Vanash Patel
Consultant Colorectal Surgeon at West Hertfordshire Hospitals NHS Trust
This is an incredible moment for everyone involved. These first procedures represent the beginning of a new era in modern medicine for our surgeons, our Trust, and most importantly – for our patients. Because without these state-of-the-art machines, we cannot offer our patients the very best care.
It was this core belief that drove me to take responsibility for building an NHS business case just months after starting as a consultant in West Herts.
Now, WHTH has become the first NHS Trust in England to install, from the outset, two Versius Surgical Robotic Systems, created by CMR Surgical. As a teaching hospital, having two surgical robots enables us to accelerate our training programme, giving surgeons who are joining the robotics programme access to this state-of-the-art technology to train when they need it, while ensuring a machine is always available in the operating room.
This means patients, surgeons and the hospital will reap the multiple benefits of robotic-assisted surgery and consistently see the return on this investment.
A business case for better care – but where to start?
Despite the financial outlay when building a business case, I learned that funding isn’t necessarily the best place to start; it’s how you build and communicate your vision to achieve buy-in from the many stakeholders involved.
I didn’t have much experience of the NHS systems and processes when seeking investment, especially for a project with such high upfront costs, and although my colleagues passed on any knowledge they had, I was still at a loss as to how to make a case.
I was put in touch with two surgeons who had recently been through the process, which helped me to realise that it could be done and gave me the motivation to keep going. For me, personally, it was great to collaborate with surgeons from other Trusts – having open discussion and cooperation to help each other realise our ambitions to improve quality for our patients.
One of the biggest hurdles I faced was the number of stakeholders I needed to engage. As well as clinicians, managers and executives, there were teams I had never come across before, such as clinical engineers, information governance, information technology, estates and facilities.
Creating an executive decision
When looking to procure a robot, I realised you must grasp every opportunity to promote your vision. It was a chance meeting between one of my colorectal colleagues and the Trust’s Chief Financial Officer that helped stakeholders to see the potential of robotics. It led to a formal meeting and presentation of the business case, which demonstrated that my vision of a robotic surgery centre aligned with the Trust’s strategy. I was then able to leverage this buy-in at the executive level to motivate divisional stakeholders.
The roadshow showcasing Versius was a pivotal moment when support for the robotics systems seemed to fall into place. The executive team were invited to experience the technology and I presented my business case against the backdrop of the Watford Football Club stadium, making for a polished display. I was delighted to receive very positive feedback.
With comprehensive financial analysis and strategic context, I was confident in my business case. But soon we were back to the question of funding. We discovered that timing is critical when submitting a case to the Trust Board. Consider the timing within the financial year, as well as exploring all possible procurement processes such as the NHS Framework.
The last two years have been a steep learning curve, but receiving delivery, training with Versius , and now starting first patient cases has been a huge achievement. After many conversations and presentations, all the hard work has paid off and it is all worth it to know that patients will be able to benefit from this advanced technology as part of our day-to-day procedures.
Surgical robotics in reality
The systems are initially being used for colorectal surgery, and will then move into upper gastrointestinal and gynaecology specialities to eventually be used across multiple disciplines. The modularity of Versius was a key reason we chose this system, as we wanted something that could be moved into different theatres and different buildings.
All our surgeons and their teams went through a comprehensive and thorough training course before taking on our first cases with patients. This included components such as online e-learning modules, practising using a Versius Trainer Simulator, as well as face-to-face mentored training in the operating room.
Our first patients have already demonstrated enhanced recovery compared to open surgery. And we’re hoping to replicate the patient benefits reported at other sites with Versius systems. Because using Versius offers more precision and control during the surgery, we expect there to be a reduction in post-operative pain, blood loss and scarring, contributing to improved time to full recovery and normal activities. Not only will this help patients get back to normal life sooner, but it also means we can operate a more efficient healthcare system – for example, if we are able to save bed days.
For surgeons, there are also benefits. The ergonomic design of the Versius systems will help prevent the physical strain of conducting manual laparoscopic or open surgery. This could potentially extend our careers, which are often cut short due to physical ailments that no longer make surgery viable and lead to early retirement. After my initial experiences in theatre with Versius, I am finding it game-changing to be able to sit or stand during surgery, whilst still being able to see and communicate clearly with my surgical team.
Being able to retain surgeons amid the staffing crisis facing the NHS is absolutely critical to providing high-quality care. Since having the Versius systems, it has helped us to recruit talented surgeons who are keen to be at the forefront of surgical innovation.
Even prior to having the robots, we were a leading centre for colorectal surgery, which was a key reason why I joined the hospital myself. Now, with Versius we are demonstrating how progressive we are as a hospital and our commitment to being a leading centre. We have already seen a high calibre of candidates applying for jobs and we have recruited two upper gastrointestinal surgeons as a direct result of our robotic ambitions.
Future-proofing now
It’s still early days in our journey towards becoming a robotics surgery centre of excellence. Once in full use, we expect at least 350 patients each year to benefit from robotic surgery. It’s hoped this will convert into an average reduction of 0.5 bed days compared to manual laparoscopic techniques and a reduction of 2.5 bed days compared to open procedures.
As robotic surgery becomes established in the UK, other hospitals will have to follow suit to keep up, driving better care not only within each hospital but the whole of the NHS. I can see a future when all types of surgery are performed using robotic systems like Versius and every patient receives the very highest standard of care.