HSE SERVICE BUSINESS PROPOSAL FORM
(For Completion within the Services or Functions in line with the HSE Property Protocol)
PLEASE COMPLETE SECTION 1 TO SECTION 4 BELOW
SECTION 1
Business Proposal Title:
Service / Care Group:
Division:
Current Location of Service:
Brief Summary of Proposal:
SECTION 2
Needs Assessment:
Current Service Arrangements:
Service Changes / Developments / Deficits:
Annual Service Plan Linkage:
Linkage to other Services / Community Groups, etc:
Risk Assessment: (Clinical & Service Risk)
SECTION 3
Service Solutions Considered:
Option Appraisal of Identified Solutions
Proposed Service Solution:
Revenue Budget Implications: (reduction / no change / increase)
WTE Implications:
(reduction / no change / increase)
Accommodation implications:
(reduction / no change / increase)
Funding Source: (if applicable)
SECTION 4
Approved by:
Service Manager / General Manager:
Signature:
(or equivalent) (Please Print Name)
-------------------------------------------------------Date:
ISM (Service) or AND (Function):
Signature:
(Please Print Name)
-------------------------------------------------------Date:
This form must be approved prior to development of a Business Case relating to a Property Transaction
application where a change to the healthcare estate is proposed.
(See Sections 2.1.1 and 3.1 of Property Protocol)
When approved, this form is retained within the Service or Function and is not for submission to Estates
Revised May 2014