Andrew Gimson sketch picThe Prime Minister and the Leader of the Opposition have become trapped in a cycle of abusive behaviour which demeans them both. David Cameron each week behaves like an Englishman in a restaurant who has been kept waiting an intolerable length of time for his main course, has lost control of himself and is unable to stop shouting. His manners desert him and are replaced by boorish contempt.

Ed Miliband responds in the manner of a head waiter who himself has anger-management issues. It would be no surprise if he invited Cameron to step outside and settle the argument in hand-to-hand combat, away from the ineffectual attempts of the Speaker, John Bercow, to get the two of them to behave like civilised human beings.

How much of this anger is genuine and how much fabricated? The two combatants probably do not know themselves. Cameron appears to have decided that the best way to get through this half-hour is to avoid any attempt to sound reasonable, or to introduce some light and shade, and instead to bellow an unrelieved series of insults at Miliband. Before long the Prime Minister declared that he is “not going to take lectures” – what a tiresome expression that is – “from a government that saw patients drinking out of flower vases”.

It would be no bad thing if Cameron and Miliband were one day to discuss what can be done to improve the truly lamentable quality of so much hospital food. I recall visiting a patient in one NHS hospital where the food was said to be brought in by lorry from South Wales, about 200 miles away, and looked like it.

But Miliband instead asked whether Cameron can guarantee that there will not be a crisis this winter in accident and emergency departments. Cameron retorted that for the 27th week in a row “we met our A&E target”. Miliband retorted that “the Prime Minister is simply wrong…the target has been missed for the 15th successive week”.

The dialogue in a Punch and Judy show is more sophisticated. Cameron proceeded to claim that the average waiting time in A&E departments is now 53 minutes, while under Labour it was over 70 minutes. Miliband accused Cameron of being “clueless”, “complacent” and “out of touch”, and Cameron accused Miliband of behaving “like the mayor of a Sicilian town towards the mafia”.

What effect is that kind of remark going to have on Anglo-Sicilian relations? Cameron’s people had arranged for Conservative backbenchers to provide him with repeated opportunities to attack Miliband for failing to inquire into intimidation by the Unite trade union: “He never stops calling for public inquiries but he hasn’t got the guts to hold one of his own.”

It is the unrelenting nature of these exchanges which is becoming insufferable. Cameron and Miliband have got locked into a war of attrition when they should be fighting a war of movement. They may claim the hooligans who sit behind them expect this kind of thing. But their monotonous double-act is starting to wear the rest of us down.