§ 5. Dr. Vincent Cable (Twickenham)
If he will make a statement on (a) the level of take-up and (b) regional disparities in the take-up of Aricept in the NHS. 
§ The Minister of State, Department of Health (Mr. John Denham)
Donepezil hydrochloride— Aricept—was prescribed by general practitioners in the national health service in all health authorities in England over the 12-month period ending March 1999. At a regional level, the number of prescriptions per 100,000 population aged 60 years and over varied from 58 in west midlands to 339 in Trent, with an average of 170 for each region.
§ Dr. Cable
I thank the Minister, but does he agree that those figures demonstrate the enormous regional disparity that is already clear to many patients and their carers? In some areas, prescriptions are freely available, but in others, patients can obtain them only at the considerable cost of around £150 a month. In view of the growing clinical evidence of the benefits of the drug and of the enormous help it gives victims and carers, does the Minister accept that the drug should be included in the first round of drugs appraised by the National Institute for Clinical Excellence?
§ Mr. Denham
Two important points must be made. First, Aricept, which is licensed for treatment of mild to moderate Alzheimer' s disease, is a symptomatic 452 treatment, and there is no evidence that it affects the progression of the underlying disease. Secondly, I am advised that it has not been widely prescribed to date because of concern that the moderate improvements it brings in cognitive function tests may not necessarily translate into worthwhile clinical and social benefits. The variation in the figures that I have given probably reflects differing attitudes among specialists to use of the drug. Research projects are under way, and a large trial organised by the NHS in the west midlands is covering 3,000 patients. In addition, it is likely that NICE will at some point be asked to consider drugs for the treatment of Alzheimer's disease.
§ Mr. Alan Duncan (Rutland and Melton)
NICE may attempt to iron out regional disparities in the availability of drugs such as Aricept, but has not its chairman, Professor Rawlins, already admitted that he will rule out advocating the use of drugs that NICE considers to be too expensive, even if they are highly clinically effective? Can the Minister name just one respectable organisation prepared to support his absurd claim that there is no rationing in our national health service?
§ Mr. Denham
Clinicians in the NHS want NICE to offer consistent guidance on the clinical effectiveness and cost effectiveness of treatments. There has been wide support from a variety of professional bodies for the establishment of the National Institute for Clinical Excellence precisely because people know that such guidance will be made available.