FEES - Transforming swallowing assessment across York and Scarborough hospitals

24 NOVEMBER 2025

The Speech and Language Therapy (SLT) teams at York and Scarborough hospitals have been equipped with state-of-the-art Flexible Endoscopic Evaluation of Swallowing (FEES) equipment, including a portable FEES system that can be used flexibly across sites, particularly benefiting stroke rehabilitation patients at Bridlington Hospital.

FEES is a specialist instrumental assessment that allows Speech and Language Therapists to directly visualise a patient’s swallowing physiology using a small nasendoscope. This provides a detailed and accurate assessment of swallowing safety and function, far beyond what can be achieved at the bedside. Importantly, it can also detect silent aspiration, when secretions, food or liquid enters the airway without triggering a cough, something that cannot be reliably identified without instrumental evaluation.

Until now, the only instrumental swallowing assessment available locally was videofluoroscopy, which requires attendance in the radiology department at the clinic held weekly. For many patients who are critically ill, on intensive care, or too unwell to travel, this meant they were unable to access instrumental assessment. The introduction of FEES has completely transformed access for these vulnerable groups.

FEES can be performed at the patient’s bedside, providing vital insights into swallowing function and enabling safer, faster decision-making about nutrition and therapy. It also gives valuable information about laryngeal function and secretion management, supporting care for patients with complex medical needs such as tracheostomy, head and neck cancer, respiratory conditions, neurological disorders, and the elderly.

By using FEES, clinicians can make quicker and more confident decisions, for example, determining whether a patient can safely resume eating and drinking or whether a feeding tube is required. This has led to patients spending less time nil by mouth, improving quality of life, nutrition, and overall recovery.

Because FEES can be performed on demand, rather than waiting for the once-weekly X-ray clinic, patients now receive timely assessments that accelerate care pathways and reduce unnecessary delays. The equipment is being used multiple times each week across wards and clinics, including Head and Neck Outpatients Clinic, where it has enhanced the quality of ongoing patient management.

Cat Squire, Speech and Language Therapist, the introduction of FEES has been “transformational for our practice.”

Cat continued “We are now able to provide truly responsive, patient-centred care. The FEES equipment has already made a significant impact, improving the quality of dysphagia assessment and earlier decision making for our patients. We are extremely grateful to the charity for making this possible.”

Photo left to right:  Emily Ambrose,  Cat Squire and Clare Quinn.