NHS robotic surgery rollout is a “postcode lottery”

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 today at the Future of Surgery Festival (20-21 April), the data – the first publicly-available national picture of how surgical robots are being used across England – 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. 

Later today at the Future of Surgery Festival in Birmingham, Mr Tim Mitchell, President of the Royal College of Surgeons of England (RCS England), will say:

“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.”

The Future of Surgery Festival, hosted by the Royal College of Surgeons of England, is a first-of-its-kind event bringing together surgeons, trainees and healthcare professionals from across specialties to explore the future of surgical practice.

Notes to editors

1. FOI data underpinning this analysis is available from RCS England on request.
2. While this analysis provides the most comprehensive national picture currently available, variation in how trusts reported data in their FOI response means some information may be incomplete. This in itself highlights a lack of transparent, standardised national data on robotic surgery provision.
3. RCS England’s updated robotic surgery guidance, Robotic-assisted surgery: A pathway to the future, can be found at: https://www.rcseng.ac.uk/standards-and-research/standards-and-guidance/good-practice-guides/robotic-assisted-surgery/
4. NHS England » Millions to benefit from NHS robot drive
5. Implementation of robotic-assisted surgery (RAS) in England
6. Fit for the future: 10 Year Health Plan for England - Big bet 5: By 2035, robots will deliver care with unprecedented precision (page 122): Fit for the future: 10 Year Health Plan for England
7. HQIP National Registry of Robotically Assisted Surgery
8. The Future of Surgery Festival will take place on 20-21 April 2026 at the International Convention Centre in Birmingham.Journalists can request a press pass by emailing pressoffice@rcseng.ac.uk
9.  The RCS England Future of Surgery Festival (20–21 April 2026, Birmingham) is a pioneering, celebration of the surgical profession, designed to shape the future of care through innovation, inspiration and connection. It brings together the entire surgical community—from trainee to consultant—to explore technologies like AI and robotics while tackling workforce and wellbeing challenges.
10. The Royal College of Surgeons of England provides world-class education, assessment, and development to 30,000 surgeons, dental professionals, and members of the wider surgical and dental care teams at all stages of their careers. Our vision is to see excellent surgical care for everyone. We do this by setting professional standards, facilitating research, and championing the best outcomes for patients.
11. For more information, please contact the RCS England press office: telephone: 020 7869 6053/6054/6047; email: pressoffice@rcseng.ac.uk; out-of-hours media enquiries: 0207 869 6056.