Sally Allen: Questions mount over NHS ‘Case for Change’ affecting Torbay heart patients

Firstly, thank you so much to all those who spared the time to come along and support our peaceful demonstration ‘The Ring of Hope’ to save our Cardiac Unit at Torbay Hospital, along the Newton Road on Saturday, December 6.

Some of you sensibly brought chairs to sit on and others even came in wheelchairs. We were blessed with the weather, as it had been biblical rain the day before, but it didn’t dampen your spirits for such an important cause. So, someone is clearly on our side!

The more we probe the Integrated Care Board and other governing bodies within the NHS, the more serious concerns and the chances of potential legal exposure related to the proposed ‘Case for Change’ and relocation of angioplasty services to the Royal Devon & Exeter Hospital become clear.

Currently these plans overlook substantial clinical risks and therefore the probability of major legal and financial liabilities for the ICB and the wider NHS.

The RD&E already transfers patients to Torbay weekly. RD&E is struggling to manage its own workload; therefore, any suggestion that it can safely absorb a substantial additional caseload is unrealistic. If capacity modelling has been undertaken, it has not been shared; if it has not been undertaken, this represents a serious governance failure.

The proposed centralisation of angioplasty services to the RD&E will inevitably increase travel times for STEMI patients and the evidence is unequivocal: delays cost lives. Just so as you are aware - An acute ST-segment elevation myocardial infarction (STEMI) arises from the occlusion of 1 or more coronary arteries, causing transmural myocardial ischemia and subsequent myocardial injury or necrosis.

If a patient dies en route to Exeter because the journey was unnecessarily extended, the ICB will have knowingly created that risk. In such circumstances, I am sure that bereaved families will not hesitate to pursue legal action, and it is highly likely that coroners, legal teams, and independent clinical reviewers will conclude that the service change will have contributed directly to avoidable deaths.

The associated litigation costs, including compensation, legal fees, and reputational damage, would fall ultimately on the NHS and the taxpayer. This is not speculative; it is predictable and avoidable.

Add to this, patients being transferred in non–air-conditioned ambulances facing extended journeys, especially during summer or on congested routes such as Telegraph Hill, are at serious risk of clinical deterioration. This is a foreseeable hazard. Proceeding without mitigating these risks exposes the system to further legal challenge, as no reasonable authority could justify knowingly increasing patient harm and risk.

Torbay Hospital routinely receives STEMI patients who self-present and require immediate intervention. If angioplasty is removed, these patients will occupy beds for extended periods while awaiting ambulance transfer to Exeter - delaying care, compromising outcomes, and creating further system blockages. This predictable operational failure will again open the door to avoidable harm and subsequent legal action.

Currently there are 20 cardiologists at the RD&E who are already, it appears, under pressure, while Torbay’s Cardiac Unit operates effectively with half that number. If RD&E cannot meet demand with double the workforce, it is unclear how it will manage if they need to double their workload, or vastly more of course in the holiday season.

While some elements of the Case for Change may hold merit, and I certainly agree that trying to avoid heart disease from an early age is a good option, the proposal to move angioplasty services from Torbay Hospital is neither viable nor safe. Pushing ahead with a plan that increases mortality risk is irresponsible, callous and smacks of discrimination.

The Equality Act states that age is a protected characteristic and obviously the Torbay catchment area has a higher average of older people. Thereby, surely it is blatant discrimination to value people’s lives around the Exeter area higher than those around Torbay and its outlying districts. Just imagine trying to get from East Prawle or Dartmouth to the RD&E within the golden time frame. Impossible.

So, there are a number of important questions that we are asking the ICB. As the RD&E admits they’re already at full capacity and their Trust states their cath labs are “fully utilised during weekdays” – and that’s why they’re running weekend sessions, how on earth can they absorb Torbay’s cardiac workload. If they’re already maxed out, where exactly will Torbay’s patients go? 

So, what they are proposing is clearly bonkers. There have been 284 inpatient transfers from RD&E to Torbay Hospital since October 2023. Read that again – RD&E is already sending cardiac patients to Torbay’s Cardiac Unit because of their own capacity constraints. And yet…the ICB wants to close the unit that's actually helping ease Royal Devon’s capacity crisis. Torbay Hospital has already offered regular cath lab availability to the RD&E, but it has not been formalised.  We also understand that the Exeter staff ring Torbay with “urgent” cases on a daily basis, pushing Torbay’s patients to the back of the queue.

You couldn’t make it up and even the most basic logistics skills would indicate that what has been proposed can’t work and makes the ICB and their ‘Case for Change’, not fit for purpose.

The Getting It Right First Time (GIRFT) programme is a national NHS England programme designed to improve the treatment and care of patients through in-depth review of services, benchmarking, and presenting a data-driven evidence base to support change. This is the programme the ICB is working to and all very worthy it sounds. The problem is that the implementation is wrong.

GIRFT confirms Torbay Hospital has capacity and freedom of information request responses have stated that GIRFT has reviewed both trusts (Torbay & Exeter) and determined “capacity was available to treat some patients from the RD&E catchment at Torbay”. So, in short, GIRFT found that: Royal Devon needs help, Torbay has spare capacity and the solution is to send patients from Exeter to Torbay.

Yet the ICB wants to do the opposite! Why?

There is so much more, but when even the basics don’t make sense, it does make you wonder if anyone knows what they are doing. It is a shocking situation, but most people making these decisions won’t even be affected by the proposed changes as they live in the RD&E catchment area! Now there’s a surprise.

Sadly, we are therefore preparing ourselves for a judicial review as clearly, we have just as much right to have the best opportunity to live, as those residing in and around Exeter. It is, after all, our basic human right.

To get the full picture, we have now launched our very informative website https://theheartcampaigntorbay.co.uk which shows all the FOIs together with a video of explanation by the award winning and recently retired head of cardiology, Dr Phil Keeling.