St George’s Hospital, Stafford & Staffordshire Clinics
Estate and contract context
St George’s Hospital in Stafford has a long history within the region’s healthcare landscape. Originally designed by Joseph Potter and opened in 1818 as the Stafford General Asylum, the main building became St George’s Hospital under the NHS in 1948 and is now Grade II listed.
Our appointment and objectives
The contractor engaged Staffordshire Cost Consultants Ltd to undertake a dedicated commission focused on final accounts for a large backlog of works orders under the MTC. The situation was typical of long-running measured term arrangements:
- Hundreds of orders had been completed over several years, with interim valuations often based on indicative, under-developed measures.
- The contractor’s internal forecasts suggested limited margin and a relatively modest outturn value.
- There was concern that a lack of detailed final measurement, combined with the complexity of NSR, might be leaving legitimate value unclaimed.
Our brief was to:
- Review and finalise approximately 500 works orders, each ranging in value from £200 to £50,000, under NSR.
- Measure and value works accurately, using the correct NSR items, build-ups and multipliers.
- Capture the full, fair entitlement for both subcontractor-delivered works and directly employed labour and materials, with clear supporting evidence.
- Maintain a fair and reasonable stance in line with public-sector expectations, ensuring that all claims were defensible, auditable and consistent with contract principles.
Scope and nature of the works orders
The works orders covered a broad spectrum of typical NHS estate requirements.
Each order had its own origin, a maintenance request, a planned intervention, a compliance-driven upgrade, but commercially they were all governed by the same NSR-based MTC.
Methodology – robust NSR measurement and valuation
Our approach to the commission was structured and data-driven:
- Information gathering and validation
- Detailed NSR-based measurement
- Fair application of rates and associated allowances
- Reconciliation and final account preparation
This process demanded not only technical mastery of NSR but also a practical understanding of how small works are actually delivered in a healthcare environment, including access constraints, infection control, and out-of-hours working.
Subcontractor and directly employed labour – aligning entitlement
A key aspect of the commission was ensuring that the contractor’s upstream entitlement (from the NHS client) was properly aligned with its downstream obligations to subcontractors and directly employed trades:
- For subcontracted works, we reviewed subcontractor applications, invoices and variations and tested them against our NSR valuations. This allowed the contractor to:
- Validate that subcontract costs were reasonable.
- Recover appropriate value from the client, avoiding the common situation where subcontractors are better at presenting claims than the main contractor is at recovering them.
- For direct labour and materials, we:
- Cross-checked internal time sheets and materials usage against NSR outputs, ensuring that internal teams were effectively “priced” under the schedule in the same way as subcontractors.
- Identified orders where internal costs were significantly under-recovered due to conservative or incomplete interim valuations.
By treating subcontract and direct labour consistently through the NSR lens, we created a coherent commercial picture and helped the contractor manage its margins across the portfolio.
Commercial impact – unlocking legitimate value
Once the full suite of approximately 500 final accounts had been prepared and reconciled, the overall commercial outcome was clear:
- The aggregate value of the final NSR-based valuations was more than double the contractor’s initial internal revenue expectations for the same batch of orders.
- In many cases, interim claims had been conservative or based on broad-brush estimates, and detailed NSR measurement revealed substantial additional recoverable value.
- Because all additional value was underpinned by the contract schedule of rates, supported by site records and delivered works, the contractor could confidently present and justify the final accounts to the NHS client team.
Importantly, the approach was not about inflating claims; it was about accurate, rules-based valuation of work that had demonstrably been carried out, thereby honouring both the letter and the spirit of the measured term contract.
Governance, fairness and client-side confidence
Working within the NHS environment demands a high standard of transparency and fairness. Throughout the commission we:
- Maintained clear audit trails for all measures and rate selections.
- Provided structured summaries and supporting detail that could be reviewed by client-side QS teams and auditors.
- Took a balanced position on grey areas, recognising the importance of long-term relationships and reputational considerations for both the contractor and the Trust.
This approach ensured that while the contractor’s revenue was significantly improved, the NHS client could see clearly what was being claimed, why it was contractually justified, and how it related to recorded works on site.
Why Staffordshire Cost Consultants
This commission demonstrates Staffordshire Cost Consultants’ strength in:
- Measured term and NSR-based contracts, particularly where large volumes of small works need to be converted into accurate, defendable final accounts.
- Contractor-side commercial recovery, identifying under-valued work and turning it into fair, properly evidenced entitlement.
- Working within NHS and public-sector environments, where probity, clarity and a fair-and-reasonable stance are critical.
For the contractor on the St George’s Hospital and Staffordshire clinics MTC, our involvement turned a modestly performing contract into a significantly more positive commercial outcome, without compromising on transparency or fairness – and while maintaining the trust and confidence of the NHS client.