The Sketch: Feeling nauseous, but not as sick as the Tories' first line of attack on health

I'm nauseated. That is, I'm nauseous (I'm trying not to say I'm sick, for fear of finding the wrong sort of agreement). And no, it's not health that's made me ill. Far from it. It's impossible to dislike Mr Milburn. What an extraordinary thing to say, I must be sicker than I thought.

Compare him with his friend and colleague Stephen Byers who was also up yesterday. Mr Byers' misfeance, maladministration and many mortal misdemeanours require him to stand at the despatch box like one of those living statues you see in street theatres; he speaks only to issue toneless departmental banalities (no change there then).

Mr Milburn, by contrast, invigorated by Brown's billions, bounces into the House smiling, joking, pointing, laughing and filled with an exuberant nervous energy. Why? It's clear. He's the woman who wins the quiz and has half an hour to spend as much as possible in the supermarket. He's on a spree. No one is going to spend as much as he is in the next half hour.

Word has it the Tories feel a wind in their sails. It's not true. They can't even nail the Transport Secretary to the latest burial-of-bad-news story. This paper had a memo leaked from the train companies' board meeting insisting that fare rises be kept as far from the media as possible.

Mr Byers told the MP not, "to believe everything he reads in the paper. If he can produce any memo, I'd be delighted to see it. I don't believe it exists".

But if Barrie Clement, our transport editor, stapled the memo to the minister's forehead he still would deny its existence. Howls of execration would leave the dead statuary of his Commons presence quite unblemished.

By contrast, Mr Milburn has one of the first political talents, that of making you want to believe. Of course, the temptation must be resisted. Last week in the House, Mr Milburn said NHS patients will be able to choose when and where they are to be treated. It's the great reform. It's the big idea. It's a complete reorientation of current working practice.

Instinctively we know it isn't true. Don't we? Charmingly, cheerfully, the minister bares his perfect teeth in order to lie through them.

On television, where ministers are constitutionally obliged to tell the truth, Mr Milburn came clean. Everyone will be able to have an appointment when and where they want provided their GP agrees, their primary care trust agrees and there is the spare capacity in the system. The chance of this combination occurring is vanishingly small.

Dr Liam Fox's first line of attack was: "If money is to follow the patient, what IT system will be required?" Call me a crude vulgarian if you will (and I'll smash your face in) but quibbling about the computer system seems rather a technical detail to spearhead the Conservative attack.

Mr Fox made many interesting, indeed powerful points – if hospitals are to be paid by results, what will happen to the hospitals that achieve 'no stars' under the Government's rating? Whatever his argument's strength, he loses the rhetorical battle.

Mr Milburn's big idea has been to reintroduce the internal market. It may work. But he is very keen to pretend he hasn't introduced the internal market. The internal market enrages his backbenches. The Tories' rhetorical strategy must be to praise Labour's effort to have another go at putting Tory policy into practice. It sounds friendly; and in politics friends are always more dangerous than enemies. Whatever reservations he may express, Dr Fox should give the full poison of support to his opponent.

Simoncarr75@hotmail.com