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.

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 SWASFT Information Governance Team

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 or authorised to administer thrombolysis to patients in the 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 when catheter lab access is delayed or unavailable, and 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 to administer thrombolysis if required for system resilience, and has the ICB asked the ambulance service to explore this as part of contingency planning?

Training, timeline, and cost: how long it would take to retrain and sign off clinicians, how many staff would need training to provide safe coverage, and 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