Investment Proposal Template (IPT3)

Revenue funding > £500,000 < £1,500,000

(unless in exceptional circumstances and approved by Commissioner for >£1,500,000)

Commissioner’s Statement

Reference Number
Commissioner Representative
Title
Contact Tele No. & Email
Date

1.	Strategic Context – (if provider requires to add any further information for strategic context this should be added to box 14 in the main proposal attached) Outline of Strategic Context within which the Commissioner is seeking service proposals. Reference should be made as appropriate to: Priorities for Action. HWIP. Strategy, Policy or Service Review documents, Local, Regional, National. Compliance with NICE, SMC and other appropriate recognised guidance on effectiveness. Likely Board/LCG service shares. Legislative/Statutory requirements.

2.	Description of Services - (if provider requires to add any further information for strategic context this should be added to box 14 in the main proposal attached) Description of services to be commissioned including: Expected activity levels, outputs and outcomes (including quality)with reference (where relevant) to any requirement to achieve: Specific PfA/HWIP targets and recognised policy standards.NICE, SMC and other recognised policy standards. Requirement, where appropriate, for partnership arrangements with other agencies e.g. voluntary organisations, housing associations etc. Timescale for implementation. Programme and format for interim and post project evaluation. Implications for Equality Impact Assessment. (S575 NI Act 1998) – Please complete a separate screening template if appropriate (contact Equality Manager, BSO) CLEARLY DEFINE OBJECTIVES (SMART)

3.	Funding -Summary of sources and amounts of available funding including: Recurrent and/or non recurrent funding from commissioners (detailed by LCGs as appropriate) Potential recurrent/non-recurrent funding from other agencies e.g. Supporting People monies from NIHE. Capital funding where appropriate.

4.	Timescale and process for submitting Timescale within which providers should submit the completed investment decision making proformas to commissioners. Timescales which providers will be advised of the commissioner’s decision. Arrangements for submitting completed documents.

PROVIDER SECTIONS

Provider	Submission date
Scheme Title
Responsible Officer -including title
Contact Details – Tele no. & Email

This business case should be prepared in line with the Green Book and NIGEAE Guidance Please complete this template with proportional effort, i.e. detail provided should be commensurate with the size of the bid.

1a) Explain how this proposal specifically meets the needs for this investment (linked directly to the Commissioner statement)
1b Describe how this proposal will reduce inequalities in Health and Wellbeing

2a) Objective(s) of this development - these will be examined in more detail in section 10 and 11) Please complete the list below - please note that this list is not exhaustive but is a minimum requirement
OBJECTIVES	DATE/ACTIVITY	EXPLANATORY TEXT IF REQUIRED
Development implemented by what date?
Target met by what date?
Activity increased by? (Further detail in Section 12)
Qualitative Benefits?
Other
Other
Other

2b) What are the Constraints of the Project? Availability of staff, recruitment difficulties, Constraints in, space, time and funding etc.

3) Option one: Status Quo or Base Case This section must be completed in all instances Current activity levels must be detailed in the appropriate currency as well as current access timescales and numbers waiting. A Costing sheet must be completed for this option – Appendix 1

4) Option Two Changes to base activity levels must be detailed in the appropriate currency as well as impact on current access timescales and numbers waiting where appropriate A Costing sheet must be completed for each new option – Appendix1

5) Option Three Changes to base activity levels must be detailed in the appropriate currency as well as impact on current access timescales and numbers waiting where appropriate A Costing sheet must be completed for each new option – Appendix1

6) Option Four – if deemed necessary Changes to base activity levels must be detailed in the appropriate currency as well as impact on current access timescales and numbers waiting where appropriate A Costing sheet must be completed for each new option – Appendix 1

7) Identify and evaluate the overall benefits of all of the options Consider costs and benefits to other parts of the public and private sectors
OPTION	PLEASE LIST & SCORE BENEFITS THEN SHOW RANK OF OPTIONS
OPTION 1
OPTION 2
OPTION 3
OPTION 4 (if deemed necessary)
Robustness/Bias Test (Sensitivity Analysis)	If benefits are not delivered as expected above would the ranking change? How much would costs increase before VFM (Ref Box 9 is impacted?

8) Financial Quantification of chosen option Express Costing in total rather than incremental terms to expose full resource consequences Please note which option is the preferred option -
OPTION NUMBER AS ABOVE	Option Name	Total £ (Rec)	Total £ (Non-Rec)
OPTION 1 - STATUS QUO
OPTION 2
OPTION 3
OPTION 4
Additional Cost (Marginal Increase: Preferred Option less Status Quo Option
Note: Detail to be contained in costing appendix. (Where cost savings or efficiency improvements are projected these must be further detailed in Section 9 below)
9) Value for Money A) Efficiency Savings (Where applicable) - Provide an accurate costing of any savings. Are these savings to be cash released or redeployed? If redeployed please provide full details of redeployment (cost, activity, outcomes etc).
B) Further demonstrate overall Value for Money by including benchmarking evidence B1) Breakdown the elements of the option and compare cost and activity to Status Quo option and benchmarking statistics eg Community Statistical Indicators, Reference Costs, Specialty Costs, HRGs etc.
B2 Please explain the reason for any positive or negative variances that exist when the preferred option is compared to B1 above. Positive Variances: eg Better working practices, more efficient use of resources etc. These will indicate VFM. Negative Variances: eg Increased complexity of services etc. These will not initially indicate VFM – More information required below in B3.
B3) If there are negative variances shown in B2 above explain how are these offset by, for example Qualitative benefits and the context of the project.

10) Preferred Option (Insert option number ) Please rank costs and benefits and summarise reasons for selection.

11) What are the Specific Outcomes of the preferred option Quality, Timescales, Quantity (detailed in box 11)

12) Activity Outcomes Activity, contacts, placements, procedures etc, please identify
SBA Activity
Original Baseline Activity	New Baseline Activity	Currency (FCE/IP/OP/DC/ Contacts/Caseload etc.)
Additional Baseline Activity
New Baseline Activity
If approved, activity will be added to Indicative volumes in Organisation’s Service and Budget Agreement (if applicable) The above table must be completed for each discreet element of the service in question, please replicate as required. If activity is for more than one LCG please detail separately.
13) Assess Risks and Uncertainties Identify the main risks associated with the proposal and how can these be mitigated – these should be scored using the Providers recognized risk scoring method
Low Risk
Medium Risk
High Risk

14) Monitoring and Post Implementation Evaluation Process – please also refer to detail contained within the Commissioner’s Statement Who will manage the implementation of this scheme? When will the development be fully implemented, when will full benefits and outcomes be realised? What post evaluation arrangements are in place, these evaluations are also subject to test drilling should be available 12 months after full implementation of the scheme if approved.
15) Other relevant information Please note any other appendices or attachments

16) Signature of individuals responsible for this bid – Provider Section
Trust Authorising Officer	Date
Title
Trust Director of Finance Signature	Date
Trust Chief Executive Signature	Date
17) Approval or rejection (Local/Regional Commissioning Use only-HSCB and PHA)
Approved	Rejected (if yes detail reasons)	Approved in Principle (if yes detail reasons)
Yes/No
Responsible Person Signature Date Position
Authorising Person Signature Date Position
Director of Finance Authorisation or delegated officer Signature Date Position
Chief Executive Authorisation Signature Date Position
SUMMARY OF FUNDS APPROVED – IF THIS DIFFERS FROM PREFERRED OPTION PLEASE DETAIL
TO BE COMPLETED BY THE BUDGET HOLDER	FYE of project (£)	CYE of project (£)	Non Recurrent (£)
SOURCE OF FUNDS (name of budget and cost centre code)