Freedom of Information Requests

For the attention of Ms Libby Ryan-Davies

Good evening Ms Ryan-Davies

I am writing further to confirmation from the ambulance service, in response to a query raised via the heart campaign, that pre-hospital thrombolysis is no longer provided by paramedics in this region, with the exception of the Isles of Scilly and Portland.

NICE guidance on acute coronary syndromes (including CG167 and subsequent updates) is unequivocal that patients with ST-elevation myocardial infarction (STEMI) must receive reperfusion therapy within defined national time standards. NICE is also clear that where timely access to primary PCI cannot be achieved, pre-hospital thrombolysis should be available in order to prevent avoidable delays to reperfusion and reduce avoidable harm, including excess mortality and long-term cardiac damage.

Against this backdrop, I am seeking clarification on how the ICB has assured itself that the proposed merger of cardiology services between Torbay and Exeter would not result in foreseeable and avoidable harm to patients.

If service reconfiguration leads to call-to-balloon times that exceed NICE-recommended thresholds for patients in the Torbay catchment area, and no effective pre-hospital thrombolysis pathway is in place, this would represent a known and predictable failure to meet national standards of care. The clinical consequences of delayed reperfusion in STEMI are well established, and any resulting increase in morbidity or mortality would be both foreseeable and avoidable.

In such circumstances, compliance with NICE guidance would require the re-introduction of pre-hospital thrombolysis, including paramedic retraining, robust clinical governance, ongoing competency assessment, and audit. These requirements have significant implications for patient safety, workforce capacity, and system-wide risk.

Can you therefore confirm:

• How the ICB has assured itself that the proposed service changes would not expose patients to increased risk of avoidable harm due to delayed reperfusion;
• Whether the absence of a pre-hospital thrombolysis pathway has been formally risk-assessed against NICE standards;
• Whether the potential need to reintroduce pre-hospital thrombolysis has been explicitly considered, costed, and incorporated into planning; and
• How accountability for any failure to meet NICE-recommended time standards has been addressed within the ICB's governance framework.

I would be grateful for a clear response setting out how these patient safety and avoidable harm risks have been identified, assessed, and mitigated.

Kindest regards

Susie Colley
Chair of the Torquay Chamber of Commerce and The Heart Campaign

FAO the Information Governance Team

Good evening

Thank you for clarifying that thrombolysis is no longer routinely practised, following the successful transition to PPCI.

In light of ongoing discussions about future cardiology provision at Torbay, I wanted to ask whether SWAST has had any engagement with the ICB regarding the potential implications for reperfusion pathways, including whether re-introduction of thrombolysis has been considered should access to timely PPCI change.

I would also be grateful to understand whether any preliminary consideration has been given to the training, clinical governance, and operational arrangements that would be required to support thrombolysis safely, noting NICE guidance on acute coronary syndromes (CG167 and NG185), which emphasises the importance of timely reperfusion via primary PCI, or thrombolysis where PPCI cannot be delivered within recommended timeframes.

This information would be helpful to inform wider system discussions, and I would welcome the opportunity for further dialogue if that would be useful.

Many thanks

Kindest regards

Susie Colley
Chair of the Torquay Chamber of Commerce and The Heart Campaign

Good evening Mr Teape

I am writing to formally challenge the current lack of clarity regarding the funding position for the cardiac catheter laboratory refurbishment.

In the email dated the 17th October 2025, you stated that a provisional sum had been earmarked within the Trust's draft capital programme and that approval was expected in January. We are now well beyond that point, yet no definitive confirmation has been provided.

Furthermore, in an email from the Acting CEO/Chief Strategic Commissioning and Planning Officer (the Integrated Care Board) Ms Ryan-Davies confirming "that NHS Devon is not aware of a request received from Torbay and South Devon NHS Foundation Trust to approve funding to refurbish two cath labs". This directly contradicts the implication that external approval or funding was required. In the absence of any such request, it is reasonable to conclude that either the Trust has not pursued the refurbishment despite having funding available, or that the position previously set out was inaccurate.

This situation is unacceptable, particularly given the clinical significance of the cardiac catheter laboratory and the need for transparency in capital decision-making.

I therefore require a clear and unequivocal response to the following:

1. Has the Trust's capital programme been formally approved, and if so, on what date?
2. Is funding for the cardiac catheter laboratory refurbishment approved within that programme?
3. If funding is not approved, please explain precisely why, and confirm whether any request has been made to the ICB.
4. If no request has been made, please explain the rationale for that decision.
5. If funding is approved, what is the confirmed allocation and delivery timetable?

If a clear position cannot be provided, please advise what steps are now being taken to resolve the discrepancy between the Trust's statements and the ICB's position, and when a definitive decision will be communicated.

Given the seriousness of this matter, I would expect a direct and timely response addressing each point above.

Kindest regards

Susie Colley
Chair of the Torquay Chamber of Commerce and The Heart Campaign

Hi Steven

Sorry to bother you again but would it be possible for you to get back to me re the answers from LRD before our next meeting on Monday 26th.

As discussed on the 12th January we are seeking urgent clarification regarding the funding position for the cardiac catheter laboratory refurbishment at Torbay Hospital.

I understood from Mr Teape in October 2025 that the ICB may be involved in funding the refurbishment. However, I have now been advised that the ICB is not aware of any capital funding request from the Trust in relation to this scheme. This sits in direct contrast to the position communicated by the Trust, which stated in October that a provisional sum had been earmarked within its draft capital programme, with approval expected in January.

As matters stand, there is no clear or consistent account of where responsibility for this decision lies, nor whether funding is available, requested, or withheld. This lack of transparency has led to significant concern locally.

I should also make you aware that a major public demonstration is now being planned as part of a campaign to obtain clear answers from the ICB and the Trust. A meeting is scheduled with the Police to plan how this can be done in a peaceful and safe manner. The purpose of this campaign is not to generate conflict, but to bring common sense and transparency to the table and to avoid further unnecessary and damaging publicity for the NHS locally.

Before matters escalate further, I am therefore requesting a clear and definitive response from the ICB addressing the following:

1. Has the ICB received any formal or informal request from Torbay Hospital NHS Trust for capital funding for the cardiac catheter laboratory refurbishment?
2. If no request has been received, does the ICB consider that the Trust has the ability to fund this scheme from its own approved capital resources?
3. If a request is required, what specific information is outstanding and what steps are necessary to enable a decision to be made?
4. What action is the ICB now taking to resolve the conflicting positions being communicated publicly?

A clear response at this stage would be a constructive step towards resolving this issue and could help prevent further escalation and reputational damage.

Given the circumstances, I would appreciate a prompt and direct reply.

Kindest regards

Susie Colley
Chair of the Torquay Chamber of Commerce and The Heart Campaign

Good evening Mr Teape

Thank you for your response confirming that teams are updating the business case in relation to capital funding for the cardiac catheter laboratories.

While we appreciate that this work is ongoing, I am writing to express serious concern about the impact that continued uncertainty is having on staff morale and retention within the cardiology service.

There is a growing and very real risk that prolonged delay, without clear timescales or reassurance about the Trust's commitment to maintaining cardiology services at Torbay, will result in the loss of experienced cardiologists and specialist staff. Once lost, this expertise will be extremely difficult to replace and would, in effect, predetermine the outcome of any future decision-making — regardless of the eventual conclusions of the business case.

In other words, if clinicians leave due to uncertainty and deteriorating morale, the ICB may "win" by default, not through a considered, evidence-based process, but through attrition. That outcome would be deeply damaging for staff, patients, and public confidence.

In this context, may I ask:

• When the updated business case for capital funding is expected to be completed and reviewed;
• Whether interim assurances can be given to cardiology staff regarding the Trust's intention to retain and support the service at Torbay; and
• What steps are being taken now to stabilise morale and prevent the loss of key clinical personnel while system-level decisions remain unresolved.

The Heart Campaign remains keen to work constructively with the Trust, but time is now a critical factor. Delay carries tangible risks that cannot be remedied retrospectively.

I would welcome an early update and, if possible, a meeting to discuss how these risks can be mitigated in the immediate term.

Kindest regards

Susie Colley
Chair of the Torquay Chamber of Commerce and The Heart Campaign

Dear Mr Teape,

I am writing on behalf of the Heart Campaign to follow up on an issue that is central to the future of cardiology services at Torbay Hospital.

We have not yet received an update on whether the Trust has secured, or identified, the necessary capital funding to refurbish the cardiac catheter laboratories. As you will appreciate, the condition and viability of the cath labs are clearly integral to the continuation of local cardiology services and to maintaining safe, effective patient care.

In the interests of transparency and mutual collaboration, we would welcome clarity on:

• Whether funding for cath lab refurbishment has been identified within the Trust or wider system; and
• If not, whether alternative options are being actively explored.

The Heart Campaign is keen to work constructively with the Trust. If the primary barrier to refurbishment is access to capital funding, we would be willing to explore whether the campaign could play a role in supporting or contributing to fundraising efforts, subject of course to understanding the scale, scope, and feasibility of what would be required.

We raise this not as a challenge, but in a genuine spirit of partnership, recognising the shared objective of safeguarding high-quality cardiology services for the Torbay population.

We would appreciate an update at your convenience and would welcome the opportunity for further discussion if helpful.

Kindest regards

Susie Colley
Chair of the Torquay Chamber of Commerce and The Heart Campaign

To: Joe Teape (Trust CEO), Libby Ryan-Davies (ICB Deputy CEO)
CC: Martin Wrigley MP
Importance: High

Good Afternoon

Thank you for confirming the intention to proceed with refurbishment of the cath labs.

I need to formally flag that the current condition of the Cath labs represents an immediate and escalating clinical risk.

While the Cath labs can be refurbished independently, the air-conditioning system is shared across the Hetherington block. A safe and sustainable solution requires a single, coordinated HVAC refurbishment to support both cath labs.

Senior cardiologists advise that failure of the existing HVAC system is a realistic near-term risk. If this occurs, there is a credible risk of sudden loss of cath lab capacity, rather than a controlled or phased degradation. This would have significant impact on urgent and elective cardiac services.

In this context, a two-year delivery timeframe is not clinically viable without either accelerated delivery of the shared HVAC works or robust interim mitigation.

For assurance on patient safety and service continuity, clarity is urgently required on:

• Interim mitigation or contingency arrangements should the shared HVAC system fail
• Whether the Hetherington block HVAC works can be prioritised or fast-tracked
• Confirmation of approved capital funding, scope, and senior responsible ownership
• How this risk is being formally recorded and reviewed through executive and Board governance

Lastly, if the Cath labs fail then neither NDD Hospital patients or RDE could be treated and hence the Trust could lose a significant income (currently >£600k).

Consequently there is substantial evidence to support both a clinical and economic argument to refurbish now.

Given the potential for unplanned service failure, I recommend this is reviewed as a matter of urgency at executive and Board level.

I am available to discuss at short notice.

Kindest regards

Susie Colley
Chair of the Torquay Chamber of Commerce and The Heart Campaign