We understand the steps that need to be taken to develop a robust business case in line with HM Treasury Green Book. Conceptually, to see this through to delivery clients need to move through a process which is worked through progressively over time SOC, OBC and FBC and reflect the five-case model specified by the Green book. In practice, elements of the five-case model vary in their development over time with the strategic case being developed first, the economic and financial case next and the commercial and management case tending to be developed last. 

Overview of our approach

  1. Understanding the case for change, the needs of the population in the local place, and the clinical strategy at a high level. Ideally, aspiration or vision can be articulated.
  2. Redesigning the models of care to develop what changes in the key pathways within the hospital and across the system are desired – and particularly what can be facilitated by the application of capital.
  3. Robust demand and capacity modelling to understand current and historic demand and project forward demand in "do nothing" and considering transformation opportunities. Typically, a capital programme needs to project forward demand over 30 years and to express that demand as capacity which is then compared to capacity availability.
  4. Developing operational policies and co-adjacencies comes next. This would detail policies on staffing levels, opening hours etc which help to translate activity into capacity requirements.
  5. A schedule of accommodation can then be developed which is crucial to the design team brief. This details the rooms required and space needed.
  6. Developing options will then be led by the design team. They will need to engage with clinicians and estates professionals to develop concept designs which are captured as options.
  7. Options will be appraised by clinicians and managers for quality, deliverability and revenue and capital costs. A structured process from nearly infinite options to long list to shortlist is followed.
  8. Setting on a preferred option more detailed designs can be developed, and engineering work undertaken in support. This will, in turn, allow more detailed costing. Procurement processes for construction can be undertaken and, in parallel, final planning consent approved.

Clinical strategy

Our process reflects clinical strategy and pathways, robust analysis and cross-functional engagement, as illustrated below:

Processes like this typically take a substantial time to conclude and involve weaving through the different strands of work. Below is a typical approach:

Options appraisal

A key aspect of the business case process is working through the development and then an appraisal of a range of options.


Understand the differences between the new CIA model and GEM