NI Encompass Digital Health Record Costs Rise to £400 Million as System Beds In Across All Trusts
The cost of Northern Ireland's Encompass digital care record system has risen to approximately £400 million, significantly exceeding the original estimate of £300 million, Health Minister Mike Nesbitt confirmed in April 2026. The system, developed in partnership with US-based company Epic, is now live across all five health and social care trusts following its final rollout in May 2025, providing citizens with a single digital care record and access to the 'My Care' patient portal for the first time.
Background
The Encompass initiative was conceived as a transformative response to Northern Ireland's fragmented and ageing health information technology infrastructure. Prior to the project, the Health and Social Care system operated across approximately 45 legacy systems, many of which could not communicate with each other, creating significant risks for patient safety and imposing substantial administrative burdens on clinical staff. The decision to replace this patchwork of systems with a single integrated platform was taken in the mid-2010s, with Epic — the dominant provider of electronic patient record systems in the United States — selected as the technology partner following a competitive procurement process.
The project was always going to be complex and expensive. Epic's system is the most comprehensive electronic patient record platform available, and its implementation in a health system of Northern Ireland's scale and complexity required extensive customisation, staff training, and data migration work. The original cost estimate of £300 million reflected the scale of that undertaking, but as with many large-scale public sector IT projects, the actual costs have exceeded initial projections.
The rollout proceeded in phases. The South Eastern Trust went live in November 2023, followed by the Belfast Trust in June 2024 and the Northern Trust in November 2024. The final two trusts — Southern and Western — went live on May 8, 2025, completing the province-wide implementation. The Northern Ireland Audit Office had previously noted that broader programme cost estimates in some business case documents had reached as high as £1.93 billion, reflecting the full scope of replacing the legacy systems, though the £400 million figure confirmed by the minister relates specifically to the Encompass implementation costs.
Key Developments
The confirmed cost of £400 million comprises £343.6 million in capital spending and £56.2 million in revenue expenditure. Health officials have characterised the expenditure as unavoidable, citing the critical need to replace infrastructure that had reached the end of its operational lifespan. The government anticipates non-cash releasing benefits of approximately £51.4 million from the system, alongside smaller cash-releasing benefits from reduced duplication and administrative efficiencies.
The 'My Care' patient portal, which allows citizens to access their health information, appointment details, and test results via web or mobile app, has been one of the most visible public-facing elements of the system. Uptake has been gradual but growing, with the Department of Health reporting increasing registration numbers across all trust areas since the full rollout was completed.
Challenges remain. GP practices currently use a read-only platform called EpicCare Link rather than full system access, creating a gap in the integrated care record that the Department of Health has acknowledged needs to be addressed. Clinical staff feedback on the system has been mixed, with some reporting significant improvements in information access and others citing concerns about the time required to navigate the new interface during busy clinical sessions.
Why It Matters
The Encompass system represents the most significant investment in health information technology in Northern Ireland's history, and its success or failure will have consequences for patient care for decades to come. The case for the investment rests on the premise that a single integrated care record will reduce clinical errors, improve care coordination, and ultimately deliver better outcomes for patients. The evidence from health systems in the United States and elsewhere that have implemented Epic suggests that these benefits are real, but that they take time to materialise as staff become proficient with the system and as the data it generates begins to inform clinical decision-making.
The cost overrun — from £300 million to £400 million — is significant but not unusual for projects of this scale and complexity. For context, NHS England's equivalent programme, which is still in progress, has faced far larger cost increases. The more important question is whether the system delivers the clinical and operational benefits that justified the investment. That assessment will only be possible in two to three years, once the system has been in operation long enough to generate meaningful outcome data.
Local Impact
The impact of Encompass is being felt differently across Northern Ireland's five trusts. In the Belfast Trust, which covers the Royal Victoria Hospital, Belfast City Hospital, and the Mater Hospital, the system has been in operation longest and staff familiarity is highest. In the Western Trust, which covers Altnagelvin Hospital in Derry/Londonderry and the South West Acute Hospital in Enniskillen, the system is newer and the bedding-in process is still underway. Patients across all trust areas can now access their records through the My Care portal, though awareness of the portal remains lower in rural areas where digital literacy and broadband access present additional challenges. The Department of Health has committed to a public awareness campaign to increase portal uptake in the coming months.
What's Next
The Department of Health is expected to publish a formal review of the Encompass implementation in the autumn of 2026, assessing the system's performance against the original business case objectives. The review will inform decisions about further investment in digital health infrastructure, including the potential expansion of GP access to the full Epic system rather than the current read-only platform. Health Minister Mike Nesbitt has indicated that the review will be published in full, including any areas where the system has underperformed against expectations.
