Eight steps to an effective NHS business case

A good business case can be the difference between a project successfully delivering on its proposals or failing miserably.

In the NHS, funding is particularly scarce, so it is important that a business case delivers both on a financial front as well as in its targets. That is why we have produced these eight steps to producing an effective NHS business case.

Step One: Creating a clear project brief

To create an effective business case, you need to gain an understanding of what it is that the client wants. This starts with a clear project brief. By having a clear brief you can gain a comprehensive and clinical understanding of the strategy required by linking the project requirements to the clinical strategy.

At this stage you should also establish and agree the key functional outputs that the client wants from the project, and then translate this into a comprehensive document that should include the Schedule of Accommodation (an itemised list of accommodation facilities and provisions required by the end user of a building project).

Once this brief has been completed, it is important to get the full client team and wider stakeholder group to “sign off” on it. This will give you peace of mind that both you and the client have a mutual agreement on what the job needs to be, and therefore enables you do deliver an accurate business case for their needs.

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Step Two: Establish a business case approval route

The next step in the process is to establish a clear route to getting your business case approved. To do this, you will need to build up an understanding of your audience and the chief decision maker.

First - consider your audience, are they likely to be influenced by the anticipated value of the project, the source of the funding or the route of procurement? The complexity of the project may also play a major factor in its approval, considering hospitals and medical centres see such high volumes of patients and staff pass through them each day.

Secondly, you need to think about those individuals who may also be involved in the decision making process? Identify whether there will be a wider NHS stakeholder involvement, such as Integrated Care System (ICS), NHS England (NHSE) or NHS Improvement (NHSI).

To ensure that your business case is approved, it is highly likely that it will need to follow the NHS 5 Case Model -  an agreed-upon standard model for any public sector organisation looking to make a big financial decision. Remember, the longer your approvals route is, the more onerous the business case requirements will be, particularly with projects of high-value, so try to keep it short and concise.

Step Three: Robust and Inclusive stakeholder engagement

The process of a business case is likely to be a lengthy and time constrictive one, so it is essential to ensure that full levels of commitment are continued for the entirety of the project as to avoid any potential delays. This means a continuity of attendance, thought and decision making from all individuals involved.

To achieve this, you will need to understand the teams that you are working with and identify the right cross-section of representatives from both sides, from operational managers to strategic managers.

The right type of people must bring  positivity and enthusiasm to the project that will in turn keep productivity up. To achieve this, the project vision should reflect the views of all involved and in turn have them invested from the start, by demonstrating how valuable their time away from the “day job” will ultimately be.

Step Four: Structure and Governance

The structure and governance of a project can often be the defining factor in ensuring the project runs smoothly and without any hiccups. If everyone involved has an awareness and an accepted understanding of which individuals fit into which teams and sub-groups, each person will know where their responsibilities lie and who to flag any issues or concerns to.

In most instances, these structures are required to be embedded fairly quickly and are often only in place for a few months, as most projects are not so large. If your structure is overly-complex, teams will have less time to form and in turn, have less time to perform.

The sub-groups of the project are effectively responsible for producing business case outputs (appendices). Setting up these sub-groups at the right time can support the “critical path” flow of information to feed the business case, whilst utilising the experience in each sub-group of the project will help to determine the Terms of Reference.

Step Five: Outlining reasonable timescales

Establishing a clear and realistic timescale of project milestones sets a precedent for the project by laying out what is expected of each team and its members. This timescale must be reasonable, achievable and mutually agreed by all parties to avoid any conflict in the process.

Having an unrealistic timescale could create a culture of missing milestones, particularly if multiple deadlines are missed early on in the project. It also places unwarranted pressure on those involved in the project, which in turn can cause friction and potentially stall the delivery of the work.

However, if you create a suitably detailed and structured programme to inform and link tasks to working groups shown within the structure chart, your project is more likely to progress with less issues. Utilising your steering group as a means of “keeping the gas” on will ensure that everyone involved pulls their weight.

Step Six: Building a compelling business case

Your business case must be compelling, if it is not it will fall at the first hurdle. This therefore requires a strong and detailed Strategic Case, detailing the key outputs. In turn, this will enable the Economic Case to select the best option against local and national drivers for change, and the Financial Case to demonstrate affordability by achieving objectives and delivering benefits.

It is also beneficial to develop a creative, ambitious and measurable benefits realisation plan. Your options appraisals process should also be robust and inclusive, to highlight the fact quality, cost and risk have been considered.

It is important to also make sure that the client dedicates sufficient and skilled resources to support the financial modelling process, to ensure that you get everything right. This includes providing accurate baseline data and taking the lead in formulating and committing to the delivery of financial benefits.

A further crucial element is to make sure that you involve “visionaries” from your NHS client teams, alongside operational and finance colleagues. This ensures that the projected benefits are sufficiently ambitious, whilst remaining wholly achievable.

Step Seven: Successfully Managing Multi- Disciplinary Teams

Controlling the flow of a business case requires the input and skills of numerous professional advisers, from the Project Manager to the Healthcare Planner and Accountant.

Understanding the process and establishing clear roles and responsibilities from the start allows you to effectively manage the multi-disciplinary teams involved in your project. By administering consultant appointments based on each member’s fully detailed scope of duties and resources, no one’s time will go to waste.

Your Project Manager must be suitably experienced and skilled in understanding the process and the obligations of each separate disciplines within the team. It is their role to ensure that team members are suitably motivated and challenged, whilst working as the middle man between each team, translating specialist jargon and processes into understandable activities and deliverables for the NHS client.

Step Eight: Making the right appointments

The first step in solving the problem of business case preparation is the appointment of the right consultant, at the right time. The right consultant can be your solution in ensuring that all gaps are plugged, and that your project is delivered successfully and efficiently.

Auburn Ainsley are able to provide flexibility in coordinating the client’s own “usual” professional advisers to work collectively on any business case. We can act as a single point of contact, appointing and managing our own team of specialists that are able to suit the NHS client.

We have extensive experience operating within the healthcare sector, including our involvement  at the award-winning Sheffield Children’s Hospital and Louth General Hospital.