Economic case

In the economic section of a Green Book business case for improving connectivity in an NHS site, the focus is on providing analysis and evaluation of options and demonstrating value for money. This section should include a cost-benefit analysis, the identification of preferred options, and an assessment of risks, benefits, and impacts.

Examples of sections and content to include:

Options appraisal

Identify options: present a range of options, with appropriate technical detail, for improving connectivity including various levels of investment. For example, for wireless connectivity at sites, options may include:

option 1 - minimal upgrade of existing infrastructure for devices no longer in support or a security risk
option 2 - comprehensive upgrade to high-speed, site or organisation wide Wi-Fi
option 3 - implementation of an entirely new, Wi-Fi system with future-proof capabilities (such as support for the latest wireless standards, internet of things devices and real time location services)
do-nothing option - include a 'Do nothing' scenario to serve as a baseline for comparison - highlight the potential risks, such as continued connectivity issues, reduced efficiency, and non-compliance with digital healthcare standards

For fixed line connectivity to your sites, options may include:

option 1 - minimal upgrade of existing infrastructure to ensure it can be kept under maintenance and management, including any changes to accommodate bandwidth within the limitations of the original service
option 2 - comprehensive upgrade to individual links where upgraded services are required, or enhanced resilience is needed. No major changes to the overall network design
option 3 - implementation of an entirely new capability, this could include a new topology, newer types of links and the implementation of Software Defined Networking technologies
do-nothing option - include a this as a baseline for comparison. Highlight the potential risks, such as continued connectivity issues, reduced efficiency, and non-compliance with digital healthcare standards.

Cost-benefit analysis

Costs: outline the costs associated with each option, including:

capital costs - equipment purchase (switches, routers, firewalls, Wi-Fi access points, servers), surveys including Wi-Fi, WAN link provisions, installation, cabling, racking, and initial setup
capital costs of environmental changes, such as additional power or Uninterruptible Power Supply (UPS), or cooling
operational costs - ongoing maintenance, support contracts, software licenses, and potential staff training
implementation costs - downtime or disruptions during installation, project management expenses, and temporary solutions during the transition period

Benefits: quantify and describe the benefits, both financial and non-financial. For example:

cashable benefits - potential cost savings from improved operational efficiency (such as reduced paperwork or streamlined patient data access), reduced network outages, and increased operational, clinical or workforce productivity
non-cashable benefits - improved patient care, enhanced communication among medical staff, ability to take calls from community and emergency response, better support for telemedicine and remote monitoring, and increased patient satisfaction
monetising benefits - where possible, assign monetary values to the benefits. For example, explain how increased resilience at a site could reduce the number of outages per year and tie this to an estimated cost of a connectivity outage at a site, and the average number of these over a set period.
estimate the time saved per staff member due to access to improved Wi-Fi, and multiply by an average staff members salary to convert into a cashable cost saving

The table below outlines a non-exhaustive list of potential metrics that align with the common benefit categories discussed in this guidance.

Data point	Unit of measurement
GP time saved per patient seen	Minutes
Number of patients seen per day per GP	Patients
Hourly value of time savings (average GP rate)	£
Number of log-ons typically expected per day per site	Log-on events
Estimated time saved per log-on	Minutes
Average downtime due to patches and upgrades before connectivity upgrades per device per week	Minutes
Average number of devices experiencing downtime per site	Minutes
Hourly normalised cost of lost output due to network outage per site	Number of devices
Post-bank holiday downtime experienced per day per device	£
Virtual appointments enabled due to better connectivity	% of overall appointments
Average distance per appointment avoided	£ per mile
Travel mileage allowance rate (reduced travel to return to home base for connectivity)	Access points
Number of network outages curtailed per year per site	£
Normalised cost of lost output due to network outage per site	Tickets
Average access points per site	Minutes
Licensing cost savings made due to upgrades per trust	£
Number of connectivity-related IT support tickets avoided per site per day	Tickets
Time to raise and resolve IT support ticket	Minutes
Value of IT support time per hour	£
Admin time saved per day per full time equivalent (FTE)	Minutes

Sustainability: highlight any sustainability benefits, for example reduced power consumption from more efficient equipment or reduction in travel time due to enhanced connectivity at remote sites. See Greener NHS (NHS England) for recommendations.

The table below outlines some suggested sustainability benefits and metrics.

Data point	Unit of measurement
Difference in power consumption between copper and fibre (per connection)	Watts
Average number of broadband connections per site	Number of connections
Average cost of kilowatt hour of energy	£
Carbon intensity of grid	kg CO2/kWh
Reduction in maintenance and repair costs for ADSL per site per year	£
Energy usage of legacy servers per site per year	kWh

Socio-economic: any benefits for wider communities or society, including:

economic (for example, employment or apprenticeship and training opportunities)
social (for example, activities that promote cohesive communities)

These benefits may be expressed as a narrative of the targeted outcomes, such as:

providing an improved patient and guest Wi-Fi network to enhance patient experience, enabling them to contact loved ones, or access entertainment
sharing connectivity infrastructure with partners to provide joined up public services from a single site to benefit the local community and reduce time and travel required
some suppliers will offer socio-economic benefits as part of their proposals, which can be referenced in the business case if known at that stage

Economic appraisal

Benefit-cost ratio: provide a ratio for each option to demonstrate value for money.

Payback period: indicate how long it will take for the benefits to offset the costs of investment.

Risk assessment and sensitivity analysis

Risks: identify economic risks, such as cost overruns, delays in implementation, technology obsolescence, and potential for not achieving anticipated benefits. Assess the likelihood and impact of each risk (check for a local risk matrix to use for this).

Mitigation measures: discuss strategies to mitigate these risks, such as phased rollouts, vendor support agreements, and future-proofing technology investments.

Sensitivity analysis: conduct a sensitivity analysis to examine how changes in key assumptions (such as costs and benefits) affect the economic case.

Preferred option

Identify the option that provides the best balance of costs, benefits, and risks. Explain why this option is the most economically viable, based on the analysis conducted. For example, a comprehensive upgrade might offer the best long-term value by enabling and supporting future healthcare technologies.

Considerations

Consider the wider impact of connectivity when listing benefits. Connectivity should be considered as a vital part of infrastructure that provides a platform and acts as an enabler for other technologies.

It can be difficult to quantify the specific value of enabling infrastructure when measuring and expressing benefits. It may be useful to consider what could be enabled, such as real time location services, internet of things (IoT) monitoring and Voice over Internet Protocol (VoIP). Make sure the investment in improved connectivity can handle future needs and growing demand for digital services. Also, consider that enhanced connectivity is a requirement for broader transformation.

List the targeted impact of benefits and tie these to clinical and patient outcomes wherever possible, such as real-time access to electronic patient records (EPRs) for staff. Think about all the people who might benefit from better connectivity. This includes clinicians, patients, and staff visiting from other organisations. Consider how the improvements will affect them and what changes they might experience. Some groups may actively use the connectivity and the services reliant on it whereas others may see indirect benefits.

Consider who will own the benefits. Benefit owners are the people who are impacted by the benefits of the project. Depending on the type and scale of the connectivity upgrades, there may be just one main benefit owner or several.

See the table below for some examples of how to tie benefits to outcomes.

Example benefits table

Benefit name	Unit	Description
Productivity improvement (for example, ability to access patient records more quickly)	Clinical and non-clinical staff hours	Enhanced connectivity allows clinical and non-clinical staff to access patient records and essential systems more quickly, reducing frustration and time spent on administrative tasks. By reducing log-in times, and time lost due to system delays staff will be less rushed, can spend more time with patients, and staff experience will be improved.
Environmental benefits as a result of reduction in travel enabled by future connectivity	Miles	With better network infrastructure, more virtual appointments can take place, reducing patient and staff travel, lowering carbon emissions, and cutting travel-related costs. By avoiding miles of travel per appointment and saving on mileage reimbursements, the NHS can achieve both financial and environmental benefits.
Seamless connectivity through multiple sites (for example, single sign-on)	Clinical staff hours	Enhanced networking solutions enable smooth transitions between multiple locations, ensuring staff can access systems quickly and securely without repeated log-ins or lost time due to failed login attempts. By saving time per log-on event, healthcare professionals can reduce frustration and maximise productivity across multiple sites.
Reduction of support costs – more efficient deployment of access points (AP)	Access points	More efficient deployment of public Wi-Fi access points can lower infrastructure costs while maintaining reliable wireless access for staff and patients. By maximising coverage from existing APs, organisations can save on overall licensing and maintenance costs and redeploy equipment to other sites or areas where it is needed.
Reduction of support costs - licensing cost savings	£	Network upgrades allow for streamlined software and connectivity licensing, reducing overall expenses for healthcare facilities. Trusts can benefit from licensing cost savings, freeing up funds for other critical digital improvements.
Reduction of IT support costs	Non-clinical staff hours	A more reliable network reduces the volume of IT support tickets, minimising the time and cost associated with troubleshooting connectivity problems. By reducing the number of IT support calls per site per day and the time required to resolve them, healthcare IT teams can allocate resources more effectively.
Environmental benefits of moving from copper to fibre - reduced power consumption	kWh/kg CO2	Moving from ADSL to fibre lowers power consumption per connection significantly, leading to cost savings and reduced environmental impact. With a lower energy demand per broadband connection and reduced kilowatt-hour costs, this transition supports both financial and sustainability goals, decreasing carbon footprint and contributing to sustainability efforts.
Environmental benefits of moving from copper to fibre - reduced maintenance costs	£	Moving from ADSL to fibre lowers power consumption per connection significantly, leading to cost savings and reduced environmental impact. With a lower energy demand per broadband connection and reduced kilowatt-hour costs, this transition supports both financial and sustainability goals, decreasing carbon footprint and contributing to sustainability efforts.
Having a resilient and reliable network set up that can handle sites capacity	Number of outages	A more resilient and high-capacity network minimises the risk of outages, ensuring uninterrupted access to critical digital services. By reducing the number of network outages per year, healthcare sites experience fewer disruptions and associated financial losses.
Reduced energy usage of data infrastructure and servers	kWh	Upgraded networking solutions and server optimisations lead to lower energy usage, cutting operational costs and supporting environmental goals. With reduced power usage from legacy servers, healthcare organisations can decrease local electricity consumption and carbon emissions.

Last edited: 27 October 2025 10:46 am