Published: 10/03/2005, Volume II5, No. 5946 Page 10

This month my book club (do not laugh) read Ian McEwan's enjoyable new novel Saturday, whose hero is a high-powered surgeon at what is clearly University College Hospital in London. I will not hurt the plot if I reveal that Dover Beach, Matthew Arnold's melancholy Victorian poem about the collapse of faith, features in a crucial scene.

In the darkness that follows, predicts Arnold, 'ignorant armies clash by night'. Naturally I thought of the phrase during last week's clash over Margaret Dixon's shoulder operation at Warrington General. By the time this reaches you - this had long been designated Labour's 'health week' by party strategists - I will doubtless have thought of it again.

When Tony Blair and Michael Howard first clashed by daylight at PM's question time I thought it a risky gamble by the Tory leader: everyone knows that hard cases rarely stand up to 360-degree examination.

Hospitals always have their reasons, even though there could be no denying that Mrs D's 'non-urgent op' could have been better managed.

The possibility that she had a 50/50 chance of dying under the knife (as my 86-year-old aunt did when she, too, gambled on pain relief) surely tips the scales.

But my interest turned to alarm when a chum at Tory HQ rang offering a series of mobile phone numbers so we hacks could ring Mrs Dixon.

'She's a 69-year-old with a heart condition. Can she stand up to this?' I asked.

As you know, she could. Mrs Dixon was a TV natural and made her case with dignity. Tory MPs and officials are genuinely delighted at what they see as a case that exposed Labour's expensive pretensions to have transformed the NHS.

They quoted the ancient Chinese military strategist Sun Tzu: 'Attack the enemy where he is unprepared and appear where you are not expected' - ie a Warrington hospital.

It is typical of Mr Howard's new adviser Lynton Crosby.

But Labour claims to be thrilled.

Alastair Campbell was not alone in calling the Tory move 'tactically clever, but strategically stupid'; one Mr Howard will regret. What do they mean by that?

Quite simply that health secretary John Reid and his allies have been trying for months to get the ignorant armies of Fleet Street and the backbenches to focus on Tory 'patients' passport' policy. Mr Howard has obliged.

By coincidence Mr Reid was due to make a speech in his former Northern Ireland capacity at the Peace Centre set up by Colin Parry, whose son was killed by Warrington's IRA bomb.

He was diverted to the Dixon case, though did not visit the lady on the plausible grounds that her invitation was both written and orchestrated by Tory HQ.

Everyone seems to have different views about how Mr Reid performed on the telly that day and, indeed, on Sunday when politics and the media's ignorant armies were also squabbling over MRSA rates (are they up or down? ) and the end-year financial state of Great Ormond Street Hospital.

Great Ormond Street is surely one of the most cherished NHS brands.

But medical chums remind me that it is always overstretched and under pressure and that the new NHS price tariff may not reflect the cost and complexity of all its work.

But that is not a nuance for an election campaign. Personally, I think Reid an articulate tough guy, a more plausible bully than former health secretary Alan Milburn was, and that his ruthlessly repeated insistence that under the Tories voters would have to pay for some NHS operations will have an impact between now and May 5.

But is it true? By the time he appeared on ITV's Dimbleby show Mr Reid had refused Mr Howard's demand that he withdraw his 'lie' and produced dusty clauses in the 1948 and 1977 NHS Acts to argue that any operation wholly or partly funded by the NHS 'must not be supplemented by a charge on the patient' as the passport policy of paying 50 per cent in some cases suggests.

My Tory chums are convinced this kite will not fly. I think they're wrong.

I also think that Bruiser Reid will win the MRSA blame game. Mr Blair says: 'Vote me out if the NHS really is worse'. Eight weeks to go.

Michael White is political editor of The Guardian.