Business Case Process

Transcription

1 Reference Number: GuCG005 Version: 1.0 Name of Originator / Author & Organisation: Responsible LECCG Committee: LECCG Executive Lead: Date Approved by LECCG Authorising Committee: Matthew Broughton & Ben Fawcett, LECCG Risk & Governance Committee Sandra Williamson Risk & Governance Committee Target Audience: Distributed via: All Staff Intradoc Website Date Policy Circulated: Page 1 of 19

2 Version Control Sheet Version Section / Para / Annex Version / Description of Amendments Date Author / Amended by 0.1 draft All sections Ben Fawcett 0.2 draft All sections Matthew Broughton 0.3 draft 2, 3, 4 Minor amendments Audrey Brown 0.4 draft 2, 3 Amendments to sign off points for project brief and business case. Introduction of decision tree and prioritisation matrix Matthew Broughton 0.5 draft 2,3, Appendix 3 Change of title of weekly QIPP meeting Matthew Broughton 0.6 draft 2 para 1,3 & 4 Minor re-wording; addition of QPDM membership 0.6 draft Review Date Extend Review Date by 6 months as no changes at this time. 1.0 Section 6 Equality Impact Assessment included Audrey Brown Matthew Broughton Ben Fawcett Page 2 of 19

3 Contents 1 BUSINESS CASE PROCESS THE IDEA STAGE THE DESIGN STAGE THE DELIVERY STAGE Project Gannt Risks and Issues Monitoring & Benefits Realisation THE PROJECT REVIEW APPENDIX 1: PROJECT BRIEF TEMPLATE APPENDIX 2: BUSINESS CASE TEMPLATE APPENDIX 3: APPROVAL PROCESS APPENDIX 4: PRIORITISATION MATRIX Page 3 of 19

4 1 Having a clear process for the development of business proposals and project management methodology provides the CCG with assurance that business processes are adhered to and sound governance is in place. This document sets out the business case and project management approach adopted by. The CCG has adopted a 4 stage business case and project management approach. Each stage must be completed and approved by the relevant group or committee (detailed within this document). The 4 stages are: The Idea Stage (Project Brief) The Design Stage (Business Case) The Delivery Stage (Implementation Plan) The Review Stage (Evaluation & Benefits Realisation) 2 The Idea Stage The idea stage is designed to enable members of the CCG to put forward ideas of service development, improvement, commissioning or decommissioning of services. At this stage the idea needs to be worked up in enough detail so a decision can be made on whether this is something worth investing time into developing a full business case, something that can be approved and move straight to delivery, or something that should not progress further at that particular moment in time. The Project Brief (see appendix 1) helps identify the aims and objectives of the idea, the major deliverables, stakeholders, resources needed to deliver, benefits, financial implications and any foreseeable risks. It also helps identify how the idea fits with the strategic aims of the organisation. Once the idea has been developed it will be taken to the weekly QIPP Planning and Delivery Meeting (QPDM), for approval on whether to progress. The QPDM will review the Project Brief and decide if this is something that: supports organisational aims and objectives; is affordable; is a priority; whether the idea can proceed straight to delivery, - if it requires development of a business case for sign off or - to cease pursuing the project further at that time Page 4 of 19

5 Membership of the QPDM is as follows: Core Attendance Accountable Officer (Chair) Interim Turnaround Director (Vice Chair) Chief Finance Officer or Deputy Chief Finance Officer Lead Nurse for Quality & Safety Programme Leads Other Attendees Development & Delivery Managers Clinical leads for specific schemes Arden & GEM Contracting/Commissioning Intelligence Page 5 of 19

6 The following decision tree will be used by the QPDM in order to make a decision on whether the idea should be progressed: Idea Does it maintain or improve health outcomes? Yes No Is there a net saving? Case for a clinical policy? Yes No No Yes Assess way forwards using prioritisation matrix (See Appendix 4) Do not progress Do not progress Develop clinical policy High Priority Rework proposal Med Priority Low Priority Stop Page 6 of 19

7 A business case will be required in the following instances: i. When financial investment is required ii. When there is need for commissioning or decommissioning of services A business case will not be required when: i. The idea doesn t require any additional financial investment or human resource ii. There is no need for any service commissioning or decommissioning If agreed that the project will go forward and require a business case, a project team will need to be assigned. This team will work together in order to develop the business case. The project team will consist (as a minimum) of: i. Project Manager ii. Clinical Lead iii. Executive Lead (SRO) iv. Finance Lead The project team will be entered into the PMO software. Should QPDM decide (with the aid of the decision tree) that the idea should not be pursued further the project will be closed. The outcome from QPDM must be recorded within the PMO. Idea Stage Summary Key Documentation Project Brief Complete Project Brief within the PMO software Take to QPDM for approval decision tree applied Continue to design or delivery stage or close the project Identify project team if project brief is approved Record QPDM outcome on PMO See appendix 3 for process flow diagram Page 7 of 19

8 3 The Design Stage Following agreement to progress, the project will enter the design stage (unless QPDM have decided that the work can bi-pass this stage and go straight to the implementation stage). During the design stage a thorough business case (see appendix 2) will be developed within the PMO software. The business case will include the following details in order for the CCG to make a final decision on whether the project goes forward to delivery: i. Background ii. The case for change iii. An options appraisal and recommended option iv. Benefits of the recommended option v. Identification and grading of risks vi. Financial costs vii. Changes in care settings viii. Financial scenario planning ix. Human resource requirements x. Stakeholder analysis xi. Market analysis and procurement process (including advice from procurement panel) xii. Measuring and monitoring xiii. Impact analysis (health impact assessment, equality and diversity assessment, quality impact assessment, information governance assessment) All of the above will be completed within the PMO software. The business case will be a joint piece of work between the project team. Clinical expertise will be required from the clinical lead and financial expertise will be provided by the finance lead. In order to ensure that the development of business cases is clinically led, the clinical forum should also be engaged during this stage to obtain a wider clinical perspective and involvement. When the business case is completed the executive lead will scrutinise and make any amendments/advise on further detail required. Once the executive lead is satisfied with the final draft, they will take the business case to the next available QPDM for discussion with project lead support if required. QPDM will assess each business case. The outcome will be one of the following: i. Business case is approved by QPDM and the project can enter the delivery stage Page 8 of 19

9 ii. iii. QPDM require further information in order to make a decision (specific feedback will be provided to the project team on what additional information is required) The business case is not approved and the project is ended (in this instance QPDM will provide rationale of why the business case was not approved) The QPDM decision will be entered onto the PMO software. Design Stage Summary Key Documentation Business Case Complete all elements of Business Case including impact analysis All members of project team make contribution Executive lead to present business case to QPDM Business case either approved, requires more information or closed Record outcome on PMO See appendix 3 for process flow diagram. Page 9 of 19

10 4 The Delivery Stage The purpose of the delivery stage is to deliver the aims and objectives of the project. The project team will need to identify all the required tasks that need to take place in order to deliver the project outcomes. 4.1 Project Gannt The key tasks and milestones will be entered into the PMO software with anticipated timescales for completion. This will produce a project gantt chart. The gantt chart will be a live document that requires regular updating throughout the delivery stage. When new tasks are identified they need to be added with timescale. When tasks and milestones are completed they will need to be signed off within the PMO software to demonstrate progress. 4.2 Risks and Issues Project risks and issues will need to be monitored and updated during the lifetime of the project. This will be done within the PMO software. An issues and risk report will be available at individual project level or as part of the PMO governance process at the request of the appropriate committee. Risks that turn into issues (i.e. a risk is something which could potentially happen and an issue is something that has/is happening) need to be escalated to the project executive lead so that plans can be made of how to manage the issue and prevent it from endangering successful delivery of the project. 4.3 Monitoring & Benefits Realisation Projects will need to clearly identify how they will be monitored during the development of the business case. Monitoring is important to ensure that the project delivers the benefits that it set out to achieve. Implementation Stage Summary Key Documentation PMO Gantt Identify how the project will be delivered Input key tasks and milestones into the PMO software Update tasks, milestones, risks and issues throughout the project Monitor the project outputs to ensure benefits are being realised Page 10 of 19

11 5 The Project Review The project review stage is required once the project itself has reached its end and the work either ceases or becomes business as usual. The project review helps the project team and CCG reflect on the lifetime of the project and whether or not it delivered its aim and objectives and realised the identified benefits. This is an important stage of the process as valuable learning can be taken from every project no matter how successful or unsuccessful it may have been. 6 Equality Impact Assessment The production of all project documentation should conform with LECCG s Equality and Diversity Policy, and should reference equality objectives to show consideration to the CCGs duty on health inequalities. This can be done initially using brief screening tools to determine if the full Equality Impact Analysis process is to be undertaken. Project leads should also give consideration if a PPI assessment is required, which should assess the type and level of involvement/consultation required (with reference to the legal duties specified in the Health and Social Care Act). More information can be found in the guide referenced below: Guidance for NHS commissioners on equality and health inequalities legal duties (2015) CCGs have duties to: Have regard to the need to reduce inequalities between patients in access to health services and the outcomes achieved (s.14t) Exercise their functions with a view to securing that health services are provided in an integrated way, and are integrated with health-related and social care services, where they consider that this would improve quality, reduce inequalities in access to those services or reduce inequalities in the outcomes achieved (s.14z1) Include in an annual commissioning plan an explanation of how they propose to discharge their duty to have regard to the need to reduce inequalities (s. 14Z11) Include in an annual report an assessment of how effectively they discharged their duty to have regard to the need to reduce inequalities (s. 14Z15). Page 11 of 19

12 Appendix 1: Project Brief Template Project Brief Project Title Date Programme Lead Executive Lead Clinical Lead Finance Lead Background Aim and Objectives For example: The aim is to reduce emergency admissions. The objective is to commission a service that targets adults most likely to be admitted as an emergency and manage their condition better in the community to prevent emergency admissions. Major Deliverables Give the major milestones that need to be completed in order to achieve the objective. Give timescales for each milestone. Project Stakeholders Identify the stakeholders who need to be informed and involved. What is the likely impact on these stakeholders, for example will some providers see a reduction in activity. Benefits What are the benefits e.g. reduction in emergency admissions? Will there be a negative impact on patient Page 12 of 19

13 care? How will the benefits be measured? Include indicators using hard data (e.g. SUS/SLAM) and in flight indicators. Finance What is the gross in year saving? Is there any financial investment required? What is the net in year saving? What is the full year net saving? Resources required to deliver (including human resource) Can delivery of this project be achieved within existing resources (remember to include finance, commissioning intelligence, procurement support etc? Risks Use the risk log in the PMO. Assess risks using PEST approach (i.e. what are the political, economic, social and technological risks). Are there any other risks identified? Strategic Alignment (tick up to a maximum of 3) 9 CCG Must Be Done s Contribution 1. Develop a high quality and agreed STP, and subsequently achieve what you determine are your most locally critical milestones for accelerating progress in 2016/17 towards achieving the triple aim as set out in the Forward View. 2. Return the system to aggregate financial balance. This includes secondary care providers delivering efficiency savings through actively engaging with the Lord Carter provider productivity work programme and complying with the maximum total agency spend and hourly rates set out by NHS Improvement. CCGs will additionally be expected to deliver savings by tackling unwarranted variation in demand through implementing the RightCare programme in every locality. 3. Develop and implement a local plan to address the sustainability 4. Get back on track with access standards for A&E and ambulance waits, ensuring more than 95 percent of patients wait no more than Page 13 of 19

14 four hours in A&E, and that all ambulance trusts respond to 75 percent of Category A calls within eight minutes; including through making progress in implementing the urgent and emergency care review and associated ambulance standard pilots. 5. Improvement against and maintenance of the NHS Constitution standards that more than 92 percent of patients on non-emergency pathways wait no more than 18 weeks from referral to treatment, including offering patient choice. 6. Deliver the NHS Constitution 62 day cancer waiting standard, including by securing adequate diagnostic capacity; continue to deliver the constitutional two week and 31 day cancer standards and make progress in improving one-year survival rates by delivering a year-on-year improvement in the proportion of cancers diagnosed at stage one and stage two; and reducing the proportion of cancers diagnosed following an emergency admission. 7. Achieve and maintain the two new mental health access standards: more than 50 percent of people experiencing a first episode of psychosis will commence treatment with a NICE approved care package within two weeks of referral; 75 percent of people with common mental health conditions referred to the Improved Access to Psychological Therapies (IAPT) programme will be treated within six weeks of referral, with 95 percent treated within 18 weeks. Continue to meet a dementia diagnosis rate of at least two-thirds of the estimated number of people with dementia. 8. Deliver actions set out in local plans to transform care for people with learning disabilities, including implementing enhanced community provision, reducing inpatient capacity, and rolling out care and treatment reviews in line with published policy. 9. Develop and implement an affordable plan to make improvements in quality particularly for organisations in special measures. In addition, providers are required to participate in the annual publication of avoidable mortality rates by individual Page 14 of 19

15 Appendix 2: Business Case Template LECCG Business Case Project Title Date Programme Lead Executive Lead Clinical Lead Finance Lead Version 1. BACKGROUND - include aims and objectives 2. CASE FOR CHANGE State the reasons why you want to make the change and ensure that the following bullet points are included in your description where appropriate. Current position Why is there need for change Best practice Describe what the options for change are 3. OPTIONS APPRAISAL Options Benefits Dis-benefits 1. Do nothing Recommended option to take forward Page 15 of 19

16 4. BENEFITS OF RECOMMENDED OPTION provide detail of the benefits of the recommended option using the following headings Patient experience Quality Clinical effectiveness Cost Workforce Patient Safety 5. RISKS OF RECOMMENDED OPTION complete risk tool Risk Mitigation 6. CHANGE IN CARE SETTINGS complete the changes in activity for the relevant sector Activity changes for primary and community care Activity changes for secondary care Activity changes for third sector - (voluntary/private sector) Activity changes for mental health care 7. COSTS - completed with finance department Cost of current service - Include the type of cost i.e. PBR, Block contact Cost of new service/service change Where known, even if rough costs Recurrent revenue impact - (old and new, please include impact on primary, secondary, tertiary, mental health where applicable) Non-recurrent revenue costs - (e.g. set-up) Identify where investment will come from (if required) 8. FINANCIAL SCENARIO PLANNING - complete with finance department Best case Worst case Middle case Page 16 of 19

17 9. HUMAN RESOURCE an estimate of what will be required to complete the project Project team resources Time 10. STAKEHOLDER ANALYSIS Complete the stakeholder analysis tool 11. MARKET ANALYSIS and PROCUREMENT PROCESS Current market profile e.g. number of providers, activity, performance etc. Desirable market state competition in, or for, the market Market management levers to be employed competition, performance management, substitution, new entrants, consolidation of market Procurement process as identified via the procurement decision flowchart Key timelines agreed for procurement process detailed in procurement plan, where known. 12. KEY PERFORMANCE INDICATORS How will the success of the project be measured (both quality and financial)? What information sources will be used? How often will KPI performance be updated? Page 17 of 19

18 Appendix 3: Approval Process Write Project Brief Send to weekly QPDM Apply decision tree and prioritisation matrix Not approved Close project Idea Approved Does the project: Require financial investment? Involve decommissioning or commissioning of services? If answer Yes to any of the above If answer No to all of the above Business case is required No business case required Assign Project Team: Assign Project Team: SRO Clinical Lead Project Manager Finance Lead SRO Clinical Lead Project Manager Finance Lead Project Team write Business Case Take to Clinical Forum for clinical engagement SRO/project manager presents Business Case to weekly QPDM meeting for sign off More information required Business Case not approved Business Case approved Obtain feedback and reason Close Project Proceed to Delivery Stage Review Date: March 2017 Page 18 of 19

19 LEVEL OF SAVINGS LOW < 0.2m MEDIUM 0.2M HIGH > 0.5M Appendix 4: Prioritisation Matrix HIGH PRIORITY High level of savings from low investment IMMEDIATE HIGH PRIORITY High level of savings from medium investment < 1 YEAR MEDIUM PRIORITY Level of investment means implementation over longer period 2+ YEARS HIGH PRIORITY Medium level of savings from low investment < 1 YEAR MEDIUM PRIORITY Level of savings needs analysing to ensure benefit is realised 1-2 YEARS LOW PRIORITY Level of savings needs analysing from low investment 2+ YEARS LOW PRIORITY Low level of savings means benefits unlikely to be significant 1-2 YEARS STOP Level of investment greater than benefits STOP Investment greater than benefits LOW MED HIGH LEVEL OF INVESTMENT Review Date: March 2017 Page 19 of 19