Picture Archiving Communication System (PACS) - Business Case by prancer88

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									                          Picture Archiving & Communication System (PACS) - Business Case
                          Template
                          Programme           Nuc Card                     DOCUMENT NUMBER

                          Prog. Director
                                                                                   NUC               000
                          Sub Prog/Proj Mgr
                          Author                              Version No         V01
                          Version Date        25-May-2004     Status             Draft




       Nuclear Cardiology Service
        Business Case Template




Picture Archiving & Communication System (PACS) - Business Case Template                 Page 1 of
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Nuclear Cardiology Business Case
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   Amendment History:

    Version                        Date           Amendment History
    V0.1                           01/10/04       First draft for comment




   Reviewers:

   This document must be reviewed by the following.

   Name           Signature               Title          Date of Issue       Version




   Approvals:

   This document requires the following approvals.

   Name           Signature               Title          Date of Issue       Version




   Document Location

   This document is only valid on the day it was printed.           Please contact the Document
   Controller for location details or printing problems.

   This is a controlled document.

   On receipt of a new version, please destroy all previous versions (unless a specified earlier
   version is in use throughout the project).




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   Related Documents

   These documents will provide additional information.

   Ref no     Doc     Reference     Number Title                                        Version

   1          NICE Technology Appraisal Myocardial perfusion scintigraphy for           Nov 2003
              73                        the diagnosis and management of
                                        angina and myocardial infarction

   Glossary of Terms

   List any new terms created in this document. Mail the librarian to have these included in the
   master glossary above [1].
    Term                           Acronym         Definition
    Myocardial Perfusion           MPS             Diagnostic procedure to assess myocardial
    Scintigraphy                                   perfusion
    Coronary artery disease        CAD             Narrowing within coronary arteries
    Myocardial infarction          MI              „Heart attack‟
    Coronary artery bypass         CABG            Cardiac surgery to bypass narrowings within
    graft                                          coronary arteries
    Percutaneous coronary          PCI             Angioplasty /stenting of coronary arteries
    intervention




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                                                                Contents

   1      General Guidance .............................................................................................................. 6
   2      Executive Summary ........................................................................................................... 7
       Introduction and Purpose ....................................................................................................... 7
       Strategic Case Overview ....................................................................................................... 7
       Economic Case Overview ...................................................................................................... 7
       Commercial Case Overview .................................................................................................. 8
       Financial Case Overview ..................................................................................................... 10
       Management Case Overview ............................................................................................... 11
   3      Introduction ....................................................................................................................... 12
   4      Strategic Case .................................................................................................................. 12
       Introduction .......................................................................................................................... 12
       National Context................................................................................................................... 12
       Local Strategic Context ........................................................................................................ 14
       The Case for Change ........................................................................................................... 14
          4.1.1     Local Investment Objectives .............................................................................. 14
          4.4.2     Existing Arrangements ....................................................................................... 15
          4.1.2     Future Business Needs and Service Gap .......................................................... 15
       Potential Scope .................................................................................................................... 15
       Main Outcomes & Benefits .................................................................................................. 16
       Main Risks ............................................................................................................................ 18
       Constraints & Dependencies ............................................................................................... 20
   5      Economic Case ................................................................................................................ 21
       Introduction .......................................................................................................................... 21
       Options ................................................................................................................................. 21
       Economic Appraisal Assumptions ........................................................................................ 23
          5.1.1     Costs .................................................................................................................. 23
          5.1.2     Risks .................................................................................................................. 23
          5.1.3     Benefits .............................................................................................................. 23
       Short-list Appraisal Findings ................................................................................................ 23
          5.1.4     Economic Appraisals ......................................................................................... 24
          5.1.5     Appraisal of Benefits .......................................................................................... 25
          5.1.6     Appraisal of Risks .............................................................................................. 25
          5.1.7     Sensitivity Analysis ............................................................................................ 26
   6      Commercial Case ............................................................................................................. 28
       Introduction .......................................................................................................................... 28
       Specification of Requirements ............................................................................................. 28
       Acquisition Strategy ............................................................................................................. 28
       Acquisition Process .............................................................................................................. 28
       Acquisition Timetable ........................................................................................................... 28
       Equipment Supplier .............................................................................................................. 29
          6.1.1     Solution .............................................................................................................. 29
          6.1.2     Best Available Pricing ........................................................................................ 29
       Commercial Risk .................................................................................................................. 29
       Payment Mechanism............................................................................................................ 30
          6.1.3     Standard Support & Maintenance ...................................................................... 30
       Performance Options ........................................................................................................... 30
       Dispute Resolution ............................................................................................................... 31
       Legacy Contracts ................................................................................................................. 31
       Proposed Contract Lengths ................................................................................................. 31
       Key Contractual Clauses ..................................................................................................... 31
       TUPE .................................................................................................................................... 31
       Implementation Time-scales ................................................................................................ 31
       FRS5 Accountancy Treatment ............................................................................................. 31
       Documentation ..................................................................................................................... 31
   7      Finanical Case .................................................................................................................. 31
       Introduction .......................................................................................................................... 31
       Assumptions ......................................................................................................................... 32
       Current Trust Funding .......................................................................................................... 32
       Impact on Trust Income & Expenditure Account ................................................................. 32
       Notes to the Financial Projections ....................................................................................... 33
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     Impact on the Trust Balance Sheet ...................................................................................... 33
     Overall Affordability .............................................................................................................. 34
   8 Management Case ........................................................................................................... 34
     Introduction .......................................................................................................................... 34
     Project Management Structure and Methodology ............................................................... 34
     Governance Procedures ...................................................................................................... 34
     NHS Gateways ....................................................................... Error! Bookmark not defined.
     Project Plan .......................................................................................................................... 34
     Milestones ............................................................................................................................ 34
        8.1.1     Implementation Plan .......................................................................................... 35
     Project Reviews ................................................................................................................... 35
        8.1.2     Post Implementation Reviews ........................................................................... 35
        8.1.3     Project Evaluation Reviews (PERs) ................................................................... 35
     Risk Management Strategy and Framework ....................................................................... 35
     Benefits Management .......................................................................................................... 36
        8.1.4     Arrangements for Benefits Realisation Plan ...................................................... 36
     Training ................................................................................................................................ 36
     Contract Management Strategy ........................................................................................... 36
   Appendix 1         Economic Appraisals (with notes) .................................................................. 37
     Appendix 1.1 Option A – “Do Minimum” .............................................................................. 37
     Appendix 1.2 Option B – “Reduced Scope” ......................................................................... 37
     Appendix 1.3 Option C – “Preferred Way Forward” ............................................................. 37
     Appendix 1.4 Option D – “Increased Scope” ....................................................................... 37
   Appendix 2         Financial Appraisal (with notes) ..................................................................... 37
   Appendix 3         Quantification of Benefits ............................................................................... 37
   Appendix 4         Quantification of Risks.................................................................................... 37
   Appendix 5         Local Service Requirement ............................................................................ 37
   Appendix 6         Service Level Agreement ............................................................................... 37
   Appendix 7         Commitment to Implementation ..................................................................... 37
   Appendix 8         Project Management Arrangements .............................................................. 37
     Appendix 8.1 Project Management Structure ...................................................................... 37
     Appendix 8.2 Nuclear Cardiology Implementation Project Board ........................................ 38
   Appendix 9         Project Risk Register ...................................................................................... 39
   Appendix 10 Benefits Realisation Plan ............................................................................... 39




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   General Guidance


   This template and guidance has been issued as an initial version to
   assist users in starting work on their Nuclear Cardiology business case.
   The template and guidance will be updated as required to reflect:
      New information available
      feedback from users of the template.
   Any comments on the template or suggestions for changes should be
   directed to: A. Kelion@rbh.nthames.nhs.uk


   This document provides a template and guidance for the development of a
   business case to support local approval for investment in a Nuclear
   Cardiology service.
   Business cases will need to be in line with delegated approval limits. Current
   Information relating to delegated limits can be found on the DH Capital
   Investment Branch Web Site:
   http://www.doh.gov.uk/publicprivatepartnership/privatefinanceinitiative/fs/en
   The template and tools will enable the production of a business case that
   satisfies both DH IM&T and local business case requirements.
   Each project or programme must have a single, named Senior Responsible
   Owner (SRO). This individual is responsible for ensuring that the project or
   programme meets its overall objectives and delivers its projected benefits
   through execution of the benefits realisation plan.
   The SRO of each project must ensure that a formal approach to project
   management i.e. PRINCE 2 method is applied and that the public sector
   standard for programme management “Managing Successful Programmes”
   must also be applied where appropriate. Further details can be found on the
   Office of Government Commerce (OGC) web site at www.ogc.gov.uk.
   The SRO is responsible for ensuring execution of the benefits realisation plan.
   The business case will need to show the extent of central funding where this
   is available.
   Strategic Health Authorities will agree with their constituent local organisations
   a timetable for implementation. Where this involves a number of local
   organisations working together, individual roles and responsibilities must be
   clear. The business case will need to identify costs falling to each individual
   organisation. The Management Case must include a realistic supplier project
   plan. This will detail timescales, resources and technology that the supplier
   will use to deliver the required outcomes.




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   Executive Summary

   Introduction and Purpose
   This Business Case seeks approval from the board of [Name of organisation e.g. XYZ Trust]
   for investment in a Nuclear Cardiology service.
   [Add a brief description of the selected option and the nature of the service provision].
   Approval is therefore required for an investment of £x.xmillion (Capital £x.x & Current
   £x.xmillion) over the ten year period. This represents the “undiscounted” cost for the provision
   of Nuclear Cardiology costs incurred by XYZ Trust will be £x.x million. Costs include VAT
   where applicable and exclude the future impact of inflation. [Guidance on recoverable VAT
   will be available once decisions on assets and payment processes are finalised.]


   Strategic Case Overview
   The Strategic Case….. [Summarise any key aspects especially relevant local business
   context]. The overall objectives for the provision of a Nuclear Cardiology service are
   summarised below. [Present the relevant objectives from the strategic case section later on in
   this document]

            Overall Objective                       More Specific „SMART‟ Objectives




   Economic Case Overview

   The options evaluated were:

   [Include some summary explanation and description of the options].

    Discounted Costs                         Option A       Option B       Option C      Option D

    Expenditure exc VAT

    Plus cost of risk retained

    Minus baseline savings

    Minus cash releasing benefits

    Minus non-cash releasing benefits

    Total




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   Commercial Case Overview
   In the provision of a Nuclear Cardiology service the Trust is seeking to comply with NICE
   Guidance, Technology Appraisal 73, Myocardial perfusion scintigraphy for the diagnosis and
   management of angina and myocardial infarction.
   The acquisition timetable for the Trust is as follows. [This timetable needs to be in line with
   procurement and ordering arrangements. The suggested contents may need amendment and
   should reflect what is described in the commercial case]:

   Activity                                                             Date

   Establish need for Nuclear Cardiology provision

   Establish local requirements specification and agree with PCTs

   Establish timetable applications for funding

   Detailed discussions with suppliers and manufacturers

   Agree central capital funding

   Agree business case for local approval

   Acquisition of appropriate resources

   Commence implementation

   Completion of Acceptance Testing

   Review Benefits




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   The table below outlines the possible placement of risk. [PCT may be replaced, depending on
   source of funding eg. public/ private partnership – PFI]

    Risk Category                                      Potential allocation

                                                       Trust        PCT         Shared

    1. Risk of non implementation NICE                             

    2. Risk development of service

    3. Implementation Risk

    4. Availability and Performance Risk

    5. Operating risk

    6. Variability of Revenue Risks

    7. Termination Risks
    8. Technology & Obsolescence Risks

    9. Control Risks

    10. Residual Value Risks

    11. Financing Risks

    12. Legislative Risks

    13. Other Project Risks

   The payment mechanism will be via [State arrangements when known e.g. monthly payments
   by the Trust, to the PFI, Manufacturers].

   The contract for hardware will be between the [State arrangements when known e.g. between
   manufacturer and the named Trust]




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   Financial Case Overview
   In the Financial Case the affordability of the preferred option has been explored, taking into
   account both the expenditure (with irrecoverable VAT applied) and anticipated funding. The
   results are summarised in the table below. This shows that the expenditure (comprising
   hardware, software and support costs plus the cost of extra local area networking and
   peripherals to support the service) over ten years will be £x.x (including VAT) and that the
   total funding over the same period (from both national and local sources) would amount to
   approximately £x.x, leaving an affordability gap totalling approximately £x.xm over the ten
   year period as shown in the table. [The table below should be replicated from the Financial
   Case section of this business case]



   x(000‟s)         Yr 0   Yr 1    Yr 2    Yr 3   Yr 4   Yr 5   Yr 6   Yr 7   Yr 8   Yr 9      Total

                    2004   2005    2006    2007   2008   2009   2010   2011   2012   2013


                    £      £       £       £      £      £      £      £      £      £         £

   Item 1 (e.g.
   service cost)

   Item 2

   Item 3

   Item 4

   Item 5

   Item 6

   Item 7



   Total Costs
   under
   Proposed
   Contract(s)

   Anticipated
   Benefit(s)

   Anticipated
   Net Cost

   Brought
   Forward

   Carried
   Forward




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   Management Case Overview
   [Set out the key arrangements for management of the project including reference to the PFI (if
   relevant), “additional service” or relevant acquisition process]
   The project, to acquire and implement a Nuclear Cardiology service is being managed
   according to PRINCE2.
   [Set out the structure and management model being adopted by the project and who has the
   key project roles including the senior responsible owner].




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   Introduction

   This document has been prepared using an agreed format based on the structure set out on
   the HM Treasury OGC website and adopted by the Department of Health. This is the 5 Case
   Model, which comprises the following components:
   The Strategic Case section, which sets out the Strategic Context and the Case for Change,
   together with the investment objectives for the Project.
   The Economic Case section, which demonstrates that the local organisation (e.g. Trust) has
   selected the choice of investment which best meets the existing and future needs of the NHS
   locally, demonstrates selection of the best option, and demonstrates optimum VFM.
   The Financial Case section, which confirms overall affordability.
   The Commercial Case section, which outlines the content of the preferred and proposed
   arrangements with the Supplier.
   The Management Case section, which demonstrates that the implementation arrangements
   for the proposed investment are achievable.


   Strategic Case
   The purpose of the Strategic Case is to demonstrate that the project is necessary to deliver a
   high quality Nuclear Cardiology service, in line with NICE Guidance (Technology Appraisal
   73), and is supported by clear and measurable objectives.


   Introduction
   The main tenets of the strategic case for the implementation of a Nuclear Cardiology service
   are outlined below.

   National Context
   MPS using SPECT (single photon emission tomography) is recommended for the diagnosis
   and management of coronary artery disease (CAD).
   CAD is the commonest cause of death in England and Wales. Angina (chest pain) is the most
   common symptom of CAD. It is usually provoked by exercise and relieved by rest and may
   become unstable, when pain is experienced at rest. This may progress to myocardial
   infarction (MI: heart attack) or sudden death. 2.65 million people in the UK have CAD, of
   whom 1.2 million have had a MI. In 2001 in the UK, it is estimated that there were 275,000
   MIs and 335,000 new cases of angina. The prevalence of CAD increases with age and varies
   across geographic regions and socio-economic groups.
   More than 378,000 in-patients were treated for CAD in the NHS. Medical treatment includes a
   variety of drugs, which may alleviate symptoms or provide a preventative strategy eg statins
   for hyperlipidaemia. In severe CAD, revascularisation may be required - 28,500 cardiac
   surgical procedures and 39,000 percutaneous coronary intervention (PCI) are performed
   annually. The cost of CAD in 1999 to the UK health care system was estimated at £1.7billion,
   the total cost being around £7 billion if informal care and productivity losses are included.
   The likelihood of CAD in a given individual may be estimated from knowledge of age, gender,
   ethnic group, family history, symptoms and the results of tests such as the resting ECG
   (rECG). This approach cannot exclude CAD, and is of limited diagnostic value. Exercise ECG
   (exECG) (which is unsuitable for people who are unable to perform treadmill exercise) and
   coronary angiography (CA) are commonly used in diagnosis. CA is not used routinely without
   prior non-invasive testing, due to associated mortality and morbidity and high cost (EMPIRE
   study). Potential complications include nonfatal myocardial infarction (0.1%), stroke (0.1%)
   and death (0.1-0.2%).

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   Non-invasive techniques that are commonly used include myocardial perfusion scintigraphy
   and stress echocardiography. Magnetic resonance imaging and positron emission
   tomography are used less frequently. MPS involves the intravenous injection of small
   amounts of radioactive tracers (3 are available in UK: thallium-201, technetium-99m-sestamibi
   and technetium-99m-tetrofosmin), allowing evaluation of blood supply to living muscle cells
   both during stress and at rest. The distribution of the radiotracer is imaged, often
   synchronised to the ECG, using a gamma camera, which rotates around the subject.
   Homogenous tracer uptake throughout the heart muscle on both the stress and rest images
   suggests normal coronary blood supply and the absence of clinically significant infarction. An
   area of reduced uptake on the stress images that normalises at rest is termed a reversible
   perfusion defect and suggests significant coronary narrowings. A defect which is present on
   both stress and rest images (fixed defect) indicates loss of living heart muscle such as after a
   MI. The complications of MPS are similar to those of an exercise ECG, and are related to the
   stress component of the test (whether by exercise or pharmacological stimulation), with
   morbidity around 0.02% and mortality 0.01%. The radiation exposure is similar to that from an
   uncomplicated coronary angiogram. The cost of a SPECT scan is estimated (2002 NHS
   reference costs) at £265, in comparison to £104 for an exECG and £1103 for a coronary
   angiogram.
   NICE appraisal outlines the diagnostic performance of SPECT, expressed as sensitivity and
   specificity, for CAD seen at coronary arteriography. Median sensitivity values for SPECT were
   higher (81%, range 63-93%) in comparison with stress ECG (65% range 42-92%). Specificity
   values were similar. The American College of Cardiologists/ American Heart Association Task
   Force guidelines quote an average sensitivity of 89-90%, and specificity of 70-76%.
   SPECT MPS has a particular value for long term prognosis. In a meta-analysis of 15,000
   patients with abnormal SPECT, this was associated with an annual cardiac event rate of
   6.7%, whereas in 20,963 patients with a normal SPECT, the event rate was 0.7%.
   Furthermore the size and severity of the perfusion defect can predict the likelihood of future
   cardiac events.
   SPECT MPS provides independent prognostic information in subgroups: women (where the
   stress ECG has low predictive accuracy); following myocardial infarction (where the ECG is
   abnormal and sECG is less useful); patients who have undergone PCI or cardiac surgery;
   medically treated patients with left main and/or three vessel disease, patients hospitalised
   with normal or non-diagnostic stress ECG and patients with diabetes. The NICE assessment
   concludes that the evidence “consistently suggested that SPECT provided valuable
   independent and incremental information predictive of outcome that helped to risk stratify
   patients and influence the way in which their condition was managed”.
   Cost Effectiveness;
   NICE assessment compared costs and outcomes of SPECT with alternative diagnostic
   strategies. Overall it was concluded “that direct CA (without any prior test) was cost effective
   when the prevalence of disease was high. At low levels of prevalence, strategies involving
   SPECT and/or stress ECG were considered to be a better use of resources than a strategy of
   direct CA. Furthermore, strategies involving SPECT were often found to be dominant or
   provided additional benefits that might be considered worth the additional cost compared with
   the sECG-CA strategy.”
   Using financial modelling, incremental cost effective ratios (ICERs) have been compared for
   investigational strategies. When compared with stress ECG-CA, SPECT-CA has more
   favourable ICERs than direct CA at low levels of CAD. At high prevalence levels, stress
   ECG-CA and direct CA strategies are favourable.
   Implications for the NHS
   In 2000 the British Nuclear Cardiology Society survey, there were 1,200 SPECT scans per
   million population. Based on current revascularisation and CA rates it is calculated that the
   optimal level of provision to be around 4,000 SPECT per million. The estimated annual
   revenue cost would be in the order of £27million.


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   Local Strategic Context
   [Include details of the local context here. This section should set out key organisational
   strategies e.g. around implementation of the service. It should also include an organisational
   overview service configuration of the existing healthcare delivery arrangements. Planned
   changes should also be recorded e.g. service reconfiguration. ].
   Suggested headings
          Referral population
          Local workflows – rapid access chest pain clinics? Cardiac outpatients?
          How will the service be used – Diagnosis? Prognosis?
          Number of coronary angiograms : normalcy rate
          Number of revascularisations
          Existing resources
          Service reconfiguration


   The Case for Change
   [Complete this section in the local context outlining the purpose of the investment, identifying
   problems with existing arrangements and how future requirements will introduce a gap in
   services which investment in nuclear cardiology will alleviate].

        Local Investment Objectives
   [There are a number of investment objectives common to all local implementations. It is for
   individual Trusts to set SMART (specific, measurable, achievable realistic and time-
   constrained) objectives targets in line with anticipated benefits. This generic set is provided
   as a starting point]:

   Investment Objective 1
   To implement the NICE guidelines
          Time scales



   Investment Objective 2
   To reduce the angiography normalcy rates
          Numbers of angiograms currently: elective/emergency



   Investment Objective 3
   To provide more effective clinical diagnostic imaging
          The ratio of MPS : angiography : revascularisation




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   4.1.2 Existing Arrangements
   The existing arrangements for imaging in the [XYZ] Trust are as follows:
   [Describe the local configuration of services, existing costs, etc using material from the Local
   Service Specification Toolkit]
   Local services are currently experiencing a number of problems due to the following
   situations…
   [Describe the main issues of the local situation and expand around the following points adding
   additional factors as appropriate:
          The current provision of gamma cameras.
          The current provision of nuclear cardiology services.
   .


   4.1.3 Future Business Needs and Service Gap
   At a local level the existing arrangements are characterised by [The list may need
   customising according to local circumstance]:
          Provision of gamma cameras within the Trust
          Radiopharmacy arrangements/provision
          Medical staff availability and appropriate experience
          Provision of technical support
          Provision of appropriate equipement and resources for providing stress testing
   [There may be issues with the siting of the service which will alter according to local
   environments eg nuclear medicine,radiology, cardiology, physics].


   Potential Scope
   [Each Trust will have a somewhat different requirement, dependent primarily on the referral
   population].

   [Scope for workload expansion will depend on developments within Trusts eg rapid access
   chest pain clinics.]




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   Main Outcomes & Benefits
   The main outcomes and benefits anticipated, for key stakeholder groups, or achievement of
   the key investment objectives, are set out below:

   [This list is generic and needs to be considered in the local context and amended accordingly
   by addition or removal of certain items. The aim is to establish that cash-releasing benefits
   can offset the revenue costs of implementing a nuclear cardiology service.]




                                                                                                  Non- Cash
   Investment Objective 1          Ref   Related Benefits Criteria




                                                                                                                  Qualitative
                                                                                  Releasing


                                                                                                  Releasing
                                                                                  Cash
   To implement the NICE                 Patients
   guidelines
                                   B01   Improved diagnostic service                                          Y

                                   B02   Special groups – females, diabetics                                  Y



                                         Clinicians

                                         Expansion of variety of diagnostic                   Y
                                         work, increased job satisfaction



                                         Managers

                                         Greater service throughput                                           Y

                                         Improvement     in    waiting    times                               Y
                                         performance




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   Investment objective 2




                                                                                                  Non- Cash



                                                                                                                            Qualitative
                                                                                     Releasing


                                                                                                  Releasing
                                                                                     Cash
   To      reduce   the                Patients
   angiography normalcy
                                       To reduce the exposure of patients to                     Y
   rate
                                       angiography with associated risks
                                       To    perform      angiography    on                      Y
                                       appropriate patients

                                       Clinicians
                                       Reduced risk associated with MPS vs                       Y
                                       angiography

                                       Managers

                                       Appropriate use of resources                              Y

Investment Objective 3      Ref     Related Benefits Criteria




                                                                                          Non- Cash



                                                                                                              Qualitative
                                                                             Releasing


                                                                                          Releasing
To      provide     more            Patients                                 Cash
effective      diagnostic
                                    To provide effective triaging prior to                                    Y
imaging
                                    angiography
                                    Appropriate       intervention    and                Y
                                    revascularisation

                                    Clinicians
                                    Improved decision making                                                  Y
                                    Improved prognostic markers                                               Y




                                    Managers




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                           Ref     Related Benefits Criteria




                                                                                         Non- Cash



                                                                                                     Qualitative
                                                                             Releasing


                                                                                         Releasing
                                                                             Cash
                                   Patients




                                   Clinicians




                                   Managers




   Main Risks
   Risks have been divided into seven high level categories.[Countermeasures to the risks
   included in the business case should be identified.]:
          Design Risks [These are unlikely to apply]
          Development / Implementation Risks [Some of these may not apply]
          Change Management Risks
          Training / User risks
          Operational Risks
          Termination Risks.
          Technology and Obsolescence Risks
   1.0   Design Risks                                                   Countermeasure
   1.1   Change in requirements of the NHS Trust                        i.e. define capacity in
                                                                        terms of all known
                                                                        developments within the
                                                                        Trust.
   1.2   Change in Requirements of Service
   1.3   Change in requirement of Users
   2.0   Development/Implementation Risks
   2.1   Trust change to specification
   2.2   Delays in functioning of gamma camera
   2.3   Insufficient trained staff to implement service
   2.4   Trust's implementation costs exceed budget
   3.0   Change Management Risks
   3.1   Organisation & staff not geared up culturally or practically
         e.g. inadequate prep, start planning, train & develop,

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         change management
   3.2   Organisation not sufficiently prepared or trained to
         implement.
   3.3   Services disrupted because of implementation/lack of
         familiarity with systems
   3.4   Loss of key staff e.g. project manager, project champions,
   4.0   Training/User Risks
   4.1   Training Costs exceed budget
   4.2   Loss of user interest and motivation due to project delays,
         poor communication etc
   5.0   Operational Risks
   5.1   Higher than expected operating costs
   5.2   Insufficient trained staff to operate systems
   5.3   Insufficient (medical) staff time for reporting
   5.4   System/services unable        to   respond        to   increased
         activity/throughput
   5.5   Non Cash releasing benefits not realised


   5.6   Non Cash releasing benefits delayed
   5.7   Cash releasing benefits not realised
   5.8   Cash releasing benefits delayed
   5.9   Cost of additional activity/throughput
   6.0   Termination Risks
   6.1   Services not able to meet changed requirements resulting
         from Trust changes e.g. merger, new services
   7.0   Technology & Obsolescence Risks
   7.1   Failure of Imaging to deliver outputs & meet existing and
         future business needs




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   Constraints & Dependencies
   The potential constraints can be grouped into 4 main areas:
          Financial Affordability
           [The financial approach will dependent on local implementation.]
          Communications
           [Trusts may need to invest in their LAN infrastructure and ensure it has the capacity
           to store images and reports. Communication with IT departments at an early stage is
           advisable ].
          Timescales
           [Service development and reconfiguration issues may place constraints on the
           timescales for implementation. There may also be urgent operational need to support
           new sites, new build or services such as Diagnosis and Treatment Centres (DTC).]
          Strategic and Organisational
           [Other initiatives may compete for investment and local skills.      There may be
           organisational issues within Trusts].
   There are also some common dependencies:
          Infrastructure
           [The project is dependent on the availability of other nuclear medicine provision and
           the siting within the Trust]
          The support of the stakeholders
           [A successful implementation of nuclear cardiology is dependent on support from
           stakeholders. Funding flows may also have to be secured from PCT Stakeholders].




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   Economic Case

   Introduction
   The purpose of the Economic Case is to confirm the preferred option, to establish the
   preferred option to be acquired and to demonstrate Value for Money.
   This section of the business case provides:
          an overview of the options (short lists) appraised, together with the selection of the
           preferred option. [A gamma camera with attenuation correction is estimated to cost
           £250,000. Local requirements will inform the preferred option. Costings need to
           include the consumables].
          a full account of the resultant acquisition and evaluation process, leading to the
           selection of the preferred supplier; and
          associated economic analysis of the shortlisted options


   Options
   [The business case will evaluate a “do minimum” option. Two more options are possible,
   involving decrease or increase of scope, which would be dictated by local circumstances e.g.
   availability of funding. This will depend on the referral population and the requirement to
   comply with NICE ]

   The following options have been considered and appraised.

   Option A            – “Do Minimum” –
   Description         This option provides a benchmark for Value for Money and is predicated
                       upon the continuation of current service for diagnosis and prognosis of
                       CAD
   Scope               [To be defined by trust] This should include a description of the
                       current service – activity and resources used.
   Service Delivery    [To be defined by trust]
   Implementation      [To be defined by trust]
   Funding             [To be defined by trust]

   Option B            – “Reduced Scope” –
   Description         This option is predicated on the implementation of a limited service eg by
                       using mobile service
   Scope               [To be defined by trust]
   Service Delivery
   Implementation
   Funding             [To be defined by trust]




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   Option C            – “Preferred Way Forward ” –
   Description         This option involves purchase of a gamma camera, and implementing a
                       new service
   Scope
   Service Delivery
   Implementation
   Funding             [To be defined by trust]


   Option D            – “Increased Scope” –
   Description         This option is predicated on the provision of a service with unutilised
                       capacity, with the option of attracting external work and/or funding.
   Scope               [To be defined by trust]
   Service Delivery
   Implementation
   Funding             [To be defined by trust]




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   Economic Appraisal Assumptions

        Costs
   The following assumptions have been made when developing the costs:
          The contract period for the investment appraisal will be for [usually 30 (the lifetime of
           the contract to the nearest number of whole years)] years.
          Revenue payments are made in line with the commencement of delivery of services
          Costs are discounted at 3.5% as advised by the Green Book 2003
          Implementation is unconstrained by other programmes and will continue in line with
           the project plan (as described in the Management Case).
          Technology refresh or projected replacement with technology upgrade must be
           included, typically at 5 to 7 years. [Check if technology refresh is covered as capital or
           recurrent revenue in the cost model. Costs should be used to populate the Costing
           Model and detail included in the relevant Appendix. Each option will be specified and
           costed separately using the Costing Model]


       Risks
   The following assumptions have been made when developing the risks:

          The risk retained is determined by the clauses of the contract

          All potential risk impacts are annual

          All likelihoods are annual

          Risks exclude inflation. Discounted risks exclude inflation

          Risks are discounted at 3.5% as advised by the Green Book 2003

       Benefits
   The following assumptions have been made when developing the benefits:

          Benefits are assumed to be common across all options in terms of the list of
           individual benefits. The values/scores of individual benefits can, however, be
           different between these.

          Benefits exclude inflation. Discounted Benefits exclude inflation

          Benefits are discounted at 3.5% as advised by the Green Book 2003

   Short-list Appraisal Findings
   The results were as follows for the Economic Appraisals, including the evaluation of
   qualitative benefits, associated risks and sensitivity analysis.




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            Economic Appraisals

     The table below summarises the key results of the economic appraisals for each option. The full appraisal is presented in Appendix 1.
     Summary of Economic Appraisals


                                       Option A                          Option B                                Option C                        Option D

                                     “Do Minimum”                   “Reduced Scope”                       “Preferred Way Forward”            “Increased Scope”
                        Undiscounted         Net Present    Undiscounted       Net Present        Undiscounted        Net Present     Undiscounted    Net Present
                             (£)             Cost (Value)        (£)           Cost (Value)            (£)            Cost (Value)         (£)        Cost (Value)
                                                 (£)                               (£)                                    (£)                             (£)

 Capital

 Recurrent

 Cost    of     Risk
    Retained

Total Cost

 Cash-Releasing
    Benefits
Costs   net     Cash
Savings
 Non-Cash-
    Releasing
    Benefits

TOTAL




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       Appraisal of Benefits
   The benefits associated with the project were considered, scored, weighted and, where
   possible, valued. Benefits that have been valued are reflected in the Economic Appraisal in
   Section 0 and section 4.1.2 and the details of the valuation are set out in Appendix 3. The
   table below presents a summary of appraisal for the benefits that have not been valued.
   Following a workshop using the agreed methodology (see DH Capital Investment Manual) for
   the assessment of benefits, the results were as follows:

   Summary Benefit Appraisal Results

      Benefit Criteria        Option A             Option B            Option C                Option D
      & Weight
                              “Do Minimum”         “Reduced            “Preferred              “Increased
                                                   Scope”              Way                     Scope”
                                                                       Forward”


      Raw             &
      Weighted
                                         Weight




                                                           Weight




                                                                               Weight




                                                                                                          Weight
      Scores
                            Raw




                                                  Raw




                                                                      Raw




                                                                                             Raw
      Cash-releasing
      benefits

      Non-cash
      releasing
      benefits

      TOTAL

      RANK



        Appraisal of Risks
   The risks associated with the project were considered, scored, weighted and, where possible,
   valued. Risks that have been valued are reflected in the Economic Appraisal in Section 0 and
   the details of the valuation are set out in Appendix 4). The table below presents a summary of
   appraisal for the risks that have not been valued.
   Summary of Risk Appraisal Results


      Risk Criteria &             Option A-        Option B-           Option C-               Option D-
      Weight


      Raw & Weighted
                                         Weight




                                                           Weight




                                                                               Weight




                                                                                                          Weight




      Scores
                              Raw




                                                  Raw




                                                                      Raw




                                                                                             Raw




   1. Risk of non
   implementation

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       Risk Criteria &         Option A-           Option B-          Option C-           Option D-
       Weight


   NICE

   2. Risk development
   of service

   3.   Implementation
   Risk

   4. Availability and
   Performance Risk
   5. Operating risk

   6.  Variability     of
   Revenue Risks

   7. Termination Risks

   8. Technology &
   Obsolescence Risks

   9. Control Risks

   10. Residual Value
   Risks

   11. Financing Risks

   12. Legislative Risks

   13. Other      Project
   Risks

       TOTAL

       RANK


       Sensitivity Analysis
   Sensitivity analysis was undertaken on the basis of “switching value” as laid down in the
   Treasury Green Book and the DH Capital Investment Manual. The outcomes of applying
   switching values to the discounted risk adjusted cost figures are shown below.
          [One method is to compare the effects of changes in the usage or performance
           metrics of the options
          The second method is to look at the effect of changes in risk or benefits between the
           various options
          The third is to examine changes in price.]




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   Summary Sensitivity Analysis

       Change in Costs (%)          Option A-   Option B-   Option C-        Option D-

                                    “Do
                                    Minimum”


       Capital Costs

       Current Costs

       All Costs

       Non Releasing Cash
       Benefits

       NET           PRESENT
       VALUE




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   Commercial Case

   Introduction
   The purpose of the Commercial Case is to demonstrate the integrity of the acquisition and
   that the contract is appropriate.

   Specification of Requirements

   Acquisition Strategy
    [Arrangements for the acquisition process. It is likely that a full procurement via OJEC (OJEU
   – Official Journal of the European Union) would be required e.g. gamma camera purchase,
   see the specification document.
   In certain circumstances existing PFI build or equipment management programmes will be
   predicated on an acquisition solution, but note that in most cases these will exclude IT
   provision. However, for some current PFI projects, the acquisition of services is independent,
   but preferential financing may be available].


   Acquisition Process
   [Details required in line with local requirements]

   Acquisition Timetable


   Activity                                                             Date

   Complete

   Establish Local requirements

   Establish timetable slot

   Detail discussions with suppliers/ manufacturers

   Agree central capital funding

   Agree business case for local approval

   Complete additional services form (SLA)

   Commence Implementation

   Completion of Acceptance Testing

   Review Benefits




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   Equipment Supplier


       Solution

       Best Available Pricing


   Commercial Risk
   This section provides an assessment of how the associated risks might be apportioned
   between NHS organisations and the PFI/manufacturer (where equipment leased), in
   accordance with the general principle that risks should be passed to “the party best able to
   manage them”, subject to Value for Money.
   The table below outlines the possible placement of risk under a managed service style
   contract structure.

   Risk Category                                       Potential allocation

                                                       Trust           Supplier   Shared

   1. Risk of non implementation NICE                                               

   2. Risk development of service                                         

   3. Implementation Risk                                                            

   4. Availability and Performance Risk                                   

   5. Operating risk                                                                 

   6. Variability of Revenue Risks                                        

   7. Termination Risks                                                              

   8. Technology & Obsolescence Risks                                                

   9. Control Risks                                        

   10. Residual Value Risks                                                          

   11. Financing Risks                                                    

   12. Legislative Risks                                                             

   13. Other Project Risks                                 




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   Payment Mechanism
   [Trusts may consider lease options instead of capital purchases].
   The organisation will make payments in respect of the proposed above Services as follows:


       Item                                       Proposed Supporting Payment

       Upfront Costs

       Capital- Hardware                          Initial one off payment (£incl. Vat)

       Capital- Software                          Initial one off payment (£incl. Vat)

       Capital- Installation                      Initial one off payment (£incl. Vat)

       Training                                   Initial one off payment (£incl. Vat)

       Operational Costs
                                                  Annual rental and support & maintenance
                                                  payments of:



       Standard Support Contract                  £ (inclusive of Vat)

       Specialist Support Contract(s)             £ (inclusive of Vat)

        Standard Support & Maintenance

   The annual charge is for ………………response time with on site next day response call out,
   different agreements may be made due to provision of „first line‟ maintenance by Trust
   engineers.

   Performance Options
   This information is contained within the schedule of the Service Agreement (Appendix 6)
   which sets out the standards to which the Contractor must deliver the Services, the
   mechanism by which Service Failures will be managed, and the method by which the
   Contractor's performance under this Agreement will be monitored. This Schedule comprises
   three key areas:
          Service Level Specification – which details the services to be provided and the levels
           of performance to be attained
          Service Failures – setting out the definitions, levels of failure and consequences
          Performance Monitoring System – describing the procedures to be followed in
           gathering and reporting the performance achieved in the delivery of the contract.
   The principles of the mechanism employed are to give a well defined boundary of what must
   be delivered together with a fair mechanism to allow the deduction of points where this has
   failed to occur and a clear and well structured process that allows all parties to determine both
   what has happened and the reasons and responsibilities where it has not been in line with the
   expectations of the contract.


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   Dispute Resolution
   [To be determined]


   Legacy Contracts
   [Trust to provide details of legacy (existing systems, agreements or contracts and how they
   will be managed to deal with changes described above).]


   Proposed Contract Lengths
   [It is assumed that the length of the agreement with the manufacturer will be for the length of
   time the equipment is operational, longer agreements may be made as part of a managed
   equipment programme].

   Key Contractual Clauses
   [It is assumed that standard contract documentation will be drawn up by the Trust and used
   as the basis of the agreement. Any local addition, should be shown in the attached schedules
   to the contract].

   TUPE
   It is assumed that there are no issues relating to the transfer of existing staff to a new
   employer. [This must be checked locally]

   Implementation Time-scales
   It is anticipated that all service(s) contract(s) and associated Service Level Agreements will
   commence in [month] n [xx] as shown within the project plan in the Management Case.
   [Describe any phased arrangements]


   FRS5 Accountancy Treatment
   [The accountancy treatment for the project is, in the main, dependent upon the outcome of
   the preferred deal with the potential service providers. The impact upon the balance sheet is
   outlined within the Financial Case. This needs to be discussed with project accountant].


   Documentation
   The final service level agreement is included in (Appendix 6).


   Financial Case

   Introduction
   The purpose of the Financial Case is to demonstrate affordability for the preferred option
   established in the Economic Case and the affordability of the proposed Deal over the life of
   the contract.
   It also sets out the anticipated payment stream (£) for the investment over the life expectancy
   of the project (i.e. 10 years) and the Balance Sheet treatment of any assets underpinning the
   service provision.
   [The Costing Model spreadsheet.]




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   Assumptions
   The following assumptions have been made when considering affordability:
          National / Local funding - The Common Requirements
                   Replacement
                   Trust Implementation
                   Backfill Training
                   Change Management
                   Infrastructure.
          Irrecoverable VAT – As VAT goes to Her Majesty‟s Treasury (HMT) it has no effect
           on the Public Sector as a whole and is therefore excluded from the economic
           analysis. But from an affordability and cash flow point of view the money still needs to
           be found so it is included here.
          Capital Charges – All Public Sector bodies are expected to make a 3.5% return on
           assets. It has been assumed that, given the preferred structure, payment for the
           service should have a strong bias towards Capital.


   Current Trust Funding
   The Trust has not made any provision in its three year investment plans for any additional
   funding to support this programme.
   The Trust is therefore entirely reliant on any additional funds and a phased redeployment of
   current systems spend. [Check that any assumptions are checked with the Director of
   Finance, Strategic Health Authority and Management].


   Impact on Trust Income & Expenditure Account
   This shows that the expenditure (comprising hardware, software and support costs [plus the
   cost of extra local area networking and peripherals where appropriate] to support Nuclear
   Cardiology) over ten years will cost £x.x including VAT and that the total funding over the
   same period (from both national and local sources) would amount to approximately £x.x,
   leaving an affordability gap totalling approximately £x.x over the ten year period as shown in
   the table below.




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    x(000‟s)        Yr 0   Yr 1    Yr 2    Yr 3   Yr 4   Yr 5   Yr 6   Yr 7   Yr 8   Yr 9      Total
                    2004   2005    2006    2007   2008   2009   2010   2011   2012   2013

                    £      £       £       £      £      £      £      £      £      £         £

    Gamma           250                                         250                            500
    camera

    Building        75                                          25                             100
    costs

    Item 3

    Item 4
    Item 5

    Item 6

    Item 7



    Total Costs
    under
    Proposed
    Contract(s)
    Anticipated
    Benefit(s)

    Anticipated
    Net Cost
    Brought
    Forward

    Carried
    Forward

   Notes to the Financial Projections
   [Include relevant notes and assumptions that underpin the financial projections. Include
   assumptions around residual values and VAT].


   Impact on the Trust Balance Sheet
   The proposed capital expenditure of £x.xm in year 0- for equipment will appear on the
   balance sheet of the Trust.
   The contractual commitment, as described in the Commercial Case, to pay a Service Charge
   over ten years for nuclear cardiology-related Services, will be recorded on the Trust‟s balance
   sheet as a long term financial obligation.




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   Overall Affordability
   The proposed cost of the project is £x.xm over the ten years of the expected lifetime of the
   contract. The full financial appraisal is presented in Appendix 2
   The Director of Finance has confirmed in principle that the provision of funds for the required
   acquisition of the services is affordable within the period for which funding is known (next 3
   years) and will be accommodated in future years.

   Management Case

   Introduction
   The purpose of the Management Case is to demonstrate that the project is well managed and
   can be successful.

   Project Management Structure and Methodology
   With an investment of the size and complexity of that proposed under this business case,
   sound project management is recognised as being of paramount importance.
   A Project Team comprising staff from various parts of the Trust has therefore been
   established to take forward the work required. Appendix 8 presents the Project Management
   Arrangements.
   The project has the support of senior executives and clinicians, and the key decision-making
   and consultative bodies within the Trust.
   Management commitment extends to rigorous planning and regular progress monitoring.
   The Project Board reports regularly to the Trust Board. The Trust Board will stipulate any
   other reporting requirements.


   Governance Procedures
   An established project management methodology will be utilised which brings these
   requirements together into a structured process. The project management methodology used
   in the project is PRINCE2 (which meets the requirements outlined above and promotes
   arrangements to ensure both rigorous and structured planning and monitoring and the
   appropriate involvement of senior staff).


   Project Plan
   The project technical and resource plans are set out in outline form and as a Gantt chart
   [These need to be developed locally]. Key activities are also summarised. Supplied with this
   business case in electronic form is a Microsoft Project file providing a detailed project plan.
   Once the acquisition phase of the project is completed the membership of the project team
   will be reviewed to ensure that it is appropriate for the implementation phase. Discussions
   are already taking place on the implementation phase so that the project can move smoothly
   into implementation following signing of any formal agreement.


   Milestones
   The diagram below presents the main milestones in the implementation plan. [These need to
   be developed locally].




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        Implementation Plan
   The implementation project will start with site preparation, final workflow analysis and the
   arrival on site of the gamma camera(s) and a workstation that can be set up for teaching
   purposes.


   Project Reviews
   In accordance with good practice the project has the following outline arrangements in place
   for project reviews:


       Post Implementation Reviews
   The project plan contains a formal date for completion of the post-implementation review.


       Project Evaluation Reviews (PERs)
   The Trust intends to use a formal post-project evaluation tool, using the benefits detailed in
   this business case as the success criteria. The project plan contains a formal date for
   completion of the project evaluation review. The objectives of the evaluation will be:
          Identify how well the project aims and objectives have been achieved.
          Determine if the project timescales were met, both overall and for each key
           milestone, and what corrective actions, if any, were taken.
          Determine if the project costs were controlled and were within budget, both overall
           and for each of the parts of the project, and what corrective actions, if any, were
           taken.
          Against the benefits realisation plan identify what benefits have been achieved (both
           cash releasing and non-cash releasing) and seek the realisation of any outstanding
           benefits, including the implementation of any procedural and process changes.
          Assess the efficiency of the acquisition process and document the shortcomings for
           the benefit of future projects.
   This will be carried out for the project, in consideration of and in conjunction with any NHS
   Gateway 5 criteria being used as the framework for these reviews.


   Risk Management Strategy and Framework
   The project will be managed in accordance with PRINCE 2.
          The project‟s resultant Risk Management Strategy is twofold. Firstly, to manage,
           mitigate and control risks, and secondly, to ensure that risks allocated – or transferred
           to the Service Provider(s) – remain the responsibility of the Service Provider(s).
          A Risk Management Plan has been developed these have been allocated in a risk
           register (Appendix 9).
          As part of its project management approach the project team is developing a
           comprehensive risk register to track and manage project, service and business risks.
           This register will be developed to support the management of the contract during live
           service operation and will be considered at quarterly service meetings. Risks will be
           managed at the appropriate level with escalation to the relevant programme board via
           the service management board when appropriate.
          The risk register will be managed and monitored on a regular basis by the project
           team and periodically assessed by the Project Board


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   Benefits Management

       Arrangements for Benefits Realisation Plan
   A detailed benefits realisation plan is set out in Appendix 10.
   The high level Benefits Realisation Strategy is to:
          Identify the benefits and responsibility for their delivery
          Establish baseline measurement where possible
          Quantify benefits where possible
          Periodically assess likely realisation and any actions required
          Record further expected benefits identified during the project
          Measure outcomes


   Training
   The project team will ensure that the training plan identifies the resources required for delivery
   of the training (including the infrastructure and equipment requirements) and will ensure that
   the training plan identifies the split of training responsibilities.


   Contract Management Strategy




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      Picture Archiving & Communication System (PACS) -
      Business Case Template




  Appendix 1 Economic Appraisals (with notes)
  This section includes the detailed cost, risk and benefit analysis for each of the options
  identified in the Economic Case.

  Appendix 1.1 Option A – “Do Minimum”

  Appendix 1.2 Option B – “Reduced Scope”

  Appendix 1.3 Option C – “Preferred Way Forward”

  Appendix 1.4 Option D – “Increased Scope”




  Appendix 2 Financial Appraisal (with notes)
  This appendix contains the full costs and affordability analysis of the preferred option.


  Appendix 3 Quantification of Benefits
  [The quantification of benefits will need to be determined by individual Trusts, dependant
  upon information in the economic case.]

  Appendix 4 Quantification of Risks
  [The quantification of risks will need to be determined by individual Trusts, dependant upon
  information in the economic case.]

  Appendix 5 Local Service Requirement
  [This will need to refer to NICE guidelines and include:

      Number of scans required (based on local population) including future increases in
       activity.
      Definition of existing service capacity, replacement of existing equipment etc.
      Assessment of other options for investigation, e.g. stress echocardiography.
      Effects on other service, e.g. angiography.]

  Appendix 6 Service Level Agreement
  [To be completed locally.]

  Appendix 7 Commitment to Implementation
  [A letter of commitment to the implementation plan, endorsed by all parties to the plan, should
  be incorporated here.]

  Appendix 8 Project Management Arrangements

  Appendix 8.1 Project Management Structure
  [The chosen project management structure should reflect the requirements to deliver a
  nuclear cardiology service within the Trust


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  A proposed structure is shown below. This should be updated to reflect the actual structure].



                                    Nuclear Cardiolgy
                                    Project Board (PB)


          Quality                          Project Steering
          Assurance                         Group (PSG)
          Group
          (QAG)


         Supplier                          Project Team (PT)
         Liaison
         Group
         (SLG)




            Project Training                Project                       Clinical User
            Group (PTG)                     Implementation                Group (CUG)
                                            Group (PIG)




  Appendix 8.2 Nuclear Cardiology Implementation Project Board
  The Project Board meets every [xx] months or more frequently when required, receiving
  reports from the project manager and making any decisions that are required

  [Identify the members, their position and responsibility in the table below].



              NAME                                  POSITION & RESPONSIBILITY

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                                   Project Director

                                   Overall project manager for the project

                                   Clinical representative

                                   Clinical representative

                                   CHD collaborative representative




  Appendix 9 Project Risk Register
  [To be developed locally. For each risk listed in the register the following information should
  be documented:
         risk number (a unique identifier)
          the date raised
          who raised the risk
          the risk owner (responsible for tracking the risk)
          a description of the risk
          an assessment of the probability of the risk materialising
          an assessment of the risk‟s potential impact (e.g., high / medium / low)
          the importance of the risk (a combination of the probability and the impact)
          proposed countermeasures or mitigating actions
          risk status (e.g. proposed / in progress / complete)]


  Appendix 10 Benefits Realisation Plan
  [To be developed locally. For each benefit identified, the following information should be
  documented:
          a description of the benefit
          the investment objective(s) to which it is related
          the nature of the benefit
           o       financially quantifiable, cash-releasing – state the value
           o       financially quantifiable, non-cash-releasing – state the value
           o       quantifiable – state the quantity and units
           o       qualitative
          any assumptions on which the benefit is based
          the tasks required to realise the benefit
          the monitoring mechanism / performance indicator to be used to track delivery of the
           benefit]


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          ownership of the benefit (i.e. responsibility for its realisation)
          review date (to assess realisation of the benefit)




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