a new dental facility as a variation to the existing private finance initiative contract at East Ayrshire community hospital is no longer a viable option, it is fully committed to meeting the identified dental needs of Cumnock and the surrounding area. NHS Ayrshire and Arran is also examining alternative means for delivering the requirements of the local dental action plan in order to fully meet the dental needs of the population. The local general dental practitioner who was interested in participating in the development at the community hospital is already actively developing plans to increase surgery capacity in the area, as are other practitioners who have recently come forward with preliminary plans to develop their own facilities.

As the cabinet secretary will know, it is estimated that more than £1 million has been spent on preparing the dental facility at East Ayrshire community hospital and rectifying the hospital now that that facility has been abandoned. Has the cabinet secretary a role to play in examining the lessons from this experience and will she share them with Parliament?

The member will be fully aware of the background to the issue, so I will not go into that in great detail here. The health board’s own audit arrangements have the lead role to play in ensuring that the whole exercise is properly audited and goes through the normal governance processes. I am happy to have further discussion with the member and any other interested members in order that I can satisfy them that the health board has learned any lessons that there are to learn from the situation and—more important—that the steps that I indicated in my answer are being taken to ensure that the dental needs of the local population are fully met in the future.

Does the cabinet secretary agree that it is a bit rich of Labour politicians to lay the responsibility at her doorstep for the consequences of a PFI contract that was signed 12 years ago, when Labour was forcing PFI on health boards and local authorities on the basis that it was—I think that this was the phrase—the only game in town? Can she investigate how health boards and others might be protected from such opportunistic behaviour by banks and other PFI funders claiming contract variation when improvements to existing facilities are being sought or services are being redesigned to better meet the needs of service users?

I am happy to investigate the detail of Adam Ingram’s question and discuss it further with them. The phrase

“it is a bit rich of Labour”

springs to my mind very often. Perhaps the best answer that I can give is that the best way to protect the Scottish public from the past follies of the Labour Government is not to re-elect a Labour Government in Scotland.

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NHS Workforce Reduction (Newly Qualified Staff)

11. To ask the Scottish Executive how planned reductions in the national health service workforce will impact on newly qualified nurses and midwives. (S4O-00258)

We continue to guarantee newly qualified nurses and midwives the offer of a job in the NHS and we have worked hard with boards and others to ensure that we continue to meet that commitment.

This year, we introduced the internship scheme with the support of both the Royal College of Nursing and the Royal College of Midwives. The scheme gives newly trained nurses and midwives the opportunity to consolidate their skills and gain additional experience in clinical practice through the offer of a one-year, fixed-term, part-time employment opportunity that is linked to completion of the flying start programme. The scheme is not compulsory and newly registered nurses and midwives are still encouraged to seek employment through their own means.

The cabinet secretary may recall previous correspondence regarding a constituent of mine who is a recently graduated nurse who has experienced considerable difficulty in gaining employment, particularly in Dumfries and Galloway. Does the cabinet secretary share my concern that the workforce reductions in Dumfries and Galloway—70 whole-time equivalent nurses and midwives this year, on top of the 57.7 that have been lost since 2009—will make it even more difficult for recent graduates to find full-time, permanent employment in nursing and midwifery? I hear what she says about internships and temporary ameliorations that she can introduce. How can we tackle the future for recent graduates who want to establish a career in nursing and midwifery but may find it more difficult as the workforce reduces?

I will not repeat my earlier answer to Neil Findlay, who is no longer in the chamber, on workforce issues, so I will specifically address Elaine Murray’s point about newly qualified nurses and midwives.

I understand the pressures and difficulties that newly qualified nurses and midwives face. That is why it is important that we offer the one-year internship scheme. However, we must also ensure that our workforce planning is correct—we have discussed that in the Parliament before—and that the number of people going into nursing and midwifery training is commensurate with the demand for nurses and midwives in the service. That is a continuing task. I annually approve the intake to our nursing and midwifery schools. It is important that we get that balance right so that people who want to be, and train to be, nurses or midwives and who have a great deal to offer do not find that they cannot achieve that ambition.

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Royal Victoria Hospital (Edinburgh)

12. To ask the Scottish Government what progress is being made with the building of the new Royal Victoria hospital in Edinburgh. (S4O-00259)

I am very pleased to confirm that the project is on time and on budget and that the new facility will be operational in June 2012.

The new hospital is publicly funded with no financial burden to the taxpayer, which is to be welcomed. Does the cabinet secretary agree that providing patients with their own individual rooms will provide a higher-quality environment and more privacy, particularly for older people, and will help to reduce the chances of hospital-acquired infections?

Yes, I agree. As Colin Keir is aware, all new hospitals are now required to provide 100 per cent single-room accommodation for patients; all refurbished hospitals must now provide at least 50 per cent single-room patient accommodation. That makes a significant contribution not only to patient dignity and privacy but to reducing the risk of infection.

On that point, I take the opportunity after the publication of yesterday’s figures on HAIs to pay tribute to national health service staff for the continued progress that is being made on reducing infections in our hospitals.

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Alcohol (Minimum Price)

13. To ask the Scottish Government when it will publish its plans to introduce a minimum price for alcohol. (S4O-00260)

Given the clear link that exists between consumption and harm, and as affordability is one of the drivers of increased consumption, addressing price is a vital part of any long-term strategy to tackle alcohol misuse. For those reasons, we will reintroduce our minimum pricing bill very soon indeed.

Does the cabinet secretary agree with Professor Tim Stockwell from the centre for addictions research in British Columbia, who briefed MSPs last week on the impact of minimum pricing in Canada, where it led to a fall in levels of drinking, that Scotland is in a position to embrace a unique opportunity to transform its alcohol policy?

Yes, I agree. Some people have used the fact that we are in a unique position to argue that we should not try minimum pricing, because nobody else has ever done it. That would be a recipe for doing nothing new about anything ever. We are aware of the work that Professor Stockwell has done. We are very interested in it and will carefully consider his full findings as they emerge. However, we already know that affordability is one of the key drivers of increased consumption. That is why addressing price is fundamental to any long-term strategy to tackle alcohol misuse.

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Cities Strategy (Environment)

14. To ask the Scottish Executive how its cities strategy will incorporate urban environmental issues such as sustainable transport and green spaces. (S4O-00261)

The cities strategy will reflect the fact that cities will play a vital part in the transition to a low-carbon economy. Sustainability issues will be addressed at a strategic level.

I urge the cabinet secretary to understand the cities strategy remit broadly, as befits its place alongside health and wellbeing rather than in a narrowly economic portfolio. I also draw her attention to the study by Mitchell and Popham in The Lancet in 2008, which the Scottish Wildlife Trust drew to my attention. That study linked greener urban areas with better life expectancy and overall health outcomes.

I endorse the thrust of Marco Biagi’s question. In the cities strategy, we will cover at a strategic level the characteristics of a city that are essential for growth: connected cities; sustainable, low-carbon cities; knowledge cities; and creative cities. The one thing that runs through all the themes is quality of life, which will be central to our cities strategy as it is to so much of our other work.