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It all depends on your priorities: when the NHS started outsourcing years ago, with the cleaners and hygiene workers, it all went tits up. When I was young (ahem) the domestics were part of the ward team, which was managed by the sister, who was, with other sisters, managed by the matron. There was a team committment, direct and instant accountability, and pride in a job well done. When they were outsourced it all went - no real committment, no team spirit, no proper accountability. It may well have been cheaper, but it was not cost effective, and i believe it was the beginning of the downhill run into MRSA etc..