Transparency data

Frontline Digitisation Programme: accounting officer assessment

Updated 28 November 2025

Applies to England

It is normal practice for accounting officers to scrutinise significant policy proposals or plans to start or vary major projects, and then assess whether they measure up to the standards set out in Managing public money.

From April 2017, the government has committed to make a summary of the key points from these assessments available to Parliament when an accounting officer has agreed an assessment of projects within the Government Major Projects Portfolio (GMPP).

Background and context

The vision of the Frontline Digitisation Programme is a digitised health and care system that gives the health service and its users the digital services and information they need to effectively manage and improve health and wellbeing.

The programme continues to support this vision by ‘levelling up’ trusts to a core level of digitisation, as set out in NHS England’s What Good Looks Like framework. This will enable frontline clinical staff to make best use of digital technology to provide care efficiently, effectively and safely, reducing variations and improving quality and outcomes.

The programme has the following ambitions:

• coverage: 100% of trusts will have an Electronic Patient Record (EPR) or implementation of the EPR will be in progress by March 2026
• capability: 70% of trusts will reach the standard for the core level of digitisation set out in the What Good Looks Like framework by March 2026, with the remaining developing plans
• convergence: integrated care boards (ICBs) and trusts are being encouraged to make decisions about coverage and capability with infrastructure consolidation and convergence in mind, so that we move towards a more convergent digital landscape

The latest business case addendum also includes the following work in support of the programme’s vision as agreed in the programme business case (PBC):

• provision of digital assurance for the New Hospital Programme
• development of blueprints and optimised workflows to support digital transformation
• further development of the What Good Looks Like framework

The nationwide EPR coverage target of 90% was achieved on time in December 2023, and the programme is on track to achieve 100% coverage by March 2026, with all trusts having implemented or being in the process of implementing an EPR.

Additionally, our ambition is for trusts to have digital capabilities that meet our standards. Currently, 56% of trusts meet these standards, and this is forecast to increase to 70% by March 2026. Confidence in meeting this target is high following a detailed review and validation of data provided by trusts against the Digital Capabilities Framework, which was not previously available.

This data set will help inform the development of the Frontline Productivity Programme and provide a baseline from which to further scale up digital maturity across care settings over the next Spending Review period. The Frontline Productivity Programme will take the good practices learned from the Frontline Digitisation Programme and use them to achieve further productivity gains from frontline investment to close the remaining gap in digital capabilities.

The Frontline Digitisation Programme has been successful in getting investment to the frontline to help the NHS reach the 100% EPR coverage target. The detailed understanding of system capability gained through this programme has identified that significant central support will be required in future years. This includes both financial and policy-based support to create foundational change and optimise the digital landscape, including investment in hosting, networks and end-user devices.

The ambition is to make sure that the coverage achieved is successfully turned into effective capability by building on the investment to increase productivity, fully using the assets that have been created over the 4 years of Frontline Digitisation investment. This will support the shift from analogue to digital, from hospital to community and enable the shift from treatment to prevention in line with 10 Year Health Plan. The intention is that this change will be led by the Frontline Productivity Programme as part of the next Spending Review.

The programme has developed and run a national Digital Maturity Assessment (DMA) to help ICBs and trusts understand their current maturity against the What Good Looks Like standard. This assessment will help them to develop strategic plans to achieve the standard and enable the Department of Health and Social Care (DHSC) and NHS England to understand whether further central investment is required in this area. The programme has also developed a comprehensive support offer to help ICBs and trusts to digitise successfully by sharing best practice and expertise across the NHS.

Assessment against the accounting officer standards

Propriety

It is our assessment that the use of public funds is proper and meets the high standards of public conduct and parliamentary expectations. The programme has been designed and is being implemented in line with Managing public money.

The programme agreed a set of funding principles based on the digital maturity, size and type of trust. Funding is allocated through investment agreements to trusts - and to integrated care systems (ICSs) for Connecting Care Records - to support the implementation of digital capabilities and enabling infrastructure.

The programme has an established approach to managing assurance and programme risks and issues that was commended during our last Infrastructure and Projects Authority (IPA) review. The ‘preferred option’ meets our standards around acceptable levels of implementation and reputational risk. There is also no known impact on any other government policy or damage to any lawful private sector business in an unwarranted way.

At the start of the programme, NHS England required trusts to use either the Health Systems Support Framework (HSSF) or Clinical Digital Solutions (CDS) framework for EPR purchasing. The HSSF expired on 16 December 2023, and the CDS framework expired on 31 March 2025. The programme has supported the refresh of the CDS framework in collaboration with the NHS London Procurement Partnership (LPP), the supplier market and trusts. This is now operational and has become the required framework for trusts to use to access Frontline Digitisation funding.

The programme recognises the need to comply with the following regulatory requirements:

• the Health and Care Act 2022, which established ICSs, made up of GP surgeries, community and mental health trusts, hospitals and other primary care services, with local authorities and other care providers, as statutory bodies in all parts of England
• the UK General Data Protection Regulation (UK GDPR), which controls how personal information is used by organisations, businesses or the government in the UK, and the Data Protection Act 2018, which applies to all organisations working in the health and care sector and all organisations handling NHS data

Regularity

The programme will leverage the investment in EPR solutions, address the variable maturity of existing EPR solutions and ensure that health and care staff have comprehensive digital information about the person at the point of care. This funding will support:

• levelling up the capability of existing solutions for sharing EPRs
• enabling the sharing of EPRs nationally through Connecting Care Record solutions across ICBs

A key aim of the programme is to reduce the number of platforms required to support the sharing of EPRs in any region. The programme business case explores several options for the model and mechanism for making funding available to support trusts to buy and implement EPR technologies. This assessment against our critical success factors (CSFs) identifies a ‘preferred option’, providing match-funded investment for over 160 trusts, with the programme’s whole-life cost standing at £2.034 billion.

The programme business case addendum has been developed in line with HM Treasury Green Book standards. It will be ratified by the appropriate NHS, DHSC, Cabinet Office and HM Treasury approval channels.

In terms of local affordability, providers will be required to contribute to the central funding provided by the programme on a ‘match funding’ basis, as this ensures joint ownership and implementation of the investment. The central review of provider business cases includes assurance of overall affordability, and providers will be required to demonstrate how they will be financially self-sustaining for the scope of the investment when central funding ends. 

Any in-year deficits identified in the business case must be acknowledged in the ICB letter of support, with the confirmation that the ICB will manage these within system budgets. This is a standard condition of approval.

The programme will also monitor the performance outcomes of trusts and systems before and after their EPR and shared care record implementation to evaluate the impact on performance.

Value for money

Within our programme business case, the programme identified a range of options for meeting our programme objectives. These were assessed against a series of core CSFs. The full detail behind the longlist and shortlist of options can be found in the programme business case (and within the full cost model). It included a ‘do nothing’ option.

A full value for money (VFM) appraisal was undertaken of the shortlisted options, aligned with the specific spending objective to fund systems to reach the required standards for core digital capabilities. This was carried out by assessing the costs and benefits of each option alongside the impact on digital maturity. Comparing the combined results helped identify the option that has the best combination of net present value (NPV) and impact on digital maturity. Investment in core digital capabilities has shown a variety of potential benefits, both quality and financial.

It also considered return on investment (ROI) and VFM ranges from ‘bottom up’ modelling and a ‘top down’ approach to ensure the robustness of the case. The ‘preferred option’ demonstrated the highest financial return and the greatest impact on digital maturity. It should also be noted that each provider will perform its own local ROI and VFM calculations as part of its business case process.  

The programme has revised the economic assessment to reflect the implementation and financial reprofiling undertaken as part of the 4th addendum, along with further research into the benefits of EPRs on frontline care and the cost benefit ratio is 4.45.

It is our assessment that the Frontline Digitisation Programme offers a good value for money proposition, and this is reflected in our full cost model.  However, this is a complex programme, with a significant number of capabilities and dimensions in scope. The extent to which these benefits will be realised will be dependent on the individual provider’s business cases and the subsequent implementation by many individual trusts. Extensive support for trusts is a core part of the programme to maximise the success of each individual programme.

Feasibility

The programme has been subject to ongoing IPA assurance. A final IPA Gate 5 Review is planned for February 2026. The reviews to date have recognised the progress to mobilise the programme across NHS trusts and the well-developed organisation, governance arrangements and proportionate assurance framework.

Trust stakeholders are supportive of the programme objectives and indicated that there is a highly collaborative approach within the Frontline Digitisation Programme team. In addition, several suppliers were highly complimentary about the current level of engagement and information sharing within the programme.

Conclusion

In conclusion, as accounting officer, I am clear of the case for change and business requirements. Providing a digitised health and care system where the health service and its users have the digital services and access to information they need to effectively manage and improve health and wellbeing is at the heart of the programme. The programme continues to support this vision by ‘levelling up’ trusts to a core level of digitisation, as set out in the What Good Looks Like framework. This will enable frontline clinical staff to make best use of digital technology to provide care efficiently, effectively and safely, reducing variations and improving quality and outcomes.

I am clear that the ‘preferred option’ that is set out is proper, regular, feasible and offers good value for money. This summary sets out the key points which informed my approval decision. If any of these factors change materially during the lifetime of this programme, then I am prepared to undertake a revised summary setting out my assessment of them.

Copies of this summary will be deposited in the library of the House of Commons and sent to the Chair of the Public Accounts Committee, Controller and Auditor General and Treasury Officer of Accounts.

Samantha Jones, Accounting Officer

28 November 2025