One in four NHS prostate cancer units have closed in the last seven years because they could not afford expensive surgical robots – despite claims the machines are unproven.
A report in the Lancet Oncology journal warns 16 hospitals in England stopped offering prostate surgery because patients want to be treated by a robot instead of a surgeon.
The study found they were losing patients to richer, larger hospitals, usually in big cities, which could afford the latest £1.5million surgical robots.
The researchers, led by experts at the London School of Hygiene & Tropical Medicine and King’s College London, warn there is no evidence these robots actually improve care.
Yet patients are increasingly choosing to travel miles from their home to access the treatment.
Researcher Dr Ajay Aggarwal, an oncologist in London, said: ‘NHS choice and competition policy is based on the principle that patients will travel to centres they think will provide the best service.
‘Closures were never intended to result from this, but the large number of patients deciding to receive treatment elsewhere meant some centres faced the risk of closures as they were no longer performing a sufficient number of procedures to sustain their service.’
The NHS has about 60 surgical robots, often bought by hospitals’ charitable trusts after local fundraising campaigns.
The most common type is the Da Vinci robot, which is comprised of four robotic arms controlled by a surgeon sitting at a console.
The machine was first used in September 2000 to remove a gallbladder, but has since become used far more frequently for prostate surgery.
The researchers calculated that between 2010 and 2017, the number of hospitals using robots for prostate surgery has more than tripled – from 12 to 42.
At the same time the NHS has lost 16 of its 65 prostate surgery centres, none of which offered robotic surgery.
Some experts claim robotic surgery is more accurate, less subject to human error, and leads to quicker recovery, reduced pain and far less visible scarring.
A previous study, published by Australian academics in 2016, found outcomes were virtually identical after three months whether their surgery was performed by a robot or a human.
Those given robot surgery experienced less pain doing day-to-day activities a week later, and had better overall quality of life after six weeks.
But after three months this evened out and after three months the average number of days off work was the same, and there was no difference in urinary and sexual function, or number of complications.
Dr Aggarwal said: ‘It just comes down to the quality of the person doing the surgery at the end of the day – not the machine.’
Some 47,000 men are diagnosed with prostate cancer in the UK each year – and 11,300 die as a result.
Roughly 5,400 men have their prostate removed to stop the spread of the disease, and according to the most recent figures in 2014/15 some 1,900 underwent this procedure at the hands of a robot – 35 per cent of the total.
Dr Aggarwal’s research relies on anonymised data – so it is not clear which hospitals have stopped performing surgery.
But charities said in some parts of the UK – including the whole of Northern Ireland – surgeons are doing absolutely no prostate operations because large city hospitals are taking all their patients.
Yet others say this centralisation is better for patients.
London Cancer, the UK’s biggest provider of robotic prostate surgery with 500 patients a year, reported side effects fell after they started using the machines.
In 2010 heath bosses in London consciously decided to stop providing prostate surgery at Whipps Cross, King George and Barnet hospitals – and instead create one big centre at University College London Hospital.
They claim this centralisation, along with the use of robots, has improved outcomes because they see many more patients, increasing their experience and expertise.
But in other parts of the country, some surgeons have gone back to performing operations by hand because they are unhappy with the results of the machines.
One of the country’s top consultant urological surgeons, Alan Doherty, of University Hospitals Birmingham NHS Trust, last year admitted he had gone back to open surgery.
‘It gives me better results than robot surgery or keyhole surgery,’ Mr Doherty said. ‘I did more than 1,000 keyhole operations and could not get the same good results as with open surgery.
‘But robots are so in favour that few people are even doing open surgery.
‘I had a recent referral from London as no one there is doing open surgery any more.
‘I’m not anti-technology, but the question is — is our money being well spent here?’
Experts believe the same trend could soon be seen with other heath areas.
Dr Aggarwal said: ‘We have to accept there is a market within the NHS. People are choosing and providers are providing.
‘But they are not given the evidence that what they are choosing is any better.’
The problem, he said, is that medical technology is not subject to the same scrutiny as drugs, which have to undergo rigorous trials by NHS watchdog NICE before they are approved.
He called for far tighter regulation and evidence gathering before technology is widely used.
‘NHS hospitals are subsequently investing millions of pounds into new and sometimes unproven technologies which has a direct impact on the type of care patients receive,’ Dr Aggarwal said.
‘Most hospitals have these robots now, so we can’t see ourselves going back, but it could happen in other areas of the NHS as well.’
Catherine Winsor of Prostate Cancer UK said: ‘If treatment in a specialist centre is chosen, it is also crucial that the correct processes are in place to ensure a high quality of patient experience and outcomes.
‘We are concerned that currently this is not always the case. For example in Northern Ireland men with prostate cancer who chose surgery are currently being sent to England for robot assisted treatment, and local surgical procedures have been stopped.
‘As a result we have heard reports of long delays to treatment, as well as inappropriate accommodation and disjointed follow up support. This is unacceptable.’