A difficult summer for David Cameron followed by his first reshuffle provided Ed Miliband with almost too many choices for today’s PMQs. He got it right by majoring on the government’s lack of delivery – Cameron’s Achilles’ heel.

After a weak first question, Miliband opened a powerful trio of attacks on delivery in infrastructure, housing and planning. Yesterday’s reshuffle was widely briefed as the government moving into a ‘delivery phase’, but without any major successes to point to Cameron will struggle under this kind of attack and he knows it. Miliband’s refrain that he has been prime minister for two and a half years and has to take responsibility will become stronger and all Cameron is left with is Flashman. In the most bizarre moment today, he appeared to accuse Miliband of not being sufficiently ‘butch’ because he made coffee for Ed Balls.

Arguably, Miliband could have gone much harder on the reshuffle, which provided a perfect opportunity to attack former health secretary Andrew Lansley’s NHS reforms and the split in the party over a third runway at Heathrow. His jibe about creating ‘another part-time chancellor’ in Ken Clarke was effective but overall Miliband was right to focus on the economy as the issue that most affects people’s lives. His closing line casting Cameron as the ditherer worked well, especially as the prime minister’s attempt to claim he led a ‘strong and united government’ brought howls of laughter.

The chamber was lively enough although backbench cheers were somewhat muted – perhaps to avoid aggravating painful heads after the excitement and gossip of the reshuffle last night. Nick Clegg had a frontbench rival for glummest expression in Lansley, who sat next to the prime minister in his new role as leader of the House. Paul Blomfield and Anne McGuire piled on the pressure over the removal of disability living allowance and Alison McGovern conjured up the ‘big society’ in response to her question on Save the Children’s campaign on child poverty in Britain. Mark Garnier and John McDonnell asked about a third runway at Heathrow – which could yet be the big story out of the reshuffle – and we learnt that Cameron is to make a statement in the coming days but will not be ‘breaking a manifesto pledge’. Don’t expect that to be good enough for Boris.

Best backbencher has to go to Dennis Skinner for his opening claim that the boos that greeted George Osborne at the Paralympics will ‘haunt the posh boys forever’ while the reshuffle of the ‘B’ team hasn’t raised a ripple. The reshuffle dithering may now be over, but until the government can point to what they have actually delivered on growth, PMQs should be increasingly uncomfortable for Cameron.

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Sarah Bickerstaffe is a former political adviser to Andy Burnham and runs a social enterprise delivering mental health first aid. She tweets @sarahbic