How to write a ‘Business Case’
Professor Roger James
A Business Case allows you to get the funding for change. The Business Cases
process and how to present them has become standardised internationally across
Industry, across Government and across the NHS. The Principles of Business Case
process are the principles of knowing your income, costs and ‘margins’. These are
principles that can be used to run a country, run a Business or run your own
Behind each Business Case is the thought ‘we want something we don’t have’, in
other words, we need to change or modernise. Health-care technology is changing
almost as rapidly as Silicon Valley. Often the need for a Business Case arises when
a new technology (e.g. a new drug) is available that provides benefits over current
practice. Equally often it may come from a recognition that something’s wrong (e.g.
long waits for chemotherapy patients) and is used to help evaluate what is wrong
and what to do about it.
The word ‘Case’ implies an argument, a set of coherent steps. It also implies a
dialogue; between those who want the change and the authority who will fund the
change. When you have achieved funding, the ‘Case’ becomes the ‘Business Plan’,
describing how you deliver on time what you want to do.
In the NHS you need to document your proposals for three reasons
1. You belong to a Public Service, which requires transparency
2. You will be entering a binding agreement (a contract) with a higher authority
(Hospital Board, Commissioner) in the NHS.
3. Your colleagues will require a ‘Road Map’ (The Business Plan) to understand
their respective responsibilities in commissioning and procurement
How do you set about writing a Business Case?
The first step is to set up a Stakeholder Group, meet regularly (e.g. monthly) and
start deciding what your proposal looks like. In particular you need to describe:
What are the options (including ‘do nothing’)?
What are your criteria for selecting the preferred option?
What is your preferred option?
The ‘Bottom Line’: how do you sell it as a viable case to the Board or to
What are the Key Steps?
In order to get to the point of presenting to your Funding Body, you need to
perform three key tasks
1. Describe your current situation. Cost it according to a set of criteria (this is
your ‘do nothing’ option)
2. Look at alternative ways (new options) of achieving your change.
a. Choose your preferred ‘new’ option
b. Show benefits of your preferred new option relative to the old
3. Set out the detailed costs for delivering your preferred new option and the
potential income or savings for this option
The Five Modules:
The most basic business case is the Strategic Outline Case (SOC). It comprises
FIVE modules and an executive summary
The management case: who will deliver the business case and how
The strategic case: is the business case aligned with NHS objectives?
The economic case: how does the proposal meet demand and use resources
The financial case: What will it cost?
The commercial case (only if capital procurement is required)
The Management Case: Delivering the project and its solution
The first module explains how you will deliver your project for change. It should be
addressed at the first meeting of your ‘Project Group’. It should comprise some
important principles such as:
Who are ‘you’ as a project group?
By when do you need to deliver this project (one year, one month, before the
end of the financial year)?
How confident are you that you can deliver within this time (Delivery
Confidence). What are the risks?
To whom will you deliver the BC? (PCT commissioners, The Hospital Board,
the Director of Finance, the Directorate General Manager)?
The Strategic case: Why is the procurement needed, what is the organisational
context? Critical success factors and benefits realisation
This provides a case to a ‘third party’ (usually aimed at your hospital Trust Board). It should
help managers understand why change is needed and why the thing you are asking for is
Can you show that your proposal is aligned with national or local policy or guidance,
or leads to changes that meet local/national goals?
What is the basic ‘driving force’ behind your project (e.g. waiting times, overcrowding,
safety, delivering treatment ‘closer to home’)?
Consider what changes will result for patients, staff and the organisation (‘Benefits
The Economic case: The value for money arguments and evidence
The economic case for change examines your ‘capacity’, ‘activity’ and demand as well
as safety and quality, some of which is defined nationally (e.g. the QIPP
commissioning framework: quality, innovation, productivity, prevention). Your Hospital
will need assurance that the changes you are proposing will be affordable and that you
have made a best attempt at describing their financial impact. It also needs to know
you have considered alternatives (‘Options’). Show the proposed change against the
current situation and at least one other alternative. The principles of care-pathway
mapping, capacity planning and activity calculations are set out in Appendix 2.
The Financial case: Is it affordable?
Consider the financial detail on your ‘preferred option’. This is particularly important if a
new post (a new salary) is involved as this has implications for employment rights.
The Commercial Case: The contract and the procurement process
In general, proposals for capital (estate, equipment) procurement should be escalated to
Board Level through the Hospital Director of Strategic Development or equivalent. In
addition, ‘public consultation’ may be needed for proposed service changes which affect
large numbers of patients or which might be perceived by the public to be controversial. An
example of this might be ‘repatriating’ a large number of chemotherapy patients from a
Cancer Centre into a Cancer ‘Satellite’ Unit some miles away, perhaps as part of a large
capital building programme (devolved or outreach services). In these cases, senior
managers need to consider whether formal consultation, involving public meetings, may be
required under sections 7 and 11 of the Health and Social Care Act, 2008 (ref:Office of
Public Sector Information @ http://www.opsi.gov.uk/si/si2009/uksi_20090462_en_1 ).
Business Intelligence: http://www.bjhm.co.uk/cgi-
NHS Scotland http://www.bitsandbobs.scot.nhs.uk/business_cases.html
DoH England Five Case Model:
A one day modular training course
Introduction to how to write a Business Case
and use it as a Business Plan for delivering
change in chemotherapy services
Drawing the Road Map and Walking down it
The course is based on general principles used across the NHS, Government
and Commerce for delivering change and aims to produce the most basic form
of BC, the Strategic Outline Case (‘SOC’)
The course consists of five separate modules or ‘cases’. (the fifth is only
needed if there is a major capital or building project involved). The word ‘case’
means ‘argument’ (as in: ‘This is the case for changing chemotherapy services
in our Hospital’).
At the end of each module you complete a Template. The four (or five)
templates are gathered together as a draft document (the Business ‘Case’-
BC), making the case for your project in four different ways, with an ‘Executive
The blank Templates are attached to this document
Hopefully, your stakeholders can agree the BC presents the road-map (the
‘Business ‘Plan’) for delivering change in your services over a fixed time.
The course also gives you a rudimentary introduction on how to actually deliver
your product, using project management tools like Prince 2.
Contact Professor Roger James (email@example.com) for more details