1.3 How can the CHIA support business case development?

The CHIA process and the Five Case Model

To make best use of available resources, the HM Treasury Green Book guidance provides a framework for thinking about spending proposals and a structured process for appraising, developing and planning to deliver best social value for money through projects and programmes - all of which are captured through a business case to support objective, evidence-based decisions.

Each business case for a project or programme follows the 'Five Case Model': strategic, economic, commercial, financial, and management cases. The project owner should explicitly detail project dimensions for each case. Each of the five cases then contributes to the development of the three key business case stages:

Stage 1 - Scoping the scheme and preparing the Strategic Business Case (SBC)

Stage 2 - Planning the scheme and preparing the Outline Business Case (OBC)

Stage 3 - Procuring the solution and preparing the Full Business Case (FBC)

In summary, this means that each business case provides information about the benefits, costs, risks, and timescales to assist decision makers to judge whether the project (or programme) is desirable, viable and achievable. The information on benefits, costs and risks becomes more detailed at each stage from SBC to FBC.  

According to the International Guide to Developing the Project Business Case, an effective business case must:

• Enable the lead organisation and its key stakeholders to understand, influence and shape the project's scope and direction earlyon in the planning process.
• Support decision makers to understand the key issues, available evidence base and to avoid committing resources to schemes that should not proceed.
• Demonstrate to senior management, stakeholders, customers, and decision makers the continuing viabilityof the project, and
• Provide the basis for management, monitoring and evaluation during and after implementation.

The CHIA process and associated guidance can support and enhance effective business case development across four of the five cases:

• Strategic Case
• Economic Case
• Commercial Case, particularly around procurement and community benefits considerations.
• Management Case

The CHIA process can:

• support evidence gathering in relation to health, equity, and wellbeing economy to inform business case development, including the strategic need for the project, costs and benefits identification and realisation, as well as risk assessment and management.
• help local authorities identify key impacts of their proposed interventions on the economic, social and environmental determinants of health
• support compliance with the Public Sector Equality Duty and implementing Best Business Case guidelines.
• enables capital spend to maximise wider benefits for local communities and the local economy, including reduced inequalities and enhanced wellbeing. 

The CHIA process will support business case development, in relation to understanding of health and equity impacts, specifically identifying:

• key benefits
• risks
• costs
• stakeholders
• and therefore, strengthening the strategic need for the project.

The ways through which the CHIA process supports business case development are described in more detail in each of the case sections below.

Strategic Case 

The purpose of the strategic dimension of the business case is to make the case for change and to demonstrate how it provides a strategic fitwithin existing programmes, as well as relevant policies and targets (Source: International Guide).

The CHIA process can support the development of the following key components of the case for change:

• Business needs - current and future - by providing access to local, regional, and national health data and guiding a stakeholder workshop to identify key health and equity impacts of a given proposal. Therefore, helping to inform a wider project stakeholder workshop (which is recommended in the International Guide), and supporting the determination of current and future needs in relation to health and equity in the project area.  The 'Making the Case for Health and Equity' section can help understand existing arrangements as it provides information about:
  • the links between economic development and health inequalities
  • why an inclusive economy, community wealth building and progressive procurement are important for maximising health and wellbeing and reducing inequalities in capital investment
  • how national, regional and city deal strategies align with this focus.

This, combined with accessible, relevant health and inclusive economy data, will help develop a comprehensive profile of the local area.

• Potential scope and service requirements - The CHIA screening workshop report, which outlines positive, negative and uncertain health and equity impacts, can inform actions to address them. This will then inform both the scope, and service requirements to be included in the business case. The CHIA screening workshop report can also inform the wider project stakeholder workshop (which is recommended in the International Guide), ensuring that the strategic need for the project is as comprehensive as possible, including consideration of health and equity.
• Main benefits and risks - The CHIA screening workshop will help identify key health and equity benefits of the proposed intervention, while also highlighting key health and equity risks. The workshop process pays particular attention to specific population groups and health determinants to understand any disproportionate impacts.
• Constraints and dependencies - The health and equity impacts identified during the CHIA process helps develop the profile of the local area; understand constraints (external conditions / agreed parameters within which the programme must be delivered, over which the project has little or no control); and dependencies (factors that must be in place / managed for the ultimate success of the project), specifically in relation to community wellbeing and equity issues.
• Beneficiaries and non-beneficiaries - the following sections in the CHIA will help outline the beneficiaries of a project and those who could be excluded or suffer unintended health and or equity impacts:  
  • 'Making the case for health and equity',
  • 'Community Engagement '
  • 'Step 1: Plan and run a CHIA screening workshop' and resulting the report.

Economic Case

The purpose of the economic dimension of the business case is to identify the proposal that delivers best public value to society, including wider social and environmental effects(Source: International Guide).

The CHIA process can inform the following components of the Economic Case:

• Critical success factors - the workshop will result in a set of identified health and equity impacts of a given proposal for the local community and area. This will inform the definition of a robust and comprehensive set of critical success factors (attributes essential for successful delivery of the project), ensuring that health and equity needs of the local community are accurately reflected. The 'making the case' section of the CHIA will also help build a robust economic case and understanding of health and equity critical factors.
• Long listed options and short-listed options (including "business as usual (BAU)" and "do minimum")the CHIA screening workshop can help inform criteria established and used to ascertain the long list of options, ensuring that they include consideration for health and equity benefits or any related risks for the community.
• Preferred Way Forward -The sections on 'Making the Case', the CHIA screening workshop, and any health impacts identified will help assess the preferred way forward in terms of additional outcomes and health benefits it can help deliver/ achieve.
• Benefits appraisal -the CHIA screeningworkshop and 'Making the Case' help identify key health, wellbeing and equity benefits. Therefore, helping to include health, wellbeing and equity benefits to the criteria and providing evidence for potential additional benefits resulting from the proposal.
• Risk assessment - the CHIA screening workshop and any subsequent full HIA, can inform the risk assessment required at this stage, by adding well evidenced health and equity risks. This allows project teams to address these risks early in the process.
• Preferred option -having undertaken a CHIA screening workshop and consulted existing relevant health and wellbeing data to provide an overview of community demographics, the project team will have highlighted a number of health and equity impacts, potential benefits and risks as a result of the proposal. This will in turn help to inform a comprehensive analysis of viable options and help identify the preferred option.

Using the CHIA, particularly 'Making the Case' can help overcome key challenges associated with justification of higher cost options in relation to "business as usual (BAU)" and the "do minimum", by including qualitative and as much as possible quantitative (not monetised) health benefits of a higher cost option.

Commercial Case

The purpose of the commercial dimension of the business case is to demonstrate that the preferred option will result in a viable procurement and a well-structured deal between the public sector and its service providers (Source: International Guide).

The CHIA resources, particularly the section 'Making the case' and the CHIA screening workshop, can help demonstrate a viable procurement strategy by identifying howdifferent approaches, including community benefits and community wealth building can help deliver best value for public and private sector.

The CHIA process can inform the thinking and knowledge about key outputs and milestones required to maximise health outcomes and any potential risks to health and equity in the design, build, funding and operational (DBFO) phases of the proposal or scheme.

The CHIA process can support the following components of the Commercial Case:

• Procurement strategy and route, by identifying potential impacts of the proposed approach on different population groups and health determinants, the outputs from the CHIA screening workshop will inform a sustainable procurement approach which may be better able to deliver better outcomes for local communities and the economy. For example, helping to develop community wealth building and taking a holistic approach to community benefits.
• Service requirements and outputs -The CHIA screening workshop will help identify health and equity impacts (positive, negative and uncertain) of the proposal or scheme for different population groups. This can help to inform key service requirements and outputs from the scheme, combined with effective community engagement, including community benefits.
• Risk allocation -by identifying potential impacts of the proposed approach on different population groups and health determinants and helping to translate these into risks or benefits, therefore allocating and addressing them effectively.

Undertaking the CHIA screening workshop can identify future risks and opportunities for health and equity. This will support project teams to become "intelligent customers" and to anticipate how best public value can continue to be secured in during the contract phase in the face of inevitable changes, as recommended by the International Guide .

Management Case

The purpose of the management dimension of the business case is to demonstrate that robust arrangements are in place for the delivery, monitoring and evaluation of the scheme, including feedback into the organisation's strategic planning cycle.

The CHIA process can support this by helping to demonstrate the added benefits of the preferred option for health and equity, but also an understanding of any potential risks and how they can be mitigated.

The CHIA can support and inform the following aspects of the Management Case:

• Benefits realisation arrangements (including plans and register) - the CHIA screening workshop can help inform this by ensuring the consideration of health and equity benefits in the proposal and how they can be maximised by the scheme or proposal.
• Risk management arrangements(including plans and register) - the impacts for key population groups and determinants of health identified through the CHIA screening workshop can help inform risk management arrangements by supporting a clear understanding of potentially negative health and equity impacts of a scheme or proposal for the local economy and communities.
• Post implementation and evaluation arrangement - by helping to identify key benefits and risks, the CHIA process can guide evaluation and monitoring arrangements in relation to health and equity risks or potential negative impacts identified.

Furthermore, the CHIA can support project teams to manage the risks in the design, build, funding, and operational phases of the project and put in place contingency plans by supporting an understanding of key risks for health and equity.  It can also inform effective benefits evaluation processes and frameworks by including clear understanding of health and equity impacts resulting from the CHIA process of the proposal from the outset.