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PMQs review: Cameron comes out fighting

On the NHS, the PM has decided that attack is the best form of defence.

In the case of his NHS reforms, David Cameron has decided that attack is the best form of defence. On the rack over Andrew Lansley's chaotic reorganisation, he finally came out fighting at today's PMQs.

The session didn't begin well for the Prime Minister as Ed Miliband mocked a health summit which excluded "the vast majority of people who work in the NHS". Sounding ever more like Gordon Brown, Cameron boasted that "we are putting more money into the NHS" before conceding that "money alone won't do the job". As Miliband rightly noted, he had "no answer" to the question about his "ridiculous" summit. Armed with a quiver of embarrassing quotes from Cameron ("we have to take nurses and doctors with us"), Miliband pressed home his advantage.

But Cameron wasn't prepared to roll over. "When is he going to ask a question about the substance of the reforms," he asked. Labour used to favour choice, competition and GPs being in charge. Now they are opposed, Cameron said. The problem for the PM is that while Labour's reforms enjoyed public support, his do not. The issue, of course, is one of trust. Cameron still has no convincing answer to the question of why he broke his promise to put an end to the "top-down reorganisations of the NHS". So long as this remains the case, the charge that he has no mandate for the reforms will stick.

The PM, however, had a trump card up his sleeve. Having questioned why Miliband hadn't asked him about the risk register (which Labour has triggered a vote on tonight), Cameron revealed why. A copy of Labour's briefing note for today's debate showed that Andy Burnham had blocked the publication of a risk register in 2009. Labour were "a bunch of rank opportunists," declared Cameron.

But while Cameron's attack will resonate in the Westminster village, it is Miliband's that will resonate with the public. "This will become his Poll Tax," the Labour leader predicted in a line tailor made for tonight's news bulletins. "He should listen to the public and drop this bill."

Cameron has no intention of doing that but, for the first time in months, he no longer sounds so defensive.