From: Susie Colley (chair@tqcc.co.uk)
To: Joe Teape, Martin Beaman
CC: Cat Johns (Torbay Council), David Thomas (Torbay Council), David Simmonds MP, Steve Darling MP, Steve Race MP, Martin Wrigley MP, Mark Hawkins (Rowcroft Hospice), Caroline Voaden MP
Subject: RE: NHF and Trust

Good afternoon Mr Teape,

Thank you for your further response. Having reviewed your reply carefully, I remain concerned that a significant aspect of my original question has not been addressed.

Throughout your correspondence, the assurances provided are framed almost entirely in the present tense. For example, you state that there are currently no requirements arising from the NHF; there are currently no service changes proposed as a consequence of the NHF; and the NHF does not currently mandate service reconfiguration.

While those statements clarify the Trust's present position, my question was directed specifically at the future implications of the Neighbourhood Health Framework once finalised and implemented. The distinction is important.

I am seeking clarification as to whether the Trust has received any indication, advice, expectation, guidance, or assurance regarding the future application of the NHF through NHS England, the Devon Integrated Care Board, or any associated planning and commissioning mechanisms. Accordingly, I would be grateful if you could provide a direct response to the following questions:

1. Has the Trust received any indication from NHS England, the Devon ICB, or any other NHS body that future planning guidance, commissioning arrangements, funding mechanisms, contractual requirements, performance frameworks, delivery expectations, or regulatory requirements arising from the NHF may be expected of NHS providers?
2. Has the Trust received any indication that compliance with future NHF-related requirements could influence, encourage, incentivise, or necessitate service redesign, relocation, workforce redistribution, outpatient reform, pathway redesign, or any other service changes at provider level?
3. Has the Trust received any assurance from NHS England or the Devon ICB that future NHF implementation will not be used, directly or indirectly, to support business cases, commissioning decisions, service reviews, or proposals affecting acute, emergency, inpatient, specialist, tertiary, or cardiac services?
4. If no such assurances have been received, will the Trust acknowledge that it is presently unable to rule out the possibility that future NHF-related requirements could influence future service change proposals?

I appreciate that the Trust is not the owner of the NHF and that responsibility for national policy rests with NHS England and the Integrated Care Board. However, as a provider organisation aligning its strategy with the NHF, it is reasonable to ask whether the Trust has been given any indication of how those policies may be operationalised in future.

I would therefore be grateful for a clear and unambiguous response to the specific future-facing questions set out above.

Kindest regards

Susie Colley
Chair of the Torquay Chamber of Commerce and the Heart Campaign
(Declined) Governor of Torbay Hospital

From: Joe Teape, Chief Executive, Torbay and South Devon NHS Foundation Trust (joe.teape@nhs.net)
To: Susie Colley (chair@tqcc.co.uk)
CC: Martin Beaman, Cat Johns (Torbay Council), David Thomas (Torbay Council), David Simmonds MP, Steve Darling MP, Steve Race MP, Martin Wrigley MP, Mark Hawkins (Rowcroft Hospice), Caroline Voaden MP
Subject: FW: NHF and Trust

Dear Mrs Colley

Thank you for your further email. It may be helpful to distinguish clearly between ownership of national policy and the assurances that we, as an NHS provider, can properly give in relation to the Neighbourhood Health Framework (NHF).

Ownership of the NHF. The NHF is a national policy framework developed and owned by NHS England, working with Integrated Care Boards. It is not authored or determined by this Trust. Questions about the intent, status, and future use of the NHF as a policy instrument are therefore most appropriately directed to NHS England and the Devon Integrated Care Board, as policy owners and commissioners respectively.

Position from the Trust's perspective. The NHF is a strategic framework setting out national ambitions for neighbourhood-based care. It does not impose statutory, mandatory, or binding requirements on us, nor does it in itself direct service reconfiguration. Any obligations placed on us as an NHS provider arise only through formal commissioning decisions or nationally mandated planning, contractual, or performance requirements. There are currently no such requirements in place arising from the NHF.

There are no service changes proposed by us as a consequence of the NHF. Should any changes ever be developed locally, they would be subject to appropriate clinical scrutiny, commissioner agreement, governance approval, and where required, statutory engagement and consultation. The NHF does not mandate, prescribe, or provide justification for changes to acute, emergency, inpatient, specialist, or cardiac services.

Engagement and consultation. The Trust's duties in respect of public involvement are set out in section 242 of the NHS Act 2006 (as amended). Formal public consultation is required where proposals constitute a substantial variation in service, assessed against recognised criteria including scale, impact on patients and access, clinical risk, and public interest. Where the legal threshold is not met, we undertake proportionate engagement appropriate to the nature and impact of the issue.

Workforce matters. We take issues relating to staffing, morale, and remuneration seriously. These matters are subject to established internal governance and include constructive and consistent engagement with our staff-side representatives.

For definitive responses regarding the framework itself, we would recommend contacting NHS England or the Devon Integrated Care Board as outlined above.

Kind regards

Joe Teape
Chief Executive

From: Susie Colley (chair@tqcc.co.uk)
To: Joe Teape, Martin Beaman
CC: Cat Johns (Torbay Council), David Thomas (Torbay Council), David Simmonds MP, Steve Darling MP, Steve Race MP, Martin Wrigley MP, Caroline Voaden MP, Mark Hawkins (Rowcroft Hospice)

Good evening,

Thank you for your response. For clarity and to avoid any further ambiguity, we require a direct answer to the following:

Will the Neighbourhood Health Framework (NHF), once finalised, impose any mandatory, binding, or otherwise enforceable requirements on the Trust that could lead, either directly or indirectly, to changes in acute, emergency, inpatient, or specialist services, including cardiac provision?

Your reply refers to the NHF as a "framework" and states it does not currently mandate reconfiguration. However, it does not address whether the NHF will carry obligations, targets, or expectations that the Trust is required to implement, whether formally or in practice. Accordingly, please confirm:

• Whether the NHF is purely advisory, or whether it creates obligations (including through NHS England performance, planning, or funding mechanisms) with which the Trust must comply;
• Whether compliance with the NHF, now or in future, could reasonably be expected to necessitate service change of any kind;
• Whether the NHF or related national policy could be relied upon, in whole or in part, to justify future changes to cardiac or other acute services.

In relation to engagement and consultation, you state that not all service changes require formal public consultation. Please specify the criteria that will be applied in determining when consultation is required, and how the Trust will ensure those duties are demonstrably met.

Finally, we remain concerned that issues relating to staffing, morale, and the alleged non-payment for additional hours worked have not been substantively addressed.

Kindest regards

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

From: Joe Teape, Chief Executive, Torbay and South Devon NHS Foundation Trust (joe.teape@nhs.net)
To: Susie Colley (chair@tqcc.co.uk), Martin Beaman
CC: Cat Johns (Torbay Council), David Thomas (Torbay Council), David Simmonds MP, Steve Darling MP, Steve Race MP, Martin Wrigley MP, Caroline Voaden MP
Subject: RE: NHF and Trust

Dear Mrs Colley

Thank you for your email and for setting out your questions so clearly ahead of the Board meeting on 07 May.

Purpose and status of our draft organisational strategy. Our draft strategy is a principles-based document. It does not contain service-specific proposals, decisions or reconfiguration plans and should not be read as doing so. The strategy has been developed in the context of national policy direction, including the 10 Year Health Plan for England and the Neighbourhood Health Framework (NHF).

Relationship with the Neighbourhood Health Framework. The NHF is reflected in the strategy through its emphasis on neighbourhood-based care, community services, and outpatient reform. The NHF does not mandate or imply reconfiguration of acute, emergency, inpatient or tertiary services and our draft organisational strategy does not state or suggest that it does.

Cardiac services. The draft strategy does not include proposals relating to cardiac services. No clinical services or specialisms are named, singled out, or implied anywhere in the draft strategy. No element of the NHF, or any other national policy, is being relied upon to justify changes to urgent, emergency, inpatient, or tertiary cardiac provision. Where the strategy refers in general terms to specialist or acute services being delivered in networked ways, this is explicitly framed as a matter of local clinical safety, workforce sustainability, and affordability, not as a requirement flowing from national policy.

Engagement, involvement, and consultation. We recognise that wider engagement on our draft strategy has not yet commenced. Subject to Board approval, we intend to undertake a series of community conversations in each of our five neighbourhoods over the summer. It is important to be clear that not all service changes require formal public consultation; the appropriate form of engagement will depend on the nature, scale, and impact of the proposal, in line with statutory duties.

In summary, the draft strategy sets direction and principles within the context of national NHS policy. It does not mandate or presuppose changes to cardiac services or any other specific area of care, nor does it rely on the NHF to do so.

Kind regards

Joe Teape
Chief Executive

From: Susie Colley (chair@tqcc.co.uk)
To: Joe Teape (Trust CEO), Chris Balch (Trust Chair)
Subject: NHF and Trust
Stated deadline: 30 April 2026

Good afternoon, Gentlemen

I am writing ahead of the Board meeting scheduled for 7 May to request formal clarification regarding the relationship between your draft strategy and the Neighbourhood Health Framework (NHF) issued in March 2026.

The NHS England National Health Framework does reference cardiology, but only in the context of improving elective and outpatient pathways. It does not authorise or imply the reconfiguration, relocation, or consolidation of acute, emergency, or inpatient cardiac services. Any suggestion that the NHF provides a mandate for changes to tertiary or urgent cardiac provision therefore goes beyond its stated scope.

I request that you clearly and explicitly set out which specific elements of the draft Trust strategy are directly required by, or flow from, the NHF; and which elements represent local policy discretion, interpretation, or independent strategic choice.

In particular, if any proposals relating to cardiac services are being justified by reference to the NHF, please provide the exact NHF provisions being relied upon, a clear explanation of how those provisions support the proposed changes, and any supporting clinical or policy rationale demonstrating that such changes are mandated rather than discretionary. If no such explicit policy basis exists, this should be clearly stated.

Please confirm how the requirement for "thorough and transparent community involvement" has been met in relation to any proposed service changes of this scale.

In addition please provide an impact assessment of call-to-balloon times for South Devon patients, including any changes over time and comparisons with national benchmarks.

I would be grateful for a written response by 30th April.

Kindest regards

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