UK patients miss out on optimal surgery as NHS forced to contain costs and plan short-term, new report reveals

Despite these benefits, the report reveals scores of patients are being denied MAS. Data outlining surgical procedures in the UK shows that 24% of hysterectomies are performed with MAS,ⁱⁱ meaning women are potentially spending more time in hospital than they need to, often with greater scarring and pain as a result of procedures conducted with open surgery. Increasing the rate of MAS has been shown to reduce the number of bed days per patient from 5.5 to just 1.5 days for 95% of gynaecology cases.ⁱⁱⁱ In one NHS hospital, the number of beds required in one department fell from 22 to just 8 after increasing the rate of MAS.^iv

The report that was commissioned by CMR Surgical, a British company developing the next-generation surgical robot, identifies several reasons why more NHS patients are not being offered MAS, including financial pressures,^v a lack of trained surgeons^vi and a short-term approach to commissioning.^vii

MAS is perceived as more expensive, as it is associated with longer operating times and greater upfront cost. With increasing pressure to tackle rising waiting times, the report reveals that some clinicians feel pressurised to conduct more open surgery to address a long waiting list. Modern tools, including robotics, can assist surgeons to operate laparoscopically. However, the survey that accompanies today’s report shows that 96% of UK surgeons believe that upfront capital costs are a barrier to the adoption of surgical robotics in the NHS.^viii

Prokar Dasgupta, Professor of Robotic Surgery & Urological Innovation, King’s College London said: “It is regrettable that we continue to perform open surgery on patients where minimal access techniques are both appropriate and possible. Now is the time to embrace surgical innovation and plan ahead to build a sustainable healthcare system”.

The report also outlines that a lack of MAS-trained surgeons is another reason why uptake in the NHS is limited.^ix Performing MAS requires a surgeon to operate laparoscopically, which requires further training and exceptional skill. 81% of gynaecological surgeons named an insufficient number of surgeons being trained in MAS as the main barrier to increased uptake.^x

Mark Slack, Consultant Gynaecologist and Urogynecologist, and Medical Director at CMR Surgical said: “Patients everywhere deserve access to minimal access surgery. We need to address the training shortage and ensure that robotic systems are affordable for today’s healthcare systems. With the NHS at breaking point, it is our duty to work together – industry and the health service – to encourage the use of surgical innovation for the benefit of patients”.

Where used appropriately, MAS can improve patient outcomes whilst promoting the efficient use of NHS resources; however, this can be inhibited when silo-thinking and short-term targets drive decision-making, according to the report.^xi. Investing in new equipment which can deliver long-term benefits should be prioritised. Robotics is one way to increase the use of minimal access surgery, but the current cost of robotic systems has made it difficult to prove a return on investment within the timeframes required by commissioners to fund new equipment, sometimes as little as 12 months,^xii the report shows. Just 30% of surgeons believe that there is adequate support and incentives in the NHS for surgical innovation.^xiii

The findings of the report demonstrate that through the uptake of MAS, the health service can reduce pressure on beds, improve patient outcomes and eventually deliver cost savings to the NHS.

Recommendations to increase the uptake of MAS include: