1.2.6 Have there been any changes to the original scope or objectives? Are the previous case spending objectives and planning assumptions still valid? Do the services to be procured/does the recommended deal still provide synergy and best fit with other parts of the organisation’s business strategy? Cost changes from those presented at OBC stage should be disclosed and explained. Strategic and policy context 1.3.1 Has the strategic context been documented? Where relevant, an organisation overview with details of structure, financial position, services provided, population and commissioners served could be useful. This should also take account of the wider context in which the organisation sits, eg the local health system (for builds), the UK as a whole (for national IT projects). 1.3.2 Has the impact on existing service configuration and the wider health economy been assessed? Is the rationale consistent with local/regional strategic priorities? This applies primarily to builds, eg the organisation’s vision, strategic priorities, clinical strategies and/or commissioning intentions appropriate) should be checked against what is known about service configuration priorities and other health priorities. Full details should be given of the consequences for other services, clinical networks and the local health system/health organisations.
1.5.4 Is there evidence of a board or governing body-approved sustainable development management plan which sets out clear milestones to measure, monitor and reduce direct carbon emissions? This will include the impact of new build and refurbishment projects associated with the estates strategy. For further guidance, see . Strategic case: IT schemes only SOC OBC FBC Ref Item Guidance Org Y/N Case ref 1.6.1 Is there a summary of the organisation's current IT capability? Does this identify the starting point for development of the IT scheme? An may include, for example, the configuration of current systems, existing level of integration, extent of paper-based systems and level of IT (information processing) expertise. 1.6.2 Is the ‘gap’ in IT provision – between the current position and the identified objectives supporting health service delivery – known? 1.6.3 Does the programme demonstrate awareness of the relevant government standards and policies for technology? How does it ensure will be met? The Technology Code of Practice and Digital by Default Service standard always apply.
2.5.2 Have benefits and risks been adjusted for optimism bias? Optimism bias and mitigation have been assessed in accordance with the optimism bias guidance on DH (NHS build specific) and/or HMT websites. Adjustments should be empirically (eg using data from past projects or similar projects elsewhere). See pp.29–30 and the . 2.5.3 Have the quantified benefits and quantified risks been combined to establish the NPV for shortlisted options? Investment proposals should provide evidence of the triangulation of demand and capacity modelling, workforce strategy, service development and efficiency programme across the lifetime of the scheme. For approval of capital investment schemes greater than £35 million, and service reconfiguration business the valued benefits must exceed risk-adjusted costs by a ratio of 4:1. This represents the absolute VfM threshold in health spending. However, achieving the threshold is not a simple pass/fail test and each business case will be assessed individually basis. DH economists advise that this is not used as a strict benchmark (that is, some cases fall below the 4:1 threshold, but have other important qualitative/strategic benefits). 2.5.4 Has an appropriate sensitivity analysis of costs, benefits and risks been carried out? This should be undertaken to demonstrate either switching values, with the likelihood of the switch explained, or percentages chosen and the basis for selection explained. It should include the worst case scenario. See pp.32–33.
3.3.5 Is there confirmation that no material changes have been made to the procurement strategy? Or if there material changes have been made, have these been detailed and adequately justified? Procurement process 3.4.1 Was a suitable range of responses/bids elicited in response to the tender process to ensure robust competition? If, for example, only one or two responses/bids have been received (raising the risk of a poor VfM outcome), this situation must be explained, including how it will be mitigated. 3.4.2 Was any shortlisting of supplier responses carried out in the appropriate way, in accordance with the Public Contracts Regulations 2015? An appropriate assessment of each shortlisted supplier (eg Dunn and Bradstreet reports) should be attached to the business case. This should form part of the evaluation of the suppliers which should be documented in the case. 3.4.3 Has an adequate summary of the evaluation process and outcome been included? Does it identify and clearly define all the pros and cons of each shortlisted bid, including the preferred bid? Has the selection of the supplier been carried out fairly and in accordance with the Public Contracts Regulations 2015? The FBC must demonstrate that the appropriate procurement procedures have been followed as required by EC Directives. A copy of the published OJEC notice should be included in the FBC.
3.7.2 Are any staff likely to be transferred? If yes, will TUPE apply? If it does, have all the provisions been complied with? TUPE – Transfer of Undertaking, Protection of Employment Regulations 2006 (and as updated since). This protects the employment conditions of public sector staff transferring to the private sector. 3.7.3 Is there confirmation that plans accord with current guidance and requirements on retention of employment (RoE) as related to pensions, and that there are plans for consultation in accordance with the law/guidance? TUPE protection does not include pensions, and DH developed RoE to cover these. Its use is now specifically restricted to soft facilities management in PFI schemes. If it applies, a copy of the legal advice received must be provided, as well as whether the health organisation’s HR director accepts or disagrees with it and why. Commercial case: schemes only SOC OBC FBC Ref Item Guidance Org Y/N Case ref 3.8.1 Have numbered and dated 1:200 (or electronic equivalent in terms of level of detail) drawings been included? These should: include site plans and elevations, where appropriate be numbered and dated, not loaded and with m2 net internal area (NIA) shown be consistent with the Schedule of Accommodation/Derogation.
3.8.6 Does the scheme demonstrate commitment to the government construction strategy? Evidence to be provided of commitment to government construction strategy including: cost reduction c15% procurement reform building information modelling (BIM) government ‘soft landings’ benchmarking. Applies to all construction including local improvement finance trust (LIFT) schemes. 3.8.7 Has a healthcare planner been appointed to the design team and have they actively contributed to the planning and evaluation process? The proposal should include a description of the service model backed by plans/drawings demonstrating clinical/non-clinical adjacencies.
4.1.3 Have any of the financial models used been appropriately quality assured? The National Audit Office's ( provides guidance on quality assuring modelling. 4.1.4 Have different funding options and their implications been considered? The cost of any funding option should be included. 4.1.5 Is there evidence that a source of (capital and revenue) funding has been confirmed? The proposal must quantify and identify the (a) type of capital funding and (b) source of funding. This must be confirmed by all relevant parties, with their agreement with the need to invest and with the preferred solution. 4.1.6 Have any elements to be funded from external sources been identified, with the profile of funding/spend by year? External sources include borrowing, public dividend capital, charitable, external grants and other non-provider sources. Confirmation in writing by the external provider of the funding must be evidenced. 4.1.7 borrowing is assumed, has the amount of loan, assumed loan term, assumed interest, prudential borrowing assessment and repayments been clearly stated? A statement showing the effect of the loan on the organisation’s financial position and appropriate) financial risk ratings before and after the loan need to be modelled and should be included in the business case.
4.5.4 Where land sale proceeds are to be used, does the business case set out the valuation basis, timing for sale and a contingency for downward market movements? Has the valuation been on the advice of a suitably qualified and experienced valuation surveyor? Use of land sale proceeds should be agreed with all relevant parties, eg NHS Property Services, DH. Any cost benefits or non beneficial aspects to the sponsoring NHS organisation(s) linked to the acquisition or disposal of land as part of the business case must be clearly stated, and the net financial impact on them made explicit in the financial modelling and affordability analysis. See 3 (Land and buildings) of the . 4.5.5 Has the organisation taken appropriate advice regarding asset impairments? Financial case: IT schemes only SOC OBC FBC Ref Item Guidance Org Y/N Case ref 4.6.1 Have the of implementation and business as usual (BAU) been included in the analysis? Over what timescale?
5.1.5 Once the OGC gateway RPA has been completed, are there clear arrangements for peer reviews? Confirmation should be provided that recommendations, in particular high priority recommendations, are addressed. Schemes with high RPA scores of 41+ will require a gateway review. Medium scoring schemes may be subject to gateway review at the discretion of the SRO. 5.1.6 Are plans and a budget in place for post implementation monitoring and post-project evaluation (PPE)? Is a clear definition of the scope of the PPE, approaches to be adopted (eg the Magenta Book), timescales and specific milestones reviews? Plans should be consistent with the benefits identified in the economic case and in line with overall objectives. What is the resource for this? Are costs for PPE included in the project cost? Participation in wider aggregate research may also be appropriate and beneficial. Note: a 5 in-use design quality indicator (DQI) assessment is classified as an element of PPE. The DQI PPE supports the benefits realisation PPE requirement of the CIM and government mandatory BIM () ‘soft landings’ process for 2016 (). Project management
2.2.1 Use of the facility: model of care patient need privacy and dignity workflows and logistics adaptability security. There is evidence that consideration has been given to future proofing the investment/facility/capacity/ capability. Will the design be appropriate for patient need? Has the importance of privacy and dignity to individuals been considered? 2.2.2 Describe and set out the access requirements for patients, staff and visitors. Consider way finding and signage, patients with disabilities, parking, goods and vehicle separation, and pedestrian access and exits. 2.2.3 Describe in the facility – patient space standards. Describe and set out the arrangements for public clinical 2.2.4 What is the impact of estates derogation on clinical care? Derogations must be approved by the medical and nurse directors of the organisation. 2.2.5 What is the impact of clinical adjacencies in the scheme design? What consideration has been to the impact of clinical and non-clinical adjacencies in the scheme design? Confirm that the health organisation has appointed a healthcare planner as part of the design team and this person has actively contributed to the planning and evaluation process. Describe the service backed by plans/drawings demonstrating clinical/non-clinical adjacencies.
2.2.6 What consideration has been to: provision of carer and parent accommodation meeting needs of staff and patients. 2.2.7 Have frontline staff and patients been involved in the design of the care environment? How have patients, the public, staff and other stakeholders been involved in shaping proposals? 2.2.8 Describe how the capital scheme proposal will improve the organisation’s patient-led assessment of the care environment scores). PLACE assessments give patients and the public a voice on local standards of care. 2.3 Does the IT system integrate with other systems for the purposes of patient quality and safety? There is evidence that the organisation has considered: system integration impact on patient safety and clinical quality clinical engagement clinical knowledge and use of the system clinical benefits realisation. Demonstrate how the IT system will integrate with other systems for the purposes of patient quality and safety. Describe and present the findings and outcome of the risk assessment and the impact on quality, including risks identified and the mitigation plan? Present the added clinical benefits of the new system. Provide evidence of clinician engagement and involvement in the project governance process.
Leadership and stakeholder engagement 2.4 Can the organisation demonstrate engagement with clinical leaders, frontline clinical and non-clinical staff, and other key stakeholders in shaping investment proposals. The business case and supporting evidence demonstrates the aspects described in clinical quality – checklist reference 2.4.1 to 2.4.3. Describe how executive clinical leaders, frontline clinical and non-clinical and other stakeholders have been involved in shaping and influencing proposals, including eliciting and acting on patient feedback. 2.4.1 Describe stakeholder engagement: involvement shaping developments high level of engagement with clinical staff.