When I was boss of a group of hospitals we were required to put many of our tasks such as cleaning, laundry, catering etc out to tender. The in house tenders were normally the best but that wasn't the message politicians of the day wanted to hear.
Today many of these services are now done by outside contractors and from what I know from old contacts most have suffered badly from the changes.
Even my local Town Council is now complaining that the County's privatised ground maintenance contract may very well lose the Town its status in the national Town in Bloom Competition as the contractor has let weeds and grass grow wild around the town. I'm about to send the local paper a photo of one of the towns welcome signs which motorists will find hard to read as it is almost covered in weeds.