David Cameron and Harriet Harman at the state opening of parliament last month. Photograph: Getty Images.
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PMQs review: Harman recovers some ground as she disciplines "gloating" Cameron

Labour's acting leader delivered an improved performance. But how wise is her new tactic?

After becoming the first prime minister since Lord Palmerston in 1857 to increase his party's share of votes and seats (as he recently boasted to European leaders), David Cameron is in even more confident form than usual. Having been roundly defeated at last week's PMQs, Harriet Harman tried a new tack today. After Cameron contemptuously dismissed her call for 16-17-year-olds to be allowed to vote in the EU referendum, Labour's acting leader chided him for "ranting and sneering and gloating" before adding, in her best line, "Frankly, he should show a bit more class". A suitably chastened Cameron responded with far more emollience to her next question (on the neutrality of the government during the referendum). The ease with which Labour's headmistress disciplined the unruly pupil suggested the Tories should invite her to lead one of their free schools. 

But after a civil interlude, Cameron riled Harman again when he quoted her statement that some Labour voters were "relieved" the party didn't win. "He just can’t help himself but gloat, can he?" she said. "Go right ahead and gloat, but why shouldn’t he just answer the question about childcare ... Perhaps we can have an answer instead of a gloating session." This time, however, Cameron opted to attack rather than to appease. "I'm sorry if the Right Honourable Lady thinks I'm gloating," he replied. "It must be the first time someone's been accused of gloating while quoting the leader of the opposition, I mean for instance, she said the other day, 'people tend to like a leader who they feel is economically competent'. I think she's been talking a lot of sense and I'm going to be quoting her as often as I can!" 

Harman's tactic ensured a better performance than last week. And Cameron would be wise not to gloat - he does after all have a majority of just 12. But whether Labour should seek to interrupt its opponent when he is making a mistake is open to question. Others will argue that Harman should focus on defeating Cameron on substance, rather than tone. 

On policy, it was notable that Cameron refused to rule out holding the EU referendum on the same day as next year's Scottish and local elections (which would likely favour the In camp). Harman's rejection of this option was aimed at the Tories' divisions but also reflected Labour's belief that the ballot must be seen as fair and not "rigged". For the same reason, Harman argued that the government must not use public funds or the state machine to bolster the In campaign. Expect Labour to seek to force Cameron to capitulate to his backbenchers on this front. 

George Eaton is political editor of the New Statesman.

Photo: Getty
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The big problem for the NHS? Local government cuts

Even a U-Turn on planned cuts to the service itself will still leave the NHS under heavy pressure. 

38Degrees has uncovered a series of grisly plans for the NHS over the coming years. Among the highlights: severe cuts to frontline services at the Midland Metropolitan Hospital, including but limited to the closure of its Accident and Emergency department. Elsewhere, one of three hospitals in Leicester, Leicestershire and Rutland are to be shuttered, while there will be cuts to acute services in Suffolk and North East Essex.

These cuts come despite an additional £8bn annual cash injection into the NHS, characterised as the bare minimum needed by Simon Stevens, the head of NHS England.

The cuts are outlined in draft sustainability and transformation plans (STP) that will be approved in October before kicking off a period of wider consultation.

The problem for the NHS is twofold: although its funding remains ringfenced, healthcare inflation means that in reality, the health service requires above-inflation increases to stand still. But the second, bigger problem aren’t cuts to the NHS but to the rest of government spending, particularly local government cuts.

That has seen more pressure on hospital beds as outpatients who require further non-emergency care have nowhere to go, increasing lifestyle problems as cash-strapped councils either close or increase prices at subsidised local authority gyms, build on green space to make the best out of Britain’s booming property market, and cut other corners to manage the growing backlog of devolved cuts.

All of which means even a bigger supply of cash for the NHS than the £8bn promised at the last election – even the bonanza pledged by Vote Leave in the referendum, in fact – will still find itself disappearing down the cracks left by cuts elsewhere. 

Stephen Bush is special correspondent at the New Statesman. He usually writes about politics.