Out of the mouths of ten-year-olds

Isn't everyone at Westminster having a high old time about the issue of public service reform? Union leaders eat beef in No 10 and wag their fingers at the Prime Minister, while other ministers waffle on about ten-year plans. All this abstract guff and bickering suffocates the real issue.

It is only away from Whitehall that I have heard some sense. It came on a visit to the swimming pool, from the son of a friend. He is ten. He said: "The NHS is crap. Look what it did to my brother."

This boy, aged 12, had a dart thrown at his hand. It went in deep enough to pierce a bone, which quickly became infected. His mother rushed him to our local hospital, a rather grand-looking and once-famous institution. There, they waited for several hours until, at last, it was time for the X-ray. Except that - oh, sorry, the X-ray department had just closed for the day. They would have to go to another hospital.

With the boy in great pain, his hand now swollen like a red ball, they drove to the next hospital. They waited for hours. After midnight, they reached the head of the queue. Except that - yes, you've guessed it - the X-ray department closed at midnight. The boy was in a bad way and a doctor would see him, however.

So he and his mother were led down a corridor. In it, there were several prone, uncovered - yes, uncovered - former patients. "Mum," said the boy, "those people look as if they are dead." Yes, indeed, they were dead; those were uncovered corpses. It was after midnight. The boy had sat for many hours in pain.

This is our British NHS. The year is 2001. The country has the fourth-largest economy in the world. There is a Labour government.

An antibiotic was prescribed. Mother and son were told to come back that afternoon. They did. The previous night, there had been only one doctor available. The following afternoon, there was still only one doctor available. It was the same doctor, now in a state of extreme exhaustion.

Why shouldn't this boy and his ten-year-old brother think the NHS is crap?

This story would matter less if it were horrifically surprising. But it is an example of tens of thousands of awful experiences across the health service. It is why Sharron Storer took on Tony Blair outside a Birmingham hospital. It is why there is raw anger among the public. It is why time is short. And already, in Whitehall, they are talking of tables, and plans, and "our members' interests", and who is more to blame, and blah blah blah. Is it really so odd that people are getting less interested in politics?

The money is now coming in. The good side of Blair and Gordon Brown is that they do seem genuinely pragmatic about getting improvements, however they are achieved, and they have finally put in the resources that the NHS will need in order to improve over the next few years. It will be hard to find all these new doctors and new nurses so quickly. Many, I suppose, will be struggling with the English language. But Blair and Brown surely know that if they don't produce real change, the country will rise up and revolt.

The government's bad side, however, its persistent failure of imagination and politics, is its inability to pass down power and responsibility, not only to hospitals, but also to schools and other services. It really is a control-freak state. Biographers have no trouble explaining why the Prime Minister and the Chancellor, and indeed other ministers, are control freaks. It's all to do with the struggle to change Labour a decade ago. But most of us are not biographers. We are patients and parents and passengers. And it is becoming clear that you cannot get reform by Whitehall diktat.

Tables and national plans, policy wonks and think-tanks - all that belongs to a different world. The hospitals that failed this boy failed because of lousy local management, special interests, a mixture of exhaustion and a sod-the-patient mentality among the employees, and the special cynicism that comes from years of no one really caring enough to make things work. Any analysis that says unionised health workers are all saints is politically correct rubbish.

With the money that is at last arriving must come real local responsibility. That means managers who deliver and who are fired by locally accountable bodies if they don't. It means higher pay, but also flexible working. And it means local differences - since imposing uniformity from London instantly stifles change and scatters excuses to all who want them.

The political failure, though, cannot be evaded. How can we get a better NHS, or schools, or railways, until departmental ministers feel genuinely free to experiment without cross-checking every semi-colon and cleared throat with No 10 and the Treasury? Devolution starts from the top. You can't have it with cowed, timid departments which are, in turn, too nervous to pass responsibility and authority downwards. You can't, in short, have devolved public services run by a control-freak government.

Part of me wonders whether anyone is really listening. Already, routine has taken over Westminster since the general election. The message sent by abstention and by those few furious voters who got through to the political classes seems to have been almost forgotten. We are back to the arid, posturing confrontations between unions and ministers, with the users excluded.

Things cannot go on like this. The health service has lasted for 50 years because this country loved it, was proud of it, relied on it, wanted more of it; and that created the political consensus that kept it going.

What is happening to that consensus now? Those boys from the swimming pool are tomorrow's voters. They think the NHS is crap. And they're right.