How the NHS wastes money in ways you dont see.

Graham Charles Lear
7 min readJul 30, 2022


I never used to be bothered about how much money the NHS wastes until 2002 when I broke my knee. After the operation to put it right I had to attend the orthopaedic clinic for a number of weeks to monitor my progress.

It had a large waiting area with very comfy chairs, patients would sit on them waiting to be called to see the consultant they were under. We would all arrive one after the other around 9 am, book in and wait to be called. For want of something to do one Tuesday morning as I waited, I counted how many chairs, there were 108. Then in last week, I arrived everyone was in the corridor waiting to go in. Porter's nurses were taking out the old chairs and bringing in new ones. When we eventually booked in I commented to one of the nurses as to why they had been changed as there was nothing wrong with the old ones.

Tell me about she said, we do this every year all through the hospital it must cost a fortune. I left it at that and recovered from my injury and went back to work.

Fast forward to 2011. I was working on a contract in Watford which happened to be a new NHS hospital building attached to the old hospital. A three-story building with a plant room that housed the boilers, air-con and electricity panels.

My firm's job was to install all the air-con and heating equipment and pipe work throughout the building. Usually, my firm would draw the drawings with everything we needed and cost the job accordingly plus man hours. Then tender to do the job.

However, the NHS had their own department that did all this themselves, all we had to do was cost the job. Looking through the drawings, I noticed a mistake on the aircon heating units that we would be installing in the ceiling space of the building. On every unit, the NHS architects had missed two valves off. The valves in question were what are called none return valves. These valves stop water from both the Air con and heating from getting mixed together a catastrophe if you are trying to cool the room or heat the room. So at the next meeting, I bought up this problem and said we have to now cost in these valves, now the cost would not have been more than £500. Yet they refused to even acknowledge they had made a mistake. I was met with a curt, just get on and do it, even when I mentioned the mistake would be picked up in the final inspection.

So now fast forward nine months. The building is now finished and it's the day of the final inspection where the NHS architects go around looking at the work and doing what's called a snagging list. This is where any faults are picked up and a list is drawn up and given to the contractors to put right.

They go around making notes then we all have a meeting. True to form they have picked up the valve situation. You will have to put that right, yes, of course, we will I respond. However, we will not be standing the cost, this will have to be an extra. We now have to empty the system of all water and dispose of the mixture of glycol coolant and water which is now mixed together safely as it can't be flushed down the drains. When that's done we will have to get a team in to do it this weekend to fit the valves, because I can't run the risk of the contract running over the allotted time which will incur a penalty which runs into thousands.

Why did you not say anything before I was asked? You must have known, yes I did I responded, I bought this up in two meetings before we had even started, and produced the minutes of that two meetings which corresponded with of course with their minutes.

OH, so you did, I can only apologise, can you get it done this weekend and can you give me a nod to how much it will cost.

I had already costed the job as I knew this would be picked up and I wrote a price down and passed it over, £155, 000, oh that looks reasonable, he said, I responded it could go higher as I dont know how much it will be to safely dispose of the contaminated water. No matter just send us the bill we will pay it. The final bill for that mistake was £195,000. On a mistake that would have cost just £500 to put right before we had even started the work.

However, that pales into nothing compared to what the electricians had to do. They had used the wrong type of wire, again all down to the NHS, that cost was well over £1 million to put that right, a further £100,000 to put right the outer cladding that was the wrong shade which again was signed off by the NHS, which later was taken down and bare brickwork is now on show.

The original cost of the building was just short of £12 million from building it to all the beds small operating room and Radiology rooms.

That was my first and last NHS contract I retired soon after. However, talking to seasoned contractors who have worked for the NHS for many years. I was told that working for them is a licence to print money. Never argue with them, dont even tell them they have made a mistake, install to their specifications, they are always making mistakes and will always pay over the odds to keep it quiet.

Times all that in the many hospitals around the country, from the furniture that does not need changing to every building and maintenance contract and you have an NHS that wastes a couple of billion a year through outright negligence alone.

And let me add something else when they come around to the inspections they come mob-handed and all walk around together, as many as twelve, usually on contracts you just have two that go around with you sometimes just one. It's more waste because when the day is finished they take you out for a slap-up meal usually a good curry restaurant where they pay for everything, all pre-booked where the beer runs freely and then onto a nightclub. Now you know why twelve people or more turn up. It's a nice jolly, and remember in a region like where Watford is or in London, there might be six or seven NHS projects going on one after the other finishing or starting.

While we were eating our meal and talking, one of the architects said something that even shocked us all.

It was this.

How do you feel about quoting to take out all the equipment in the plant room? We have decided that we should make the plant room into wards, we think the block is too small. That would mean building a new plant room on top, of the roof.

You could almost hear the ching, ching as we all quickly did a rough calculation of what it would cost.

We never did remove the plant room, it stayed as it was. Sane heads must have shelved the idea. However that night in that restaurant they were deadly serious.

We all hear of the over-the-top manager problem along with the money spent on cosmetic surgery, the medicine problem, along with paying agency nurses to work the night shift which costs the NHS billions each year. But we rarely see the unseen side where they waste money, as it's actually hidden from the public. It's only when you are involved personally that you get to see it.

Readers might ask the question as to why I did not authorise the valves anyway as it was only £500.

Well, it's an easy answer. My duty and loyalty were to my firm and my colleagues. I had a duty to make money for the firm, so it could prosper. I also had a duty to make sure I kept my workforce in work on a decent pay structure. I had told them twice there was a problem. Twice too often as a fellow contractor said when we were talking about it all. He would not have even mentioned the problem. He would have just hit them with the £195,000 in fact it would have been more knowing him.

I have said for a very long time that a person with a bit of intelligence could save the NHS billions and it's true they could.

The first thing I would do is shut down all the regional architect departments. It costs millions to run them.

Any new NHS buildings would be tendered out to local architects to draw up the building specifications. Drawings for heating aircon and plumbing would be tendered out to firms who would draw them from scratch themselves. When you do that, mistakes are very rare and if there are any you stand the cost yourself. Same with electrical components. It's absolute folly to have all that in-house. It's a charter for unscrupulous people to make a lot of money from the taxpayer.

And yes, I hear you ask, do people take bribes, absolutely they do, in the form of luxury holidays and work done in their homes for free. Heating and aircon firms will install boilers and bathroom suites. Decorators will decorate homes, if they dont need work, it's not a problem you buy them tickets for a cruise or flights to destinations all over the world. Does it cost you to do any of that? NO, you add it to the cost of the extras at the end of the job? Because any contract will have extra work done, it's quite normal. So its quite easy to put £6.000 on £2, 000 quotes

Now you know why so many mistakes are made, and why I say that department should be shut down.

Did my firm offer bribes? I can honestly say I dont know for sure. I was only a director, not the owner and my department only dealt with the pricing of contracts and overseeing the contracts large or small. I was never given a brown envelope to give to a client from the accounting office, and I never authorised work to be done at the homes of anyone. That is not to say it never happened, just that I was never involved in that sort of thing.



Graham Charles Lear

What is life without a little controversy in it? Quite boring and sterile would be my answer.