Wednesday 8th February 2012 | 14:02

PMQs sketch: top-down reorganisation looming for Lansley?

Advance copies of the script had done the rounds all morning. PMQs was going to be about the National Health Service. Ed Miliband doesn’t like the government reforms and someone in Downing Street thinks the health secretary, Andrew Lansley, should be "shot." But David Cameron, despite promising before the election that there would be "no more top down reorganisation of the NHS", thinks the reforms are wonderful. Well, he supports them anyway. We were shortly to find out why.

Except we didn't. Instead the prime minister descended rapidly into a crimson-faced fury, allowing Miliband to adopt a passive-aggressive and ever-so-slightly patronising calm which had Cameron's heckles in immediate need of some urgent treatment. Even that adenoidal delivery took on a velvety tone as the Labour leader delighted in the sight of Cameron thrashing around in a bombardment of personal attacks in an attempt to shake off Miliband's attempts to pin on him the unpopularity of the reforms.

But the NHS barely got a look in as the PM's temper frayed at every a possible edge. Andrew Lansley has probably seen it all before. The Health secretary usually stands near the entrance to the Commons chamber, arms folded, grinning confidently/nervously (delete as applicable), removed from the tightly-packed front benches. Today, however, he was invited to join the rest of his colleagues. Or perhaps told. Hidden at the far end of a row of Cabinet ministers – no chance of being in shot (for want of a better word) with the PM – and with government whip Michael Fabricant placed alongside him in a show of slightly unsettling support, Lansley shouted about "bottom up reforms" but he was, as Ed Miliband happily noted, "a safe distance away." At least, Cameron snapped back, Lansley had better "career prospects" than Miliband himself; as a ringing endorsement went, this was at finger-cymbal level.

And whenMiliband rattled his way through a list of Labour's achievements with the NHS, Cameron's reply was unconvincing: "If the record was so good, why were they thrown out at the last election?" There's a follow up question to that involving coalition governments and lack of majorities, and it looked like a few on the Tory benches may have been mulling it over.

On the NHS itself, Cameron told Miliband that one Anne Campbell – a former Labour MP who now works for an NHS Trust – supported the plans. Hardly a reference to plaster on the CV. "Even the Prime Minister doesn’t believe the nonsense he’s coming out with" replied Miliband, adding that the Tory Reform Group of MPs didn’t either. "It comes to something when even the Tories don’t trust the Tories on the NHS" he stated, giving his backbenchers the rare gift of a soundbite to take home. "I'm not surprised he's getting so agitated – the promises he made are company back to haunt him" Miliband continued, prompting an unidentified MP to do his bit for doubters of Parliamentary maturity by emitting a ghostly howl.

Cameron did have one good line, as he caused Miliband to shift awkwardly in his seat by declaring that "this is not a campaign to save the NHS – it's a campaign to save his leadership." But that was one for Westminster Village: if the message sticks that the dear old NHS is under Tory attack, then Ed Miliband's poll ratings are hardly likely to make for water cooler conversation.

As usual a phalanx of Tory backbenchers were despatched to prop up the PM, with Steve Baker deriding "Labour's tragic legacy" in his own High Wycombe hospital, but the dangerous silence across the Conservative benches hardly hinted at a deep love for their Health Secretary's reforms.

The gun may not be loaded yet, but the prospect of some top down re-organisation of the government looks more likely than ever.

Sam Macrory is political editor of The House Magazine