The Sketch: Never mind the Algarve, the hooligans were out in force in the House

The Prime Minister put in such an energetic performance it verged on the hooligan. "If he wonz an' argument, leddim come on an' 'ave it!" It was the deepest exploration yet of the Prime Minister's estuarial hinterland.

The Prime Minister put in such an energetic performance it verged on the hooligan. "If he wonz an' argument, leddim come on an' 'ave it!" It was the deepest exploration yet of the Prime Minister's estuarial hinterland. It wouldn't have been out of place in a Portuguese café. Maybe it's part of a UKIP Outreach strategy. Maybe he's just trying to suck up to the terrace element of his own backbench. He was talking about Michael Howard and the future of the NHS, incidentally.

Mr Howard said that a constituent of his had to wait 349 days for a knee operation, whereas just over the boundary the same operation could be had in 33 days. Hence, he said, the Tory policy for the patient's "right to choose". Mr Blair ("delighted to join battle") said "choice" was introduced by his government. It was hardly a rebuttal, let alone a refutation. He's been waiting so long you'd think he'd be better prepared.

Mr Howard went on. Labour's plan is to send patients who've been waiting more than six months to a different hospital for their operation. But the hospital is chosen by the Government. Under the Tory plan, it seems, the patient chooses.

Frankly this is a 16th century theological argument. The holy grail is this thing "choice", but there is a protestant way to choose (individually) and a catholic way to choose (through the governing body). Thousands died resolving that argument, and doubtless thousands are dying now. This distinction between good choice and bad choice, our sort of choice and your sort of choice is so irritating to normal people (I exclude myself, obviously) it's no wonder they decline to vote.

"People get fed up with those who continually run the NHS down," the Prime Minister said. That may be true, but people also get fed up with those who continually talk it up. In fact, the media's corrosive cynicism is probably directly caused by the Government's pathological optimism.

We also get fed up with people who continually run their opponents down. "We want to make the health service better and they want to wreck it!" Mr Blair declaimed triumphantly. Do we really believe that? Do Tories want to eat babies and put thalidomide in the water supply as well? It seems an unlikely way to get votes in this day and age.

In fact, both parties are moving in very similar directions on the health service; Labour's idea of reducing cataract waiting lists by contracting out to the private sector, for instance, is very much what Oliver Letwin means when he describes the NHS of the future (and is denounced for "wrecking the health service"). As the parties converge so the rhetoric becomes wilder.

There remains the distinction between the catholic and protestant varieties of choice - but while the argument is conducted with all the grace and precision of a terrace chant it's a distinction that won't be bothering us for a while.

simoncarr75@hotmail.com