System-wide working has brought new possibilities for better integration across health and social care services. Cost pressures and increasing waiting lists require openness to new and different projects that can improve patient outcomes and enable the NHS to achieve more for less. But the high demand means most effort is currently focused on delivering day-to-day services. And, to make it harder, funding for new projects is extremely limited.
So, organisations looking to innovate need to make it as easy as possible for an integrated care board (ICB) to say yes to their proposal by putting forward a robust case for change. While the exact content will change depending on the nature of the activity, we have identified five key areas to focus your attention based on our experience of NHS funding bids and new projects.
1. Set out a clear case for change
Define your vision, clearly articulating the purpose of your project and the change you are looking to implement. Explain the benefits you intend to deliver and how the outcomes will be measured. Include evidence to support your bid – where have similar programmes worked elsewhere? What literature reviews or data support your case? Using population health data and scenario modelling, provide a baseline showing the trajectory of the existing service or approach if you do nothing, compared with the expected impact of the change. You may want to show different scenarios to add depth to your proposal, but more detailed modelling is best done separately, with key findings summarised in your business case.
2. Identify priorities and funding
ICB finance directors will be looking for two things – a link to ICB priorities or a clear source of funding. Ideally, there will be both. Familiarise yourself with your ICB’s Joint Forward Plan and national NHS priorities and indicate how your project will support these. Be explicit in the information you provide, showing how your bid will help the ICB achieve its goals.
This was a key element in the successful funding bid put forward by Sowe Valley PCN in developing an anticipatory and targeted care model for patients. The PCN’s bid was aligned with and linked to system priorities and established approaches to population health management, helping the ICB to easily identify how the project supported its forward plan.
Do your research on available funding and clearly identify suitable national, regional and local funding pots. If you have already identified an appropriate funding source and identified how your change will meet system priorities, it will be easier for your ICB to give the green light.
3. Demonstrate the financial impact
Articulating the financial impact of your change is about more than cost savings, albeit that is often a compelling argument. Your business case should cover:
- Cost efficiency – how your change will deliver more within existing resources such as better throughput and caseload management
- Cost effectiveness – cost efficiencies that also deliver better patient outcomes
- Cost reduction – where the project may lead to reduced costs, such as upskilling nurses resulting in reduced demand on GP time
- Cost savings – actual savings which can be realised and spent elsewhere.
4. Demonstrate the impact on workforce and patients
Funding bids often overlook the impact on the workforce, which is especially important given resource constraints and the challenges of integrated working. The business case for your new project should acknowledge where a system is culturally and identify where a separate workstream may be required to support teams through change. Doing this well can directly affect the financial impact of a project. Retaining staff is often far more cost efficient, saving time and money on recruitment and training, as well as having a positive impact on patient satisfaction.
For example, in working with South Warwickshire GP Federation to develop a new Primary Care Gynaecology Service, we were able to highlight that local clinicians would be able to extend their experience and expertise within gynaecology. This would help to attract and retain staff, while patients would benefit from quicker treatment, often closer to home.
In identifying patient impact, you should set out how you have engaged with patients in developing the project and the impact you expect to see in terms of patient experience and/or health outcomes.
5. Understand the governance and decision-making process
As part of your due diligence, it’s important to clarify who needs to approve the bid and which groups or committees need to review it. In some situations, the approval process for a project may be separate to the funding decision. If funds are being held by a trust, for example, on behalf of a system, it is likely your project will need to go through both the ICB’s governance process to secure support for the project, as well as a separate process to access funding. Understanding and planning for this from the outset will reduce the risk of unexpected delays or obstacles later on.
Rather than waiting for your bid to reach the board table before discussions take place, socialise the business case with your stakeholders across the system so that partners have time to fully understand the case for change and address any queries. Not only does this encourage better integration, but it also allows board meetings to focus on the key discussions with all the relevant information at hand to be able to make a decision.
Encouraging innovation and sharing best practice are key to improving the sustainability of the NHS and improving patient outcomes. By creating a robust case for change, supported with clear evidence, funding and appropriate support, system partners can accelerate change and achieve more within limited resources.
Mui Wan is associate director for finance and performance improvement at NHS Arden & GEM.
