When Essential Services are Run for Profit: eg. wheelchairs

Our taxes are often used to fund essential services provided by private companies. 

• Should a company reap a profit at the taxpayers' expense? 
• Should the provision of essential services that are paid for by taxes be left up to the private sector?

Companies supplying services ***ESSENTIAL goods and SERVICES*** that are paid for by taxpayers are generally making things more expensive because a profit has to be paid to the company owners. 

note: I'm the first one to admit that this is a simplification: there are owners of (small) companies who really don't make obscene profits. The bosses generally work in the company and only make enough to cover their own wages and company's bills and everyone's wages.

There have always been private businesses involved in providing some essential stuff and paid by taxpayers, but it proliferated from the 1980s

A clear example of where the taxpayer is paying more is when private companies are involved in building schools and hospitals. We also pay shockingly high rates to water and energy companies now, after our state-run services were privatised.

This year, wheelchair users have faced difficulties in getting their equipment repaired. 

This is essential equipment and often provided for via taxpayer funding.

I was amazed to discover that wheelchair parts and repairs are in the hands of the private sector.

When a major player, NRS Healthcare, faced financial difficulties, it was wheelchair users who had to stay in their homes and suffer the consequences:

NRS Healthcare was a leading UK provider of community equipment, wheelchair services, and technology-enabled care, but the company entered liquidation in 2025, creating disruption for thousands of users and professionals reliant on their services. 

The company is no more, and its NHS contract has been transferred to Medquip. 

 * * *

I'm sure we all find it hard to imagine things being run in a different way to what we know.

But it really doesn't have to be this way.

I don't know much about mobility aids, tbh, but I can talk to you about hospital cleaners and porters:

Back in my day...

I remember the good old days when ancillary staff were directly employed by the NHS. They were employed where they worked and had good terms and conditions.

In the mid 1980s there was a move to 

* SAVE MONEY

* contract out...

Let's say there were 2 or 3 domestic workers on a hospital ward who were all directly employed by the NHS with full rights, pensions, and holiday pay. Some access to training, etc.

Now, a private company comes along to SAVE MONEY - do the job cheaper AND make a profit for the company shareholders.

How is that possible?

Answer: It is only possible by doing one or all of these:

• Cutting the working hours of domestic staff on the ward
• Cutting staff pay or other perks (such as pensions) 
• Cutting back on equipment and uniforms

The fact is, cleaners were working hard on those shifts, and there were numerous tasks that had to be completed daily to align with the ward routine. So this money-saving exercise had to involve cutting back on some aspect of hospital cleaning.

Experienced staff left in droves.

The NHS is the nation's biggest employer. Therefore, it can offer economies of scale (cost savings) through its finance and payroll system and its human resources team. 

There is simply no logical reason for any staff member who works in an NHS setting all the time to be employed by an outside employer.

 * * *

Hiring the cheapest staff on the worst contracts may have been cheaper and may have cut costs for the taxpayer (I doubt it), but what does it say about the kind of society we want to live in? 

There are currently not enough jobs, and people can't afford to live on their wages. 

Would we all prefer that taxes were paying for an extra part-time cleaner on a hospital ward rather than the costs of having people without jobs?

Dr John Lister is one person who really does understand the consequences of "contracting out" in the NHS, a process of transferring work from the public sector to the private (for-profit) sector. Studying this has been his life's work. He has published on the failure of 40 years of the private sector being invited into the NHS.

 * * *

Wheelchair repairs and hospital cleaning staff are just two examples of where essential services are being provided by the private sector for a profit.

What about the private sector being used to provide clinical services? Yes, they do operations to reduce waiting lists and they provide other clinical services routinely. All of this is a drain on the NHS and into private profit.

It would be far better if that money were spent on the NHS, building up the NHS. It has the capacity for more work -- the buildings and staff are in place, they just need the funding. 

It has been a political decision to fund the private sector instead. 

And it is not just me saying it, the BMA said the same about outsourcing.