Building Business Cases for Capital Investment

28th October 2022
Charley Ward Supporting Digital Transformation

Charley Ward Supporting Digital    Transformation

How we support the production of robust business cases

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:

  • Facilities may need to be refurbished or built to accommodate new or moved services.
  • New equipment or technology solutions may need to be purchased to enable new clinical pathways.
  • New staff may need to be onboarded, or existing staff upskilled and deployed differently.
  • Programmes to deliver key priorities on a national scale need to be able to distribute and manage funding, provide support and guidance to local organisations and to manage benefits realisation.

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.

Our approach

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:

Digital Programme Business Cases

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:

  • Wayfinder, an NHS Transformation Directorate programme to deliver a solution that enables people and carers to access information about secondary care referrals and their elective care via the NHS App or NHS Login. The main driver for this capability is the growing elective care waiting list and the need to keep people informed and empowered to manage their elective care pathway. This business case was approved in June 2022.
  • PODAC to enable implementation of the national PODAC digital strategy (NHS Transformation Directorate) intended to enable digital leveling-up of the five sectors of community pharmacy, optometry, dentistry, ambulance and community health services. This business case was approved in 2021.
  • Electronic Referral System – we provided critical review and improvement of the draft business case prior to submission for approval for this NHS Transformation Directorate programme aimed at delivering the next generation of digital booking, triage and referral services.

NHS111 Economic Case

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.

How we can help you

If you have a business case you need support with and you’d like to discuss how we can help, please get in contact.