The NHS market testing programme led to a series of contract failures and reduction in cleaning standards in the 1983-2000 period (Public Service Action, 1983-1997). By 2002 some 52% of domestic services contracts were outsourced with an estimated value of £94m according to an unpublished NHS outsourcing study.

Standards had declined to such an extent that the NHS Plan launched in 2000 included a additional £31m to improve the quality of cleaning combined with a Patient Environment Action Team (PEAT) to visit every hospital to inspect standards (Department of Health 2000). In autumn 2000 only 20% of NHS Trusts had a achieved a good standard of cleanliness, rising to nearly 80% by summer 2004. Additional investment specifically to improve cleaning had risen to £68m by 2004 and the DoH issued a revised specification, recommended minimum cleaning frequencies, a revised Healthcare Facilities Cleaning Manual and best practice guidance on evaluating and awarding contracts as part of a renewed campaign to control infection, particularly MRSA (Department of Health, 2004).