Patients must reap the benefits of the latest surgical innovations warns new report

Failure to adopt new surgical techniques quickly into everyday clinical practice means NHS patients are missing out on ground-breaking new procedures, warns a new report from the Royal College of Surgeons.

The report, entitled From innovation to adoption: Successfully spreading surgical innovation, sets out for the first time the factors that have helped and hindered the adoption of new surgical techniques in England.

It highlights that from the first antiseptic operation, through to organ transplantation, keyhole techniques and robotic technology, innovation has revolutionised NHS care. From innovation to adoption warns that if we are to continue to be at the forefront of improving patient care, supporting research, new techniques and ideas must become business as usual for the NHS.

Based on an examination of five mainstream surgical procedures the study explores why, after new surgical techniques have been trialled, it can still take years for patients to benefit from them. Insufficient evidence to prove the safety and effectiveness of a new procedure; ensuring surgeons have the new skills required; investment in new equipment or the need to redesign services (infrastructure) and the level of clinical and patient demand are among the reasons why the widespread adoption of a new surgical procedures is often delayed.

One case study in the report, for Laparoscopic colorectal surgery, starkly outlines the problems.

The quality of the evidence for laparoscopic colorectal surgery meant that the technique received a positive recommendation through NICE’s technology appraisal process, which carries with it a legal requirement for hospitals to make the treatment available within three months. However, this requirement was waived for four years due to a lack of appropriately trained surgeons in the NHS to deliver the desired workload, meaning the availability of the treatment on the NHS was not mandated.

Strong clinical leadership and advocacy from Sir Mike Richards, then National Clinical Director for Cancer was instrumental in securing action and adequate funding from the Department of Health to ensure that this legal duty could be fulfilled by training surgical teams which led to the procedure eventually being adopted.

The report seeks to address how to progress the uptake of surgical innovations in a practical way, eradicating delay to ensure their benefits are realised by patients as quickly as possible.

It argues the absence of evidence that a new innovation is truly beneficial can make it harder to secure the funding needed to develop surgical skills and establish the correct infrastructure to support an innovation’s wider use.

The study states that ultimately clinicians must want to use a new procedure and patients must want to receive it, if a treatment is to be widely adopted. This will require the provision of appropriate information on its benefits and risks.

From innovation to adoption also makes six achievable and affordable recommendations, which, if implemented, will benefit patients in future years. Among the recommendations is a call to NHS England to work in partnership with NICE and the Royal College of Surgeons of England to develop a horizon scanning process to quickly identify and review new surgical procedures that have the potential to improve patient care.  Other recommendations include:

• Providers of NHS services should be financially incentivised to support surgical innovation
• NHS England should work in partnership with NICE and the Royal College of Surgeons of England to agree on an appropriate service delivery model. The Royal College of Surgeons should provide advice on training requirements, including the number of centres, to safely introduce the new technique
• Patients should be offered a choice of different surgical interventions that are appropriate for them, including new practices and techniques
• Patient groups should work with surgical specialty associations to develop appropriate information for patients on new surgical procedures

Professor Norman Williams, President of the Royal College of Surgeons, said:

‘Many patients are not benefitting from groundbreaking procedures even when surgeons firmly believe that they can save or extend lives and improve their quality.  This cannot continue. We cannot afford to neglect the kind of surgical innovation that has made such a difference to a chance of survival and recovery, for example, in keyhole surgery, advancements in transplant surgery and the rapid developments we are now seeing in robotic surgery. Now is the time for the NHS, the government and the surgical profession to understand how the adoption and diffusion of new, innovative surgical practices can be accelerated.’

Notes to editors

For more information and a copy of the report please contact the RCS press office on:

• 020 7869 6047 / 6052
• communications@rcseng.ac.uk
• Out-of-hours: 07966 486 832
• The Royal College of Surgeons of England is committed to enabling surgeons to achieve and maintain the highest standards of surgical practice and patient care. Registered charity number: 212808

One of the five case studies in the report is for Laparoscopic colorectal surgery

The quality of the evidence for laparoscopic colorectal surgery meant that the technique received a positive recommendation through NICE’s technology appraisal process, which carries with it a legal requirement for NHS providers to make the treatment available within three months. However, this requirement was waived for four years due to a lack of appropriately trained surgeons in the NHS to deliver the desired workload, meaning the availability of the treatment on the NHS was not mandated. Strong clinical leadership and advocacy from the National Clinical Director for Cancer was instrumental in securing action and adequate funding from the DH to ensure that this legal duty could be fulfilled by training surgical teams in the NHS through a national training programme (NTP).The novel approaches of the NTP further fuelled the speed of the programme and ensured adequate data were collected to continually demonstrate the benefits of the programme and maintain funding and momentum in the surgical community.

The first robotic surgery was offered to NHS patients in 2004

However, to date the NHS has not funded the procurement of a surgical robot – funding from charitable donations and endowments has been used to meet the significant costs involved. The lack of a substantial evidence base has meant a strong signal from national guidance has not been given, which fuels NHS trusts’ reluctance to invest in surgical robots. This has meant that the geographic spread of the technology has been varied and limited to trusts with such resources available. In 2010/11, 20 providers performed robotically-assisted procedures on the NHS, accounting for 13% of all prostatectomy and cystoprostatectomy procedures. Proponents of the technique advocate for a doubling in the number of robots in use in the NHS.

The Royal College of Surgeons has worked with our partners, the National Institute of Health Research, the Rosetrees Trust and Cancer Research UK, to establish a national network of surgical trial centres to develop and expand clinical trials in surgery, raise surgical standards and transform the quality of patient care across a breadth of conditions.