LEEP

The Lung Exercise and Education Programme (known at North Bristol NHS Trust as “LEEP”) is a Pulmonary Rehabilitation programme for people who are limited by breathlessness from a chronic lung condition.

LEEP began at Frenchay Hospital in 1994. It has evolved, moved locations, and adapted to improve the programme, patient experience, and to meet the growing demand.

LEEP values and mission

Who runs LEEP?

What happens on the programme?

Why LEEP?

Who can do LEEP?

Self-referral

What happens afterwards?

Feedback from people who have recently completed LEEP

“It would only be to your advantage and you’re allowed to take the sessions at your own pace”

“I found all of it helpful and got inspiration from watching others in worse health than me, doing the course”

“The thought of physical exercise frightened me but the programme encouraged me to try and push myself”

“The staff are so helpful in explaining and giving confidence to cope with your condition”

“Anyone with chest problems can only gain from this course, apart from meeting other people affected, and building confidence and knowledge of how you can improve your condition” 

© North Bristol NHS Trust. This edition published March 2025. Review due March 2028. NBT003758. 

The Respiratory Physiology is situated at Gate 12, Level 1, Brunel building, Southmead Hospital. It forms part of the North Bristol NHS Trust (NBT) Lung Centre. 

The function of the department is to perform breathing tests to aid in the diagnosis of lung disease. The department also participates in various research projects and is involved in the Trust's teaching program.

The Service is provided Monday-Friday for both in and outpatients.

Testing procedures include:

• Spirometry and flow volume loops
• Full lung function testing (including lung volumes and gas transfer studies)
• Allergy tests
• Bronchial reactivity tests
• Fit to Fly tests
• Respiratory muscle strength assessments and diaphragm screening
• Overnight sleep screening
• Carbon monoxide monitoring
• Blood gas assessments
• Exhaled Nitric Oxide monitoring
• Induced sputum sampling
• Exercise assessments (walk tests, CPET)
• Hyperventilation provocation testing 
• Upper airway assessments 

Contra-indications for performing lung function tests:

• Haemoptysis of unknown origin - may aggravate the underlying condition
• Pneumothorax
• Unstable angina pectoris
• Unstable cardiovascular status (eg, recent MI or PE - blood pressure changes may aggravate these conditions
• Thoracic, abdominal or cerebral aneurysms - danger of rupture due to increased thoracic pressure (surgical advice)
• Recent eye surgery - increased intra-ocular pressure
• Recent thoracic or abdominal surgical procedure
• Acute disorders affecting technique (e.g. nausea and vomiting)
• Poor comprehension

Home spirometry – measuring your lung function at home

Our acute respiratory beds are based on wards 28A and 28B. Many of our beds are occupied by patients with chronic respiratory diseases, both chronic and acute, including:

• chronic obstructive pulmonary disease (COPD)
• asthma
• lung cancer
• Interstitial Lung Disease (ILD)
• pneumonia
• pneumothorax
• pleural effusions
• obstructive sleep apnoea

We also care for patients with general medical conditions.

Our bed base includes specific high dependency beds and are used for critically unwell patients who need close monitoring.

Specialty: Plastic Surgery

Secretary Jane Baker

Tel: 0117 414 7629

Preparation for your treatment

If you are having a general anaesthetic you must arrange for a responsible adult to take you home and stay with you for 24 hours. Anaesthetic drugs remain in your body for several hours and during this time you will react more slowly.

Remember for at least 24 hours after your procedure, if you had a general anaesthetic:

• You must not drive a car or any other vehicle.
• You should not cook, boil a kettle, or operate machinery.
• You should not drink alcohol or take sleeping tablets.
• You should not take any important legal or financial decisions, or sign any documents.
• You should drink plenty of fluids.
• You may eat what you like – light diet, nothing too greasy or spicy.
• You should take things gently until you feel fully recovered.

Preparing for day surgery using Local Anaesthetic

Even if you are having a local anaesthetic it is recommended to have someone take you home. You must not drive if your mobility is restricted by surgery. The day after your operation a member of the day surgery team may ring you.

Before coming into hospital
If you are unwell before your surgery (e.g. with a cold or ’flu), please ring us for advice. We recommend that you do not smoke for 2 days before your operation.

On the day of your operation, please arrive at the time indicated in your letter.

Eating and drinking

• If your operation is in the morning, do not eat or drink anything, including chewing gum, from midnight the night before. You may drink water until 5.30am.
• If your operation is in the afternoon, have a light breakfast (tea and toast) before 7.30am. You may drink water until 10.30am.

If you have diabetes and have worries about not eating, please ring for advice.

Immediately after your operation
After your operation you will be taken to the recovery area where we will treat any pain or sickness you may experience. You will then be moved to the ward area, where you can rest quietly, and have a drink and a biscuit.

What is AAC? 

AAC stands for Augmentative and Alternative Communication. It includes all the different ways people can communicate when they can’t use their voice easily.

Some AAC is used by everyone. For example, waving goodbye, giving a thumbs up or pointing to a picture when you don’t speak the same language. 

AAC helps people share what they think, how they feel, and what they need - even if they can't speak.

What are the different types of AAC?

• No-tech AAC does not require any tools. Examples are signing (Makaton or BSL), gestures, facial expressions, sounds or eye movements. 
• Low-tech or paper-based AAC does not need power. Examples are pen and paper, communication board/book, alphabet boards, photos and E-Tran frames. 
• Mid-tech AAC devices use batteries or simple technology. Examples are a GoTalk, a voice output switch like a Big Macks or a MegaBee.
• High-tech or powered AAC are powered devices. They speak out loud and show words or symbols. Some look like tablets or computers and can be controlled by touching the screen, using switches, or even with eye movement. 

How can AAC WEST help me with AAC?

AAC WEST specialises in supporting people who have difficulties with their speech. We can help you find the best AAC set up for your needs. From high-tech devices to paper based AAC. 

No one type of AAC is better than another. What matters most is what helps the person communicate clearly and easily. Some types of AAC give more independence, but our main goal is autonomy – making sure the person can say what they want, to who they want, when and where they want.

Many people use a mix of AAC tools. Different tools can work better in different situations. We assess each person and recommend the options that suit them best. 

© North Bristol NHS Trust. This edition published December 2025. Review due December 20208. NBT003835

GMC Number: 4214135

Year of first qualification: 1995, University of London

Specialty: Urology

Clinical interest: Oncology

Secretary: Becky Champness

Telephone: 01174145001

Having completed subspecialist training in West London at St Mary's and the Royal Marsden Hospital, Mr Edwards Rowe was appointed to North Bristol NHS Trust (NBT) in October 2007.

With a specialist interest in prostate, bladder, kidney and penile cancer, he works as part of the busiest UK uro-oncolgy team.

He is the urology cancer lead, and continues to develop robotic prostate and bladder surgery.

Therapy Sessions
Please remember to bring:

• Glasses
• Hearing aids
• Comfortable day clothes (trousers/skirts with elastic waists are often useful)
• Walking aids
• Supportive footwear

Visiting
Sleep plays a vital part in patient recovery in the early stages after a stroke, and visitors can be very tiring for a patient. 

For this reason, we ask visitors to visit only during the designated visiting hours. We also ask that each patient has a maximum of 2 visitors at a time. A crowded bed space can make it difficult for a nurse to carry out essential duties. Visiting is welcome in the lounge or balcony area.

We have a rest period from 12.45pm – 2.00pm. At this time we turn the lights out and encourage patients to participate in bed rest.

Family and friends can visit the ward out of visiting hours to attend prearranged meetings or treatment sessions.

Meals
You are given menus to fill out for the following day. Your relatives or a nurse can help you complete it. If you require a pureed, minced or soft diet, as a result of swallowing difficulties you might have less choice from the menu. If you are ‘nil by mouth’ you might require your food via a feeding tube. Halal and Kosher meals are available upon request. You might be advised to have a special diet such as high protein or low sugar.

We encourage as much independence at mealtimes as possible. Heath Care Assistants will assist you to eat your meal if required. Individual arrangements can be made if a patient requires help from a relative or regular carer to eat their meal.

Visitors are welcome to bring in snacks and drinks. Please ask us what is recommended. We are not allowed to re-heat food or keep items in the fridge for more than 24 hours.

Meals and drinks are served at the following times:

• Breakfast 8am
• Morning tea 10.30am
• Lunch 12.00pm
• Afternoon tea 3pm
• Evening meal 6pm

Doctors
Consultant Stroke Physicians look after each ward.  Each Consultant has a weekly ward round. Both wards have a team of ward doctors including a Medical Registrar, Senior House Officer and House Officers. If you wish to meet with a Consultant, please ask the ward receptionist or nurse to make an appointment.

Nursing Staff
Nursing staff work in teams. A qualified nurse is responsible for coordinating patients’ daily care. Health Care Assistants support the nurses and provide personal care. Nurses & Health Care Assistants work in shifts. There is always a Nurse in Charge on each ward. He/she wears a yellow badge.

Administration Assistant
The administration assistant on HASU/ASU may contact your family to arrange progress meetings. She can be contacted on HASU/ASU.

Advanced Nurse Practitioners for Stroke (ANP) / Stroke Nurse Practitioners(SNP)                                                                                                                                                                                                                                                                                                                                 They are nurses who have undergone further study and training to be able to see, diagnose and treat patients independently. They assess acute stroke patients presenting to the Emergency Department, facilitating early imaging, assessment, diagnosis and treatment and ensure a smooth patient journey from ED to the Acute stroke unit. They offer information, advice and support. Transfer of regional thrombectomy patients is also co-ordinated by them, ensuring that patients receive the necessary assessments, checks and investigations prior and post procedure in a time critical fashion. ANPs review patients presenting to TIA clinic. As well as clinical work they are also involved in audit, teaching programmes – including running in-house and regional Simulation workshops - and research.

Social Worker
The social worker works with the stroke team in planning your discharge. They will arrange to see you/your family if you are in need of support after hospital.  This might be:

• Arranging packages of care to help people at home.
• Arranging care homes for people who are unable to manage in their own home.
• Support for families who are providing care.
• Making contact with other services, for example benefits advice, support groups, luncheon clubs, transport schemes.
• Applications for re-housing.

Occupational Therapy
Occupational Therapist identify any difficulties you may have with everyday tasks such as feeding yourself, getting washed and dressed or simple kitchen activities.

Problems in these areas may be due to:

• Muscle weakness
• Poor balance
• Memory changes
• Difficulty with concentration
• Altered understanding

The Occupational Therapist will work with you to improve your skills and confidence. This may include:

• Practice of a task
• Advice on new ways of doing things to increase your independence and safety
• Provision of equipment such as handrails, commode etc
• Looking at how you will manage in your own home and what help you will need if you are ready to be discharged
• Advice on returning to work or leisure activities

Physiotherapy
The aim of physiotherapy is to help you regain mobility and relearn the movements required to be able perform activities such as standing up, walking or reaching for objects following a stroke.

The Physiotherapists assess how the stroke has affected the way you move when you are first admitted to the unit.

During Physiotherapy sessions we work with you to improve:

• Moving around in bed
• Moving from bed to chair
• Sit to stand
• Balance
• Muscle strength
• How to improve arm movement
• Walking

The Physiotherapists and Occupational Therapists also assess positioning to ensure that you are comfortable when you are in bed or in a chair and that your affected arm is well supported.

Speech and Language Therapy
If you are having communication difficulties (talking, understanding, reading or writing), a Speech and Language Therapist will see you. They will assess the level of your problems and find ways for you and your family to make communication easier.

If you have swallowing difficulties, a Speech and Language Therapist will also see you. They will advise the stroke team how to make sure you swallow safely (i.e. ensure food and drink do not go down the wrong way into your windpipe and lungs). This may mean having a special consistency diet that is easier and safer for you.
If you cannot swallow safely at all, you will be unable to eat and drink. You will be ‘nil by mouth’ and may have a feeding tube passed via your nose directly to your stomach. This will be fully explained to you.

Dieticians
If you have a poor appetite or are unable to eat a normal diet due to swallowing difficulties, the dietician will see you.  They will discuss with you the best way to keep you well nourished, which may include a special diets, supplements or feeding using a tube. Some medical conditions require special diets, recommended by the dietitian. Please ask to see a dietician if you have any dietary issues.

Psychology
Stroke can affect you emotionally as well as physically. It is normal to experience a variety of psychological responses as you adjust to the changes in your life. For example, mood, concentration and memory may be affected. The Psychologist can help you and your family to adjust to what has happened to you.

Pharmacy
A Pharmacist comes to the ward every weekday and will check the medications you are taking. You can ask them any questions you have.

Carotid Doppler Test
Carotid doppler ultrasound is a non-invasive test that uses sound waves to measure the flow of blood through the large carotid arteries that supply blood to the brain. These arteries can become narrowed due to atherosclerosis (furring up) or other causes, and this can lead to transient ischemic attack (mini-stroke) or stroke. The carotid doppler test can help doctors determine stroke risk and the need for preventive measures.
A carotid doppler test may be performed if you are considered to be at risk of having a stroke due to decreased blood flow in the carotid arteries.
It is a non-invasive procedure, and no special preparations are necessary. The ultrasound technician will apply a jelly-like substance to both sides of your neck, where the carotid arteries are located. This helps lubricate the skin and allow the ultrasound sensor to move more freely. The sensor is moved back and forth over the neck and generates sound waves that bounce off the arteries. The echo that bounces back is measured, and the changes in frequency can measure the flow of blood. The flow will be different in areas that are narrowed.
This test takes an average of 15 to 30 minutes for most people, though it can vary. Once the test is completed, you will be free to resume normal activities with no restrictions.

Echocardiogram
An echocardiogram is a test that uses sound waves to create a moving picture of the heart. It allows doctors to see the heart beating, and to see many of the structures of the heart in a noninvasive way. A trained sonographer performs the test. You will be asked to remove your clothes from the waist up and lie on an examination table on your back. A gel will be spread on your chest and then an instrument called a transducer that transmits high-frequency sound waves is applied. The transducer picks up the echoes of the sound waves and transmits them as electrical impulses. The echocardiography machine converts these impulses into moving pictures of the heart. The probe records the motion of the blood through the heart.
An echocardiogram can help to identify heart problems that may cause blood clots to form.

ECG
ECG (electrocardiogram) is a test that measures the electrical activity of the heart. Your chest area is cleaned with alcohol and electrodes are stuck on. The electrical impulses made while the heart is beating are recorded and shown on a piece of paper. Any problems with the heart's rhythm can be identified, to enable the correct treatment.
24 Hour Tape ECG Monitoring
Some problems, like palpitations, are difficult to identify during routine heart examinations as they only happen now and then. 24 Hour Tape Monitoring is a test carried out to monitor your heart during your normal daily activities, over a 24 hour period. You will not be required to stay in hospital for the monitoring. Your chest area is cleaned with alcohol and electrodes are stuck on. Wires from the electrodes connect to a small tape recorder on a belt worn around your waist. You can carry out normal activities and you keep the monitor on all day and night. You will be asked to return to the hospital the next day to return the monitor and its recordings.

CT scan
A CT (computerised tomography) scanner is a special kind of X-ray machine. CT scans are far more detailed than ordinary X-rays and give multiple cross-section pictures through the body. The scanner is particularly good at testing for bleeding in the brain so it will identify what kind of stroke you have had.

Magnetic Resonance Imaging (MRI) scan
MRI scans use strong magnetic fields and radio waves to produce a detailed image of the inside of the body.

Diffusion Weighted MRI (DWI MRI)
Is a type of scan used to identify areas of an organ, such as the brain, which have recently been damaged. The MRI machine is set to detect small restrictions in the movement of water molecules inside the injured areas. These small changes are detected by the MRI machine and appear as bright spots on the screen.