1. Gill Smith Innovation & Quality Improvement Lead, NHSCT
The Recipe for Success The right ingredients for a simulation business case
Gill Smith
Innovation & Quality Improvement Lead, NHSCT

2. What is a Business Case .…the terms people use
Outline Business Case (OBC)
Investment Appraisal
Investment Proposal
SOC required only where the planned expenditure exceeds £20m or where the project is novel, contentious, sets a precedent or could have repercussions across other Departments
OBC sets out the strategic need for project and identifies a number of options for meeting this need. The preferred option is the one which is deemed to offer the best value for money and is identified by comparing and assessing options against their costs, benefits and risks. Both monetary and non-monetary and costs and benefits are examined. Also includes an affordability assessment, proposed arrangements for financing, management, market, procurement, monitoring and evaluation of the preferred option.
There are 10 basic steps to an OBC – the level of information provided should be proportionate to scale and cost of the project.
DoF have a template designed to cover expenditure up to £2m
OBCs are submitted to the Investment Directorate, DoH for assessment/approval.
FBC – must be documented prior to financial closure and award of contract. Contains all the information required to award the contract and commit funding. Should address the conditions included in the letter of approval for the OBC.
PROVIDE HANDOUT ON 10 BASIC STEP AND GUIDANCE FOR COMPLETION
“Green Book” business case
Economic Appraisal

3. The “Technical Challenge”
A business case is often required to secure investment (capital, revenue or both) to fund the development of simulation
Various documentation is required at different stages to inform key decisions, principally:
Strategic Outline Case (SOC) – unlikely to be required
Outline Business Case (OBC) – required
Full Business Case (FBC) – likely to be required for ‘test drilling’
SOC required only where the planned expenditure exceeds £20m or where the project is novel, contentious, sets a precedent or could have repercussions across other Departments
OBC sets out the strategic need for project and identifies a number of options for meeting this need. The preferred option is the one which is deemed to offer the best value for money and is identified by comparing and assessing options against their costs, benefits and risks. Both monetary and non-monetary and costs and benefits are examined. Also includes an affordability assessment, proposed arrangements for financing, management, market, procurement, monitoring and evaluation of the preferred option.
There are 10 basic steps to an OBC – the level of information provided should be proportionate to scale and cost of the project.
DoF have a template designed to cover expenditure up to £2m
OBCs are submitted to the Investment Directorate, DoH for assessment/approval.
FBC – must be documented prior to financial closure and award of contract. Contains all the information required to award the contract and commit funding. Should address the conditions included in the letter of approval for the OBC.
PROVIDE HANDOUT ON 10 BASIC STEP AND GUIDANCE FOR COMPLETION

4. Level of Investment, Delegated Limits & Effort
Up to and including £50k – 2-3 pages
Over £50k and up to £250k – 5-10 pages
Over £250k and up to £1m – pages
For investment up to £1m Trusts have delegated limits that they can work within, and can secure general capital within their own organisation. This means they develop the Business Case, but have the ability to improve internally. Over this amount requires business case to be approved by DoH and funded by them through allocation.
Annually the DoH will ‘Test Drill’ a sample of delegated limited business cases to gain assurance that Trusts are carrying out the process in accordance with the guidance.
The level of detailed included in the BCs is commensurate with the level of investment and each delegated limit threshold has a standard template to complete.

5. How to make a ‘Show Stopper’
Engage early with relevant colleagues (its not just finance!) to develop the business case, secure their input, buy-in, get relevant internal approvals
Don’t just think of the capital – there will be revenue consequences – Sim Lead, Faculty input, Tech/AV support, admin support, storage
Be clear about your funding model – can you generate revenue?

6. How to make a ‘Show Stopper’
Get equipment recommendations from sources such as Technician's Network
Procurement advise from PaLs
Consider - set-up times, reliability, ease of use, popularity amongst educators, usual applications, limits on the system etc.
Can equipment be easily transported if required?
Is the supplier listed on the NHS Supply Chain and added to the preferred suppliers list for the Trust – this can speed up procurement
If the engineers used are not Belfast based there can be days of lead time to get a call out
Some companies send equipment to Japan or USA for repair – this could mean equipment could be out of commission for a long time
NHSCT had to identify and secure funding for some storage post business case. Original case did not include any revenue consequences outside equipment maintenance i.e. Sim Lead, Tech/AV support, Admin. Further funding had to be secured later.
Example from one Trust that needed 8 front of neck access trainers for a course, these cost £360 each with replacement parts of £100.  However a 3D printer is £3,000 and can print 8 models for £15 in consumable materials, and can also print a variety of other models, representing a long term saving in the Trust.

7. How to make a ‘Show Stopper’
What maintenance contract will be included and where from?
What are the common consumables and their costs?
Is equipment flexible in its application?
Secure storage for equipment and course materials is often overlooked
NHSCT had to identify and secure funding for some storage post business case. Original case did not include any revenue consequences outside equipment maintenance i.e. Sim Lead, Tech/AV support, Admin. Further funding had to be secured later.
Example from one Trust that needed 8 front of neck access trainers for a course, these cost £360 each with replacement parts of £100.  However a 3D printer is £3,000 and can print 8 models for £15 in consumable materials, and can also print a variety of other models, representing a long term saving in the Trust.

8. How to make a ‘Show Stopper’
Make early contact with finance colleagues in your Trust – you need their input and expertise
For significant investments always try and prepare the ground early on with an informal meeting with relevant DoH colleagues
Test your business case against the DoH checklist for completion of economic appraisals
Give them copy of checklist

9. How to make a ‘Show Stopper’
Common pitfalls include:
not making your objectives SMART (quantifiable and time-bound is key) limited options explored
failure to consider monitoring/evaluation
not using a weighted scoring approach to options
not including the reasons for non-selection of other options
Assessment of risks across options not robust
Be prepared to queries – it’s unusual to get approval in the first pass

10. What is the ‘cook period’?
Trust develop case – anything from 2 mths to longer (depending on scale)
Internal Trust approvals – key sponsor, finance, SMT (at least 2 mths)
DoH Economists – first pass and then queries returned (1-2 mths)
Trust – resolution of DoH queries and return to DoH (at least 2 mths)
DoH – (i) content to progress to DoF or (ii) further queries to Trust (1- 2 mths)
DFP review – queries and resolution (2-3 mths)
DFP – final approval and allocation letter (1 mth)
There are many cooks in the tent!
Timelines are not definitive but based on experience and common practice
Some local arrangements may apply i.e. Trust Board approval
Not everything goes to DFP – depends on value

11. This is where you get SMART!
S – Specific M – Measurable A – Achievable R - Realistic T - Time bound
Group exercise for 20 mins and then feedback on setting SMART objectives for a simulation business case (capital and revenue)

12. This is where you get SMART!
Some tips to get you thinking….
Patient safety
Expanding your offering
Adverse incidents and near misses
Wider human factors
Patient experience
Also….. How will you evaluate objectives?
Revenue generation by X amount X date by offering simulation resources to third parties. Ability to generate income in line with the business model approved for Simulation, and the goal of self-sustainability of the model
Deliver the learning experience to other locations through the use of video conferencing – which will promote widespread learning and development opportunities.
Reduction in travel costs through use of VC sim training
Reduction in adverse incidents. Post implementation evaluation could assess the rate of adverse incidents reported for procedures for which simulation training is provided against those where simulation training is not provided.
Using simulation to learn from adverse incidents as proposed to traditional investigation methods
Increase level of multi-disciplinary based learning
Improve team work and communication through scenario based learning

13. Making your own ‘Signature Bake’ – where do you find out more?
Northern Ireland Guide to Expenditure Evaluation and Appraisal (NIGEAE)
PPE evaluation required. If less than £50k within 12 months. Over £50k quick exercise after one month and then externally commissioned evaluation within 12mths