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Strategy, Insights

Public sector business cases: set up for success

The Hospital Infrastructure Plan (HIP) has allowed many NHS Healthcare providers and systems to fast-track estate investment plans.

For the shortlisted Trusts, setting up a programme to deliver a robust and compelling Strategic Outline Case, or business case, is key to realising this once in a lifetime opportunity to transform care for patients.
This article sets out our three key factors for organisational leaders to consider when setting up a capital programme to succeed in this competitive funding environment:

1. Build support from the whole system
2. Ensure a high-quality output
3. Follow a robust and compliant process

Public sector business cases: set up for success

1. Building support from the whole system

The HIP programme gives whole systems the chance to realise their strategic priorities as they move towards integrated systems.

The business case must be aligned with the organisational, Integrated Care System, and Long Term Plan direction. Specifically, it needs to demonstrate that it fits within with the clinical and estate’s strategies for local organisations and ensure that the project’s success is measured against these.

It is vital that the strategic direction and scope of the project is agreed early between partners, and key questions or gaps identified and resolved. The investment objectives and critical success factors for the business case should be clear, simple, and resonate with the whole system, not just an individual organisation or site.

2. High quality output

Capital investment presents an opportunity to transform how care is delivered by systems to better meet patient needs, with organisations working more effectively together. In our experience, the most impactful business cases are those that unite organisations and stakeholder groups, build momentum, and clearly articulate the value to patients and staff for the future investment.

They need to capture the benefit from future opportunities to deliver care differently, maximise research and training opportunities, and ensure value for money for the taxpayer.

Projects that are clear on how they meet patient, staff, and public needs, as well as the system, and can articulate this in simple terms are most likely to succeed, building the political and public support required.

Targeted stakeholder engagement with patient groups, multi-disciplinary teams, and partners will ensure that they build and own the future vision. This will deliver both the best answer for the system, and generate the momentum required to progress to Outline Business Case at pace. This should be captured in a comprehensive but short business case – less is more! You can read more on our website about how buildings can transform clinical models.

3. Robust and compliant process, driven at pace

A well scoped and focused programme is key to ensuring your business case identifies a preferred way forward that works for the health system and can progress through regulator and departmental reviews at pace. This will make sure effort is focused on viable options, not a complex long list that does not meet the agreed objectives.

Critically, it helps ensure that you agree the best answer for patients, staff and the system, through a compliant process that can stand up to regulator and public scrutiny. This is particularly important where service reconfiguration is considered that may require public consultation (e.g. a PCBC).

Key to delivery of this is:

  • A consistent options appraisal, with close alignment of inputs and assumptions between workstreams (e.g. strategy, clinical options, site options, economic, financial, and demand and capacity modelling)
  • Robust finance and economic analytical outputs, with transparency on key assumptions that are agreed early with partners, the system, and regulators
  • Clear articulation of the benefits to support improvements to existing models of care

Why The PSC

The PSC has market leading experience of delivering all stages of a business case programme, and have successfully supported Trusts and systems in attracting significant funding for some of the highest profile and most complex capital build programmes in the UK.

We have live experience of the new “stream-lined” approvals process, health-planning and clinical model design, options development, capacity and financial modelling (including the new CIA economic model), and SOC drafting. Alongside our partners, we can also provide specialised estates advice including Master Planning, designs, and cost assurance.

If you would like to know more about our offer and approach, please get in touch with Samuel Rose or Jonathan Chappell.

Further examples of our market-leading business case experience can be found within our Strategy service page.

Case study - Cambridge Children’s Strategic Outline Case (SOC), Cambridge University Hospital NHS FT

The PSC team supported the acute provider, the local mental health Trust, and the University of Cambridge to develop a £300m SOC for a whole, standalone specialist Children's Hospital. This complex programme required negotiation across three partner organisations, alignment with existing capital programmes and management of multiple suppliers. After not progressing for 25 years, the Boards of all organisations signed-off the SOC and in December 2018 the project received an initial £100m funding from central government towards the build.


Main image: Architectural rendering of Cambridge Children’s hospital (reproduced from Cambridge Children's hospital)

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