Patients face a postcode lottery in accessing robotic-assisted surgery on the NHS, new analysis by the Royal College of Surgeons of England (RCS England) has revealed. Published at the Future of Surgery Festival, the data shows that, despite national guidance from NHS England, there are major differences in how the technology is funded, distributed and used across NHS trusts in England.
Freedom of Information data from NHS trusts raises concerns about equitable access for patients. The data also shows that some hospitals rely on charitable fundraising to purchase robotic platforms. For example, Royal United Hospitals Bath NHS Foundation Trust reported spending more than £2 million raised through donations, underlining how access to cutting edge care can depend on local fundraising rather than consistent NHS funding.
The findings come despite the Government identifying robotics as one of five “big bets” in its 10 Year Health Plan for England, with a vision that robots will help “deliver care with unprecedented precision”. NHS England plans to dramatically increase the use of surgical robots, with half a million robotic-assisted operations a year by 2035, suggesting the technology is expected to become routine for many minimally invasive procedures. But the new analysis suggests a clear gap between national ambition and frontline reality, with no consistent strategy for how robotic surgery should be funded, distributed or used across the NHS. This reflects a broader lack of coordinated national planning, with decisions about robotic surgery often made locally rather than as part of a joined-up NHS strategy.
Robotic-assisted surgery can offer real benefits for patients, including faster recovery times, fewer complications and shorter hospital stays. RCS England has argued its rollout must be underpinned by clinical evidence such as NICE’s recent reviews - including the types of surgery it offers benefit for. It also emphasises that not every hospital needs its own surgical robot, but all patients should have equitable access to hospitals and surgeons that provide robotic surgery.
The data shows that:
• Access to robotic-assisted surgery varies significantly by region, resulting in a postcode lottery for patients, with some parts of the country having far greater access to robotic systems than others. For example, while some trusts have multiple robotic systems, others have none. NHS trusts in the London region together have 28 systems, compared with just 6 across trusts in the Southwest NHS region and 15 in the East of England.
• There is no standard, consistent funding model for robotic surgery across the NHS, with trusts relying on a mix of capital funding, leasing and managed service agreements, cost-per-case arrangements, and in a number of cases, charitable funding.
• There is no single, transparent national dataset on robotic surgery provision routinely or consistently available at a national level, making it difficult for NHS England, DHSC and ICBs to plan services strategically, assess equity of access and ensure value for money as robotic surgery expands.
RCS England says that realising the benefits of robotic-assisted surgery for patients will require:
• The government to create a national public directory of surgical robotic systems, alongside the national robotic surgery registry that is currently being commissioned, to enable better national planning, equity of access, and efficient use of resources.
• A clearer, more consistent funding model, including centralised capital funding, so trusts avoid relying on piecemeal local or charitable funding and to support equitable access for patients.
• Investment plans that reflect the full cost of robotic surgery, including workforce, training, infrastructure, maintenance, consumables and productivity, not just robotic platforms themselves
• Better use of existing robotic systems, with staffing planned to enable access across different surgical specialties and use throughout the working week, maximising patient benefit and value for money.
• A continued focus on training, governance and patient safety, with strong clinical oversight and access to structured training for the whole surgical team. RCS England has set out clear expectations through its updated good practice guidance on robotic-assisted surgery.
• Action from industry to improve affordability and sustainability including more support for refurbished systems and flexible financial models to give more opportunity for trusts to acquire surgical robots.
At the Future of Surgery Festival in Birmingham, Mr Tim Mitchell, President of the Royal College of Surgeons of England (RCS England), said: “Robotic-assisted surgery can transform care and help reduce NHS waiting lists, but access remains a postcode lottery. For one of the Government’s five ‘big bets’, it is extraordinary that some NHS hospitals are having to resort to local fundraising to raise vital funds.
“It's clear from this data that there is an urgent need for more grip on where robots are located and how they are funded, to ensure robotic-assisted benefits all patients, not just those in the right postcode.”
