§ 12. Mr. Swayne
If he will make a statement regarding the regional availability of Aricept in the NHS. 
§ Mr. Milburn
Information about the prescribing of Aricept in the national health service is available only for prescriptions dispensed in the community in England; in many health authorities, these will have been issued in hospitals. Available data show that prescriptions have been dispensed in 99 of the 100 health authorities in England. However, I understand that many health authorities are reluctant to commit resources to the drug because of the perceived lack of evidence about its clinical and cost-effectiveness.
§ Mr. Swayne
Will the Minister say what a patient should do when the general practitioner advises him—or, more likely, one of his relatives—that the condition would benefit from the prescription of Aricept but that, under the local regime, that is not possible? Should the patient move house?
§ Mr. Milburn
The hon. Gentleman raises an extremely important issue, with which I think the whole House will sympathise. Alzheimer's disease is among the most distressing of medical conditions, not only for the sufferers, but perhaps particularly for the carers and close family. However, there is no instant, miracle cure and there is certainly no wonder drug either on the market or about to come on the market. Published data show that Aricept has a limited beneficial effect on the symptoms of the disease. It is important that hon. Members, from whatever party, do not raise unrealistic expectations about the ability of this or any other drug to deal with this severe, debilitating and ultimately fatal condition.
§ Dr. Harris
The hon. Member for New Forest, West (Mr. Swayne) raises a wider question—the availability of treatments apparently by postcode rather than by 168 cost-effectiveness. The Liberal Democrats and the Minister disagree about funding, but will he at least accept that the people who make decisions on funding should take some democratic responsibility? Decisions to ration treatment because of cost are taken locally, but there is no local mechanism to vote people out if they are not prescribing certain drugs or treatments.
§ Mr. Milburn
The hon. Gentleman is right—there is a disagreement between my party and his on the funding of the national health service: his party wanted to put in less money. On rationing by postcode, it is important that we put the issue into perspective. For most patients in most places for most of the time, most services and treatments are available on the national health service. We should say that loudly and clearly, and we should celebrate it, because it is a success story for the NHS. However, we want to build on that and, as the hon. Gentleman is aware, our proposals in the White Paper for a national institute of clinical excellence and for national service frameworks are intent upon bearing down on unacceptable and unjustifiable variations in performance and availability of service. We want a genuinely national health service to be available to people.