Our strategy is to rebuild the NHS. Theirs is to run it down so they can dismantle it

Tony Blair

Mr Blair, who has accused the Tories of "undermining" the NHS throughout the row, admitted there were pressures on the health service but insisted his government's investment was making things better.

The prime minister was also pressed to make time for a ban on fox hunting but public services dominated the exchanges once again.

The Tories opened a second front on Labour's links with striking rail unions but Liberal Democrat leader Charles Kennedy focused his interrogation on healthcare

Mr Blair challenged his Tory opponent to say whether he would match his extra health spending.

He told MPs: "Our strategy is to rebuild the NHS. Theirs is to run it down so they can dismantle it."

Casualty concerns

The Conservative leader attacked Mr Blair's handling of the Addis row - in the wake of their confrontation on the case at the previous week's question time.

He said: "One minute the prime minister says that the public servants put scars on his back, the next moment he's turning the entire weight of his government and its machine on a 94-year-old lady.

"He turns that machine on people that complain because they have nowhere else to go.

Charles Kennedy said cancelled operations cause trauma

"When will you grasp the fact that the problems in the NHS are not the fault of doctors, nurses or patients, but of you?"

The Tory leader also raised worries about the state of hospital accident and emergency departments.

The number seen by a doctor in A&E within an hour had fallen from 75% under the Conservatives, when Mr Blair had claimed the casualty departments were in "crisis", to about 50% now.

Mr Blair said he recognised there were pressures facing casualty departments but argued the way of counting A&E waiting times had changed.

'Facts wrong'

"Whereas your government used to measure the time people spent in A&E from the time they were first seen, we measure the time from when they first enter the A&E department.

"So you've got your facts wrong."

The National Audit Office, using its own figures, said last October that the number of people waiting more than an hour in casualty units had got longer since 1996.

Its report warned, however, that more hospitals had been surveyed in 2001, which could have affected the comparison.

Blair was urged to introduce a hunting ban urgently

The trauma caused by hospital operations being cancelled worried Charles Kennedy, who questioned why cancellations had risen by 50% to 77,000 last year.

Mr Blair called the figures "unacceptably high" and said patients deserved better.

But 19 out of every 20 operations did go ahead on time, he stressed.

"We know the challenges are there. But as the independent review report found there are also real improvements," he continued.

Passenger 'misery'

Rail strikes formed the second arrow in Mr Duncan Smith's armoury.

The Labour Party was still taking �80,000 from the RMT union while passengers were losing money through the misery of its strikes, said the Tory leader.

Mr Duncan Smith, who suggested on Tuesday that tougher anti-strike laws might be needed, urged the prime minister to sever his RMT links and take action.

Hunting hedging

The prime minister condemned the strikes as both "unjustified, indeed unjustifiable" but said investment was the way to improve the railways.

Banning the right to strike would be the "very worst thing", he continued.

Meanwhile, Labour MP David Crausby urged Mr Blair "urgently" to bring in a bill to ban hunting with hounds and put the majority of the country who wanted the move out of their misery.

But Mr Blair would only repeat his promise to give MPs a vote on the issue and its date would be unveiled "at the appropriate time".