Authors: Liz Knight
Published: 20 May 2020

Service reconfiguration often requires the development of a Pre Consultation Business Case (PCBC). A PCBC is the document on which a decision to consult on service change is taken, as shown below. 

 

What a PCBC is

  • A Word document with a mix of text and exhibits (slides) that is approximately 100 pages in length with an additional 250 pages of appendencies
  • A formal Board document which presented the business case for changes on which the CCGs agree to consult
  • The legal document that will be scrutinised as part of a Judicial Review so it must be complete and correct
  • The document in which CCGs show that they have properly considered the option, undertaken pre-consultation engagement, submitted to the required scrutiny and met the four test and three conditions.

What a PCBC isn't

  • Is NOT the consultation document. A public-facing 20-30 page summary document will be produced for consultation.
  • Is NOT the final business case - following consultation a decision-making business case (DMBC) will be produced which will be the basis for the final decision to proceed with changes. Additional implementation business cases may then be required (for example, provider business cases for capital funds)
  • Is NOT a report of the project i.e. it won't include a description of the process followed to develop the PCBC expect at a very high level


A successful PCBC needs to:
 

  • Incorporate the views of key stakeholders whilst remaining internally consistent. 
  • Establish a single narrative voice with a strong golden thread running throughout the document. 
  • Be based on robust analysis and a credible decision-making process. 
  • Be publicly signed off by key stakeholders such that they are invested in its success. 
  • Have an eye to the eventual decision-making business case and final decision on service change, such that the final process stands up to judicial review. 

 
At CF, our approach to authoring the pre-consultation business case is to: 

  • Agree on framework for the PCBC. This includes the headline content, the process for iteration and sign-off and a plan for development. Each of the sign-off points is mapped alongside a consideration of what is required in the PCBC to ensure it is ultimately successful (for example, in successfully getting through the Trust Board, Health Overview & Scrutiny Committee (HOSC), CCG/ICS approval, investment committee, judicial review and any Independent Review Panel (IRP)). 
  • Collect and review the available information and identify any immediate gaps. We then work with content leads to agree and manage a process for filling these gaps. This work needs to start early to ensure there is time to fill any critical gaps. 
  • Draft, iterate and agree on the 2-page storyline. We find it is very helpful to start with a short storyline or executive summary for the PCBC around which the full document can be built. This is the storyline around which key stakeholders can coalesce and forms the basis for the communications effort around the consultation. It is easier to get agreement on a short document at the beginning of the process rather than trying to get everyone to agree with an executive summary after the PCBC has been written. Developing this storyline is an iterative process which is done alongside the review of information.  
  • Draft PCBC. Once the storyline has been agreed, the PCBC can be drafted. Depending on the local resource, this can either be done by local content leads and then edited into a single narrative voice, or the content can be written into a business case by one author. We are experienced in doing this either way.  
  • Iterate with a small group of stakeholders. We find that it is more helpful to iterate the often 250-300 page PCBC with a small group of people, usually the SRO, the clinical lead, the Finance Director and the programme team. It works well if each section of the PCBC has a named lead for detailed review and sign-off. It is also important to have legal input and communications input to ensure that the document is JR-proof.  
  • Navigation through the approvals process. The PCBC then needs to be navigated through the approvals process which may require iteration with NHSE (or the ICS/STP) before it is made public and signed-off by the Trust Board, CCGs/ICS/STP, HOSC, investment committee and NHSE. The sign-off process can be very complicated and requires early agreement alongside proactive stakeholder management. 

It is important to include communications colleagues at an early stage so that the content within the PCBC reflects what is ultimately in the consultation document.

Managing the multiple stakeholders can be difficult when developing a 250-300 page PCBC which is why we advocate: 

  • Mapping of stakeholders and designation of responsibility for individual stakeholder management to senior members of the team, alongside robust communication and engagement plan. 
  • Early development of a 2-page storyline around which key stakeholders can coalesce – this is easier than trying to agree a 250-300 page document. 
  • Early agreement on the process for signing off the PCBC, such that key stakeholders are publicly tied into the document and everyone understands the key dependencies. 
  • Early engagement with NHSE, especially investment committee, as this is often a limiting factor on timing. We have a wealth of experience in managing this process. 
  • Early engagement with the Health Overview and Scrutiny Committee and local politicians to ensure early buy-in and the early sight of issues, which may be able to be resolved prior to completion of the PCBC. 
  • Clinical leadership of the document and sign-off from the lead clinicians to ensure they own the document and are happy to communicate it to other key stakeholders. 

At CF, we have extensive experience of developing PCBCs, supporting consultations, and navigating the regulatory assurance and approvals process. This includes Shaping a Healthier Future in NW London, the recent Kent & Medway stroke reconfiguration, Healthier Together in Greater Manchester, Community Hospitals in Devon and the Guernsey Princess Elizabeth Hospital modernisation programme.