While the government is betting big on robotic-assisted surgery, the Royal College of Surgeons of England says problems with equitable access remain.
Patients face a postcode lottery in accessing robotic-assisted surgery on the NHS, according to the Royal College of Surgeons of England (RCS England).
The College has found that, despite national guidance from NHS England, there are major differences in how the technology is funded, distributed and used across NHS trusts in England.
Freedom of Information data from NHS trusts raises concerns about equitable access for patients. The data also shows that some hospitals rely on charitable fundraising to purchase robotic platforms. For example, Royal United Hospitals Bath NHS Foundation Trust reported spending more than £2 million raised through donations, underlining how access to cutting-edge care can depend on local fundraising rather than consistent NHS funding.
“Robotic-assisted surgery can transform care and help reduce NHS waiting lists, but access remains a postcode lottery,” said the College’s president Tim Mitchell.
“For one of the government’s five big bets, it is extraordinary that some NHS hospitals are having to resort to local fundraising to raise vital funds,” he added.
A big bet
The government has identified robotics as one of five big bets in its 10 Year Health Plan for England, with a vision that robots will help “deliver care with unprecedented precision”. NHS England plans to increase the use of surgical robots, with half a million robotic-assisted operations a year by 2035, suggesting the technology is expected to become routine for many minimally invasive procedures.
“Robot-assisted surgery is a perfect example of innovation improving patients’ care and transforming the way the NHS works – the number of procedures being carried is set to rapidly grow over the next ten years according to our analysis,” said John McGrath, consultant surgeon at North Bristol NHS Trust, and chair of the NHS England steering committee for robotic assisted surgery, when the plan was announed.
But the new analysis suggests a clear gap between national ambition and frontline reality, with no consistent strategy for how robotic surgery should be funded, distributed or used across the NHS. This reflects a broader lack of coordinated national planning, with decisions about robotic surgery often made locally rather than as part of a joined-up NHS strategy.
Significant variations
The RCS England data shows that access to robotic-assisted surgery varies significantly by region, resulting in a postcode lottery for patients, with some parts of the country having far greater access to robotic systems than others. For example, while some trusts have multiple robotic systems, others have none. NHS trusts in the London region together have 28 systems, compared with just six across trusts in the Southwest NHS region and 15 in the East of England.
There is no standard, consistent funding model for robotic surgery across the NHS, with trusts relying on a mix of capital funding, leasing and managed service agreements, cost-per-case arrangements, and, in a number of cases, charitable funding.
There is no single, transparent national dataset on robotic surgery provision routinely or consistently available at a national level, making it difficult for NHS England, DHSC and ICBs to plan services strategically, assess equity of access and ensure value for money as robotic surgery expands.
What is needed, the College says, is a national public directory of surgical robotic systems, alongside the national robotic surgery registry that is currently being commissioned, to enable better national planning, equity of access, and efficient use of resources. That needs to be backed by a clearer, more consistent funding model, including centralised capital funding, so trusts avoid relying on piecemeal local or charitable funding, and to support equitable access for patients.
RCS England has set out clear expectations for continued focus on training, governance and patient safety, with strong clinical oversight and access to structured training for the whole surgical team through its updated good practice guidance on robotic-assisted surgery.
“It’s clear from this data that there is an urgent need for more grip on where robots are located and how they are funded, to ensure robotic-assisted benefits all patients, not just those in the right postcode,” said Mitchell.
