With David Cameron at the G20 summit in Mexico and Nick Clegg at the UN summit in Rio, it was left to William Hague, who is First Secretary of State as well as Foreign Secretary, to hold the fort at today's PMQs, with Harriet Harman deputising for Ed Miliband (as is traditional on such occasions).
The session began slowly, with several banal questions from Harman on Burma (she asked Hague whether he would join her in expressing admiration for Aung San Suu Kyi). In response, Hague pointed out that he was the first European foreign minister to visit Burma earlier this year. However, the encounter took a partisan turn when Harman raised the NHS, traditionally a trump card for Labour at PMQs.
Hague managed to respond adequately enough to reports that cost-cutting NHS trusts are rationing care (he described it as "totally unacceptable" and pointed out that the Secretary of State can intervene) but failed to rebut Harman's claim that Cameron had broken his promise to increase the number of midwives. In response, in a series of references to Rebekah Brooks's infamous text to the PM, the deputy Labour leader quipped that before the election it was "Yes, we Cam". Now it's "No we can't." She added: "the Prime Minister said he could sum up his priority in three letters: NHS. Isn't it more like LOL?" The text was a political gift to Labour but Harman's jokes felt forced and fell rather flat.
It was Hague who had the line of the session when he noted Ed Balls's absence and quipped that he was off commissioning another poll into what people think of him, causing even Harman to laugh. The shadow chancellor, whose PMQs taunts routinely unsettle Cameron, will be pleased to know he was missed.
But on a more serious note, today's session was a reminder of why the NHS, even more than the economy, could prove an electoral headache for the Tories. Cameron worked hard to convince the electorate that the Tories could be trusted with the NHS and many now feel understandably betrayed. While Hague could deflect Harman's question about midwives with a reference to the doctors' strike (which Harman then condemned), that's not a trick Cameron will be able to play come 2015. "It's always the same, Labour builds up the NHS and Tories drag it down," said Harman at one point. The danger for the Tories is that most voters agree with her.