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@NotThamesWater
Let's not forget that NHS management and leadership is a fucking shambles - it should come as no surprise that farming out services can lead to an improved, and yet cheaper, service.
The real issue is regulation, control and accountability - poorly written private sector contracts are going to be exploited, and when that happens, it's next to impossible to drag them back into line.
That is where successive governments fuck up time and time again (whether it's health or any other service), because some pocket lining fuck shortcuts proper due diligence, in order to make a little more cash on the side.