THERE is no possibility of reforming the National Health Service for, if it had been possible, it would have been done before now. Every government since the Eighties has tried and failed. That the NHS is crying out for reform is not in doubt. It is the world’s biggest employer next to the army of the People’s Republic of China. More people work for the NHS than there are in the whole population of Estonia; and its budget is larger than that of many countries.

But the NHS will never receive the radical and sane reform that it needs. So what will happen to it? It will continue to grow ever more bloated, increasingly hamstrung by its own massively incompetent bureaucratic procedures, until it collapses under the monstrous weight of its ponderous inefficiency and its impossible financial demands.

But why can the NHS never be reformed?

When the NHS was instituted in the Forties, it was a lean, efficient organisation run by the matrons, doctors and nurses with modest help from the almoners’ department and the hospital management committees.

Now it is a nightmare bureaucracy consisting of tens of thousands of professional administrators, officials and clerks. Something destructive happens to organisations when they grow too large: they cease to exist for the sake of the people they were created to serve and they come to exist for the benefit of the people who work in them. The NHS now exists only incidentally for the sake of the patients. It is there to serve the interests of its managers and employees. In a casual, innocent remark the other week, Ed Miliband gave the game away. He said that the proposed reforms of the NHS would offend “those who work in it”.

And what is true of the NHS is true also of the state education system which does not exist for the good of the pupils – otherwise standards of achievement would not be so disgracefully low – but for the benefit of its employees, especially the powerful teaching unions and the useless army of educational bureaucrats.

By the Education Department’s own reckoning, more than 40 per cent of British children leave school, after 11 years of compulsory state education, unable to read, write and count efficiently.

The incurable problems in the NHS and the schools are the product of a deeper malaise in the Government itself. I suppose, in our innocence, we all like to imagine that governments have as their top priority trying to run the country efficiently and fairly. Individual governments may disagree about how this is to be achieved. But that is not the point.

All modern governments are in essence the same. Like the armies of bureaucrats in the NHS and the education system, they do not work for the public good but for their own good.

The top priority of every government is to preserve its members in power and so to order their doings that, with luck, they win the next election. The mechanism which they all employ to achieve this depressing aim has two main parts: the first part is a selfserving bureaucracy which, for all the governments since the Second World War, sees its job as managed decline and keeping up appearances.

The second part, a function of the first, is propaganda. So they operate by bureaucracy and propaganda or, to put it another way, by self-preservation and advertisement.

Bad news for the people.