The Sketch: Insidious spread of cross-party support for health reform chokes Labour MPs

One of the Health ministers, nice young John Hutton, sat on the front bench yesterday sporting the remnants of a fabulous black eye. A great shining bruise fading on his upper left cheekbone. I asked his doctor (all right, his spin doctor) where this black eye had come from. "It isn't a black eye," he said. "It is a black eye," I said. "It's a red eye," the doctor said.

Black, red. Red, black. That's what it's like in the health service. No two people see the same thing. And after Mr Hutton collected his black eye, I would be surprised if he saw anything at all. Where were we? Nicholas Winterton demonstrated the rhetorical strategy that the Sketch has been recommending for years now (sometimes I don't know why I bother). It's perfectly simple, and even sounds rather nice. Mr Winterton praised the Government's plan for foundation hospitals. "I fully support the concept," he said, "because of the responsible freedoms it gives to management."

For new entrants to the story, the Labour left thinks that the concept of foundation hospitals comes from the single lowest circle of hell. The left is offering to fight to the death to prevent their establishment.

So it was that Mr Winterton's pleasant words sent waves of poison gas rolling out across the government back benches. As George Stevenson went down scrabbling at his chest, we heard him choking on these words: "Given the Tory policy on health, doesn't support from those quarters give the minister the slightest concern?"

Because that's exactly the point. The one thing the Tories have at this stage in their disintegration is a toxic touch. Their endorsement contaminates. Their praise poisons. When Tories voice approval of public-service reforms it sends the clearest signal to the unions and 85 per cent of the workforce that the changes must be resisted at all costs. It also rams home the wedge between the government front and back benches.

If the Tories want the government split to materialise they must spend 65 per cent of their efforts praising the Government. The other 35 per cent of the effort can be spent doing what Marion Roe did: singing the professionals' song of disappointment and discontent: "Two weeks ago, Dr [Ian] Bogle [British Medical Association chairman] said there was new evidence that 80 per cent of doctors hadn't seen any improvement in the NHS and that excessive national targets were preventing money from reaching the front line." This, incidentally, made a happy contrast with the Prime Minister's totalitarian proclamation the day before – that everyone (everyone, damn you!) agreed that the NHS was improving.

Finally: Labour's Tony Wright revealed how heart operation targets were being met. One of his constituents woke up in hospital after a heart attack. He was not given an angiogram to diagnose his condition precisely. He went home on a promise. A letter arrived offering him an appointment in a year's time.

Until he is diagnosed he doesn't appear on a waiting list. When you hear that waiting lists for heart operations have been fixed, bear this little vignette in mind, and recall the piping voice of little Hazel Blears twittering: "Clinical priorities are always the most important issue in the NHS."

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