Robot-assisted Surgery
The final item of business is a members’ business debate on motion S4M-01932, in the name of Richard Baker, on UCAN’s campaign for robot-assisted surgery. The debate will be concluded without any question being put.
Motion debated,
That the Parliament congratulates UCAN, the north-east-based urological cancer charity, on its bid to raise £2.5 million by 2013 in order to bring to the area pioneering robotic equipment for the provision of keyhole surgery; understands that three of the four most common cancers, prostate, bowel and bladder, as well as gynaecological conditions such as endometriosis, can be treated using robotic equipment; believes that this equipment will enable the use in Scotland of the most advanced technologies for minimally invasive surgery and that this will be of huge benefit to patients in minimising the impact of surgery; welcomes the aim of UCAN, which is to create a theatre suite at Aberdeen Royal Infirmary with two integrated operating theatres that will have the capacity for robot-assisted surgery, and hopes that this campaign will receive support throughout the north east.
17:04
I thank members from all parties in the Parliament who have supported my motion for debate. I know that UCAN greatly appreciates the support that it has had from across the political spectrum in the north-east for its campaign for robot-assisted surgery and for its broader work for cancer patients in our part of Scotland.
The campaign that UCAN launched to establish robot-assisted surgery for patients at Aberdeen royal infirmary is an initiative that builds on the success that the charity has already had. Many members who are present will have visited ward 44 at Aberdeen royal infirmary, where UCAN has already done so much to improve the difficult experience of treatment for urological cancer patients.
UCAN was launched in 2006 by two consultant urological surgeons who are based at ARI—Sam McClinton and James N’Dow—with the aim of adding value to the national health service by raising £2 million over three years to create a recognised centre of excellence for urological cancers in the north of Scotland. They saw a need to raise awareness of urological cancers, to make a diagnosis as early as possible and to improve the patient experience of care, treatment and aftercare.
Through the charity’s work, facilities at ward 44 have been greatly improved and substantial refurbishment has been carried out. There is now an office for staff and an information point for patients, as well as a lounge where patients and visitors can relax. That makes a huge difference for patients who spend a long time on the ward and for their families, and it helps to make the experience more comfortable and that bit less traumatic. For example, patients who might previously have been given the difficult news about their prognosis at a bed that was separated from others on the ward by only a curtain can now be told in the privacy of a separate room. That struck me as important on a human level.
The improvements have been made because of the commitment of staff at ARI to their patients and the tremendous efforts of volunteers whose lives have been touched in many ways by cancer. They have a clear vision of how they want the patient experience to be improved and they have displayed a can-do spirit. That is epitomised by the work of leading local businessman George Stevenson, whom many of us will know, who has made huge efforts on behalf of UCAN. George is one of those people who simply will not take no for an answer. Even I felt a pang of sympathy for NHS Grampian’s estate department when George told me just how plain he had made it that he would not take no for an answer in relation to many of his goals for refurbishing the ward. That spirit and the determination to get things done have been crucial to UCAN’s success.
The approach has led the charity to campaign for robot-assisted surgery to be based at ARI, as it offers the opportunity for a step change in the treatment of those whose conditions would benefit from the new surgical technology. The robotically assisted surgical system is an advanced tool that enables precision surgery to be carried out for many more patients and which speeds up operating times and reduces recovery times. Three of the four most common cancers—prostate, bowel and ovarian—as well as gynaecological conditions such as endometriosis, can be treated using the robotic equipment.
Professor Sam McClinton, who is consultant urological surgeon at ARI and the chairman of UCAN, has said:
“Robotic-assisted surgery is the best technology currently available for minimally invasive surgery and we want to ... buy this advanced equipment and the updated theatres to properly house it.”
That is why the campaign to raise £2.5 million has been launched. The money will fund the purchase of the new technology and the establishment of two operating theatres that are required to enable its use.
Let us be clear about the advantages that the technology offers to patients. Minimally invasive surgery has been proven to offer benefits for clinical outcomes and patient satisfaction, with a lower risk of post-operative wound infection; less post-operative pain; shorter post-operative recovery and a shorter stay in hospital; a reduction in the use of blood products; and a more rapid return to normal activity and work. The advantages that the technology brings would make such a difference to patients. Of course, if patients recover from operations more quickly, that brings benefits to the NHS by freeing up bed space and other resources.
Currently, 26 robotically assisted surgical systems are in use in England, but as yet there are none in Scotland, so the scheme would be a first for Scotland. Ministers will of course want to be sure that the use of the technology will improve treatment in the way that has been outlined. I am aware that ministers must make difficult decisions on investment in these testing times for public finances, but I believe that the evidence that UCAN has established of the benefits to patients from the use of the systems elsewhere makes the case persuasively.
UCAN is launching the fundraising efforts to bring the technology to Scotland, and I hope that ministers will assist in whatever way possible. The ambition to raise £2.5 million by the end of next year is a challenging one, but significant donations have already been pledged, and thousands of pounds were raised in just a week of a fundraising website going online. There are encouraging signs for the campaign. I hope that the Scottish Government will support and work with the charity, so that, if there is a funding gap at the end of the campaign, it will explore how that might be bridged.
The hope must be that, if the use of the technology can be established in Aberdeen, other patients in Scotland will in time benefit, too, and the experience of its use in the north-east will lead to it being used in other hospitals. I know that prostate cancer campaigners in Edinburgh are very interested in the benefits that the surgical technology could bring.
Let us congratulate UCAN on its efforts in this important campaign, which I know is already supported by many members across the chamber. I hope that the campaign will win favour with ministers as well. Ultimately, we all want the best treatment that we can give patients in the north-east and in Scotland as a whole. The technology and UCAN’s campaign offer us that opportunity.
17:11
I congratulate Mr Baker on securing the debate.
Aberdeen and the north-east have a proud tradition of philanthropic giving to health services in the area. For example, Foresterhill came into being as a result of large donations. In recent times, we have had Friends of ANCHOR—the Aberdeen and north centre for haematology, oncology and radiography—the Archie Foundation and UCAN. Mr Baker is right to pay tribute to Dr George Stevenson for the efforts that he has made in that regard, and I also join the member in paying tribute to Professors McClinton and N’Dow. The campaign already has a huge amount of support in Aberdeen and the north-east.
Some time ago, UCAN was helped by a grant from the common good fund and, just recently, it received money from the Lord Provost’s Charitable Trust. It will be the main beneficiary of money raised from the Crathes vintage car and motorcycle rally, and Fraserburgh football team members decided to pose naked recently, covering their modesty with footballs, to raise money for the campaign. I, too, have made a donation. I have no intention whatsoever of posing with a football covering my bits and I am sure that that is a great relief to everyone.
Mr Baker listed many of the benefits of this robot-assisted surgery. The key thing for me is the benefits for patients if it comes into play, which I am sure will happen. The huge benefits for the patients include smaller surgical incisions, of 1in or less; less blood loss during surgery and less need for blood transfusion; reduced post-operative pain and discomfort; shorter hospital stays; faster overall recovery; earlier restoration of urinary and sexual function; and less cosmetic scarring.
There are also huge benefits for the surgeons who would use the equipment: enhanced 3D visualisation; improved dexterity; increased range of movement; greater surgical precision; improved access; consistent performance; the simplification of many existing MIS techniques; a shortened training time for MIS procedures; and less physical demand on the surgeons.
UCAN has made some great advances since it came into being at ward 44 in 2008. As Mr Baker rightly pointed out, a recent refurbishment was led and scrutinised by Dr Stevenson. Like Mr Baker, I do not know how the estate staff at the hospital coped with that. On a recent visit to the Parliament, Dr Stevenson inspected the woodwork—that is the way of the man. He is to be greatly respected for the efforts that he puts in.
I named some organisations that are rallying behind the campaign. I hope that there will be more of that and that the target is reached sooner rather than later.
17:15
I, too, congratulate Richard Baker on this debate on UCAN. I am delighted to have the opportunity to echo his praise of the excellent work that UCAN is doing to raise funds for groundbreaking new medical facilities at Aberdeen royal infirmary. That fundraising is progressing well, but the charity will need continued support if patients in Aberdeen and the north-east of Scotland are to have access to the best possible surgical treatment for prostate, bowel and bladder cancer.
As Richard Baker said, UCAN has worked to provide not only advanced treatment options, but support and counselling to patients and relatives after diagnosis. It is to their credit that the staff at UCAN—and those who support the charity, as has been said—never rest on their laurels. They constantly seek new ways to improve cancer patients’ lives. The campaign to raise funds for technologically advanced robotic equipment is simply the latest in a series of ambitious targets, all of which have been met.
As the Deputy Minister for Health and Community Care in 2006, I had the pleasure of contributing to an early initiative that dovetailed with the launch of UCAN—the installation of positron emission tomography imaging equipment to improve cancer diagnosis and treatment at the ARI. In 2008, I was delighted to lodge a motion to congratulate UCAN on a successful application for grant funding of more than £500,000 from the Big Lottery Fund, which allowed the charity to develop its vital support facilities for patients and their families, which we have heard about this evening. I hope and trust that I will soon welcome the news that UCAN has reached its latest fundraising target and that cancer patients in the north-east will be able to benefit from the latest surgical techniques, which are aimed at improving not only their chances of survival but—importantly—their post-operative quality of life.
As we have heard, the possibilities for the equipment—the first of its kind in Scotland—extend even beyond treating cancer, as robot-assisted surgery could be used in cardiac, gynaecological and paediatric procedures. UCAN’s success in its campaign would not only be great news for cancer patients and their families, but would add to the reputation of Aberdeen royal infirmary as an innovative and enterprising teaching hospital that is willing to embrace new technologies in an effort to save more lives. Long may that continue.
As all of us—particularly those from the north-east—recognise, remaining close to homes and families while undergoing treatment is important for cancer patients in Aberdeen and the north-east. People will of course travel to hospitals in Edinburgh and Glasgow for treatment and procedures if they must, but that is physically demanding and emotionally difficult for all concerned. UCAN’s efforts to improve the facilities that are available in the north-east are to be commended for the wider benefits that they bring.
I have no doubt that, through the hard work of the charity and its supporters, and the generosity of people in the north-east—to which Kevin Stewart referred—UCAN will again succeed in reaching its fundraising target. The hard work of charities such as UCAN is a powerful weapon in the fight against many of Scotland’s health problems.
I hope that the minister agrees that the efforts of such charities need to be matched by investment from the Government, as with the PET imagers six years ago. A successful fundraising campaign will save lives not just in Aberdeen and the north-east but across the whole country. Anything that can be done to help to tackle Scotland’s poor record on cancer should be a priority for us all.
17:19
I commend Richard Baker for securing the debate. I have disagreed vehemently with him and his Labour colleagues on a number of issues in Aberdeen recently, but we are at one in praise of UCAN and its on-going fundraising campaign. I am delighted that he has brought this unique and excellent charity to Parliament’s attention.
As a young anaesthetist in Aberdeen royal infirmary many years ago, I gained a fair bit of experience in my regular gynaecological list of the traumas of major surgery such as hysterectomy and pelvic floor repair. I was also involved in colorectal surgery and prostatectomy. Patients often had to be transfused to replace blood that had been lost, and they were left with sizeable abdominal wounds that took weeks or months to heal enough to let them return to work and their daily lives. Laparoscopy was just beginning to be pioneered as a minimally invasive procedure, and the subsequent development of keyhole surgery has revolutionised procedures such as cholecystectomy and other major abdominal surgery, which has led to early recovery, fewer surgical complications and shorter stays in hospital. The more recent development of robot-assisted surgery has taken minimally invasive surgery a stage further by allowing more surgeons to be trained more easily to undertake complex surgical procedures and benefiting an increasing number of patients, as a result. These are changed days, indeed, since my early medical experiences.
No one visiting the UCAN care centre in the urological ward in the ARI could fail to be impressed with the care of the patients as they embark on their journey following diagnosis of prostatic and other urological cancers. In the calm and pleasant surroundings of the unit, which were provided in great measure thanks to the generous philanthropy of George Stevenson and his company and others donating to the UCAN charity, patients have their conditions and treatments explained to them. They also meet up with patients who have experienced what they are embarking on, which takes much of the mystery and fear out of what lies ahead. That peer support is freely given as they progress through their journey of care.
UCAN works hard, too, to raise awareness of prostate cancer, by encouraging the early diagnosis that can make such a difference to the prognosis of that cancer, which is very common in men. Surgeons working in the urological unit have become extremely skilled in operating on those patients using minimally invasive techniques. The next move is to take that a stage further by introducing robot-assisted surgery. When I visited the unit, I was most impressed by the possibilities of that technique—as explained to me by the consultant who demonstrated them to me—not only in urology, as we have heard, but in several other specialist areas as well.
UCAN’s efforts to procure the equipment for Aberdeen are ambitious and very worthy of support. The £2.5 million that UCAN aims to raise by next year will allow the installation of the robot in the new theatre suite that is required to house it and will bring high-precision robot-assisted surgery to the north-east. That will bring benefit to many local people who require specialist surgery by allowing many more to be treated, and by speeding up operating times and reducing recovery times.
Many people believe ideologically that NHS provision should come entirely from the public purse, but the £2.5 million that is required to ensure the success of the UCAN project is simply not available within the NHS budget. Those who are spearheading the fundraising efforts are to be highly commended for bringing the latest in advanced surgical technology within the reach of patients in the north-east of Scotland, Orkney and Shetland.
I wish UCAN every success in this exciting project and hope that it acts as an exemplar for community-minded people in other parts of Scotland, allowing more NHS patients to benefit from techniques and equipment that are currently beyond the reach of the public purse but which, by reducing recovery time and complications, not only can help more patients, but can result in savings within pressured NHS budgets.
17:23
I echo the sentiments that have been expressed by the members who have spoken before me. It is to Richard Baker’s great credit that he has brought this members’ business debate to Parliament this evening.
I am not going to attempt to do what Nanette Milne did and describe many of the surgical procedures. Although I am sure that Dr Simpson would be able to pronounce them, I certainly could not without a sheet in front of me.
We have heard of the benefits that UCAN will, we hope, deliver to patients once the targets have been achieved. I have had keyhole surgery, and the benefit to me as a patient was immense. The surgery was less invasive, I was in hospital for less time, which freed up a bed, and I was back home with my family in support much sooner than I would have been had I undergone a more invasive procedure.
I am impressed with UCAN’s approach not only to the patient, patient care and post-operative care, but to the families. The specialist staff can advise, inform and counsel not only those who will be going through the procedure, but their families and friends so that everyone can fully understand what is happening with the procedure and what post-operative care is intended.
It is incredibly important that we have that type of facility for patients. Kevin Stewart and Lewis Macdonald—indeed, I think everyone who has spoken—talked about Dr Stevenson’s immense work to try to ensure that the work happens.
We must try to ensure that the type of procedure that we are considering is the way of the future. We are introducing 21st century technology, and when we think about the invasive surgery of the past it is quite mind boggling that robotic procedures will be carried out on patients in theatres. I can hardly get my head round that. The approach requires immense skill on the part of surgeons, so training is important.
There is no doubt that the benefits to patients will be immense. Early diagnosis, early intervention and early procedures mean that there is a greater chance of patient survival.
I wish UCAN all the success that it needs if it is to achieve its goal and get the funds that it requires for a most innovative 21st century technology, which will benefit patients in Aberdeen and the north-east.
17:26
I am glad to have the opportunity to join so many members from the north-east in welcoming the UCAN initiative.
Prostate cancer is a significant problem, and radical prostatectomy, when surgery is the preferred option, has problems, including interference with neurological pathways, which can result in erectile dysfunction and a degree of incontinence. As Nanette Milne said, there can also be significant blood loss.
There is a need to consider all forms of management of the condition. I recently chaired a meeting on behalf of the prostate cancer group in my constituency, and I was interested to learn that the group is concerned to ensure that there are effective managed care networks, through which consideration can be given to all forms of treatment of prostate cancer, including watchful waiting, chemotherapy, radiotherapy and surgery in its different forms—of which robotic surgery is the newest.
Robotics are an intriguing development, which I first came across in relation to work in the American military, which was doing robotic surgery remotely. The potential for remote surgery in Scotland, and elsewhere, in the future might be significant.
I welcome the briefing from UCAN. I was particularly interested in the comparative study of twins Jim and Sandy. One of the twins was operated on through robotics, in the south; the other was operated on in the more traditional way. Single-case studies of that sort are often undervalued, although they can point the way towards more robust studies.
I commend UCAN’s theatre suite initiative. The approach should be carefully monitored and evaluated, and if it is successful the facility should be used to train surgeons from throughout Scotland. The important point is that charities such as UCAN and enthusiasts such as Dr George Stevenson—who is clearly an enthusiast of enthusiasts—are extremely welcome, in partnership with the NHS. I sound a note of caution, to which I am sure the minister will pay heed. It must be clear that the running costs will be met by the charity or by the health board. Before the money is raised and the equipment put in place, I am sure that there will be a proper business plan, which I am sure will be approved.
The principle of partnership between charity and the NHS is an important one, particularly in times of austerity such as this, and should be encouraged. Partnership in the health service is perhaps most exemplified in the hospice movement, where there is a triple partnership. Local people who want a community hospice raise money, and through gift aid, Government can enhance and augment the money that is raised. Such an approach can be taken to gifts to UCAN. The triple lock on the system is the approach that Michael Forsyth introduced—I must say to Nanette Milne that I do not often praise him—whereby money that is raised by the community is matched pound for pound by the Government, on an on-going basis. That approach saved the hospice movement in the 1980s, when there were great problems with finance, and there was no such initiative in England. That mechanism is an important one and I commend it to the minister as a potential area to look at.
I note that the technique can be used for other operations, such as those for bowel cancers, for which I understand the keyhole techniques can be enhanced. It can also be used for gynaecological operations, including for endometriosis. The potential benefits to patients of minimally invasive procedures that are enhanced by robotics are clear, as are the other gains to the patient that Richard Baker outlined. There are accompanying benefits, such as more rapid rehabilitation and shorter hospital stays, which benefit the health service economically as well. I therefore hope that there will be a proper economic evaluation of the procedure as we go forward.
I welcome the motion and commend the UCAN campaign.
17:30
The debate has been very interesting. It is not every day that we get the opportunity in Parliament to discuss robotic surgery. A number of members rightly expressed their interest in the area and the important issues that we face in that regard, particularly some of the challenges around prostate cancer among men in Scotland.
I thank UCAN for the work that it has undertaken. Richard Baker set out clearly the work that UCAN is doing on robotic surgery, but he also highlighted the extent of its wider work. UCAN has secured a considerable amount of public money in a very short period of time, during which there has also been considerable financial restraint. Kevin Stewart referred to one way in which UCAN is raising money, but I do not wish to dwell on that. However, it illustrates the innovative ways in which UCAN is trying to raise funds.
UCAN has developed a strong reputation in the north of Scotland for its broader work and its commitment to raising awareness of neurological cancers and helping to ensure that people who have symptoms get early diagnosis. That fits very well with the Government’s approach in the detect cancer early programme. We know that the earlier the diagnosis of such cancers, the more likely we are to succeed in effective treatment. That is the hard edge of that area of work, but UCAN also plays an important role in helping to support families and individuals in dealing with some of the difficulties that can arise from ill health. That work is greatly appreciated and UCAN should be congratulated on its extent.
Members across the chamber will recognise that our vision for the Scottish health service is that, through our quality strategy, Scotland will be a world leader in healthcare quality with a health service that is person centred, safe and effective. All three of those dimensions play very well with the subject that we are debating. Quite rightly, we all want to see the most modern, leading-edge treatment that is effective for patients with a variety of conditions. We should recognise that such work is often led by clinicians on the ground, who see the progress that can be made by the introduction of new means of treating patients. The clinicians are often the catalysts and drivers of such reforms in the health service.
In deciding whether to introduce new treatments, whether they are drugs or technologies, to the NHS we need to ensure that the decision is based on sound evidence of safe use and clinical and cost effectiveness. I am sure that all members recognise the Scottish Medicines Consortium’s international reputation in this area. Health boards are often keen to look at developing services in which there are advances in technology; that includes partnerships with charities to introduce technologies that can assist patients within their own area.
However, members will also be aware that, in Scotland, the evidence on clinical effectiveness is gathered, assessed and disseminated independently of the Scottish Government by Healthcare Improvement Scotland in guidelines, evidence reports and health technology assessments. That work is managed by a range of organisations, including public partners such as the Scottish intercollegiate guidelines network and the Scottish health technologies group.
In this instance, the Scottish health technologies group will provide advice to NHS Scotland on the results of a health technology assessment that is currently being undertaken by the University of Aberdeen, comparing robotic versus laparoscopic surgery for localised prostate cancer. We expect to have that report in September this year, at which point we will be able to evaluate how we move forward with such surgery in the NHS in Scotland.
That review process includes an expert panel in the field. It also involves patient representatives, clinical users, managers of technology and clinicians who have recently been trained in the area of expertise. They must carefully consider how the approach is developed. That work at the health services research unit at the University of Aberdeen is supported by the chief scientist’s office at the Scottish Government.
In the meantime, I reassure members that the absence of a specific service, treatment or technology in Scotland does not mean that it is not available to people who live here. It is quite the contrary, as a patient—whether a man or a woman—who needs robotic surgery continues to be able to access it through an individual patient treatment request if their clinician identifies it as appropriate.
That process enables a clinician to set out the clinical case for a particular treatment or treatments, which is then considered locally by an individual review panel. Members will appreciate that the Government is not directly involved in the process. However, I emphasise that, when it is clinically assessed as being required, there is always the option for such an individual patient treatment request to be made.
I thank all members for their speeches. I assure them that, when we receive the report in September, we will consider it in detail and consider what further progress we can make on robotic surgery within the NHS in Scotland.
I again congratulate UCAN on its outstanding work and the way in which it has been able to improve the overall treatment for patients in the north-east of Scotland. I wish it well with its continued fundraising work.
Meeting closed at 17:37.