The government's NHS reforms are in critical condition. After today's roasting from an in-form Ed Miliband, surely even the spin doctors can't save them now.
By Alex Stevenson Follow @alex__stevenson
It has been a few weeks since Ed Miliband chose to concentrate his entire ration of questions on a single topic. Maybe this was the reason it felt like David Cameron was on the receiving end of a barrage of never-ending, unrelenting bombardment. Every question saw Miliband push the prime minister further and further into his corner. This is one-way traffic: it was, for once, a triumph for the leader of the opposition.
Football analogies are usually a sign a politician is feeling desperate. So, when Cameron complained that "even when he moves the goalposts he can't put it in the back of the net", we knew he was feeling a little off his game. "The person who's missing the goals," Miliband shot back, "is the prime minister." Ed Miliband has given us numerous demonstrations of his curious ability to miss open goals, but he did not make any mistakes today.
Cameron even resorted to personal attacks against Miliband's leadership. Earlier this year his deliberate low blows had a withering, bullying quality, a kind of genuine pitiable-little-worm feel which actually threatened to topple the Labour leader. Not today. "This is a campaign to save his leadership," Cameron protested.
Playing the man and not the ball might work in a slow news week, but not when the government's extraordinarily unpopular NHS reforms are at stake. For all his faults Miliband has not fallen for the temptations of hyperbole, that perpetual peril which awaits all opposition politicians. When he says - in a tender, more-to-be-pitied-than-censured tone, to boot - that Cameron knows in his heart of hearts this is a complete disaster", he means business.
The Labour backbenchers were in a much more cheerful mood leaving the chamber than they were at the start. They are fed up at having the mild 'hear-hear' they give Miliband when he is called to speak interrupted by sarcastic cheers from government MPs. "We are taking people with us," Miliband began with, prompting cruel laughter from opposite. Cameron grinned as the Speaker made an early interruption. Those Labour MPs looked as grumpy as they did when their man at the despatch box was Gordon Brown.
But then, through cumulative, attritional questioning, Miliband slowly developed his attack. He quoted the "irreparable damage" warned of by the Royal College of general Practitioners. He scoffed at the Tory Reform group's concerns (even Nick Clegg couldn't help but smile at this). He mocked Cameron for being "agitated". The last was not quite accurate: the PM was more like an automaton, mouthing the same platitudes about cutting bureaucracy and improving the NHS that he has for over a year.
Another tired tactic of the PM's is his reliance on blaming the last government. The one group of people he definitely won't be taking lessons from are Labour, he made clear. Shadow chancellor Ed Balls nodded along, eyes gleaming, in sarcastic approval. Miliband leapt up: "I'll tell him about our record in the NHS!" he declared, before listing achievement after achievement. His elder brother David, whose article of two weeks ago called for Labour to be prouder of its record in power, will doubtless be very pleased.
"If the record was so good," Cameron replied rather woodenly, "why were they thrown out at the last election?"
There were no cheers from the Tory benches, and then - after a brief pause - triumphant shouts from the opposition. They were pointing out Cameron's failure to secure an overall majority in 2010. It was the kind of slip-up which the PM makes very rarely. On the kind of off-day he suffered today it stuck in the memory.
If the campaign to save the NHS is also a campaign to save Miliband's leadership, it's certainly working.