PMQs review: Cameron rattled by Miliband’s NHS attack

Once again, Cameron struggled to defend the coalition’s health reforms.

Rarely has David Cameron appeared as rattled as he did at today's PMQs. Ed Miliband's decision to lead on the coalition's troubled NHS reforms proved fortuitous as the Prime Minister struggled to offer a coherent defence of his Health Bill.

Asked if he was planning any further amendments, Cameron prattled on about "cutting bureaucracy" and disingenuously claimed that the coalition would prevent "cherry-picking" by the private sector. As is frequently the case, his disregard for detail let him down. Asked if it was true that the NHS would be subject to EU competition law for the first time in its history, the PM appeared either unwilling or unable to answer Miliband's question.

Instead, for the third time in recent months, he selectively quoted from a speech by John Healey in which the shadow health secretary declared that "no one in the House of Commons knows more about the NHS than Andrew Lansley . . . these plans are consistent, coherent and comprehensive. I would expect nothing less from Andrew Lansley."

What Cameron failed to acknowledge is that Healey went on to argue:

They [the Conservatives] believe that competition drives innovation, that price competition brings better value, that profit motivates performance, and that the private sector is better than the public sector. I acknowledge the ambition but I condemn this as the core philosophy being forced into the heart of the NHS. It's wrong for patients. It's wrong for our NHS. It's wrong for Britain.

Miliband, who enjoyed his warmest reception from the Labour benches in months, made easy work of Cameron, but his lengthy questions frequently threatened to turn into speeches. At one point, he reeled off a long list of Labour's achievements on the NHS, a passage that, as Cameron suggested, was remarkably reminiscent of Gordon Brown's machine-gun delivery.

Towards the end, Cameron, visibly angered by the opposition to his reforms from the British Medical Association and Liberal Democrat activists, denounced the BMA as just another "trade union". His willingness to pick a fight with some of the country's most trusted professionals shows how determined he is to push these reforms through. There is no prospect of a forests-style U-turn.

In an attempt to demonstrate that he isn't the only one taking a political gamble, Cameron warned Miliband, whom he humorously referred to as "Son of Roadblock", not to "set his face against reform". Should the coalition's reforms prove unexpectedly popular, it is the Labour leader who will have to change tack. But for now, all the signs are that Cameron is facing a crisis entirely of his own making.

George Eaton is political editor of the New Statesman.

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Geoffrey Howe dies, aged 88

Howe was Margaret Thatcher's longest serving Cabinet minister – and the man credited with precipitating her downfall.

The former Conservative chancellor Lord Howe, a key figure in the Thatcher government, has died of a suspected heart attack, his family has said. He was 88.

Geoffrey Howe was the longest-serving member of Margaret Thatcher's Cabinet, playing a key role in both her government and her downfall. Born in Port Talbot in 1926, he began his career as a lawyer, and was first elected to parliament in 1964, but lost his seat just 18 months later.

Returning as MP for Reigate in the Conservative election victory of 1970, he served in the government of Edward Heath, first as Solicitor General for England & Wales, then as a Minister of State for Trade. When Margaret Thatcher became opposition leader in 1975, she named Howe as her shadow chancellor.

He retained this brief when the party returned to government in 1979. In the controversial budget of 1981, he outlined a radical monetarist programme, abandoning then-mainstream economic thinking by attempting to rapidly tackle the deficit at a time of recession and unemployment. Following the 1983 election, he was appointed as foreign secretary, in which post he negotiated the return of Hong Kong to China.

In 1989, Thatcher demoted Howe to the position of leader of the house and deputy prime minister. And on 1 November 1990, following disagreements over Britain's relationship with Europe, he resigned from the Cabinet altogether. 

Twelve days later, in a powerful speech explaining his resignation, he attacked the prime minister's attitude to Brussels, and called on his former colleagues to "consider their own response to the tragic conflict of loyalties with which I have myself wrestled for perhaps too long".

Labour Chancellor Denis Healey once described an attack from Howe as "like being savaged by a dead sheep" - but his resignation speech is widely credited for triggering the process that led to Thatcher's downfall. Nine days later, her premiership was over.

Howe retired from the Commons in 1992, and was made a life peer as Baron Howe of Aberavon. He later said that his resignation speech "was not intended as a challenge, it was intended as a way of summarising the importance of Europe". 

Nonetheless, he added: "I am sure that, without [Thatcher's] resignation, we would not have won the 1992 election... If there had been a Labour government from 1992 onwards, New Labour would never have been born."

Jonn Elledge is the editor of the New Statesman's sister site CityMetric. He is on Twitter, far too much, as @JonnElledge.