Business Cases 15 th March 2016

What is a business case? Statement of total impact (quality and financial) of undertaking a proposal – what will change by doing this? A demonstration of: – Economy, efficiency and effectiveness – Strategic fit, operational capacity and capability, and risk assessment

Why do a business case? To persuade decision makers to invest resource (time/money) in your proposal. – Why do something at all? – Why do this over something else? – Should and can we do it? Plus demonstrates probity, provides an audit trail…

Approval process CDG and Divisional Board Combined Board Business Case Advisory Panel Capital Investment Group Finance & Performance Committee Commissioners – CCG or NHS England Trust Board NHS Improvement (external body) Size and complexity

Structure of a business case

Options What is driving the change? – The ‘do nothing’ option What are the options? – Do this – Do something else – Do something else entirely – Think carefully about this choice

Appraisal Financial Impact – Income, costs, WTE, capital, and cash Benefits – Patient experience, staff satisfaction, clinical outcomes Risks – Stakeholders, delivery, workforce, legal

Recommendation Your preferred option Should be the natural conclusion following the appraisal undertaken on each option Still needs to be affordable and ‘do-able’

Exercise 1 The Trust currently doesn’t do Medical Thoracoscopy. What information do you need to write a business case to support the investment in this service?

Exercise 1 - Information What is the approval process? Is there a standard form or template? Key contacts e.g. Finance Manager What is current pathway? What is proposed pathway? How many patients? What is potential for expansion? What’s the tariff? Who pays? What’s the cost? What equipment is needed? Charitable funding? Any ongoing maintenance, consumables or CSSD? Where will the procedure take place? Do they have capacity? Who will undertake procedure? Training requirements? Any other impacts e.g. diagnostic imaging? Performance impact? Improve RTT or Cancer access? Clinical outcomes/ audit evidence (I’m sure you’ve got this one) Patient benefits (and this one)

What makes a good business case?

3 key tests The ‘if’ test The ‘sniff’ test The ‘pitch’ test

The ‘if’ test If it were your money, would you do it? Need to demonstrate the benefits outweigh the costs: – Income > expenditure – Savings > expenditure – Doing something > doing nothing

If it were my money... What is really driving the change? – New requirement – Addressing a risk – Opportunity to do something better Be clear about what you are asking for and the benefits – No hidden extras or surprises – “Clinical evidence suggests a 10% increase in recovery rate” is better than “outcomes will improve” Have you thought through all the consequences? – Impact on other departments, not just your own – Both cost and benefit

The ‘sniff’ test Does it smell right? Need to demonstrate this solution is the same any other reasonable person would propose – Are there any potential conflicts of interest? – Why this proposal and not a different one? – Are you tackling the cause and not the symptoms?

Key questions Are there any unexposed underlying motives? – Who benefits? – Declare any ‘conflicts of interest’ Is it realistic? – Does it have commissioner support? – Does it have patient support? – Do other departments support it? Does it look like a gold plated solution? Are the risks and benefits clearly defined?

The ‘pitch’ test Can I explain it clearly and simply? Remember your audience: – Not experts, but not totally ignorant – It needs analysis, not an essay – Quality not quantity (use appendices) Use your ‘pitch’ as the framework for writing your case

Exercise 2 How would you structure the Medical Thoracoscopy business case? What is your ‘elevator pitch’?

Time for the pitch…

Structure Executive summary (pitch) Current pathway New pathway Net benefit of new pathway over old – Quality – Financial Supporting evidence (in appendix) Commissioner support (in appendix)

If you remember anything… Have you got to the real heart of the issue? Start with your ‘pitch’ and build your case around this Choose your options carefully Have evidence for each claim (in an appendix) Be realistic Talk to people and get help Keep it concise and focus on the key elements