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.
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.