To receive an update from NHS Devon on the draft case for change development process and associated timeframes for engagement. 

Dr. Anthony Hemsley (Medical Director Secondary Care ICB and Medical Director Royal Devon and Exeter Foundation Trust) and Peter Collins (Chief Medical Officer) from Devon Integrated Care Board (ICB) presented an update on their work to develop a case for change in cardiovascular services.  The previous proposal (May 2025) was withdrawn duefeedback from public and clinicians and a recognition from the ICB that they didn’t engage as widely as they should have.  The current proposal is not a decision-making document, but an articulation of challenges facing Devon’s population in cardiovascular health and inequality of access across Devon.  The ICB is responsible for providing resources to maximise services to benefit the most people.

Key challenges identified are:

·                Cardiovascular disease (CVD) is one of the leading causes of preventable illness and death in Devon and the UK.

·                There is a need to improve access to both prevention and complex interventions.

·                The ICB has a statutory duty to describe these challenges and engage clinicians and the public in shaping solutions.

Engagement and collaboration:

·                The ICB is working with Executive Directors of acute Trusts in Devon and Cornwall.

·                A listening exercise is underway to foster collaborative working and focus on patient care and health inequalities.

·                The plan aligns with the NHS 10-year strategy, emphasizing:

·                Shifting care from hospitals to community settings.

·                Digital transformation via EPIC electronic patient records.

Public and Councillors’ concerns:

Susie Colley made representations on behalf (Heart Campaign for Torbay):

·                Criticised the lack of transparency and accountability.

·                Opposed any reduction in cardiology services at Torbay Hospital.

·                Called for the ICB to scrap all proposals and instead expand services.

·                Highlighted that Torbay Hospital was ranked 4^th in the Country and had improved and been honoured over the last decade.

·                Highlighted the impact the original proposal had on the public without the development of a case for change and questioned why it was going to take another twelve months of uncertainty.

·                Raised concern over the future of Healthwatch.

Councillors’ questions and issues raised:

·                Scope and involvement: Who was involved in the scope? Who was shaping the case for change? Were MPs and ministers involved?

·                Wait times: Torbay Hospital has low wait times, making it a vital resource.

·                Financial implications: What were the projected costs and savings?

·                Culture and collaboration: Concerns about Exeter Trust’s practices and lack of co-operation.

·                Health inequalities: Torbay, Paignton, and Brixham show high deprivation and cardiovascular disease (CVD) admissions.

·                Hospital future: Fears that Torbay Hospital might be downgraded or closed.

·                Transparency and data: Criticised the lack of figures in recent Trust Board papers.  Concerns were raised about decisions being made behind closed doors at Executive Board meetings.

·                Impact on ambulance services: what about emergency care and ambulance implications. 

·                Why cardiology first?

The following responses were provided by the ICB:

·                While local MPs have been briefed and raised questions in Parliament, they were not directly involved in decision-making.

·                The ICB aimed to maximise regional resources, including treating patients from other areas at Torbay Hospital.

·                The case for change is not a proposal, but a statement of challenges. Financial implications will be addressed during consultation. The ICB must operate within its financial envelope, with a focus on prevention.

·                The ICB acknowledged the issue of transparency and data and committed to developing a broader case for change with public consultation starting in September.

·                Any proposal would need to be reiterated through the Executive Team before public release.

·                The ICB acknowledged the burden of CVD and stressed the importance of equitable service delivery and inclusive engagement.

·                The focus of the ICB is on prevention and community care and not hospital closures.

·                No proposals have been made yet, and any future changes will be fully consulted with stakeholders, including ambulance services.

·                National data shows a decline in cardiology interventions since 2017, attributed to successful prevention efforts.

·                CVD is the leading cause of preventable death in Devon, making it a priority. They committed to returning with a completed case for change.

·                Next Steps and Timeline:

·                The ICB plans to begin public consultation in September 2025.

·                No fixed end date was provided; the proposal would be released when it was adequately developed.

·                An Engagement Plan was being constructed to ensure inclusive representation across Devon.

Pat Harris from Healthwatch Torbay confirmed Healthwatch is still active and will ensure service user and clinician voices are heard during the development of the case for change.

Resolved (unanimously):

1.       that the Integrated Care Board (ICB) notes the strength of concern from Torbay residents and considers how they can engage further with residents as they develop their case for change;

2.       that the ICB be requested to provide the Adult Social Care and Health Overview and Scrutiny Sub-Board with details of who will be involved in engagement with the case for change so that they can be assured that all relevant groups are included and confirm the date that the case for change will be available for publication; and

3.       that the ICB be requested to engage with the Adult Social Care and Health Overview and Scrutiny Sub-Board as they develop their case for change and any other significant changes to health care affecting Torbay’s residents and that appropriate professional colleagues be invited to the Sub-Board to give evidence.