Essential insight into NHS matters in the North West of England, with a particular focus on the devolution project in Greater Manchester. By Lawrence Dunhill

Robot wars

A reasonable, albeit temporary, solution has been reached over urology cancer surgery in Lancashire, where one of the acute trusts had taken matters into their own (robotic) hands.

Lancashire Teaching Hospitals Foundation Trust and East Lancashire Hospitals Trust – the two trusts that provide the service – both accept that specialist surgery needs to be consolidated on one site. But where that site will be is a thorny question still to be resolved.

New robotic surgical equipment has been transforming the way urology services are delivered, and surgeons at both trusts have been understandably keen to make these advances.

In terms of case numbers, LTHFT runs the bigger centre at Preston, but its surgeons were unable to persuade their board to invest in the £1.5m Da Vinci robot (which comes with annual maintenance costs of £150,000).

The board justifiably pointed to NHS England guidance, which said new purchases should be avoided until a national policy has been developed.

But the surgeons at East Lancashire had more luck, with their board opting to defy national commissioners by splashing out on the equipment last June.

You can imagine the chagrin among the Preston surgeons when their colleagues in the east declared they would “position ourselves as the leading provider of prostate cancer surgery in the network”.

With no commissioning agreement in place, East Lancashire has been making a loss from the robotic service for the last year.

But NHS England has now agreed to a temporary solution, where it will fully fund robotic surgery on the condition that the equipment could be transferred if Preston is selected as the single surgical site. The Preston surgeons must also be allowed to train and use the robot in the meantime.

It all sounds a bit school playground doesn’t it? Although we shouldn’t lose sight of the fact that the unapproved purchase has almost certainly improved care for patients, as it might otherwise have been years before NHS England approved a robot purchase for either trust, especially with the single site review potentially lasting to 2019. (Surely it shouldn’t take this long?)

So, things are all well and good for now.

But the situation could have done without a trumpety press release from East Lancashire last week, in which the trust said it had received “official confirmation from NHS England special commissioners to be the only site to carry out robotic assisted surgery for urological cancer in Lancashire and South Cumbria”.

There was no mention of this being a temporary arrangement, or the future consolidation, or the conditions attached to the deal.

What’s a fair share?

For several months now, I’ve been trying to get an explanation about how Greater Manchester’s “fair share” transformation fund was calculated.

The region has been allocated £450m over five years, with £60m coming in 2016-17. This sounds pretty generous to most people, and it seems important to understand how it was reached.

The region’s devolution team will not answer questions on it, and refers the issue to NHS England. But the national body seems extremely reluctant to offer any help.

After several attempts they finally told me that £450m represents 5.6 per cent of an £8bn national fund for “relevant policy and transformation initiatives”.

This sounds fair enough when you consider the region’s clinical commissioning groups receive 5.6 per cent of the national allocation for CCGs.

But what is this £8bn figure? It’s not clear whether this refers to the real terms increase in NHS spending agreed by the government in November’s comprehensive spending review, or a newly defined pot of transformation cash.

And when you consider that Greater Manchester’s hospital trusts will retain separate access to the national “sustainability and transformation” funding for another year at least, it looks a good deal for the newly devolved authorities.

It could easily be argued that Greater Manchester deserves more than its fair share of the national pot, given the impressive progress being made. But if that’s the case then NHS England (and the devo team) should be open and transparent about how and why that decision was made.

I’m still pressing for clarity, which unfortunately means a freedom of information request (frustrating, but a last resort). If anyone who has the answer is able to help me out, then please do get in touch.

North by North West takes an in-depth weekly look at one of the NHS’s most challenged and innovative regions. There will be a particular focus on the devolution experiment in Greater Manchester, but my scope will also include Merseyside, Lancashire, Cheshire and Cumbria.

Please get in touch to let me know how I can improve it, and to tip me off about stories you think I should cover: If someone forwarded this to you, sign up to get your own copy here