This is how a two-tier workforce is created: first, outsource cleaners, porters etc; guarantee terms and conditions, but not for new staff, meaning that over time, those services employ staff on worse pay and conditions. The result? What starts as a way to avoid VAT ends in a backdoor privatisation. This should not be allowed to happen in our NHS. Labour are challenging it and demanding an end to the VAT loophole being used by NHS Trusts.