PATRICIA Hewitt, the Health Secretary, came under fire last night after taking a swipe at the health service north of the Border.
The Cabinet minister made an ill-timed joke as thousands of staff face jobs cuts and hospitals are threatened with closure because of a cash crisis in the NHS.
As Michael Martin, the Speaker, returned to work for the first time yesterday after an angioplasty operation at Glasgow Royal Infirmary on 17 February, Mrs Hewitt said: "May I on behalf of the whole House say how delighted we are to welcome you back.
"I'm sure you were in the very safe hands of the NHS - even if it was in Scotland rather than in England."
The exchange drew gasps and strained laughter from MPs, who were gathered to hear Mrs Hewitt explain why some GPs were paid up to 250,000 a year under government contracts while other workers faced the axe.
Margaret Davidson, chairwoman of the Scotland Patients Association, hit out at Ms Hewitt for patronising Scottish patients and insulting Scottish NHS staff, asking: "How dare she? What it she implying? That the English NHS is better than the Scottish one?
"It is very patronising of her. The NHS is just as good in the hands of Scottish ministers as in the hands of English. Perhaps the health service is better in Scotland but we would not patronise the English by saying that."
An aide close to Mrs Hewitt played down the incident in the Commons, pointing out that the Health Secretary was not known for her sense of humour.
"It was a light-hearted remark from Patricia Hewitt, it was really a joke that fell a bit flat.
"She would be mortified if she knew that anyone could be possibly insulted by it. Patricia is far too professional to take a swipe at the Scottish health service."
A spokesman for the Scottish Executive refused to comment.
Mr Martin, who is the MP for Glasgow North East, had been off work for nearly two months recovering and thanked the members of the public and MPs who had inundated him with messages of support.
The Tories, who under David Cameron have been careful to appear supportive of public services, were quick to pay tribute to the nurses and doctors who had cared for Mr Martin.
Andrew Lansley, the shadow health secretary, said: "You are indeed a testament to the quality of care in the NHS and we're delighted to see you."
This is not the first time that tension over the health service has arisen between Westminster and the Executive. Just weeks before the last general election, Tony Blair left the First Minister, Jack McConnell, deeply embarrassed over the performance of NHS Scotland by saying it provided an example to England of how not to run a health service.
The Prime Minister highlighted that Scotland's soaring waiting lists proved that public spending was useless without market-based reform.
One of the benefits of devolution was that the government had "empirical evidence" from which it could assess progress, he said.
Mr Blair took another swipe during Labour's autumn conference, when he said that Scotland and Wales provided the "test for the NHS" reforms.
The devolved governments of Scotland and Wales had largely rejected his reforms, and both have seen mushrooming hospital waiting lists, while England has sharply cut waiting lists by using the private sector.