§ 5. Mr. Christopher Chope (Christchurch)
Which health authorities authorise the prescribing of Aricept on the NHS. 
§ The Secretary of State for Health (Mr. Alan Milburn)
I understand that there is some prescribing of Aricept in all health authority areas.
§ Mr. Chope
May I take this opportunity to tell the Secretary of State how disgusted people in Dorset are at the fact that, for the second year running, they will have the lowest per capita increase in health funding? Is that not discrimination by the Government against a county with a lot of Conservative Members of Parliament?
Does the Secretary of State accept that there is postcode rationing of Aricept at the moment? If one lives in the Southampton constituency of the Minister of State or over the border in New Milton, one can receive Aricept when it is recommended by a clinician. If one lives in Highcliffe, one cannot receive Aricept on the NHS, even when it is recommended by a clinician. Is not that wholly outrageous and unfair? What are the Government going to do about it?
§ Mr. Milburn
I thought that the hon. Gentleman was going to stand up to thank the Government for the extra £28 million that we are investing in his health authority area from April next year. That is on top of the extra millions that we are already investing. If the hon. 654 Gentleman has a complaint about a lack of investment in his area, he ought to take it up with his Front-Bench colleagues. They oppose our spending plans. The Conservative party cannot get away with saying simultaneously that the Government are spending too much money on our public services, that our spending plans are reckless, madness and irresponsible, and that we are spending too little.
§ Mr. Milburn
It is time for Opposition Members—including the hon. Member for Woodspring (Dr. Fox), who is chuntering from the Front Bench—to come clean on this matter. Which is it? Do they want more spending, or less?
On Aricept and the lottery of care, it is worth reminding Conservative Members that it was their Government who created the lottery of care in the national health service and that the present Government not only acknowledge that it exists but are taking action to tackle it.
§ Mr. Vernon Coaker (Gedling)
I thank my right hon. Friend for the extra 7.46 per cent. that Nottingham health authority will have next year.
Dementia is a cruel condition from which an increasing number of people suffer. It is difficult to know what effect Aricept has on dementia, but will my right hon. Friend please ensure that research on dementia, which does not have the same buzz as cancer and heart disease, gets its fair share of NHS resources?
§ Mr. Milburn
I agree with what my hon. Friend says. Aricept and other potential anti-Alzheimer's drugs are precisely the sort of drugs that we have referred to the National Institute for Clinical Excellence for its first work programme, which includes an assessment of drugs and treatments not only for dementia but for other serious and chronic conditions such as cancer, heart disease, multiple sclerosis, hepatitis C and motor neurone disease.
That is important because, for the first time, the national health service, in all parts of the country, whether in the form of health authorities or of individual clinicians, will have clear, authoritative guidance about the treatments that work best for patients. That is a real step forward. Not only do we acknowledge that there is a lottery of care but the NICE programme is the first assault that has ever been made on that lottery in the NHS.
§ Dr. Peter Brand (Isle of Wight)
I very much welcome the referral of Aricept and what we hope will be more effective anti-dementia drugs to the National Institute for Clinical Excellence, but will the new criterion that NICE must take into account—affordability—prove a handicap to making a proper assessment? We all hope that we will eventually have an effective drug for dementia but the main saving will be not necessarily for the NHS budget but for other Government budgets and, especially, for carers. Who will make the assessment? Will NICE determine whether the drug is affordable, or will Ministers take their proper responsibility?
§ Mr. Milburn
It is Ministers' job to take responsibility. I and my fellow Ministers will have the final call on all these issues, but it is right and proper for the National 655 Institute for Clinical Excellence to take into account both clinical and cost-effectiveness, as we made clear from the outset, when we first proposed its establishment.
The hon. Gentleman makes an important point about Aricept. There is a temptation in the House and elsewhere—I know that he is the last to succumb to it—to suggest that Aricept, or indeed any other drug currently on the market, is a wonder drug that can cure Alzheimer's disease. There is no known cure for Alzheimer's disease.
At best, the evidence seems to suggest that the drug will have limited, if any, effect on the underlying progression of the disease but may have some success in temporarily alleviating the symptoms for some patients. We should not get caught up in all the hype that we read in our newspapers about new wonder drugs coming on the market and solving all these serious and chronic health problems. It is terribly important to keep a sense of discipline and balance about how we handle these issues, as otherwise we hold out false expectations and hopes not only to dementia sufferers but to their relatives and friends.
§ Mr. Philip Hammond (Runnymede and Weybridge)
Given the continued denial of drugs such as Aricept and, for example, beta interferon to patients whose doctors say that they need them but whose health authorities say that they cannot afford them, can the Secretary of State explain what he meant when he told the House thatno one will be denied the drugs that they need. That is a guarantee"—[Official Report, 30 June 1998; Vol. 315, c. 143.]?
§ Mr. Milburn
That is precisely what we are doing. [Interruption.] If the hon. Gentleman wants to ask another question, he may get up and do so, but I wish to answer his first question before he asks a subsequent one. No one denies that the national health service, just like every other health care system in the world whether public or private, has to set priorities and make hard choices. The issue is not about whether choices have to be made but about how those choices are made.
On that issue, the parties have a clear difference of view. The Conservative party says that the choice should be made according to people's ability to pay, because it wants to force more people out of the NHS and into private health insurance. We say that the choice should be made according to people's ability to benefit, with the job of NICE being to focus growing NHS resources on those treatments that can best improve people's health.