With increasingly squeezed health and care budgets, it is vital that leaders make value for money investment decisions informed by robust business cases.
Transformation of health and care services often requires expenditure of capital and revenue:
The benefits of transformative change need to constitute good value use of public money. In order to demonstrate this, Public sector organisations are required to follow HM Treasury best practice guidance for significant investments. This guidance (the “Green Book”) provides a framework for how to consider spending proposals and sets out a logical, structured process for how to develop, appraise and plan for delivery of projects and programmes that will deliver best value for money. The outcomes of the process are captured in a detailed business case that enables objective, evidence-based decisions about public investment to be made.
Within the NHS, HM Treasury Green Book compliant business cases that follow the five-case model (Strategic, Economic, Commercial, Financial and Management Cases) are required for significant capital expenditure, or investment in property, infrastructure or technology. Depending upon the value and the nature of the business case there are different assurance and approval routes. For projects that involve significant service change, there is also the need to articulate a clinical case that describes the need for change and the proposed new model of care.
We have extensive experience of supporting a range of NHS organisations, leaders and systems to develop and submit HM Treasury Green Book compliant business cases. Most of our team have undertaken Better Business Cases™ training and have achieved at least Foundation level. A large proportion of our team have also achieved Practitioner level. Our team also includes qualified accountants who are experienced in the economic and financial modelling using NHS Digital and Comprehensive Investment Appraisal (CIA) Models.
We understand that producing a business case is about far more than simply authoring a quality document. Our approach is rooted in deep stakeholder engagement (internal and external) and is dependent upon the establishment of essential workstreams (e.g. options, benefits, finance, workforce, build & estates, procurement) and clear decision-making and governance processes. Our business case readiness assessment tool and project management expertise ensure that we agree an appropriate business case delivery plan which incorporates progress to date as well as addressing any significant gaps and weaknesses.
We have worked with national programmes, integrated care systems and providers to support a range of business cases as follows:
We supported the development of several programme business cases for national digital programmes. For most of these we led the development of HM Treasury compliant five case model business cases to enable capital and revenue investment. In addition to authorship, we led the economic appraisal including full benefits evaluation and supported these programmes right through the assurance and approval process. Recent programme business cases include:
NHS England engaged the TU to develop the Economic Case for a Green Book compliant Outline Business Case (OBC) for the re-procurement of NHS 111's telephony infrastructure. We led on production of the risk quantification model, benefits quantification, economic modelling and authorship of the Economic Case. We undertook extensive stakeholder engagement to inform the benefits mapping and quantification that involved patient representatives and NHS England colleagues. We devised and implemented a process to enable measurement of qualitative benefits that better enabled differentiation between the options. We also worked closely with the appointed legal advisors to support drafting of contracting schedules and bidder guidance. The OBC was approved in February 2020.
Worcestershire Acute Hospitals NHS Trust – we led coordination and authorship of a Full Business Case (FBC) to enable major refurbishment of Urgent & Emergency Care facilities using funding of c.£15m made available through the Health Infrastructure Plan (HIP). We rapidly undertook an assessment of the previous short form business case to identify what additional detail needed to be generated for the FBC. We worked alongside clinical teams and the appointed architects to ensure the necessary design inputs were produced in sufficient time. We also led on the economic modeling including facilitation of workshops around benefits and risk. The FBC was delivered within just 2 months and approved by the trust board in January 2021.
If you have a business case you need support with and you’d like to discuss how we can help, please get in contact.