FOI Tracker

Freedom of Information Requests

This page tracks all Freedom of Information requests submitted as part of The Heart Campaign Torbay's investigation into cardiac services in Devon.

Official Position vs. Reality: On 3 December 2025, NHS Devon published an open letter claiming the "case for change does not contain any proposals for 'change' or 'closure'" and that the programme is "not about reducing or closing local services." However, FOI requests reveal proposals were already being discussed to suspend emergency cardiology services on an "eight-week test and learn basis" - directly contradicting these public assurances.

Click any request to view details and download documents where available.

Last updated: 5th February 2026

10
Documents Available
1
Overdue
4
Awaiting Response
4
Under Review/Challenge

Overdue

Why This Matters: The Royal College of Physicians identified 29 concerns at Royal Devon in 2020. While RDE claims 25 cardiology recommendations were completed, questions remain about whether the broader concerns have been addressed.
Status: Response now overdue. Extension was granted to 15 December 2025. Exemptions claimed have been challenged.

This request seeks the Royal College of Physicians' recommendations and reviews of cardiology services at RDE, particularly any reviews conducted after the 2020 report that identified 29 concerns.

Awaiting Response

Context: Submitted the same evening the Trust issued its incident response (12 March, 17:17). That response confirmed both labs failed but failed to address the core allegation - that RDE declined a transfer request for a patient from Teignmouth who was subsequently sent to Derriford Plymouth instead. This FOI asks all four organisations directly to provide the documented record of what happened, who made the decisions, and why.
Why This Matters: The Trust's incident response stated that RDE "offered support" - directly contradicting the allegation that a transfer was declined. One of these accounts is wrong. This FOI requests the official incident log, divert records, and internal communications so the documented facts can be established, not just competing narratives.

Organisations requested to respond:

  • Royal Devon University Healthcare NHS Foundation Trust (ref: RDF4139-26, acknowledged 13 March 2026)
  • South Western Ambulance Service NHS Foundation Trust (awaiting acknowledgement)
  • NHS Devon Integrated Care Board (awaiting acknowledgement)
  • Torbay and South Devon NHS Foundation Trust (awaiting acknowledgement)

Information requested:

  1. Whether a transfer request was made for a patient from Teignmouth requiring emergency cardiology intervention during the outage, including the date and time of the request
  2. Whether that transfer request was declined by RDE, and if so the role (not name) of the individual who made the decision
  3. The clinical or operational rationale recorded for accepting or declining the transfer
  4. The escalation pathway followed, including internal clinical discussions, cross-trust communications, ICB involvement, and application of SOPs for emergency cardiology diverts
  5. Whether alternative receiving centres were contacted and the responses given by each

All answers requested with reference to the official incident log, divert record, and internal communications. No personal data requested.

Status: RDE acknowledged 13 March 2026, reference RDF4139-26, response due 14 April 2026. Acknowledgements from SWASFT, NHS Devon ICB, and Torbay and South Devon awaited. This request directly tests the contradiction between the Trust's claim that RDE "offered support" and the documented patient case in which a transfer to RDE was allegedly declined and the patient sent to Plymouth. The four organisations' responses - or failure to respond consistently - will establish the factual record.

Context: Submitted 17 minutes after the transfer handling FOI (RDF4139-26). Where that request asks what happened and why, this one requests the raw documented evidence - the actual divert log, SWAST triage notes, and cross-trust communications. Together the two requests cover both the decision-making record and the operational record. NHS Devon ICB is not included in this request as they would not hold operational divert documentation.
Why This Matters: The Trust's incident response (12 March, 17:17) gave a narrative account of what happened during the outage. Divert logs and SWAST records are the contemporaneous documented evidence against which that narrative can be tested. If the logs show a transfer request was made and declined, that contradicts the Trust's account that RDE "offered support." If they show no transfer was requested, that contradicts the patient case reported to the campaign.

Organisations requested to respond:

  • Royal Devon University Healthcare NHS Foundation Trust (ref: RDF4140-26, acknowledged 13 March 2026)
  • Torbay and South Devon NHS Foundation Trust (originating site, awaiting acknowledgement)
  • South Western Ambulance Service NHS Foundation Trust (responsible for transport and clinical handover decisions, awaiting acknowledgement)

Information requested:

  1. The full site-to-site divert log for the date of the outage, including:
    • Timestamp of divert activation
    • Units placed on divert
    • Time the divert was lifted
    • All attempted transfer requests
    • Responses from each receiving hospital
    • Notes or escalation actions
  2. Any SWAST clinical triage notes relating to the Teignmouth patient transfer on the same date, with personal identifiers removed
  3. Any cross-trust communications relating specifically to the acceptance or refusal of that patient

All answers requested with reference to official documented records, not narrative accounts.

Status: RDE acknowledged 13 March 2026, reference RDF4140-26, response due 14 April 2026. RDE's sequential numbering (RDF4139-26 and RDF4140-26) confirms both requests were logged consecutively, consistent with the 17-minute gap between submissions. Acknowledgements from Torbay and South Devon and SWASFT still awaited. SWASFT's response is likely to be particularly significant as the ambulance service holds dispatch and handover records that are independent of either hospital's account.

Why This Matters: If key decision-makers were aware of the Royal College of Physicians' findings about quality concerns at Royal Devon, yet still proceeded with plans to move services there, this raises serious questions about patient safety priorities.

This request asks whether relevant decision-makers were aware of the Royal College of Physicians review findings and the six critical issues identified.

Why This Matters: This detailed follow-up seeks to establish precisely what information was known about the RCP investigation, when it was known, by whom, and whether it informed the Case for Change proposals - including the 8-week "test and learn" closure of emergency cardiology services.

Full request text covers five areas:

  1. Awareness of the RCP investigation - earliest date each of the following became aware: Royal Devon University Healthcare NHS Foundation Trust; Torbay and South Devon NHS Foundation Trust; the Chief Executive of Torbay and South Devon NHS Foundation Trust; Professor Briggs. If awareness was gained through correspondence or meetings, copies of relevant documents requested.
  2. Inter-trust information sharing - whether information relating to the RCP investigation was shared between Royal Devon and Torbay and South Devon prior to the development of the Case for Change, including dates, form of communication, and copies of any records where the RCP investigation was referenced.
  3. Case for Change formulation - the date the Case for Change was first drafted; the date the 8-week "test and learn" proposal was first discussed; copies of early draft papers, options appraisals, or briefing documents; and whether decision-makers were aware of the RCP investigation at the time of drafting.
  4. Governance, risk, and assurance - whether the RCP investigation was recorded as a risk or dependency within Case for Change programme documentation, risk registers, assurance frameworks, or board papers. If not recorded, the documented rationale for its exclusion.
  5. Completeness of information - if any information is stated to be "not held", confirmation of whether it was ever held and subsequently deleted, and the applicable retention schedule.

Status: Response due 10 February 2026. Now significantly overdue. No response received.

Deflection: Rather than answer these questions about their own services, RDE suggested contacting the ICB instead.
Why This Matters: Torbay publishes its cardiac cath lab waiting time openly (7 weeks, October 2023). When asked for equivalent data, RDE claimed it was "not available" - yet they want to take over Torbay's workload. If RDE won't answer basic questions about their efficiency, staffing, and costs, how can anyone assess whether they're capable of absorbing more patients?

Questions RDE refused to answer:

  • Why do 8 interventional cardiologists still require locum cover for sickness?
  • What are the costs of running weekend sessions?
  • Why are Torbay's waiting lists increasing due to RDE patient transfers - and why isn't this acknowledged?
  • Why can't RDE publish waiting time data that Torbay provides transparently?

Response: RDE suggested writing to the ICB instead of responding directly.

Download Original Request (PDF)

Under Review or Challenge

Why This Matters: This request asked fundamental questions about RDE's capacity and reliance on Torbay. The incomplete responses and failed internal review suggest RDE doesn't want to reveal the full picture of their dependency on Torbay's cardiac services.
ICO Investigation: The Information Commissioner's Office has formally confirmed that our complaint regarding RDE's handling of this FOI request is eligible for investigation. Awaiting findings.
32.9
Average weeks wait
for angiogram
72.86
Maximum weeks wait
for angiogram
£7,080
Average cost
of angioplasty

What we asked for:

  • Waiting times for angiogram, angioplasty, pacemaker insertion
  • Weekend angiograms in private hospitals
  • Cases referred from RDE to Torbay - and whether Torbay was paid
  • How often Torbay locum cardiologists covered RDE staff shortages

Status: Internal review failed to address deficiencies. ICO investigation now formally confirmed and underway.

Download Original Request (PDF) Download Initial Response (PDF) Download Follow-up Response (PDF) Download Internal Review (PDF) Download ICO Complaint (PDF)
Major Reversal: NHS Devon initially claimed "we do not hold this information." After Internal Review challenge, they now admit they DO hold the information but are withholding it using Section 22 (future publication - with no publication date) AND Section 36 (prejudice to effective conduct of public affairs - need for "safe space"). This is the Edge Health modelling that underpins the entire cardiac services reconfiguration.
Why This Matters: Edge Health was commissioned to model demand and capacity across all 5 Peninsula hospitals including cardiology. This modelling is being used to justify service changes, yet the public cannot see the data, methodology, or findings. NHS Devon claims publishing it would be "detrimental" and that they need "safe space" for "free and frank conversations" - essentially arguing the public should not see evidence used to make decisions about their healthcare.

What Was Requested:

Information about Edge Health Ltd's commission to undertake demand and capacity modelling across Devon's acute hospitals, referenced in the Peninsula Acute Sustainability Programme (PASP). Specifically:

  1. Commissioning authority - Who commissioned the work
  2. Scope and purpose - Which hospitals and specialties were included (explicitly asking if cardiology was modelled)
  3. Timescales - When work was conducted and forecast period
  4. Outputs and deliverables - Reports, presentations, findings
  5. Contract and costs - Contract value, date, procurement method
  6. Governance and oversight - Which boards reviewed findings, meeting papers/minutes

What NHS Devon Revealed (16 February 2026):

  • Commissioned via: NHS England's Recovery Support Programme (RSP) on behalf of Peninsula Acute Provider Collaborative (PASP)
  • Process: NHS Devon requested support from NHS England Southwest to identify Edge Health as existing provider
  • Joint arrangement: Edge Health commissioned via joint working arrangement through NHS England's RSP
  • Specification provided: "PASP - Scenario modelling 15.3.2024 v0.2" - 20-week project covering all 5 acute hospitals
  • Contract costs: Still claims doesn't hold this information (contradicts NHS England's response)

What They're Still Withholding:

  • Actual modelling outputs and findings
  • Whether cardiology was explicitly included in scope
  • Timescales and forecast periods used
  • Reports, presentations, executive summaries
  • Contract value and procurement details
  • Board papers, minutes, governance documents

NHS Devon's Justification for Withholding:

Section 22 (Information intended for future publication):

  • Report being incorporated into draft 5-year ICB Commissioning Intentions and Strategic Commissioning Plan
  • "Would be detrimental to publish this report in isolation without wider context"
  • No publication date provided - "NHS Devon is unable to provide a date/format when this report will be published"

Section 36 (Prejudice to effective conduct of public affairs):

  • "ICB must be assured it has a safe space where it can conduct robust free and frank conversations"
  • Need to "explore all possible scenarios with partners and clinicians"
  • Claim that disclosure "will inhibit and hinder these conversations"
The Problem with Section 22: ICO guidance is explicit: "a general intention to publish at some point in the future is insufficient; there must be a clear and specific intent to publish the information within a reasonable timeframe." NHS Devon has provided no publication date, making this exemption legally questionable.
The "Safe Space" Argument: Section 36 is being used to hide evidence that underpins major service changes affecting public healthcare. The argument that the public cannot see modelling used to justify closing their local cardiac services because officials need "safe space" for "free and frank conversations" fundamentally contradicts transparency and democratic accountability.

PASP Specification (Disclosed):

The specification document reveals the modelling project was:

  • 20-week timeline (started March 2024)
  • Covered: All 5 acute hospitals across Devon, Cornwall & Isles of Scilly
  • Included: Demand and activity modelling, workforce modelling, travel modelling
  • Deliverables: Static report, interactive model, workshop materials
  • Used GIRFT expertise - Getting It Right First Time programme data and case studies
  • Purpose: "Developing a sustainable model for acute services" - described as "exit criteria for Devon"

Good afternoon

Thank you for your response to my Freedom of Information request (FOINHSD25/1474).

I am writing to request an internal review of the decision, for the following reasons:

1. Incorrect application of Section 22 ("information intended for future publication")

Section 22 can only be applied when:

  1. There is a settled intention to publish, and
  2. Publication is planned for a specific or at least reasonably identifiable date, and
  3. The public interest in withholding outweighs the public interest in disclosure.

Your response states: "The information held by NHS Devon is intended for future publication… The publication date is still to be confirmed."

A publication date that is not set does not meet the legal test for a "settled intention" under Section 22. ICO guidance is explicit on this point: "a general intention to publish at some point in the future is insufficient; there must be a clear and specific intent to publish the information within a reasonable timeframe."

Therefore, the exemption is incorrectly applied unless NHS Devon can: identify what will be published, identify where, provide an approximate publication timeframe, and demonstrate a public interest test explaining why withholding is in the public interest.

2. NHS Devon's statement that NHS England holds Q1 and Q5 contradicts NHS England's own FOI decision

NHS Devon stated: "NHS Devon does not hold the information in response to questions 1 and 5… you may wish to have direct communication with NHS England."

However, NHS England has already responded under FOI-2510-2272157, stating clearly that: "NHS England does not hold this information."

This creates a clear contradiction. Under Section 1(1)(a) FOIA, the authority has a duty to confirm whether it does or does not hold information. Authorities cannot redirect applicants back and forth where each denies holding the data.

Given that commissioning and contracting of local modelling for PASP would logically fall within the remit of NHS Devon (the statutory system commissioner), the assertion that the ICB holds none of this information requires proper clarification.

3. The decision does not address each question individually

Even where Section 22 may apply to some outputs, it cannot logically apply to: dates of commission, procurement method, contract value, governance structures, oversight boards, the scope of modelling (e.g., whether cardiology was included). These are factual details describing process, not unpublished documents.

Summary of Requested Actions

  1. Conduct a full internal review
  2. Reassess the decision to apply Section 22 without a publication date
  3. Reassess the claim that NHS Devon does not hold Q1 and Q5
  4. Provide all information that is not legitimately covered by Section 22
  5. Provide a lawful public interest test if you maintain the exemption

Kindest regards

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

Status: Initial response claimed "does not hold information" - challenged 25 November 2025. Internal Review received 16 February 2026 partially reversed decision - NHS Devon now admits it DOES hold information about commissioning authority and provided specification document, but is withholding modelling outputs, findings, contract costs, and governance documents using Section 22 (no publication date given) and Section 36 ("safe space" argument). The specification reveals this was a major 20-week project covering all Peninsula hospitals. Campaign successfully forced NHS Devon to admit holding information and disclose specification, but core modelling data remains hidden.

Download Internal Review Response (PDF) Download PASP Specification (PDF)
Why This Matters: The "Case for Change" is the foundational document justifying the proposed relocation of cardiac services. NHS Devon initially refused to confirm whether they even hold documented timelines, then admitted they hold "part" of the requested information but provided minimal detail.
29 Jan
2026 Board meeting
for "next steps"
s40(2)
Exemption claimed
for SRO details
0
Timelines provided
(original or revised)

What we asked for:

  • Information about the SRO's "temporary unplanned absence"
  • Original and revised timelines for the Case for Change
  • Internal risk assessments mentioning delays
  • Confirmation of interim SRO arrangements

What NHS Devon revealed (8 December 2025):

  • NHS Devon confirmed it holds part of the requested information
  • Next steps to be considered at 29 January 2026 Board meeting
  • Refused to provide SRO absence details citing Section 40(2) (personal information)
  • Did not confirm whether documented timelines exist
Internal Review Challenge (9 December 2025): Response failed to confirm whether documented timelines exist or provide any substantive information about programme delays. Internal Review response due approximately 7 January 2026 (20 working days).

Status: Initial response received 5 December 2025 (clarified 8 December) confirming NHS Devon holds part of the requested information but provided minimal detail. Internal Review requested 9 December 2025 challenging failure to confirm existence of timelines and lack of transparency about programme delays. Awaiting Internal Review response.

Download Response (PDF) Download Internal Review Request (PDF)
ICO Investigation: Formal complaint submitted 23 December 2025 citing serious concerns about NHS Devon's handling of this request. The response was inadequate, incomplete, and appears to fall below the standards required under the Freedom of Information Act 2000.
Why This Matters: NHS England says NHS Devon commissioned Edge Health, but NHS Devon claims it holds no documentation. The public cannot access basic procurement information about modelling that underpins major service changes affecting their healthcare.

Background:

After NHS England confirmed it "does not hold information about who authorised Edge Health" and directed the request to NHS Devon ICB as the commissioning authority, this FOI requested:

  1. Authorising individuals - Names and job titles who approved commissioning
  2. Dates of approval - When authorisation was given
  3. Contractual documentation - Contract, purchase order, business case, approval papers, procurement route
  4. Correspondence - Internal NHS Devon correspondence about decision; correspondence with Edge Health about scope
  5. Costs - Total cost, invoices, payment records

NHS Devon's Response (16 February 2026) - What They Revealed:

  • Process: NHS Devon requested support from NHS England Southwest to identify suitable provider
  • Selection: Edge Health identified as existing NHS England provider
  • Arrangement: Commissioned via "joint working arrangement" through NHS England's Recovery Support Programme (RSP)
  • Approval date: "Resource confirmed in place July 2024"
  • Cost to NHS Devon: Nil - "covered by RSP"
  • Specification: PASP Scenario modelling document (same as FOINHSD25/1474)

NHS Devon's Claims of "Information Not Held":

  • No contract, agreement, purchase order, or call-off documentation
  • No business case, approval papers, or decision reports
  • No procurement route documentation
  • No internal correspondence about decision to appoint Edge Health
  • No invoices or payment records
The Implausibility Problem: NHS Devon acknowledges it was involved in the Peninsula Acute Sustainability Programme, it knows who authorised the commission, it knows the timeline, it knows the funding source — yet claims to hold no documentation whatsoever. It is highly unlikely that a public body could be involved in a programme of this nature without generating or receiving any emails, meeting notes, briefings, reports, or communications.

ICO Complaint - Grounds for Investigation:

  1. Implausible "information not held" claims
    NHS Devon asserts it holds no procurement documentation, contractual records, internal correspondence, decision-making material, or funding arrangement documentation. The ICO has repeatedly ruled that blanket assertions of "information not held" require clear justification. NHS Devon provided none.
  2. Failure to demonstrate adequate searches (Section 1 breach)
    The authority did not describe searches undertaken, identify systems checked, explain search terms used, or confirm whether relevant staff were consulted. The response gives the impression that no meaningful search was conducted at all.
  3. Breach of duty to advise and assist (Section 16 breach)
    NHS Devon did not explain why it holds some information but not other related records, clarify its governance responsibilities, or provide meaningful assistance in understanding the division of responsibilities between NHS Devon and NHS England. Simply redirecting to NHS England is not sufficient to discharge the Section 16 duty.
  4. Lack of transparency around commissioning and governance
    NHS Devon provides no explanation of why it retains no documentation, whether it received deliverables from Edge Health, whether it participated in meetings or oversight, or whether it was consulted during commissioning.
  5. Evasive response inconsistent with normal public-sector practice
    It is not standard practice for a public body to be involved in a programme, know who authorised it, know when it commenced, know the funding source — yet hold no documentation, correspondence, or records. This raises concerns about inadequate record-keeping, failure to retain information, potential non-compliance with statutory obligations, and reluctance to disclose information.
  6. ICO Action Requested:
    • Investigate the adequacy of NHS Devon's searches
    • Require NHS Devon to conduct fresh, properly documented searches
    • Require NHS Devon to provide a compliant response
    • Assess whether NHS Devon breached Sections 1 and 16 of the FOI Act
    • Consider whether NHS Devon's record-keeping practices comply with public-sector standards

The Circular Redirection Pattern:

Question NHS England Says NHS Devon Says
Who authorised Edge Health? "Contact NHS Devon" "We don't hold internal correspondence - contact NHS England"
Contract documentation? "We don't hold this" "We don't hold this - contact NHS England"
Business case/approval papers? "We don't hold this" "We don't hold this - contact NHS England"

Status: Response received 16 February 2026. NHS Devon claims it doesn't hold contracts, business case, approval papers, or internal correspondence despite being the commissioning authority. Formal complaint submitted to ICO 23 December 2025 on six grounds: implausible "information not held" claims, failure to demonstrate adequate searches, breach of duty to advise and assist, lack of governance transparency, evasive response inconsistent with normal practice, and inadequate record-keeping. Awaiting ICO determination.

Download Response (PDF) Download PASP Specification (PDF)

Responses Received

Why This Matters: NHS Devon's consistent response of "we do not hold this information" is part of a pattern that fragments accountability. The ICB should have oversight of waiting times if they're making decisions about service configuration.

Requested waiting times for cardiac procedures carried out at RDE from 1 July 2025.

Outcome: NHS Devon does not hold this information. Request referred to RDE (see RDF3688-25).

Download Document (PDF)
EQUIPMENT FAILURE OCCURRED (8-10 March 2026): Both cardiac catheterisation labs at Torbay Hospital failed over the weekend of 8-9 March. Specific patient case documented: Patient from Teignmouth requiring urgent cardiac intervention - Torbay cardiology staff requested transfer to RDE, RDE declined despite regularly receiving help from Torbay, patient sent to Derriford Plymouth instead. Campaign escalated immediately to Trust CEO (7 March) and Medical Director (10 March) with five urgent questions about contingency arrangements and transfer protocols. The warnings about equipment failure and lack of system resilience have been proven correct with concrete evidence of patient harm from longer travel times. Trust CEO responded 16 February 2026 confirming £5.7m replacement programme, but manufacturer support ends June 2026 - creating 15-month uncertainty window before replacement completed September 2027.
Why This Matters: If Torbay's cath labs generate income for cardiac services, where does that money go? Understanding the financial flows helps explain whether underinvestment in Torbay is strategic rather than necessary.

Asked where cardiac services finances go and whether there is money available to refurbish catheterization laboratories.

Key finding: Funds held in central budget. Expenditure budgets aim to cover costs of activity less any agreed efficiency targets.

Escalation Timeline:
  • October 2025: Trust CEO stated funding was "earmarked" pending approval in January, implying ICB involvement
  • September-October 2025: NHS Devon ICB confirmed they received no request from Torbay
  • 20 January 2026: Formal challenges submitted to both organisations
  • Before 26 Jan 2026: Trust confirmed business case being updated, but no timescales provided
  • 26 January 2026: Campaign responded highlighting staff retention crisis - delay risks clinician exodus and de facto closure by attrition
  • 26 January 2026: Partnership offer made offering fundraising support
  • 29 January 2026: HVAC failure risk escalated - immediate threat to cath lab capacity
  • 3 February 2026: Formal structured request sent with 7-day deadline for funding position, timeline, and costs
  • 16 February 2026: Trust CEO responded confirming funding and timeline
  • 8-9 March 2026: CRITICAL - Both cath labs failed over the weekend
  • 7 March 2026: Escalated to Trust CEO requesting incident details
  • 10 March 2026: Escalated to Medical Director (CEO on leave) - Specific patient case documented: Patient from Teignmouth requiring urgent cardiac intervention - Torbay requested RDE transfer, RDE declined, patient sent to Derriford Plymouth instead
  • 10 March 2026: Five urgent questions raised about contingency arrangements, transfer protocols, and incident review
  • 12 March 2026: Trust Deputy CEO responded via Comms - confirmed both labs failed, admitted SOPs for diverts were inadequate, committed to strengthening cross-site protocols. Did not address the specific patient case or RDE refusal allegation.

The Contradiction:

  • Trust CEO (17 October 2025): Provisional sum earmarked in draft capital programme, approval expected January. Implied ICB involvement in funding.
  • ICB Acting CEO: "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"
  • Trust CEO (before 26 Jan 2026): Confirmed business case being updated for capital funding
  • Trust CEO (16 Feb 2026): Funding confirmed through Trust capital programme. National bid unsuccessful. 18-month timeline to completion.
  • ACTUAL OUTCOME (8-10 March 2026): Both cath labs failed over weekend. Patient from Teignmouth requiring urgent cardiac intervention - Torbay requested RDE transfer, RDE declined, patient sent to Derriford Plymouth instead. All warnings proven correct. Concrete evidence of patient harm from longer travel times.
  • Trust incident response (12 March 2026): Trust states RDE "offered support" - directly contradicting the documented patient case. Two formal FOIs now submitted to establish the factual record (RDF4139-26 and divert log request).

Critical Risks Identified:

  • Staff retention: Prolonged uncertainty risks exodus of experienced cardiologists. Once lost, expertise cannot be replaced - predetermining service closure by attrition. "ICB may win by default."
  • HVAC failure: Shared air-conditioning system at risk of near-term failure. Would cause sudden total loss of cath lab capacity affecting both Torbay and RDE patients, with >£600k annual income loss. UPDATE 7 MARCH 2026: BOTH CATH LABS HAVE FAILED.
  • Manufacturer support ends June 2026: Cannot guarantee repairs from June 2026. Creates 15-month uncertainty window before replacement completed September 2027.
  • System resilience breakdown: RDE allegedly declined to provide support during Torbay's cath lab failure despite regularly receiving assistance from Torbay when RDE labs are over capacity.

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

To: Joe Teape (Trust CEO), Libby Ryan-Davies (ICB Deputy CEO), J. Govett
Subject: Urgent: Cath Lab Replacement - Funding Position, Timeline and System Risk
Deadline: 16 February 2026 (7 working days)

Good evening Mr Teape, Ms Ryan-Davies, Mr J.Govett.

Further to my email of 29 January and my discussion with Mr J Teape yesterday, the 4th Feb, I am writing in my capacity as Chair of the Heart Campaign and on behalf of the Torbay business community through the Chamber of Commerce.

The purpose of this email is to request clarity on the replacement of the Torbay Hospital cardiac catheter laboratories, and specifically:

  1. Whether a funded replacement programme is in place
  2. The timescale for delivery
  3. The level of clinical and system risk should the current labs fail or become unavailable

As you will appreciate, this is not simply an internal equipment issue. If Torbay were to lose cath lab capacity, the wider catchment would face increased time-to-definitive treatment for acute cardiac events, with inevitable impact on outcomes. This is a system resilience and patient safety issue, not just a local operational concern.

To enable constructive support locally, could you please provide the following in writing within the next 7 working days (16th February):

A) Replacement plan and timeline

  • Confirmation of the Trust's intended plan for cath lab replacement (one lab / both labs)
  • The current timeline and key milestones
  • Any contingency plan should one lab fail before replacement is completed

B) Capital requirement

  • The total estimated capital cost for the replacement programme (headline figure)
  • Whether this includes enabling works, installation, commissioning and any associated estates works

C) Funding position

  • The amount of funding already secured
  • The current funding gap (if any)
  • Whether this scheme is in the ICB capital programme and/or submitted for national capital funding

If the Trust and ICB are not currently able to confirm the above, then I would be grateful for a clear statement of what information is outstanding and when it will be available.

Given the potential patient safety implications, I would appreciate a response by 16th February 2026. [7 working days from today].

Once we have the confirmed position and the headline figures, we can consider what support the local community and business sector may be able to offer in terms of advocacy and assistance in unlocking the appropriate funding routes.

regards

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

From: Joe Teape (Chief Executive)
Date: 16 February 2026

£5.7m
Total capital cost
for replacement
Sept 2027
Target completion
date
HIGH
Trust-confirmed
risk level
June 2026
Manufacturer stops
guaranteed repairs

Funding Confirmed:

  • Programme funded through Trust core capital programme for 2026/27 and 2027/28
  • Total cost: Approximately £5.7m (includes new air handling, installation, commissioning, estates works)
  • Budget context: £14.3m total capital for entire organisation - cath labs represent 40% of Trust's capital budget
  • National funding bid FAILED: Estates Safety Fund 2026-2031 bid unsuccessful "due to high demand"
  • Other priorities competing for capital: Cancer aseptic pharmacy (essential for chemotherapy), LINACs (radiotherapy), diagnostic equipment

Timeline:

  • Design phase: Starting shortly, minimum 6 months legally and clinically required for safety-critical facilities
  • Design completion: September 2026
  • Full replacement: September 2027 (18 months from now)
  • Subject to: Ratification through internal governance process

Risk Level - Trust Confirms HIGH:

"The level of risk is high, which is why replacing both cardiac catheter labs has been prioritised within our capital programme."

Critical Warning - Manufacturer Support Ends June 2026:

  • Manufacturer has notified Trust they cannot guarantee repair support from June 2026
  • Equipment will not automatically "stop working or become unsafe" at that point
  • But repairs "may still be possible but cannot be guaranteed"
  • This "increases the level of uncertainty over time"

Contingency Plans:

  • Trust has experienced failures in past - team acted quickly to rectify and maintain service
  • Developing strengthened mitigations through governance routes
  • Working with manufacturer to understand different fixes for different failure scenarios
  • Reviewing internal escalation plans
  • Assessing how to maintain safe service if one lab unavailable
  • Mobile unit under consideration if both labs fail simultaneously (though unlikely)
  • Financial contingency built into capital programme

System-Wide Impact Acknowledged:

"We fully recognise the important role the labs play in supporting the wider system. Any sustained loss of capacity would have a direct impact on patient flows, pathways and system performance."

Key Constraint - National CDEL Cap:

Trust explains Capital Departmental Expenditure Limit (CDEL) is the national cap on NHS capital spending. Every capital pound counts towards this single national limit. "The NHS is legally required not to exceed this limit." Even if a trust has cash or can borrow, spending still counts towards CDEL and may not be permitted if national limit is close to being breached.

To: Joe Teape (Trust CEO), Libby Ryan-Davies (ICB Deputy CEO)
Date: 7 March 2026

CRITICAL INCIDENT: Both cardiac catheterisation labs at Torbay Hospital failed. RDE allegedly declined to provide support despite regularly receiving assistance from Torbay when their own cath labs are over capacity. The warnings about equipment failure and lack of system resilience have been proven correct.

Good evening Mr Teape,

I am writing to request immediate clarification regarding a serious matter that has been brought to my attention concerning the recent failure of both cardiac catheterisation labs at Torbay Hospital.

I have been informed that, during this incident, the Royal Devon and Exeter Hospital declined to provide support to Torbay's cardiology service. This is particularly troubling given that RDE reportedly requests - and receives - regular assistance from Torbay when their own cath labs are over capacity and patients require urgent treatment.

If accurate, this raises significant concerns about patient safety, inter-hospital cooperation, and the wider operational resilience of cardiology services across our region - especially since Torbay's cath labs are considered "terminal" and in need of replacement.

To understand the gravity and implications of this situation, I request confirmation of the following:

  • Whether this event occurred as described
  • The date and time of the incident
  • How many patients were affected
  • What actions were taken to manage patient care
  • The clinical outcomes for those patients
  • The reasoning provided by RDE for declining assistance, if applicable

This information is essential for reassurance that appropriate protocols were followed and that patient welfare was not compromised. I would appreciate a prompt and transparent response.

Kindest regards

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

To: Chris Balch (Medical Director), Joe Teape (Trust CEO)
CC: Steve Darling MP, David Thomas (Torbay Council), Steve Race MP, Steven Clark (NHS Devon ICB)
Date: 10 March 2026 18:21

SPECIFIC PATIENT CASE: Patient from Teignmouth requiring urgent cardiac intervention over the weekend (8-9 March). Both cath labs non-operational. Torbay cardiology staff requested transfer to RDE. RDE declined. Patient sent to Derriford Plymouth instead. This is concrete evidence of system resilience failure and patient harm from longer travel times.

Good evening Mr Balch

I am writing to you as a matter of urgency regarding concerns raised over the weekend about the availability of emergency cardiology services at Torbay Hospital.

I wrote to the Chief Executive on Saturday but understand he is currently on annual leave and given the seriousness of the situation I felt it appropriate to bring this directly to your attention.

We have received reports that a patient from Teignmouth requiring urgent cardiac intervention was to be taken to Torbay Hospital over the weekend by ambulance, but this was not undertaken as both "cath" laboratories were not operational at the time. Allegedly, it has further been suggested that cardiology staff at Torbay sought to transfer the patient to the Royal Devon and Exeter Hospital but that this request was declined, resulting in the patient being transferred to Derriford Hospital in Plymouth.

As you will appreciate, this raises significant concerns regarding resilience in emergency cardiac services and the contingency arrangements in place when the catheter laboratories at Torbay are unavailable.

The HEART campaign has already highlighted ongoing concerns that the current cath lab equipment at Torbay is ageing and increasingly unreliable. We understand the laboratories have been described as effectively "terminal" and prone to breakdowns, which is why discussions have been taking place about the urgent need for replacement facilities.

Considering the reported incident this weekend, I would be grateful if the Trust could urgently clarify:

  • whether both catheter laboratories at Torbay Hospital were unavailable at the time
  • what contingency arrangements are in place when the labs are not operational
  • whether a request was made to transfer the patient to the Royal Devon and Exeter Hospital
  • who is responsible for accepting or declining such transfers within the regional cardiac network
  • whether any review of the incident is now taking place

While we fully respect patient confidentiality, reassurance regarding the resilience of emergency cardiac services at Torbay Hospital is clearly in the public interest.

Given the level of concern locally, I would appreciate a response at the earliest opportunity.

regards,

Susie Colley
Chair of the Torquay Chamber of Commerce and The Heart Campaign
Elected Governor of Torbay Hospital

From: Jane Harris, Associate Director of Communications and Partnerships (on behalf of Adel Jones, Deputy CEO and Chief Operating Officer)
To: Susie Colley (Heart Campaign Chair)
CC: Steve Darling MP, Martin Wrigley MP, Steve Race MP
Date: 12 March 2026, 17:17

CONFIRMED BY TRUST: Both cardiac catheterisation labs at Torbay Hospital simultaneously failed due to unplanned technical issues. The Trust has admitted that existing standard operating procedures for managing this scenario were not adequate and has committed to strengthening cross-site protocols. The failure mode the Heart Campaign warned about has now occurred - and the Trust's own response confirms the system was not prepared for it.

Dear Ms Colley

Thank you for taking the time to write and for setting out your concerns so clearly. I recognise the important role you play in advocating for people with heart conditions and I understand why any suggestion of disruption to local cardiology services would be concerning.

Both of Torbay Hospital's cardiac catheterisation labs did experience a short, unplanned outage recently due to technical issues. These issues have since been resolved and services are currently operating as normal.

During the period of disruption, cardiology clinical teams worked together across Devon to agree appropriate support arrangements, in line with established clinical protocols. However having reviewed the incident carefully, we have identified a need to strengthen the standard operating procedures for cardiology diverts with the senior management teams to ensure that cross-site support across Devon is improved and I have agreed with Chief Executives across Devon that I will take this forward at pace.

Both University Hospitals Plymouth NHS Trust and Royal Devon University Healthcare NHS Foundation Trust offered support as part of these arrangements over the weekend period. I can confirm that no patient was left without appropriate clinical oversight or escalation.

Thank you again for raising these concerns. We value constructive engagement with patient representatives and campaign groups, and we remain committed to working closely with partners to ensure safe, resilient cardiology services for our population.

Yours sincerely
Adel Jones
Deputy Chief Executive and Chief Operating Officer
Torbay and South Devon NHS Trust

What this response does not answer:
  • How long "short" actually was - the duration of the outage is not stated
  • Whether PPCI was available to Torbay catchment patients during the outage window
  • What happened to the specific patient from Teignmouth documented in accordion 9 - the response does not address the alleged RDE refusal or the Plymouth transfer
  • "Appropriate clinical oversight or escalation" is not confirmation that emergency cardiac intervention was accessible
  • Why the Comms Director responded on behalf of the Deputy CEO, to emails addressed to the CEO and Chair - neither Joe Teape nor Prof Chris Balch responded directly

Status: Trust Deputy CEO (Adel Jones) responded 12 March 2026, confirming both cath labs simultaneously failed over the weekend of 8-9 March due to unplanned technical issues and are now restored. Trust acknowledged existing SOPs for managing cath lab diverts were inadequate and has committed to strengthening cross-site protocols "at pace." However, the response does not confirm the duration of the outage, whether PPCI was available to Torbay catchment patients during the window, or the clinical outcome for the patient documented in accordion 9 (transferred to Plymouth after RDE declined). Response sent by Comms Director Jane Harris on behalf of Adel Jones - neither Trust CEO Joe Teape nor Chair Prof Chris Balch responded directly to emails addressed to them. Two formal FOIs now submitted to establish the factual record: RDF4139-26 (transfer handling, four organisations) and a divert log request (three organisations), both due 14 April 2026. £5.7m replacement programme confirmed (16 Feb) but completion not until September 2027. Manufacturer support ends June 2026.

Download Original FOI Response (PDF)
Why This Matters: NHS Devon ICB claims Royal Devon can absorb Torbay's cardiac workload, yet this data reveals their cath labs are already "fully utilised during weekdays." If RDE is at full capacity and already transferring 284 patients TO Torbay, how can they take on Torbay's cases?
2,674
Weekend procedures
Jan 2023 - Oct 2025
20.29
WTE consultant
cardiologists
284
Inpatient transfers
to Torbay since Oct 2023

This request sought information about cath lab capacity and utilization rates, weekend elective cardiology procedures, consultant staffing levels, and patient transfers between RDE and other hospitals.

Key finding: RDE cath labs are "fully utilised during weekdays" - they are running weekend sessions to manage demand.

Download Document (PDF)
Why This Matters: This was the first attempt to get information about Edge Health's commission to model demand and capacity across Devon's hospitals - the modelling that underpins proposed cardiac service changes. NHS England's response: "We don't hold this information. Contact Devon ICB."

What Was Requested:

  1. Commissioning Authority - Which NHS organisation commissioned Edge Health; who initiated or requested the modelling
  2. Scope and Purpose - Which hospitals and specialties were included; explicit confirmation whether cardiology was modelled
  3. Timescales - When work was conducted; forecast period covered
  4. Outputs and Deliverables - Reports, forecasts, capacity models, presentations produced
  5. Contract and Costs - Contract date, value, reference number, procurement method
  6. Governance and Oversight - Which boards reviewed findings; minutes, papers, summaries

NHS England's Response (17 November 2025):

"NHS England does not hold this information."

NHS England explicitly directed the request to:

NHS Devon Integrated Care Board - "responsible for the majority of NHS budget and services in Devon"
The Critical Statement: NHS England explicitly identifies NHS Devon ICB as "responsible for the majority of NHS budget and services in Devon" - positioning them as the authority that should hold this information. This makes Devon ICB's subsequent claims that they hold no contracts, business cases, approval papers, or internal correspondence fundamentally implausible.

Status: Response received 17 November 2025. NHS England confirmed it does not hold information and explicitly directed request to NHS Devon ICB as the organisation "responsible for the majority of NHS budget and services in Devon." This triggered subsequent FOI requests to Devon ICB (FOINHSD25/1474, FOINHSD25/1520, and FOI-2510-2272157 NHSE:0679333).

Critical Finding: SWASFT confirmed prehospital thrombolysis is NOT provided in South Devon (only Portland and Isles of Scilly). Paramedics haven't been trained in thrombolysis for over 10 years. No specialist ECG interpretation service exists. Moving cardiac services from Torbay to Exeter would extend diagnostic uncertainty from 15 to 43+ minutes - directly contradicting NICE guidance that requires thrombolysis when PCI cannot be delivered within 120 minutes.
Why This Matters: If ambulances don't carry clot-busting drugs and paramedics aren't trained to administer them, then every extra minute travelling to a cath lab increases heart damage and death risk. NICE guidelines are unequivocal: if timely PCI cannot be achieved, prehospital thrombolysis MUST be available to prevent avoidable harm and excess mortality.

Key Findings from SWASFT Response (26 January 2026):

  • Zero thrombolysis capability in South Devon - medication only carried in Portland and Isles of Scilly
  • No paramedic training for over 10 years - not part of current education programmes
  • Zero administrations 2022-2025 - no crews have carried medication in South Devon
  • No dedicated specialist ECG interpretation service - crews cannot routinely access cardiology advice
  • RD&E has no advice line - only PPCI activation function available
  • 75-minute threshold - SWASFT guidelines require critical care support if PPCI cannot be reached within 75 minutes (not 120)

The NICE Compliance Trap:

NICE guidelines (CG167 and NG185) are unequivocal: where primary PCI cannot be delivered within 120 minutes, prehospital thrombolysis MUST be available to prevent avoidable delays to reperfusion and reduce avoidable harm. Moving emergency cardiology from Torbay to Exeter creates a choice:

  1. Option 1: Expose patients to call-to-balloon times exceeding NICE thresholds = foreseeable and avoidable harm
  2. Option 2: Reintroduce prehospital thrombolysis = paramedic retraining, clinical governance, competency assessment, audit, significant cost and risk
HSSIB Report (October 2025): National investigation found ambulance crews struggle to identify borderline STEMI cases, ECG auto-interpretation fails when needed most, and clinical support hubs lack specialist ECG expertise. In 9 ambulance trust investigations into missed STEMIs, only ONE had auto-interpretation correctly identifying "STEMI" - the others showed only "abnormality of some description."

The Diagnostic Uncertainty Problem:

Being taken to Torbay means borderline cases get expert cardiology eyes within ~15 minutes. Extending travel time to Exeter means diagnostic uncertainty persists for 43+ minutes. This directly contradicts the HSSIB findings that crews already struggle with borderline STEMI diagnosis.

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 NG185) 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.

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.

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.

Kindest regards

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

To: SWASFT Information Governance
CC: Joe Teape (Trust CEO), Libby Ryan-Davies (ICB Deputy CEO), Steven Clark (ICB), ICB Executive Office, Steve Darling MP
Subject: Query re thrombolysis provision and ambulance crew training (Torbay pathway resilience)

Dear Nicole

Further to your concise answers in your email of the 26.01.2026 would you be able to furnish us with additional information please?

My understanding is that ambulance crews are no longer licensed/authorised to administer thrombolysis to patients in Torbay Hospital catchment area. Given the time-critical nature of acute coronary syndromes, I would be grateful if you could confirm whether this is correct and, if so, the rationale and timeline for that change.

Current position

Can you confirm whether any ambulance clinicians in your service are currently able to administer thrombolysis in the prehospital setting within the Torbay Hospital catchment area?

Impact on heart attack care

  • What is the current pathway for patients with suspected STEMI / time-critical heart attack when catheter lab access is delayed or unavailable?
  • What mitigations are in place for patients in rural or remote areas where transport times are longer?

Planning and resilience

  • Has the service, or the local ICB, considered the option of retraining crews (or a defined cohort of clinicians) to administer thrombolysis if required for system resilience?
  • Has the ICB asked the ambulance service to explore this option as part of contingency planning?

Training, timeline, and cost

  • How long it would take to retrain and sign off clinicians (or specialist teams)?
  • How many staff would realistically need training to provide safe coverage?
  • Who would be responsible for funding training, governance, and ongoing competency?

Kindest regards

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

Status: SWASFT response received 26 January. ICB challenged same day on NICE compliance and patient safety implications. Initial follow-up sent to SWASFT 27 January asking about ICB consultation. Comprehensive follow-up sent 5 February with detailed questions on current licensing/authorisation, rationale for change, STEMI pathways when cath lab delayed, rural area mitigations, whether ICB requested contingency planning, and retraining costs/timelines. Awaiting responses on whether contingency planning for thrombolysis reintroduction has been explored and what system resilience options exist if cardiac services change.

Download Original Request (PDF) Download SWASFT Response (PDF)

FOI Contact Information

To submit Freedom of Information requests to the relevant organisations:

  • Royal Devon University Healthcare NHS Foundation Trust:
    Email: rduh.foi@nhs.net
  • Torbay and South Devon NHS Foundation Trust:
    Visit: Freedom of Information page
  • NHS Devon ICB:
    Email: d-icb.foi@nhs.net

All documents obtained through legitimate Freedom of Information requests.
Documents are provided for transparency and public interest in cardiac healthcare services across Devon.