Rarely has Ed Miliband been as explicit about as his desire to make the general election a referendum on the NHS as he was at today’s PMQs. He told David Cameron that what Nigel Lawson called “the closest thing the English have to a religion” would “be on the ballot paper in May”. Miliband’s stance is both good policy – the health service is in urgent need of greater funding and attention – and good politics: Labour leads the Tories by 12 points on the NHS – its best performance on any issue. One party strategist told me recently: “We will return to it again and again and again”.
Cameron’s response when Miliband did today was to renew his assault on the Labour-run Welsh NHS. He attacked the administration for refusing to agree to an inquiry by the OECD (on the grounds that it would be selectively quoted by the Tories in advance of the general election) and said the Labour leader was “totally terrified” of defending his party’s record.
But Miliband had a ready riposte: “Every time he mentions Wales, we know he’s running scared in England”. He later added: “Instead of smearing the NHS in Wales, he should be saving the NHS in England”. Given the two countries’ relative size and polls showing that the majority of voters believe the health service has got worse under Cameron’s stewardship, this is likely to be enough for Miliband to preserve Labour’s advantage. One aide told me yesterday: “Every time he mentions the NHS, it just helps us.” The polls certainly suggest as much.
The defining problem for the Tories is that their reorganisation of the service (which senior cabinet ministers have admitted was their “biggest mistake” in government) means it is even harder for them to avoid the blame for its deteriorating quality. Miliband also sharpened the politics of the issue by, for the first time, linking the Tories’ refusal to support Labour’s proposed windfall levy on tobacco firms with Lynton Crosby (a past lobbyist for the industry). When Cameron sought to unsettle the Labour leader by quoting a shadow minister who said that “we don’t have a policy problem, we have a massive Ed Miliband problem”, he replied that he wouldn’t take lectures on leadership from a man who had lost two MPs to Ukip, seen nine of his party’s 2010 intake choose to stand down, and who “changes his policy on Europe every day”.
The other notable moment came when Cameron was challenged by Labour MP Nic Dakin to rule out another VAT increase. He replied that “our plans don’t involve rises in tax”, the same formulation he used before increasing the levy to 20 per cent in 2010. One Conservative aide recently told me that while not committing to any tax rises, the party would not make a “read-my-lips” style pledge during the election. Given the stubborness of the deficit, the Tories know they can’t afford to rule this option out. But if they re-enter coalition with the Lib Dems, they will have a convenient alibi.
Rather than Cameron or Miliband, however, the real drama came from the public gallery. As the PM mocked Chuka Umunna for once referring to Wichita, rather than Worcester, a thud was heard as a man threw what turned out to be marbles at the glass screen. He was swiftly removed by the Commons security officers as he continued to shout away.