Top doctor's warning of dire consequences for cancer patients over refusal to fund robotic ops

Dr Michael McBride, Northern Ireland's chief medical officer and former chief executive of the Belfast Health Trust has castigated Board officials for refusing to fund robotic surgery for Northern Ireland. Picture by Mal McCann
Seanín Graham

NORTHERN Ireland's most senior doctor has warned of "significant consequences" for cancer patients following the refusal of NHS administrators to fund pioneering robotic surgery which is everywhere else in the NHS and the Republic.

Confidential correspondence seen by the Irish News reveals a devastating assessment on the future of some surgical specialties from Dr Michael McBride, the north's chief medical officer - with prostate cancer sufferers worst hit.

"Numerous" other patients with gynae and bowel cancers will also be adversely affected, according to the top medic, with some surgeries becoming "unsustainable".

Prostate cancer is the most commonly diagnosed cancer among men in the north, with around 1,000 cases each year.

Patients are currently flown to a London hospital for a radical procedure, known as a prostatectomy, in which the prostate gland is removed using tiny robotic 'hands' controlled by a surgeon. The operation is much less invasive than conventional surgery carried out in Belfast and has a dramatically reduced recovery time.

Almost 200 patients, many of them elderly and frail, have travelled to London for the operation in the past five years.

Senior officials at the Health and Social Care Board informed Dr McBride in January they had decided not to provide funding for the £1.4m robotic device - which has been used in English hospitals for more than a decade - on the grounds it would "not represent sufficient benefit for the population".

A board chief also stated there was not enough patients in the north to sustain the service and raised concerns about the "lengthy" training required for surgeons.

But in a hard-hitting reply Dr McBride, who was acting chief executive of the Belfast Trust at the time, castigates boards officials for their "shortsighted" views and dismisses their case for refusing the technology, saying it is an odds with expert opinion, including that of Professor Rafael Bengoa.

He goes further by saying the failure to invest will severely impact on the north's recruitment and retention of top surgeons - with some already leaving to work in hospitals where the technology is available.

The Da Vinci robot has been hailed as a breakthrough in treating prostate cancer patients. Northern Ireland is the only region in the NHS and Ireland that does not have the technology

"The Trust cannot agree with this decision which will have significant consequences for the patients of Northern Ireland who have the most commonly diagnosed male cancer," he said.

"The message that it sends to the public is that Northern Ireland is unable and not prepared to offer a full range of treatments for our most prevalent cancer within our own service and believe it is appropriate for patients at the time of such a significant and traumatic diagnosis to travel to the UK for treatment.

"The Trust believes the decision contradicts commissioned expert opinion. Professor Bengoa, Sir Liam Donaldson and indeed the board's urological expert, Mr Mark Fordham have all been clear that NI should be a technology hub for healthcare and that this should include robotics."

Significantly, he adds: "The Trust believes that the decision is shortsighted because of the impact it will have on the ability of the Trust to treat other pelvic urological cancers...Numerous patients with gynaecological and colorectal (bowel) cancers require surgical input from urologists with expertise in bladder and prostate cancers for advanced pelvic cancers. If these skills are lost it will most probably destabilise several other surgical services."

Dr McBride revealed he was aware of a "highly experienced locally trained surgeon" who left the Belfast trust for a job in Liverpool where he now performs robotic surgery procedures. He warns that no surgeon from outside the north has applied for urology jobs while there is little interest from new trainees in the field.

"It would be the trust's strong belief that the lack of outside interest is in large part related to the fact that Belfast is probably the only unit in the UK or Ireland performing major urological cancer surgery that does not have a robotic programme."

He refutes the board's claim around lack of sustainability due to lower patient numbers as one based on "cost" and not "clinical effectiveness".

The senior medic also argues that the specialist operating tool cancer can be used for other cancers, while the training of two specialist surgeons will take "six months at most".

In a devastating conclusion he writes: "The urology service in the Belfast trust is not sustainable if we do not invest in robotic surgery. This will have inevitable significant impacts on other surgical specialties".



190 patients from Northern Ireland flown to London for treatment


A TOTAL of 190 patients with prostate related illnesses and cancers have been funded by the north's health service to fly to London for treatment over the past five years.

The main hospital used is Addenbrooke's in Cambridge, with the "vast majority" of patients receiving robotic surgery, the Health and Social Care Board has confirmed.

Many of the patients are elderly and some have other diseases, including dementia and heart conditions.

Most patients require three trips to London - for assessment, surgery and post-operative check-up - and are usually accompanied by a relative. The cost of the surgery alone is £14,000 before flights and accommodation.

The board said it was unable to provide the total cost for sending the north's patients to London since 2012.

The daughter of an elderly Belfast patient with prostate cancer and Alzheimer's disease travelled with him to Addenbrooke's hospital last month and spoke of the "trauma" created by the upheaval of the travel.

"The staff at Addenbrooke's were excellent but transporting my elderly father there when he is frail and suffering from Alzheimers and cancer was very difficult. My mother, who is also elderly, accompanied him on the first visit but I paid separately to travel with them for the second trip when he had surgery.

"The operation was very successful and he was able to walk out of the hospital that evening. He has to go back again in a few weeks which I know they are dreading due to his vulnerability."



Technology offers surgeons precision


DEVELOPED by Nasa and the US Department of Defense, robotic assisted technology allows surgeons to operate at high levels of precision without ever touching their patients.

Known as the 'Da Vinci' robot, it is made up of a console operated by the surgeon, and a patient-side system with four robotic arms.

The surgeon sits at a console - which resembles an old fashioned games console - and operates the instruments with his or her hands and feet. Using master controls, he manipulates the robotic arms and they mimic his movements to perform the surgery.

Treatment offered includes radical prostectomy, the complete removal of the prostate gland. The procedure requires just five small cuts. The system allows for high precision, with robotic "wrists" inserted inside patients that have seven degrees of motion, one more than the human wrist.

Prior to robotic surgery, the conventional method was open scalpel and incision operations, which involved a lengthy stay in hospital, major blood loss and a six-month recovery period. Side effects includes incontinence and impotence.

With the advent of the Da Vinci robot, the operation was reduced to an hour and patients could leave within 24 hours. Recovery time and the potential for side effects were also massively reduced.

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