Why It Matters
Torbay's Cardiac Excellence
Torbay Hospital's Cardiology Unit exemplifies everything the government claims to want from the NHS: innovation, research, community integration, national recognition, and outstanding patient outcomes. For more than 25 years, this unit has pioneered practices now adopted across the country.
This is not a failing service in need of centralisation. This is a centre of excellence delivering exactly what the Health Minister Wes Streeting's NHS reform agenda demands – and doing it in one of the most deprived and elderly populations in England.
The proposal to dismantle it contradicts multiple stated priorities of the NHS reform.
Audit data shared with local scrutiny committees has consistently shown Torbay Hospital’s cardiac unit performing at a high level for Primary Angioplasty (pPCI) – the emergency procedure that saves lives during heart attacks. This reflects the unit’s sustained performance over many years.
National awards include:
- Beacon Award for Coronary Heart Disease (2000) – recognising pioneering chest pain services
- BMJ Cardiology Team of the Year (2017, runner up) – for integrated heart failure services
- Royal College of Physicians Quality Improvement Award (2017, runner up) – for heart failure innovation
- NIHR/RCP Lead Consultant Research Award (2016) – Dr Phil Keeling for research excellence
Torbay pioneered pre-hospital thrombolysis in 2003 – one of the first centres globally to enable paramedics to deliver life-saving clot-busting drugs before reaching hospital.
The government's NHS reform agenda emphasises innovation, community-based care, and reducing hospital admissions. Torbay's cardiac unit has been delivering this for decades:
Heart Failure Virtual Ward
Dr Yung pioneered a Heart Failure Virtual Ward that delivers daily face-to-face care for patients with severe heart failure, either in outpatient settings or at home. Internal modelling showed this innovation could save the Trust £1.3 million annually by preventing unnecessary hospital admissions, enabling early discharge, and freeing up acute beds. Despite proven effectiveness, funding for this service ended in April 2025. Why was funding withdrawn when it saved £1.5m?
Integrated Heart Failure Service
Established more than a decade ago, Torbay was one of the first UK District General Hospitals to create a fully integrated heart failure service working across hospital and community settings. This aligns perfectly with the government's shift-to-community agenda – yet it's being threatened with closure.
Innovation in Clinical Roles
- Among the earliest centres to enable paramedics to deliver pre-hospital thrombolysis (2003)
- Early adopter in Europe of Reveal cardiac monitoring devices
- One of the first centres globally to train nurses and physiologists to implant Linq monitoring devices outside catheter labs
- Early European leader in training cardiac physiologists to perform autonomous trans-oesophageal echocardiograms (TOEs)
AI and Technology
Dr Keeling served as Chief Investigator for the FOOT Study assessing AI-powered HeartFelt devices for monitoring heart failure patients at home. This technology can detect deterioration early and prevent hospital admissions – exactly what NHS England's digital-first strategy demands.
Since the late 1990s, more than 2,500 patients have been enrolled in over 75 cardiology research studies at Torbay. This research has generated in excess of £5 million, which has been reinvested to support the cardiology unit.
Research isn't an optional extra. It represents:
- Additional expert care for patients who gain access to cutting-edge treatments
- Significant financial investment returned to the local NHS
- Training opportunities for clinicians
- National and international recognition
- Evidence generation that improves care across the country
Dismantling the unit would jeopardise a research programme that has brought more than £5 million into Torbay over the years.
Torbay serves one of the oldest and most deprived populations in England. Cardiac disease disproportionately affects older people and those in socioeconomic deprivation. Greater distance to specialist care risks widening inequalities, particularly for patients and families least able to absorb the financial and practical burdens of travel.
Torbay's cardiac unit provides:
- Same-day access to emergency life-saving treatment for the most vulnerable
- Specialist nurse-led clinics reducing consultant waiting times (currently 9–13 weeks)
- Community-integrated services reaching patients where they live
- Virtual ward services enabling home-based care for severe heart failure
- Rapid triage at the "front door" ensuring nobody waits for critical treatment
Increasing travel distance to specialist cardiac care would disproportionately affect frail, elderly and low-income patients – those already at greatest risk of poor outcomes. Any reconfiguration must demonstrate clearly that it will not worsen these inequalities.
The government claims reconfiguration is about efficiency. The evidence suggests otherwise:
- Torbay's Heart Failure Virtual Ward saves an estimated £1.3m annually – yet lost its £150k funding
- Research activity has generated over £5m reinvested in services
- Audit data shows Torbay’s pPCI outcomes among the top nationally
- Innovations pioneered at Torbay have been adopted NHS-wide, saving money nationally
- Patient education videos developed at Torbay are now used across the entire NHS
Torbay's cardiac unit has pioneered extended roles for specialist nurses and cardiac physiologists, creating career pathways and reducing pressure on consultants:
- Cardiology Nurse Specialists – Torbay was pioneering in developing CNS roles across multiple sub-specialties
- Autonomous Arrhythmia Nurses – over 4,000 nurse-led cardioversions performed to date
- Device Implantation by Non-Doctors – early adopter of training nurses and physiologists to implant monitoring devices
- Physiologist-Led TOEs – more than 20 years of autonomous trans-oesophageal echocardiography practice
These innovations don't just improve patient care – they create sustainable workforce models that other trusts are now copying.
Torbay Hospital's Cardiology Unit delivers everything the government's NHS reform agenda claims to prioritise: innovation, community integration, research excellence, reduced admissions, and outstanding patient outcomes.
No clear public clinical case has been presented to justify moving or reducing these services. The evidence supporting Torbay’s model is extensive.
Why It Matters
Every year, Torbay's cardiac unit performs hundreds of emergency PPCI procedures - a specialist treatment used during major heart attacks to rapidly open blocked coronary arteries and restore blood flow to the heart. Because heart muscle begins to suffer permanent damage the longer treatment is delayed, speed is critical in these cases. Understanding this time-sensitive medical reality is essential when considering the potential risks of moving this service further away from the communities it currently serves.
Below, we first explain what PPCI involves and why swift access matters. We then outline the political decisions now placing this service under threat.
Some definitions for you:
- STEMI (ST-segment elevation myocardial infarction). The immediate, emergency treatment for a specific type of severe heart attack.
- PPCI (primary percutaneous coronary intervention) is the specific term used when this procedure is carried out as an urgent response to a full-blown heart attack.
- Angioplasty is the general term for using a balloon (and usually a stent) to open an artery.
- PCI is the medical abbreviation for the entire procedure, which typically involves both a balloon and a stent.
What is Primary Angioplasty (PPCI)?
Primary angioplasty, or PPCI, is an emergency procedure used in the UK to treat a heart attack (STEMI) by unblocking a coronary artery. A catheter with a balloon is inserted through the wrist or groin and guided to the blocked artery, where the balloon is inflated to restore blood flow. A stent (a small mesh tube) is then left in place to keep the artery open.
- A thin, hollow tube called a catheter is inserted into an artery in your groin or wrist.
- The catheter is guided to the blocked coronary artery using X-ray imaging.
- A balloon at the tip is inflated to push the blockage aside and reopen blood flow.
- A metal stent is often placed to keep the artery open once the balloon is removed.
- A heart attack occurs when a clot blocks a coronary artery.
- PPCI directly opens the artery to restore blood flow as quickly as possible.
- Clot-busting drugs (fibrinolysis) are an alternative but are not as effective in many cases.
- PPCI is a time-critical treatment; faster treatment improves outcomes.
- Patients require close monitoring and a short inpatient stay after the procedure.
- Long-term recovery depends on medication, lifestyle changes, and follow-up care.
The Threat to This Service
NHS transformation should align with national strategy, local need, and the lived realities of patients and staff. The current programme of modelling and reconfiguration being undertaken across Devon does not meet this standard.
Although NHS Devon Integrated Care Board (ICB) states that it aims to "improve efficiency" and "meet future demand", its approach prioritises cost and consolidation over community need. Much of the work has taken place without clear public communication, leaving staff and patients without meaningful involvement.
This does not feel like reform. It feels like erasing a vital local service.
NHS Devon ICB commissioned Edge Health, a private consultancy, to model demand and capacity scenarios across Devon’s acute hospitals – including Torbay. This commission has not been clearly communicated publicly, and its outputs have not been released.
We have submitted Freedom of Information (FOI) requests to establish:
- How much public money was spent;
- Who authorised the commission;
- When workshops or meetings took place;
- Which NHS bodies or Trust leaders were involved; and
- Whether the outputs were shared with Trust Boards or the public.
Until this information is made public, the legitimacy of the process cannot be fully assessed.
Staff across Torbay and South Devon report growing anxiety, uncertainty, and frustration as rumours circulate without clarity or consultation. Patients and families fear losing access to timely, safe, local care – especially in rural and coastal communities where longer travel times can increase risk during time-critical emergencies.
The NHS Constitution commits the service to transparency and working in partnership with patients. The "case for change" being modelled by Edge Health appears to have been developed with minimal engagement from those most affected, which is difficult to reconcile with these principles.
We call for an approach that is:
- Transparent – all reports, models, and findings by Edge Health and NHS Devon ICB must be published in full.
- Collaborative – local clinicians, staff, and patients must shape the future of services, not external consultants.
- Accountable – every decision and contract must be open to scrutiny.
- Evidence-Based – transformation must improve outcomes, not simply reduce costs.
The HEART Campaign is:
- Pursuing FOI requests regarding the Edge Health commission;
- Seeking clarity from Torbay and South Devon NHS Foundation Trust leadership about their involvement;
- Sharing testimonies from NHS staff and patients about the impact of these proposals; and
- Advocating for a pause on service reconfiguration until the full evidence base is public.
Support our campaign by sharing your story, attending local meetings, or contacting your elected representatives.
Together, we can ensure Devon’s NHS serves the people who need it.