7th May 2024
Introduction
The NHS Transformation Unit supported the development of a HM Treasury green book compliant business case for implementing electronic bed and capacity management systems (eBCMS) and care coordination centres across acute trusts.
The Challenge
The challenge in urgent and emergency care (UEC) services, especially in emergency departments, lies in promptly matching patients requiring admission to suitable inpatient beds. The absence of suitable beds may lead to prolonged waiting times for admission, inappropriate ward assignments, patient transfers, and delays in surgical procedures. Many hospitals still rely on manual processes to manage bed capacity, such as whiteboards and spreadsheets, walking the wards and telephone calls.
Insights from desk research and supplier engagement revealed that eBCMS, along with care coordination centres, could enhance patient flow, potentially reducing UEC and ambulance wait times, and improving operational efficiency. eBCMS are a digital solution that provides real-time insight to manage patient flow, allowing frontline clinical staff to make use of digital technology effectively, and freeing up their time to deliver better care quality and patient outcomes.
Our Approach
We worked closely with the eBCMS programme team. This was important to us because the collaborative approach enabled us to fully align the final business case with their goals and objectives. The time spent in fostering a productive partnership throughout the process helped us to deliver a high-quality business case. Here is a breakdown of the steps we took:
- Desk Research: We conducted comprehensive desk research so that the programme could demonstrate alignment with national strategies and plans as well as the challenges the proposed solution would resolve.
- Strategic Context: We gathered evidence to build a compelling case for change, including assessing existing position, understanding political landscape, and articulating the future business needs.
- Options Appraisal and Facilitation: We worked closely with the programme team to establish spending objectives and critical success factors, and to implement an effective options development approach. Five short-listed options underwent economic appraisal. Critical in this stage was early engagement with subject matter experts (SMEs) who would conduct assurance of the business case.
- Economic Appraisal: We produced the inputs for economic appraisal, including benefits mapping and quantification, to identify the preferred option. We used the established NHSE economic model for cost benefit analysis, and our own internally developed tools to ensure that the inputs to the model were realistic.
- Commercial Case: We facilitated stakeholder engagement to establish a commercial approach for the allocation of funding to Trusts and to provide a compliant procurement route for the eBCMS solutions.
- Management Case: We worked with the programme team to document the programme management, change management and benefit management approaches.
- Business Case Authorship: We coordinated and authored a high-quality business case using the five-case model.
- Review and Assurance Support: We provided support for formal review and assurance processes, engaging with NHSE Transformation Directorate and DHSC Assurance SMEs to address feedback.
- Finalisation: We finalised the business case in response to comments from formal assurance and review, to meet governance deadlines. The changes and decisions had a full audit trail.
Outcome
An investment of £68.6 million for electronic bed and capacity management system and care coordination implementation was approved by NHS England Transformation Directorate’s Executive Transformation Group in 2023. The business case subsequently received approval from NHS England Joint Investment Committee and HM Treasury. We received positive feedback from the client, who praised us for our flexible approach and responsiveness to program team needs.