ABHI robotic-assisted-surgery white paper sets out the case for a national strategy

The Association of British HealthTech Industries (ABHI) has launched a white paper: Robotic Assisted Surgery and New Models of Surgical Care, which sets out the case for a national multi-stakeholder strategy for Robotic Assisted Surgery to support its uptake across the NHS. In this article for Health Business Magazine, ABHI’s Robotic Assisted Surgery Group Vice Chair, Chris Gray, explains the thinking behind the paper

The benefits of Robotic Assisted Surgery (RAS) versus manual surgery are increasingly well catalogued. Reduced trauma to patients that can lead to quicker recovery and better experience, fewer days spent in hospital freeing up much needed capacity including Intensive Care Units and High Dependency Units, less physical stress on surgeons, potentially extending their working life, and procedures being performed on high-risk patients or patients with complex conditions where open surgery would not be an option, as well as the capacity to track and measure surgery, far more than has ever been achievable with manual approaches. The use of RAS is increasing in abdominal, thoracic and orthopaedic surgical specialities and the benefits of using these systems are beginning to resonate across the NHS.
    
The NHS is reforming, some of it planned, some of it driven by necessity. The expected changes are in part, a response to the underlying challenge the NHS faces - ensuring healthcare remains accessible and free at the point of need - despite an ageing population, rising demands and cost pressures, and a fatigued NHS workforce facing an endemic challenge of recruitment and retention. In parallel, the NHS will, for the foreseeable future, deal with the elective surgery backlog.
   
In England, a move to integrated care with regional strategies directing future investment, could lead to different models of elective surgery emerging to address local/regional requirements and objectives. This could be an opportunity to recognise RAS, in a similar way to how Scotland and Wales have recognised the role of RAS in their national planning.
 
With this in mind, we at the Association of British HealthTech Industries (ABHI) have launched a white paper: Robotic-Assisted-Surgery and New Models of Surgical Care, which sets out the case for a national multi-stakeholder strategy for RAS to support its uptake across the NHS.
    
The paper has been spearheaded by ABHI’s dedicated Robotic Assisted Surgery Group, which sits within the Association, and brings together HealthTech companies, the clinical community and other relevant organisations who have a strong interest in furthering the use of RAS.
    
The timing of this paper is important. The NHS in England is at a significant juncture, with political decisions about how the healthcare system is structured and what is prioritised post-Covid all to be made in the coming months. This will set the direction and course of the NHS for a generation.
    
The document recognises the common themes and challenges across the environment for providers, clinicians and industry, in supporting the adoption of RAS, and makes a series of recommendations across the key areas of regulation, policy, evidence, awareness and training.
    
We have also identified building blocks that we view as crucial for the sustainable growth of RAS including:

Enable the efficient evaluation of clinical and economic value of RAS through the utilisation of real-world evidence
The capacity to generate, capture and analyse data can drive a revolution in our ability to understand more quickly the safety, effectiveness and value of new digitally enabled technologies.
    
However, this capacity and the potential benefits it can offer, also needs to be accompanied by clarity in thinking on what data needs to be captured, for what purpose, how will it be used to inform decisions and by whom.
    
The move in England to population-based healthcare strategies delivered by integrated care systems and providers could pave the way for understanding the benefits of technologies beyond the setting in which they were utilised.
    
Whilst RAS has well-reported benefits supporting patients to recover quicker and leave hospital sooner following surgery, how this benefit is maintained and enables them to return to normal life, is less understood. Demonstrating the potential ‘ripple effect’ of RAS through perioperative care, is one area that requires further attention.

Support the development of professional education, training, and expanding the knowledge of RAS to non-surgical NHS staff
RAS is a revolution and a significant leap forward from how surgery was performed even 20 years ago. Nevertheless, whilst the technology can significantly enhance the skills of the surgeon and their team, it still requires surgical competency, knowledge and understanding to deliver outcomes safely and efficiently.
    
As Robotic Assisted Surgery becomes more widely adopted, the need to train surgeons and NHS staff at scale will continue to grow.
    
The HealthTech industry recognises that training will necessarily vary because of the different RAS platforms specialties they are being used for. Ensuring high standards in training and access to continuous professional development, therefore, will be critically important.

Improve the general understanding of RAS and its benefits, to positively inform the development of patient pathways and integrated care strategies
Equity of access to minimally-invasive-surgery, let alone RAS, remains a problem in the NHS. This can have serious implications for the patient, their treatment choices, and their overall wellbeing and recovery.
    
The patient benefits of RAS, including reduced trauma leading to quicker recovery, are not always recognised beyond the surgeon and their team. Raising awareness of RAS and demonstrating its benefits to those supporting patients through their treatment journey will be important for them to make informed choices about their treatment.
    
More pressing is the need to address the surgical backlog that has grown significantly since the start of the COVID-19 pandemic. Greater awareness amongst NHS planners of RAS, especially its positive impact on reducing length of stay of patients and reliance on Intensive Care Units and High Dependency Units, could help alleviate the burden on capacity that some Trusts are facing.
    
Lack of payment for RAS procedures can also be a disincentive for Trust investment in robotic surgery. Block contracts do not support uptake of RAS due to a lack of legacy payment mechanisms for such technologies outside urology.

Recognise RAS when formulating policy, for example, in response to the current backlog of elective surgeries and in future life sciences strategy
For the UK to take a leading role in research and development of digitally enabled technologies such as RAS, it needs to positively and proactively recognise it in key policies and strategies.
    
This recognition would provide a welcome signal that the Government and NHS sees value in nurturing this fast-growing sector. An active partnership with industry is needed to demonstrate the value it can bring to patients and improved efficiencies in health delivery.

In Conclusion
Ensuring that the NHS and patients can realise the benefits from RAS is a key motivation behind this paper. It is our view that RAS should be viewed strategically, and given key consideration when looking at future surgical care configuration and patient pathway design.
    
The opportunities that further RAS adoption presents will only be delivered safely, effectively and efficiently through collaboration across industry, the NHS, Government, and patients.
    
Fundamentally though, collaboration will be key to realising the benefits of RAS, and through the ABHI group, we will be using the paper as an engagement tool to inform future work and partnering opportunities.

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