Robot wars in Lancashire as trusts compete to be specialist site

East Lancashire Hospitals Trust bought and installed a Da Vinci robot at the Royal Blackburn Hospital earlier this month, which will be used by cancer surgeons to remove prostate glands.

The machine is expected to improve outcomes, but an NHS England spokeswoman told HSJ it was bought against commissioners’ advice.

Urology cancer services are being reviewed across Lancashire and south Cumbria, with the expectation there will be a single site for specialist surgery.

In terms of case volumes, the Royal Blackburn is the smaller of two centres within the network, with Lancashire Teaching Hospitals Foundation Trust hosting a larger service at the Royal Preston Hospital.

Leaders at Preston said they have considered purchasing the robotic equipment, but were waiting for further NHS England guidance.

An NHS England policy statement on robotic surgery last year pointed out the high costs of buying the technology, including annual maintenance costs of £150,000.

It added: “A proliferation of centres offering robotic surgery should be avoided until a national policy can be developed.”

The NHS England spokeswoman said it was not consulted by East Lancashire about its purchase. She added: “When NHS England was made aware that East Lancashire intended to purchase a robot, [it] advised there should be no new market entrants in line with the NHS England policy statement.”

Asked if this meant the trust was advised not to buy the equipment, she said “yes, that is the position”.

East Lancashire did not respond to HSJ’s questions on this point.

Shahid Islam, clinical director for urology at the trust, said his team wanted to develop the robotic service “for the network”, following guidance from the National Institute for Health and Care Excellence, which said all patients requiring prostatectomy should be offered the chance of robotic assisted surgery.

He added: “Preston had tried for two years to get subscription from their execs but to no avail. We have been fortunate that we turned this around in just under six months and we are operational.”

He said Royal Blackburn performs about 60 out of 160 prostatectomies within the region a year, and confirmed the trust intends to “position ourselves as the leading provider of prostate cancer surgery in the network”.

However, a spokeswoman for Lancashire Teaching Hospitals said: “We undertake a significant majority of these procedures in Lancashire and south Cumbria, so we consider ourselves to be the leading provider in this area. We are also the provider of tertiary cancer services.

“Our five year strategy sets out our aim to expand specialist service provision, and specifically to be designated as the single provider of cancer urology procedures in [the region].”

The FT said it performs more than 110 out of 150 procedures a year.

Steve Brown, training programme director for urology at the North West Deanery, said robotic surgery is expensive, partly because US firm Intuitive Surgical is currently the only supplier.

He added that trusts would need at least 150 cases a year to make it a viable option, and “it could be money wasted if there’s not a strategic plan”.

Mark Speakman, president of the British Association Urological Surgeons, said: “We’ve been fairly critical of the lack of planning around this, and it’s been the bullish nature of some chief executives to say ‘we’re going to get one before our neighbour does’.

About a third of the 150 hospitals which perform urological surgery now have a robot, he added.