NHSE&I expects that trusts will need to contribute £3 billion, under matched- funding arrangements, between 201920 and 2028–29 to meet its current plans for a digital transformation.42 However, in their written evidence to us NHS Providers, the Royal College of Midwives and the NHS Confederation all raised concerns about the ability of trusts to fund digital transformation programmes.43 The Royal College of Midwives told us that in its survey of ‘digital midwives’, a lack of money was the most common answer to its question on why they had not achieved digital transformation within their trust. NHS Providers also told us that that that access to funding was one of the factors driving the variation in digital maturity between trusts. We have reported on the financial and service sustainability of NHS bodies every year since 2011, and have consistently highlighted a range of challenges faced by the NHS, including rising demand, lack of capital investment and tackling trust deficits.44 We asked the Department how it was ensuring that those trusts which had financial difficulties were still able to invest in digital transformation. The Department told us that the funding for digital transformation was not ring-fenced. It expected the £3 billion from trusts to come through its matched-funding arrangements under which the Departments and trusts contribute equivalent funding for local projects. It explained that as part of its strategy to return the provider sector to financial balance, it planned to engage with the most financially-challenged trusts to develop recovery plans.45 However, our reports have illustrated that many trusts have deep-routed structural issues that are difficult to fix. For example, our report on NHS financial management and sustainability found that writing off the loans owed by struggling trusts does not solve the underlying problems facing these organisations.46 The cost and benefits of the digital transformation