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.