Creating the Case for health system transformation

Strategic, Outline and Full Business Cases for Isle of Wight NHS Trust

From outlines to fully fledged Cases

The IoW NHS Trust is an integrated Trust which provides acute, community, mental health, and ambulance services to an island population of 140,000.

The Trust commissioned 4OC to deliver a series of three Treasury Green Book-compliant business cases for their £48m programme of digital and estates transformation, which enables the delivery of high-quality, safe care to local people.

We delivered a Programme-level Strategic Outline Case, followed by Outline and Full Business Cases for the £30m estates investment.

The business cases were developed during a period when the Trust, in common with the whole of the NHS and wider health system, was under extreme operational pressures because of the Covid-19 pandemic. We worked hard to balance engagement with key stakeholders involved in the development of the cases with the need to minimise demand on their time during an exceptionally challenging period for the Trust.

Working in Partnership

The development of the business cases also required the co-ordination of input from other partners, including the Trust’s cost advisor, design team and Principal Supply Chain Partner. We ensured that the cases were developed to time and in line with regulator expectations and requirements.

Our small team of experienced health care consultants drew upon their significant experience of NHS and commercial capital schemes and business case development to ensure that all three business cases reflected the needs and aspirations of the Trust, whilst also being compliant with Green Book requirements.  We supported the Trust in updating plans to reflect learning from the pandemic, building the justification for the inclusion of an additional ward reconfiguration project at Outline Business Case stage.

Thoughts from the Trust

The 4OC team has provided the Trust with first rate support to our £48m investment programme. The 4OC team consistently produces high-quality outputs, working to tight timescales. The Strategic Outline Case produced by the team was top notch and was approved by our regulators and the Treasury on first submission. It feels as though we are working in a genuine partnership with 4OC – we do together as opposed to being ‘done to’.”

Darren Cattell, Chief Executive

“The 4OC team brought considerable experience and insight in order to help the Trust with our business case development process. The team delivered all three business cases on time, and successfully met the expectations of the Trust and our regulators.”

Richard Harvey, Programme Manager, Investing in Our Future Programme

“The Strategic Outline Case ... was approved on first submission”

Our team worked in partnership with the Trust to produce three HM Treasury Green Book-compliant business cases, successfully securing regulatory approval for each case.

4OC supported the Trust in developing a robust case for updating the estate to reflect learning from the Covid-19 pandemic, ensuring the continued delivery of high-quality, safe care to local people.

If you’d like to find out more about how we delivered this work, or our approach to partnering, strategies and business casing, please contact us at


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