This page will help you understand questions such as:
- What should an NHS business case include?
- How can I show that my innovation aligns with NHS priorities and local needs?
- What evidence do NHS decision-makers need to understand value, impact, and risk?
- How should I present costs, affordability, and potential savings?
- How can I demonstrate that the innovation can be implemented and sustained in practice?
Why your NHS business case matters
For healthcare innovators, a clear business case is often essential to moving from early interest to NHS adoption. It helps NHS teams understand why change is needed, what value the innovation could bring, and what would be required to implement it safely and sustainably. A strong business case should not just describe the product or service; it should clearly set out the problem, the evidence, the expected benefits, the costs, the risks, and the practical steps needed for adoption.
How NHS business cases are reviewed
The approval route for an NHS business case will depend on the scale, cost, complexity, and risk of the proposal. Smaller changes may be reviewed through local governance processes, while larger investment decisions may require approval from senior leaders, committees, or boards. Because each NHS organisation has its own thresholds and decision-making arrangements, innovators should work closely with their NHS sponsor to understand what evidence, documentation, and approvals are needed.
Initial agreement: An early decision on whether the proposal is worth exploring further.
Outline business case: A more developed assessment of options, expected benefits, value for money,
risks, and delivery requirements.
Full business case: A detailed proposal that supports a final investment or implementation decision.
NHS business cases are often informed by the Five Case Model, which is part of HM Treasury’s Green Book guidance. In practice, this means decision-makers will want to understand whether the proposal is strategically relevant, offers value for money, can be procured and delivered effectively, is affordable, and has a realistic plan for implementation.
- Strategic case: Is there a clear need for change, and does the proposal align with NHS priorities?
- Economic case: Which option offers the best overall value for money?
- Commercial case: Can the innovation be procured, contracted, and supplied in a viable way?
- Financial case: Is the proposal affordable, and are the funding requirements clear?
- Management case: Can the project be implemented, governed, monitored, and sustained?
For innovators, the Five Case Model can be a helpful way to anticipate the questions NHS partners are likely to ask. It also provides a structure for presenting evidence in a way that supports clear, proportionate, and confident adoption decisions.
The Five Case Model: what healthcare innovators need to cover
The strategic case
The strategic case explains why change is needed. It should describe the current challenge, who is affected, and what could happen if no action is taken. It should also show how the proposal aligns with national NHS priorities, local service objectives, patient outcomes, workforce needs, or operational pressures. Where possible, link the case for change to measurable outcomes so decision-makers can see what success would look like.
The economic case
The economic case considers whether the proposal offers value for money when compared with realistic alternatives, including doing nothing. This should include a balanced view of costs, benefits, risks, and likely outcomes. For healthcare innovations, this may include evidence on patient benefit, staff time saved, service efficiency, avoided costs, health outcomes, or wider system value.
The commercial case
The commercial case shows whether the innovation can be bought, supplied, contracted, and supported in a way that works for the NHS. It should explain the proposed procurement route, supplier arrangements, contract terms, implementation dependencies, information governance considerations, and any risks linked to delivery, data, support, or ongoing maintenance.
The financial case
The financial case focuses on affordability. It should set out expected costs over time, including licence fees, implementation costs, training, integration, staff time, maintenance, and ongoing support. It should also make clear how the proposal would be funded, what assumptions have been made, and whether there are any expected savings, efficiencies, or cost pressures for the adopting NHS organisation.
The management case
The management case explains how adoption would happen in practice. It should cover governance, roles and responsibilities, implementation milestones, change management, training, communications, risk management, benefits monitoring, and evaluation. This section should give decision-makers confidence that the proposal can move from approval to implementation in a controlled and sustainable way.
Practical tips for building an NHS innovation business case
Start with the NHS problem, not the product. Be clear about the current challenge, who is affected, and why the issue matters now.
Connect evidence to decision-maker priorities. Show how your innovation could support outcomes such as access, productivity, patient experience, workforce capacity,
quality, safety, or financial sustainability.
Be realistic about implementation. Explain what the NHS organisation would need to do, who needs to be involved, how long adoption may take, and what
support you can provide.
Present costs and assumptions transparently. Include direct and indirect costs, and be clear about the assumptions behind any savings, efficiencies, or return
on investment.
Address risk early. Identify clinical, operational, technical, financial, information governance, and adoption risks, and explain how these could be mitigated.
Use proportionate evidence. The level of evidence should reflect the cost, complexity, and risk of the decision being made.
A strong NHS business case shows why an innovation is needed, what value it could deliver, and how it can be funded, procured, implemented, and sustained. The Five Case Model provides a useful structure for presenting this clearly to NHS decision-makers.
Useful documents
- Preparing a successful business case: A practical guide for suppliers of innovative products and services: https://healthinnovation-em.org.uk/images/Introduction_to_NHS_Business_Cases.pdf
- The Green Book: Templates and support material: https://www.gov.uk/government/publications/the-green-book-templates-and-support-material