WP12 Developing a Business Case

Developing a Business Case

This toolkit is for the implementation of all PRSB standards

The "5 case" model

The standard business case model for the UK Public Sector including Health and Social Care is the “5 case model” defined in: “The Green Book: appraisal and evaluation in central government” published by HM Treasury.

Every organisation will have its own template for a business case and local governance for how business cases are prepared, quality assured, and approved.
How a project/programme is funded, choice of funding source, capital vs. revenue, VAT recovery is entirely a local decision and maybe at an organisation level (for example Mental Health Trust) or at a system level (for example ICS). Funding may be impacted by bids for external funding (with associated constraints) or may also be impacted by including one transformation within a wider transformation (with associated change controls). This toolkit therefore does not provide a template business case but provides content that can be included within your local context.

Toolkits

The “5 Case Model” is used to structure business cases considering 5 different dimensions or “cases” as shown in the table below (click to enlarge)”

Aligning your business case to organisational benefits

Business cases should reflect the local priorities of the health and social care organisation (provider) and the integrated care system (ICS) as set out in organisational and ICS strategies. A well developed and written business case , once approved, provides a strong basis for the Project Initiation Document (PID).

A well-written business case considers the following factors:

STRATEGIC DIMENSION

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What is the case for change, including the rationale for intervention? What is the current situation? What is to be done? What outcomes are expected? How do these fit with wider government policies and objectives? Answers the “why”. Note the point about alignment with other initiatives (for example consider the NHS Long Term Plan and the PRSB Core Information Standard). The As-Is, To-Be and Gap Analysis / Transitions is often best covered in this section then options and benefits contrasted throughout.

Economic Dimension (Case Benefits)

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The financial investment needs to be balanced against the benefits (cash releasing and non-cash releasing) irrespective of the option (solution) chosen. What is the net value to society (the social value) of the intervention compared to continuing with Business As Usual? What are the risks and their costs, and how are they best managed? Which option reflects the optimal net value to society? The benefits case for the project and the options being considered/recommended.More discussion of capturing and articulating benefits.

Commercial Dimension

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Can a realistic and credible commercial deal be struck? Who will manage which risks? Procurement if required but also consider resourcing (people)

Financial Dimension

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What is the impact of the proposal on the public sector budget in terms of the total cost of both capital and revenue? How will this project be funded? (where does the money come from?).

Management Dimension

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Are there realistic and robust delivery plans? How can the proposal be delivered? Project / Programme / Portfolio management arrangements but also consider governance, audit or assurance and compliance.

Learning from the Local and the 'BART'

Your business case needs to reflect the service needs and priorities of your local context. We have included a reference to “Learning from Local” (https://future.nhs.uk/learningfromlocal/grouphome) because it shares lessons learned, experiences, and templates from interoperability initiatives throughout the country across Health and Social Care:

“The Learning from Local initiative was established as part of NHS England’s Local Health and Care Record (LHCR) programme. It has the responsibility of providing tools, assets, and opportunities that help facilitate and encourage the sharing of learned knowledge and experience amongst the LHCR community and other local shared care record projects underway across the country.”

NHSx published the “Benefits Analysis and Realisation Tool (BART)” which can be used as robust input to the Business Case.

Commercial (Procurement)

Choice of system procurement route is a local decision and driven in part by the proposed option in the Economic Dimension (for example an extension to an additional service vs. a completely new procurement). 

There will be national and local procurement protocols that will need to be followed in relation to the PRSB standard implementation. You should discuss with your local digital lead for shared care records any concerns you may have about the suitability of existing systems. In particular, the PRSB has developed a conformance pack for vendors so they can ensure their systems meet your needs with regard to the PRSB standard. You are strongly advised to require your vendors to demonstrate that they comply with this conformance pack. Further information about the vendor conformance pack can be found on the PRSB website.

Other considerations you may wish to discuss with your local digital lead for shared care plans include:

• Alignment to shared care records and their interoperability
• How local Personal Held Record apps or Web sites which support people engaging with data about them, about their care or living with a given condition are supported and interoperate with central systems
• How obligations for Information Governance, Cyber Security and Clinical Safety are satisfied – “Clinical Safety” being defined in “DCB0129a: Clinical Risk Management: its Application in the Manufacture of Health IT Systems” and “DCB0160: Clinical Risk Management: its Application in the Deployment and Use of Health IT Systems”.

Guiding Questions

Guiding questions to help you make a business case and communicate your project:
You don’t have to be a project management expert or deploy the full firepower of Prince methodology to run effective projects. Even if others are responsible for the formal project management of your PRSB standard implementation projects you can understand and communicate the project aims and progress more effectively by answering the following questions with your teams and stakeholders.
The discipline of answering these questions also helps when constructing a business case to attract support and resources for your own initiatives.

Download Guiding Questions
Download Guiding Questions

Click to view/download the guiding questions document (pdf)

Personalised care and support planning for people with severe mental illness

A review of a sample of current care plans, and the way they have been developed, may be helpful in identifying the priorities for this improvement. The PRSB Implementation Guide provides more detailed explanations about each element of the plan, including advice on how the planning process might be best conducted.
These questions might form a checklist for current plans to be compared with. 

1. Does the plan include an About Me section in which the service user, in their own words, can indicate the information they want to be available about their lives, their values, their interests, and priorities, available for all those who may care for them?
2. Is the approach to developing a care plan patient centred and engaging, allowing plans to be based on patient priorities goals, and aspirations, along with the actions they plan to take and the support that they will receive?
3. Is there space for a “formulation” to be recorded in which the person receiving care and the professionals who provide it, share and record the personal meaning and the origins of the person’s difficulties?
4. Are relevant procedures and therapies recorded?
5. Where relevant, are one or more contingency plans included for anticipatable disruptions, exacerbations, or deterioration, and do they include advice on what to do and points of contact for those called upon to respond?
6. Where relevant are additional supporting plans incorporated, (an example being an “educational and health plan” for someone with a neurodevelopment disorder)
7. Is a version of the plan available to a service user (if they wish to have it) in a form and format that they can understand and find to be of value?
8. How is a version of the plan available to the GP and other key parts of the health and care system?

Work conducted by PRSB and partners recently has looked specifically at the suitability of this approach to the development and documentation of care and support plans for people with Severe Mental Illness. This resulted in an updated version of the standard (v1.4), for use by any service and for any group of service users, but with some modifications to ensure that it meets the needs of this community. The approach to a patient centred process of identifying goals, hopes, and values, and the support needed to achieve them, is fully compatible with and can be conducted using, specific tools in use in mental health, such as DIALOG, DIALOG+, and ReQoL, for example. 

Where analysis indicates the need for improvement in the content and process of personalised care and support planning for patients with Severe Mental Illness, specific improvement projects should be instituted to co-design with service users and their representatives, and the relevant staff groups, new approaches, and documentation that would be of value in delivering improvement. The toolkit includes a range of existing resources that could be used to engage in this improvement work, including signposting to relevant existing approaches informed by patient experience-based design.

Moving to a single holistic plan

A review of a sample of current care plans, and the way they have been developed, may be helpful in identifying the priorities for this improvement. The PRSB Implementation Guide provides A key development, consistent with national policy on support for Personalised Care across all health and care sectors, is the move towards an individual with complex needs having a single, integrated, care plan, rather than a series of plans developed by different parts of the health and social care system in isolation of one another. For a patient with severe mental illness, the related concerns and challenges might form a very prominent part of such an integrated plan; many will also have concurrent health challenges and needs. The intention is that the relevant services work together to plan and wrap support around the patient and their family in an integrated way, rather than as a series of sequential or disconnected encounters in which the service user or their friends and family have to adopt the role of the integrator.

A starting point would be to agree priority groups of service users who may already have more than one care plan because they need care from more than one part of the system of health and social care. This could be initiated by looking at service users registered with some sentinel practices or PCNs. Alternatively, the approach might focus initially on people with defined co-morbidity or risk that entails collaborative care with agencies beyond specialist mental health services.

The focus here is on the process of care planning and agreement on what should be shared, rather than solely on the technology used;

1. What is the process to agree which professional will initiate care planning and act as the “lead point of contact” for the service user?
2. Will initial plans be agreed with the service user in joint consultations or sequentially? Where and how will they be conducted?
3. What will be the process to agree the elements of the plans which should be available to professionals and potential authorised users beyond the immediate care teams, (A&E services, Ambulance Services, Social services, etc.) with the service user’s consent?
4. How will elements of the plan be updated following consultations in a way which is proportionate, to allow contact and progress notes to be maintained by the service conducting the consultation, whilst avoiding unnecessary work for partners in care if there is no significant change to the personalised care and support plan?
5. What are the implications for workload, logistics, and administration arising out of these decisions?

The answers to these questions and others will best be elicited through focused joint working, grounded in real, or at least realistic examples. This will entail process mapping, and co-design with a range of professionals, service users, and families. Resources from the toolkit and outputs from the Simulation element of this project will be valuable. Some organisations would adopt an approach such as a Rapid Process Improvement Workshop, planned over several weeks and conducted over a number of sequential days, to develop prototype ways of working that could be tested in the field.