The NHS is centre-stage, politically. It's not always a comfortable spot, but the acoustics are great if you can hack the limelight.

After Monday's cul-de-sac of an Opposition Day debate, today we had PMQs, during which Labour party leader Ed Miliband used all of his questions on the NHS.

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Click here for details of 'You say substantive and I say substantial', Issue 7 of subscription-based Health Policy Intelligence.

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The relevant text from Hansard is copied below, with a few observations here.

1. Looks like it was a deliberate mistake by Ed Miliband on saying 42 GPs signed the Telegraph letter (actually 43), to give a symmetry with the 42,000 members of the RCGP.

2. Hard to know if Cameron's describing of Kenneth Clarke's GP fundholding, which arrived under John Major, as a Labour scheme was a deliberate error to stress that the reforms are continuity, or a genuine error.

3. That is the first reference I've heard from the PM to "terminating" the unfulfilled NPfIT contracts. Interesting.

From Hansard:
Edward Miliband (Doncaster North) (Lab): A year into his Government, how would the Prime Minister rate his handling of the NHS?

The Prime Minister: I think that the most important thing we have done is increase spending on the NHS, which is something that has happened only because of the commitment we made at the last election. So an extra £11.6 billion will be going into the NHS because of the decisions we have taken. In addition, there is a £200 million cancer drugs fund, so that people get the drugs they need and, for the first time in a long time, the number of doctors is growing very quickly and the number of bureaucrats is actually falling.

Edward Miliband: In case the Prime Minister did not realise, it takes seven years to train a doctor, so I would like to thank him for his congratulations on our record on the NHS. I have to say to him, if it is all going so well, why have we seen the number of people waiting for diagnosis rising again this morning? More than 10,000 people are waiting to get their tests, three times the number it was a year ago. I also noticed that he did not mention his top-down reorganisation when he talked about his handling of the NHS. Let me remind him of what he said just a month ago. He said: “I’ve been involved in designing these changes way back into opposition with Andrew Lansley”.

Will he therefore confirm that the failing NHS plans are not the Health Secretary’s fault, but his?

The Prime Minister: The Leader of the Opposition himself has said that no change is not an option. We are seeing the usual empty opposition. I am glad that he mentioned waiting times, because, two weeks ago, at that Dispatch Box, he said that waiting times “have risen month on month under this Government”.—[Official Report, 27 April 2011; Vol. 527, c. 169.]

That is not true. The figures, which he had at the time, show that in-patient waiting times fell from 9.1 to 9 weeks. For out-patients, they went down from 4.8 weeks to 3.5 weeks, the lowest for a year. It is important when we come to this House and make statements that are inaccurate that we correct the record at the first available opportunity.

Edward Miliband rose —

The Prime Minister: Hold on. Would he like to take this opportunity to correct that specific mistake?

Edward Miliband: No, waiting times are rising. I notice that the Prime Minister did not even take the opportunity to take responsibility for the health policy. Where is the Health Secretary, after all? Where is he? It is becoming a pattern with this Prime Ministers. This morning, in the papers, we saw the Universities Minister being dumped on for his tuition fees policy; we see the Schools Secretary being dumped on for his free schools policy; and the poor Deputy Prime Minister just gets dumped on every day of the week. The Prime Minister must believe that something has gone wrong with his health policy, because he has launched his so-called listening exercise. Can he reassure doctors, nurses and patients that it is a genuine exercise?

The Prime Minister: Of course it is a genuine exercise. Let me be clear: the right hon. Gentleman is wrong on the waiting times. The figures are clear and I shall place them in the Library of the House of Commons. Waiting times went down last month and he ought to have the guts and the courage to correct the record when he gets it wrong. He asks about my Health Secretary, and perhaps I can remind him of what his health spokesman has said. He said it this week. He said the general aims of the reform are sound. That is what he said. He said earlier, “I have no problem with the broad aim of the changes,” and went on to praise them. When I look at this, it all reminds me of Labour 30 years ago. They had a leader with the ratings of Michael Foot and he was being undermined by someone called Healey, as well.

Edward Miliband: We read in the papers about a PMQs makeover, but I have to say that it did not last very long. Flashman is back. Of course, the thing is that Flashman does not answer the questions, so let me ask the right hon. Gentleman again. Can he explain why the chief executive of the NHS, Sir David Nicholson, wrote to NHS staff on 13 April, after the Prime Minister’s so-called pause had begun, and said that they should “press on with implementation” of the plans? That does not sound like a pause to me.

The Prime Minister: I can absolutely guarantee that there will be significant and substantial changes to the reforms because we want to get them right and because we want to guarantee an NHS that is free at the point of use and available based on need rather than the ability to pay. Unlike the Labour party, which is now cutting the NHS in Wales, this Government will put more money into the NHS.

The right hon. Gentleman talks about what is in the newspapers today, but he ought to be looking at the GPs representing 7 million patients who wrote to the papers today to say that this is evolution, not revolution, that it is good for patients, and that it will help some of the “most vulnerable” people in our community. I have to accept that some of the recent cultural references—Michael Winner, Benny Hill—are all a little out of date, but I must say that when I look at the right hon. Gentleman, who told us that the fight back would start in Scotland before going down to a massive defeat, he rather reminds me of Eddie the Eagle.

Edward Miliband: Let me congratulate the Prime Minister on getting 42 GPs to write to The Daily Telegraph supporting his plans. The Royal College of General Practitioners represents 42,000 GPs and it says—the Prime Minister said that he would protect the NHS, so I would have thought he would be embarrassed by this—that his plans will cause “irreparable damage” to the core values of the NHS. I do not know whether he even knows about the letter that David Nicholson sent, but the truth is that the Prime Minister’s pause is nothing more than a sham.

The Prime Minister: Why does not the right hon. Gentleman for once in his life actually deal with the substance of the reform? The truth of the matter is that he has said, quite rightly, that no change is not an option. We believe that no change is not an option and that is what the overwhelming amount of people in the NHS feel. Let us look at the elements of the reform: GP fundholding started under Labour and is now being improved under this coalition; foundation hospitals started under Labour and are now being taken forward by this coalition; payment by results—so that we make sure that we get good value for money in the NHS—started under Labour and is now being carried forward under this coalition. That is the point. He should be seriously engaging in how we make sure we have a strong NHS for all our people for the future. Instead, we have empty opposition, which got him absolutely nowhere last week.

Edward Miliband: In a phrase that the Prime Minister is familiar with, “Calm down, dear.” Calm down. Does not his mess on the NHS tell us all we need to know about this Prime Minister? He breaks his promises, he does not think things through and when the going gets tough, he dumps on his colleagues. On a day when waiting lists are rising, this confirms what we always knew about the Tories—you cannot trust the Tories on the NHS.

The Prime Minister: What we have seen is just the product of empty opposition and weak leadership. It is this Government who are putting more money into the NHS; it is this Government who are putting money into the cancer drugs fund; it is this Government who are seeing the number of doctors and nurses grow while the number of bureaucrats shrinks. It is this party that is defending the NHS and it is Labour in Wales that is cutting the NHS. That is the truth. There is only one party you can trust on the NHS and it is the one that I lead.

Liz Kendall (Leicester West) (Lab): The Prime Minister knows about the real pressures faced by London’s emergency services, including those they will face in the run-up to the Olympics next year. What risk assessment has he made of the London ambulance service’s decision to cut 20% of its work force, including 560 front-line NHS staff?

The Prime Minister: I have discussed with London’s emergency services some of the challenges they face, not least the Olympics and the terrorist threat. All organisations in this country are having to make savings and efficiencies and try to concentrate on the front line. That is what is happening in the police and elsewhere. The point about ambulance services and the NHS is that we are protecting spending on the NHS. There was, frankly, only one party that proposed that at the last election. If we had not proposed that, it would not be happening. We listened to the Labour party, including the former health spokesman, the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson), who spoke earlier, and they were going to cut the NHS. That would have affected the London ambulance service like everything else.

Caroline Nokes (Romsey and Southampton North) (Con): Given the high demand from the public to attend the consultation events on the future of children’s cardiac services in Southampton, will my right hon. Friend the Prime Minister join me in calling for additional events so that the maximum number of people in the wider Southampton area can participate?

The Prime Minister: I certainly agree with my hon. Friend, and in the review of child cardiac services—this affects my constituency as well as hers, and people are talking about how Southampton and Oxford should work together—I think that there should be as many events as people want to go to, as much transparency as possible and, if specialisation is necessary, as much explanation as possible about why it is necessary and why it is good for patients. In the end that must be the test of everything we do in the NHS.

Mr Richard Bacon (South Norfolk) (Con): What discussions he has had with the Minister for the Cabinet Office and the Secretary of State for Health on the performance of Computer Sciences Corporation in installing Lorenzo software within the national programme for IT in the NHS.

The Prime Minister: We are very concerned that the NHS IT projects that we inherited were of poor value for money, an issue we raised repeatedly in opposition. According to the National Audit Office, even in 2008, delivery of the care records system was likely to take four years more than planned. Since coming into government, we have reviewed the projects with the intention of making the best of what we have inherited. In part, as a result of our work, the Government have cut £1.3 billion from the cost of the national programme for IT in the NHS, including planned savings of at least £500 million from Computer Sciences Corporation.

Mr Bacon: Does the Prime Minister agree that the NHS IT programme will never deliver its early promise, that in particular CSC has failed with Lorenzo and that, rather than squandering £4.7 billion that is still unspent, the solution is to negotiate a way forward that frees up billions of pounds for the benefit of patients?

The Prime Minister: I agree with my hon. Friend that we are absolutely determined to achieve better value for money. Let me reassure him that there are no plans to sign any new contract with Computer Sciences Corporation until the National Audit Office report has been reviewed and until the Public Accounts Committee meetings and the Major Projects Authority reviews have taken place. The Department of Health and the Cabinet Office will examine all the available options under the current contract, including the option of terminating some of, or indeed all of, the contract.