The warning came as speculation mounts that the Treasury will change borrowing rules to allow the Government to increase capital investment in the NHS. Tim Mitchell told a gathering of UK healthcare and technology professionals at the two-day conference at ExCeL London that without money for investment in technology and surgical capacity in the new government’s first Budget, the NHS ‘will not see a meaningful step change’ in the numbers of patients on hospital waiting lists. He said: “If the government is serious about meeting the 18-week target, it’s got to get serious about investment in capital spend – even if that means difficult decisions about where that money is coming from. Ultimately, it’s for the good of patients, and the good of the economy. We cannot continue working in hospitals that are falling down and with IT systems that are falling over.”
Although the last decade had seen a growth in surgeons and other NHS staff, the RCS President said many healthcare buildings were ‘still deteriorating, with little extra capacity’. “It’s no wonder,” he added, “ that the number of operations per surgeon hasn’t been going up, because we don’t have the extra space and investment in technology we need to carry out more operations more efficiently.”
Charting ‘the remarkable innovation and development surgery has witnessed over the last five years, despite the huge challenges facing the NHS’, he said: “The Prime Minister has warned there can be ‘No extra funding without reform’. Ahead of the forthcoming Budget, I say: ‘There cannot be meaningful reform without extra funding. Especially in our estates and technology.’”
Highlighting the challenges NHS hospitals face due to lack of capital investment, Tim Mitchell cited ageing infrastructure at Epsom and St Helier University Hospitals NHS Trust in London: “St Helier Hospital in London already invests millions each year to maintain its buildings, many of which pre-date the NHS, and this year alone they will spend nearly £2 million to upgrade their theatres, he explained. “Despite this, broken lifts and flooded corridors caused by its ageing estate mean hundreds of patients have their operations cancelled, increasing short-term costs and frustration for patients because the hospital needs long term investment.”
He also discussed NHS England and NICE proposals for a new model to evaluate medical devices – similar to the way new medicines are reviewed – which he said would both help NHS patients in England access ‘the most innovative and cutting-edge’ medical technologies faster, and ensure the NHS is using the most clinically and cost-effective products. He urged the new Health Secretary, Wes Streeting, to ‘back NICE and NHS England, and crack on with setting it up’.
On a positive front, he celebrated ‘examples of innovations pioneered by surgeons in the NHS’, including how:
• Robots are getting smaller, and more patients are undergoing surgical robotics intervention for a much wider range of ailments, with University Hospital Southampton now trialling the use of robots in paediatric kidney surgery.
• In Ear, Nose and Throat surgery, robots are being used to resect cancers in the pharynx and larynx, and even in thyroid surgery.
• Genomics is helping ‘treat the previously untreatable’, with baby, Opal, from Oxfordshire born deaf, but now able to hear thanks to ‘a game-changing gene therapy’ used by surgeons at Addenbrookes Hospital in Cambridge.
• Virtual reality is being used to prepare for some major surgeries in advance, with mixed reality used during operations to access all the information the surgical team needs to complete the procedure to a high standard. A recent UK surgical team used VR & AR to plan and successfully separate conjoined twins in Turkey.
The President of the Royal College of Surgeons of England’s speech came almost six years after the Commission on the Future of Surgery. The Commission’s final report looked five, 10, and 20 years into the future to identify advances in medicine and technology ‘that are likely to change surgical care’.