The NHS has become the Tories' biggest political headache and Ed Miliband has every intention of making it worse. He devoted all six of his questions to the subject at today's PMQs, the last before the recess, and earned one of his most convincing victories to date. Confronted by the sheer size of the opposition to the health bill, an ill-tempered David Cameron was forced to fall back on platitudes about his "care" for the NHS and Brown-esque statistics on higher spending. He quoted the Labour manifesto on the need for "sustained reform", forgetting that the choice isn't between reform and no reform but good reform and bad reform.

At one point, after Miliband had recited a roll call of Labour's NHS achievements, Cameron replied: "if the record was so good, why were they thrown out at the last election?. A quip which rather invited the response: "if the record was so bad, why didn't you win?" It was an embarrassing and undistinguished performance.

A confident Miliband, buoyed by polls showing that Labour enjoys a clear lead on the NHS, declared of Cameron: "he thinks he knows better than the doctors, better than the nurses, better than the midwives, better than the patients associations." It was a damning charge that the PM had no way of refuting. Armed with a quiver of poisonous quotes from No 10 ("Lansley should be taken out and shot"), Miliband could legitimately claim: "he knows in his heart of hearts this is a disaster." The PM's protestations to the contrary only made him look insincere.

It was notable that Cameron offered a less than fulsome defence of Andrew Lansley, remarking only that his "career prospects" were better than Miliband's, a comment that will do nothing to dampen speculation over the Health Secretary's position.

"The NHS will go on going better and his (Miliband's) prospects will go on getting worse," Cameron snapped towards the end of the exchanges. But an increasing number of Tories fear the reverse is true: the NHS will go on getting worse and Miliband's prospects will get better.