Michael White: Is the summer silly season over?

This week Prince Andy complained that the support of big unions (and their financial backing) unfairly tilts the contest towards frontrunners and said the rules should be changed. I think that should be seen as an admission that a Miliband is set to win.

Never mind. Henry VII (1485-1509) was famously parsimonious, rebuilding rackety royal finances after the Wars of the Roses. So Andy Tudor is a man for our times as the coalition finalises its cuts and this week’s TUC threatens union strikes.

That confrontation will be an important test of public opinion and the Daily Mail (busy organising voter militancy against late tax demands) may have misjudged the mood out there as cuts in services emerge. We will see.

How did MPs’ moods measure up? By chance it was Andrew Lansley’s health team’s turn to face Commons question time on day two. I did not detect much money saving zeal.

Indeed, when Prince Andy warned that the Tory promise to increase real term NHS spend would mean “severe cuts to councils which need to provide care support to older people to get people out of hospital”, Mr Lansley was unapologetic.

Our focus is “improved outcomes for patients” and more jobs would be lost under Labour, he insisted. What’s more, the government’s pledge “does not mean an increase in real terms for every part of the NHS all the time”. A good point.

MPs in all parties asked more about GP-led commissioning, assorted reorganisations and hospital closures than any other issue. None said: “Please close my surplus beds.” Indeed, new Tory MP for Central Suffolk Daniel Poulter, (an obstetrician by trade), asked for better resourced rural maternity services. He was promptly joined by his new Suffolk Coastal neighbour, Therese Coffey (she is a chemist turned finance director), who wants any new funding formula to reflect the cost of distances travelled in rural areas.

Both good points too, but neither is cheap. Anne Milton, ex-nurse turned public health minister, agreed with Ms Coffey.

“That is why it is so important that local commissioners will shape the services for their patients. It is they, not the pen pushers in the primary care trust, who know best what is right for their patients.”

“Pen pushers”, minister? Politicians can deploy such language in opposition, but surely not in office when the pen pushers’ cooperation is needed, if only to accept your handsome offer of an up to £130,000 voluntary redundancy package.

That figure had not surfaced when these exchanges took place. But scepticism about the promised shake-up (a mere “rebranding” of PCT services in Doncaster, protested ex-minister Caroline Flint) was not the only cash item worrying MPs. Only slightly fewer questions were asked about urgent cancer treatments, a topic which has cash registers ringing.

Postcode lotteries and the availability of Avastin (cancer drug of the month?) and Afinitor? The need to avoid “under-treatment” of elderly cancer patients? Coalition MPs joined the scramble for these goodies. Mr Lansley insists his £50m cancer drug fund “in no way undermines the National Institute for Health and Clinical Excellence”, though it obviously does.

With Prince Andy warning that Labour will fight “high handed and arrogant” changes all the way, the coalition must learn to get its complex messages across more clearly to survive the battles ahead. Masochism is not enough.