FACED with an uncertain wait to find out if the NHS in Wales would fund the cutting-edge cancer treatment he wanted in England, David John decided to pay for it himself.
The 56-year-old, from Caerwent, forked out more than £13,000 for robotic keyhole (laparoscopic) surgery in Bristol, to remove his diseased prostate gland.
Newly diagnosed with cancer, he felt he could not wait several weeks for an individual patient funding request to be made to, and considered by, his health board.
But had he lived a few miles away over the Severn, the "bureaucracy" he says he faced here would not have been an issue, as the surgery is more readily available. Eighteen NHS trusts in England
There is no blanket refusal of requests by Welsh patients for such surgery, in this case a prostatectomy. The robotic technique is also known as Da Vinci surgery.
But neither is there a guarantee that the NHS in Wales will fund all patients for the surgery at an English hospital - and with no robotic surgery available in Wales, Mr John says that is "terribly
unfair" on patients in Wales.
"I didn't much fancy the treatment options I was presented with in Wales, which were open surgery, radiotherapy, and brachytherapy. There are a lot of potential after-effects.
"I read about robotic surgery and was convinced it offered me a better experience, with the least potential after-effects. But I got the impression funding would be a stumbling block.
"It's iniquitous because if I lived five or six miles further east in England, I wouldn't have to jump through so many bureaucratic hoops.
"I'm lucky. I could afford to have my operation privately, but there will be many who can't. The NHS should be about fair treatment for everyone, but it doesn't feel like that."
Robotic surgery for treatment of prostate cancer is being evaluated through the UK Health Technology Assessment Programme, with findings due later this year.
"Prostate cancer patients in Wales have access to a range of well-established and effective treatments," said a Welsh Government spokesman.
"Given this (robotic) treatment is a relatively recent innovation, it is not currently available in Wales. This may change as more evidence on its effectiveness becomes known.
"Where a patient needs a treatment not normally provided by the NHS in Wales, they can make an Individual Patient Funding Request application to their Health Board, via their doctor."
One of the unknowns, given robotic keyhole prostatectomy is a relatively new treatment, is the long term outcome, but Mr John said his own experience has been very positive.
"I had my operation in the morning, was discharged with a catheter the following morning. I had no problems regarding incontinence, or impotence.
"Five weeks later I was back running three miles a day and back on my motorbike not long after. I can only speak for myself but my outcome has been absolutely 100 per cent.
"But I feel like I've encountered a postcode lottery. If we can't have a robotic surgery unit here, then people should be able to go to England without delay."
Mr John, who had his surgery last year, is backing the charity Prostate Cymru's Operation Robot campaign, to raise £1.7m to fund the setting up of a specialist robotic urological surgery unit in
"Although it doesn’t guarantee a better outcome in the long term, it offers a number of benefits. It’s minimally invasive, so causes less trauma, requires shorter hospital stays, and there’s less
risk of complications such as impotence and incontinence," said the charity's founder and chairman Ray Murray.
It is "grossly unfair" he added, that prostate cancer patients in England are likely to get it free on the NHS, while patients in Wales have no guarantee the NHS will pay for it.
“We all know public money is very tight, so Prostate Cymru wants to help raise funds for our first Welsh robot. It’s expensive, so as a first step we need to raise awareness and get public backing.
There are dozens of these machines in England. Surely we can bring one to Wales.
“Robotically assisted surgery is the future for medical treatments and Operation Robot needs the support of the public."
To find out more, visit www.operationrobot.com