What is Bell’s palsy?

Bell’s palsy is a medical problem causing weakness of the muscles on one side of the face. It is usually temporary - with most people making a full recovery within two to three months. It comes on suddenly and the cause is unknown. 

The facial nerve supplies the muscles in your face. In Bell’s palsy this nerve is affected, leading to weakness or paralysis of the muscles that control smiling, frowning, eating and closing the eyelids. It can also affect your ability to taste. 

Bell’s palsy can affect men and women of any age but is most common in 15-45 year olds. In the UK it affects approximately one in 70 people at some point in their lifetime. 

What are the symptoms of Bell’s palsy?

The symptoms of Bell’s palsy often occur very quickly, over a few hours or overnight. The weakness or paralysis usually affects one side of your face. 

The symptoms will vary and may include:

• Facial pain around your ear on the affected side.
• Drooping of the face on one side.
• When you smile, only one side of the face may move, you may not be able to frown, and speaking clearly may be difficult.
• Difficulty closing your eye. It may not fully close and may water or become dry.
• Difficulty when chewing food, you may dribble slightly.
• Altered or loss of taste on one side of your tongue.
• Sensitivity to noise. Noises may sound louder than usual which can be uncomfortable. 

Treatment

Medications

You may have been prescribed oral steroids (prednisolone) if your symptoms started in the last 3 days. If you have been prescribed steroids take 50mg (10 tablets) once a day for 10 days along with omeprazole 20mg once a day for 14 days then stop. Steroids may help to reduce inflammation and decrease the likelihood of damage to the facial nerve. 

Mouth care

As the facial muscle may not be functioning fully, food may become stuck around the teeth and gums on the affected side. Make sure you remember to clean this area well and remove all debris after eating. 

Eye care

Eye care is very important if your eye is affected. If your eye does not close when blinking: 

• The eye can dry up. You should use eye drops or artificial tears to keep the eye moist. Use artificial tear drops during the day and a thicker solution at night. Ask your pharmacist for advice.
• The eye will not have the normal protection from the eye lid closing. It is important to protect the eye and avoid scratching the cornea (the thin, transparent layer covering the eye). Do not use contact lenses until your eye returns to normal. You may be advised to wear an eye patch by day and to tape the affected eye lid closed at night if your eye does not close when you sleep. Tape such as transpore can be used for this. 

Advice for taping of the eye shut at night

1. Cut the tape slightly longer than the width of your eye.
2. If using night time ointments these should be inserted into the eye.
3. Look down.
4. Assist the eye closure with the back of your finger.
5. Apply tape from the inner corner to outer corner of the eye in a horizontal direction so that it extends beyond the width of the eyebrow.
6. Ensure that the eyelid is fully closed; the tape is on the upper lid and covers the area underneath the eye.

Video: How to Tape Your Eye Closed (Adults) - Facial Palsy UK

Exercises can be useful to tone the facial muscles as the movement begins to return, perform 10 each of these exercises 4 times a day:

• Gently raise your eyebrows – you can help the movement with your fingers.
• Wrinkle your nose.
• Try and flare your nostrils.
• Lift one corner of the mouth and then the other.
• Smile without showing your teeth, then smile with showing your teeth.
• Bring your eyebrows together in a frown. 

Prognosis

75-90 people in every 100 people who have Bell’s palsy start to improve within three weeks, and make a full recovery within two to three months. However, about 5-10 people in every 100 people who have Bell’s palsy have some slight weakness which remains forever. Rarely there may be little or no improvement. 

Do I need follow up?

Most people with Bell’s palsy make a full recovery in 3 weeks to 3 months. If you do not make a full recovery in 3 weeks then make an appointment with your GP. 

If you are unable to close your eye normally and develop pain, stinging or visual disturbance please attend the Eye Casualty at the Bristol Eye Hospital in the next 24 hours. The Bristol Eye Hospital Casualty is open 7 days a week from 8.30am - 4.30pm. Further information can be found at Bristol Eye Hospital - How to find us 

© North Bristol NHS Trust. This edition published June 2025. Review due June 2028. NBT003415.

If your child has ingested (swallowed) a super strong magnet

If your child has swallowed a button battery

© North Bristol NHS Trust.  This edition published April 2024. Review due April 2027. NBT003414.

Easy Read

VNS stands for Vagal Nerve Stimulator.

It helps treat your epilepsy.

It is a device in your body that send signals to a nerve. It helps calm down your brain activity when you have a seizure.

The battery on your VNS is low. 

You need to come to the hospital to have a new VNS battery.

Before your surgery, you will see the epilepsy nurses to make sure you are healthy and ready for surgery.  

You can't have food or drink before your surgery. 

You can have your normal medications. 

You will arrive at the hospital for your appointment at the time you have been told. 

Your family or carer can support you. 

You will go to Medirooms. It is in the blue zone. 

You will check in at the desk. 

You will wait in the waiting room.

Your name will be called. 

A nurse or healthcare assistant will show you to your room. 

You will wait in your room. This is your room for the rest of the day. 

The nurse will check you in. They will ask you lots of questions to check you are healthy for the surgery. 

The doctors and anaesthetist will see you in your room. 

You will have a cannula fitted to your hand or arm. 

You will be taken to the theatres. 

Your family member or carer can get dressed into scrubs and come with you.

The anaesthetist will give you medicines to help you sleep.

You will have your VNS battery changed.

You will be asleep and won’t feel anything.

You will wake up in your hospital room.

Your family or carer can be there when you wake up.

You might have monitors on your arm when you wake up.

You might still have a cannula in your hand or arm.

You will have a bandage on your chest.

If you feel sore, the nurses can give you medicine to help you.

Your nurse will look after you.

When you have woken up you can have something to eat and drink.

When you are feeling well enough you can go home.

Wear your bandage for one week.

Keep your bandage dry when you shower.

A nurse will take the bandage off.

You will see your epilepsy nurse to check the VNS.

If you have a learning disability or autism and have any questions, you can call the hospital learning disability and autism liaison team on 0117 414 1239.

© North Bristol NHS Trust This edition published January 2026. Review due January 2029. NBT003502 EASY READ

Information for day case patients

You have been diagnosed as having an abscess that needs surgical treatment. We have arranged for you to have your operation as a day case.

This means that you will come back first thing in the morning, have your operation and go home on the same day.

Where do I go?

You need to report to the theatre reception Gate 20, level two. You will be asked to go there at 7.30am.

Preparation for day surgery

• Please make arrangements to leave young children at home with someone. We have no facilities for children.
• 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. If you are taking a taxi home you must have a responsible adult to go with you.
• Even if you are having a local anaesthetic it is recommended that you have someone to take you home. You must not drive if your mobility is restricted by the surgery or if you have had an anaestheic. Your insurance may not cover you immediately after an operation.
• Please arrive promptly at 7.30am as instructed. Do not eat or drink anything except water from midnight the night before. You may drink water until 6am.
• If you feel worse overnight or need some advice ring 0117 414 3233 or NHS 111.
• Before coming in, remove all make-up and nail varnish.

What should I bring?

• Leave all your valuables and jewellery at home.
• Bring in any tablets, medicines and inhalers that you normally take.
• Bring a dressing gown and slippers. We will give you an operating gown to change into for your operation.
• We suggest you bring a book or something to do while waiting for your surgery. The staff will let you know how long you have to wait. 

Arriving for your operation

• The staff in the theatre mediroom will take down details of how you will get home. We will phone your escort when you are ready to go home.
• The nursing staff will get you ready for your operation and answer any questions you may have.
• The anaesthetist will see you before your operation and explain the anaesthetic. The surgeon will have explained and consented you in SDAU/SAU but if you have any further questions please ask to speak to the surgeon the day.
• Most patients will be put to sleep i.e. have a general anaesthetic for the procedure, but in some cases the abscess may be treated with a local anaesthetic which means the area will be made numb. The doctor who has assessed you will have told you which is most appropriate.
• Your operation will be planned to be first on an operating list reserved for patients with an emergency condition. However, if an urgent operation for a more life-threatening condition is needed, your operation may be delayed. If this happens, we will do our best to perform your operation later in the day.

Immediately after your operation

• You will be taken back to a mediroom where we will treat any pain or sickness that you may experience.
• You will be offered a drink and a biscuit.
• Your can dress in the mediroom.
• You can then sit and wait for your escort to arrive.

Discharge home

We expect that you will go home the same day. If there are complications such as severe pain or sickness, you may have to stay in hospital.

If you do have any problems when you arrive home, contact your GP, district nurse or NHS 111 or for major problems SAU on 0117 414 3233.

Anaesthetic drugs remain in your body for several hours. During this time you will react more slowly and be more likely to have an accident. You may need some days off work and help at home.

We advise that for 24 hours you should not:

• Drive your car or any other vehicle
• Cook or operate machinery
• Drink alcohol or take sleeping tablets
• Make important decisions or sign legal documents

You will need regular painkillers immediately after the operation. If you do not have suitable painkillers at home, you will be given tablets to take home with you. You will be given verbal and written advice about wound care and pain relief.

You will likely require a dressing on the area, often changed regularly for a few days or weeks. You can arrange for your GP practice nurse or district nurse to do this, please take your discharge summary as soon as possible to your surgery to arrange this. If your GP surgery cannot provide the service most NHS walk-in centres will. In most cases, the abscess will heal and you will not be seen again at the hospital.

If follow-up is planned, for specific complicated abscesses, this will be arranged for you by the hospital team and you will receive a letter in the post for the test or clinic.

How to contact us

Major Trauma Team
Surgical Assessment Unit
Gate 32B, Level 1
Brunel Building
Southmead Hospital
BS10 5NB

Telephone: 0117 414 3233

© North Bristol NHS Trust. This edition published July 2022. Review due July 2025. NBT002946

This page is for patients diagnosed as having a rib or chest injury.

Chest injuries are extremely common following blunt and penetrating trauma. They can vary in severity from minor bruising or an isolated rib fracture, to severe crush injuries. These can cause multiple fractures and bleeding which result in pain and breathing problems.

Common causes of rib injury include motor vehicle accidents, falls, and assaults. Treatment aims to relieve pain allowing you to perform normal tasks while the injury heals.

The majority of chest injuries are treated without requiring an operation, but a chest drain may need to be inserted.

Occasionally with severe injuries the ribs may have to be fixed. This requires an operation that is performed under general anaesthetic (you will be asleep).

If you follow the advice given to you in this booklet and by the healthcare professionals on the ward, you should find your chest injury much easier to understand and manage.

Types of injury

Your clinician will let you know which injury type you have.

Rib fractures

Flail chest

Sternal fracture

Pneumothorax

Haemothorax

Lung contusion

The chest

The ribcage supports the upper body, protects internal organs, including the heart and lungs, and assists with breathing.

Rib injuries include bruises, torn cartilage and bone fractures.

Symptoms of chest trauma

• Pain at the injury site.
• Pain when the ribcage moves. For example with movement, when you take a deep breath or when you cough, sneeze or laugh.
• Breathing difficulties.
• Coughing up blood or discoloured sputum.
• Increased temperature.

Treatment of chest injuries

• Pain relief.
• Oxygen therapy.
• Early mobilisation.
• Physiotherapy.
• Chest drain(s).

Very occasionally surgery is required to stabilise the fractures. In severe cases intensive care treatment is also required. If this is needed your doctor will discuss it with you/your family.

Complications

Possible complications of chest trauma include:

• Pain.
• Pneumothorax/haemothorax (definitions above).
• Chest infection – to avoid this it is important to ensure your pain relief is enough so you are able to take deep breaths, cough, and mobilise.

Pain management

• The most important treatment with chest trauma is to have good pain relief.
• Take regular pain relief so you are able to deep breathe, cough, and mobilise – these are vital for you to do as they aid your recovery and help prevent complications such a chest infection.
• Inform your nurse and doctors if you feel your pain relief isn’t adequate.
• Take the recommended pain relief and/or anti-inflammatory tablets; these will improve your healing time.

Lidocaine plasters for rib fractures

Local anaesthetic nerve blocks (epidural, paravertebral or “fascial plane” blocks)

Chest drains

If you have a pneumothorax or haemothorax you may need to have a chest drain inserted. If this is required your doctor will discuss it with you and explain the procedure.

A chest drain is a sterile soft plastic tube that is inserted into the space between the lung and the chest wall. It is used to drain air (pneumothorax) or blood (haemothorax).

If you have a chest drain some important things to know are:

• You may see air bubbling out through the drainage bottle or fluid draining. This is expected and will be monitored.
• You must keep the drainage bottle below the point the drain enters your chest. Usually it is placed on the floor. It is also essential that the bottle is kept upright.
• The drain can come out if pulled or twisted so try to be careful when moving. If the drain does come out tell someone straight away.
• The drain may cause discomfort, but is unusual to cause significant pain. If it is painful inform your nurse and ask for painkillers.

Physiotherapy and breathing exercises

Breathing exercises

Start in a comfortable position, ideally sitting upright in the bed or chair with your shoulders relaxed.

• Take a long, slow, deep breath in, as much as possible.
• Hold this breath for three seconds.
• Slowly breathe out.
• Take three more deep breaths in the same way.
• Return to breathing normally.
• Try to repeat once every hour.

Coughing

The breathing exercise should be followed by a cough. It is very important to cough effectively after a chest injury so that you can clear any sputum promptly and help prevent a chest infection.

Discomfort may be reduced by using a folded towel or pillow to support your chest while coughing.

If you feel that you are unable to clear your chest effectively or are concerned about an excessive amount (too much) of sputum, please inform your nurse who will refer you to the respiratory physiotherapist.

Repeat the breathing exercises and coughing at regular intervals for the first few days following your injury. They may be discontinued (stopped) when you are walking independently and your chest is clear.

Early mobilisation

You will be assisted by the nursing staff or physiotherapist to mobilise (move around) as soon as possible after your injury. It is essential your pain relief is adequate to enable you to do this.

What to do once you are discharged from hospital?

It is very important to continue to take regular pain relief as prescribed.

Once you have been discharged from hospital make an appointment to see your GP within three days.

Your GP may order a follow up chest X-ray and monitor your broken rib(s).

You need to tell your GP:

• If you are feeling more unwell since going home.
• If you develop a fever.
• If your pain medication is not working.
• If you are not able to deep breathe or cough.
• If you are a smoker.
• If you are constipated from pain medication.

Take your hospital discharge summary with you. This summary tells the GP what has happened, tests done and what should happen with your care.

You should seek medical advice immediately from either your GP or emergency department if you have any of the following symptoms after discharge:

• Sudden onset of chest pain.
• Difficulty breathing.
• Shortness of breath.
• Uncontrolled pain.

© North Bristol NHS Trust. This edition published April 2024. Review due April 2027. NBT002945

When you are discharged from hospital after being critically ill, it will take time to recover physically and emotionally. We feel it is important to ensure you are not alone during this time. 

Our Follow-Up Clinic aims to support you and your family through this journey. As one of the largest ICUs in the country we treat around 250 patients a month so we have a huge number of potential visitors to our follow-up clinic. To manage waiting times we actively invite certain groups of patients to attend. This is based on how long a patient was in the ICU and their condition. If you are not contacted by us, but feel you would like to discuss your time in the ICU please contact us by email. 

For those who we actively contact, we aim to get in touch about 8 weeks after you are discharged from hospital. We ask you to complete a health questionnaire to give us more information about your recovery. Once your questionnaire has been completed and returned to the Follow-Up Clinic, a member of the team will contact you. They will discuss your recovery in more detail to find out whether you would benefit from more input. In this case, you may be invited back to the hospital for a face-to-face or virtual meeting with the team. We will aim to establish any current issues, assist you to deal with these, or direct you to available support.    

We also welcome feedback from patients and relatives about their experience on ICU, and what we can do to improve our care in the future. If there is anything you would like to feedback, please contact us via our email address: icufollowup@nbt.nhs.uk 

Useful links

• Life after a critical illness
• ICUsteps: Fact sheets about what to expect after an ICU admission, and patient stories.
• Healthtalk: Real life patients talking about their experiences in ICU.

Referrals

We accept referrals to the follow-up clinic from wards, specialty clinics, GPs and patients themselves. 

If you are a clinician please contact icufollowup@nbt.nhs.uk  if you have a patient you would like to refer or visit ICU Follow-up NBT (Remedy BNSSG ICB) for more information. 

South West Placenta Accreta Spectrum (PAS) Network – For Clinicians

In order to refer patients to the South West Placenta Accreta Spectrum (PAS) Network visit the referapatient website at www.referapatient.org/patient/genericreferraltypeform.

This service is only for patients that meet network criteria as stated on the Placenta Accreta Spectrum pathway. Please read the pathway guidance below: 

- Booked pregnancy within the South West of England

- Have had uterine surgery/procedure in the past

- Have been reviewed by a local fetal medicine doctor who has concerns that there may be features of FIGO 2 or 3 PASD (placenta increta or percreta)

Please include as much relevant clinical information as possible including recent imaging and reports. 

This is NOT an emergency referral system. If your referral is an emergency, then please request to speak to our on-call Obstetric Consultant via Switchboard on 0117 950 5050. Once you have spoken to the on-call Obstetric Consultant, then please submit your referral via the referapatient system to ensure follow up and relevant multi-disciplinary planning. 

Regardless of the level of urgency, if you feel that you need to discuss the referral in detail via a telephone conversation, then please feel free to do this on the above number. 

The network team will receive and aim to action your referral within 5 working days.  

The range of specialised Histology reporting we offer includes:

• Breast pathology
• Endocrine pathology
• Genitourinary pathology
• Gynaecological pathology
• Head and neck pathology
• Lymphoreticular disease (part of the Specialist Integrated Haematological Malignancy Diagnostic Service (SIHMDS))
• Oral pathology
• Paediatric and perinatal pathology
• Renal pathology
• Thoracic pathology
• Dermatopathology
• Upper and lower gastrointestinal pathology, including liver and pancreatic pathology

We also provide a referral service in many of these specialisms for other NHS trusts and Pathology providers.

The laboratory offers the following specialist services:

• Rapid Intra-operative Diagnosis (frozen sections)
• Support for Moh’s micrographic surgery
• Immunocytochemisty including Her-2, ALK D5F3, PDL1 testingImmunofluorescence

Welcome

North Bristol NHS Trust acknowledge that older people are an important and growing population in our community. We celebrate the fact that our population is living longer and commit to providing care and support for patients, carers, and their families. Our aspiration is to provide the best possible care and support for people living with Dementia and those who care for them in a holistic way.

Intro from Chief Nursing Officer

At North Bristol NHS Trust, we are committed to our focus of providing a high quality care for people living with dementia. We will deliver this through our dedicated workforce and amazing volunteers, developing their skills and knowledge through innovation and research.

A key aspiration of Challenge on Dementia 2020 (DoH 2015) is to create dementia friendly hospitals.

The National Dementia Action Alliance and Dementia Friendly Hospital Charter (NDAA 2019) contribute to improving the experience and outcomes for people with dementia in hospital care.

Within this strategy, there is recognition of the importance of taking a holistic person-centred approach when we deliver care. We recognise the need to support and engage with our patients who have dementia, their carers and family.

- Professor Steve Hams, Chief Nursing Officer

Our vision

Our vision is to put individuals at the centre of their own health and care. People will be inspired and supported to care for themselves more and to take an active role in how we provide care and treatment at NBT. Our services will become more joined up, informed by public decision making and where possible closer to or at home. Access to our leading-edge hospital and specialist services will be simplified and capable of best caring for the population we serve.

Our aspiration is to provide the best possible care and support for people living with dementia and those who care for them.

“Dementia is a long-term condition affecting memory, cognition, health and behaviour experienced by the person and their family/carers that can benefit from proactive planning, timely treatment, support and compassionate care”. Department of Health, Making a Difference in Dementia: Nursing Vision and Strategy (refreshed September 2016).

Our commitment

To empower people to have a more active role in their own care.

To ensure that people who use services and the professionals who provide care work together as partners.
 

Empowering people in their own care involves three core steps.

1. Listening to our people about what matters to them
2. Including patient voices in addressing areas of concern and give patients/carers an active role to participate in improving services.
3. Working together to enable people to understand their health, condition, and treatment, enabling shared decision making.

We recognise there is more we can do to make this happen and need to start by sharing the journey of improvement that we have been on and giving patients and the public full confidence in the services that we provide.

We aspire to move towards understanding and involving the public more in decision making, using consistent and agreed co-design methodologies.

Our goals

• Our goal is to create a dementia friendly hospital in line with the ambitions of the Challenge on Dementia 2020 (DoH,2015). The National Dementia Action Alliance and Dementia Friendly Hospital Charter (NDAA 2019) supports improving the experience and outcomes for people with dementia in hospital care.
• In providing a dementia friendly hospital, we aim to work with the NICE guidance to support initiatives that will enhance this. (NICE, 2019).
• We will implement the principles related to reasonable adjustments to deliver the best quality experience of hospital care for people with dementia and their carers.
• North Bristol Trust fully supports and is committed to achieving this through exceptional healthcare personally delivered.

Introduction

Purpose of the Strategy

The launch of Challenge on Dementia 2020 (DoH 2015) is to create dementia friendly hospitals, and since the National Dementia Strategy in 2009 much has been achieved nationally and locally.  However, dementia care continues to provide challenges to maintaining our achievements, toward implementing our objectives and planning for the future.

The aim of the strategy is to provide a clear overview and understanding of how staff and volunteers at NBT can support people with dementia when they are in our care.

This support could be as an inpatient, attending outpatients or day services or as family members or visitors to our hospital.

The Dementia Strategy sets out the objectives for exceptional healthcare personally delivered for people living with dementia recognising the vital role that family and carers provide.

Fundamental to NBT providing support is the relationship with the person living with dementia, the patient, the family/relative/carer and the healthcare professional.

The Carers Trust (2015) described this as the carer’s ‘Triangle of Care’. 

This promotes safe care and support through communication.

 

National and Local Picture

Process of Delivery

Ensuring our strategy is delivered

Engagement

Our objectives

This is what NBT aims to provide for people living with dementia.

1. Assessment
2. Person-centred care
3. Structured quality governance framework to provide safe exceptional care
4. Skilled workforce
5. Dementia friendly hospital/environments
6. Care/family involvement in personalised care
7. End of life care
8. Research and innovation

Objective 1 - Assessment

Objective 2 - Person-centred care

Objective 3 - Structured quality governance framework to provide safe exceptional care

Objective 4 - Workforce: We will have an informed, confident and competent workforce

Objective 5 - Dementia Friendly Hospital/Environments

Objective 6 - Carer/family involvement in personalised care

Objective 7 - End of life care

Objective 8 - Research and innovation

How we will measure and improve our dementia care

This strategy will require us to continue to build on the achievements and the commitment and energy of staff, volunteers, partner organisations and patient and carer representatives to ensure delivery.

Acknowledgements 

• John's Campaign
• Alzheimer's Society
• Carers Support Centre, Bristol & South Gloucestershire
• Young Dementia Network, hosted by Dementia UK
• Dementia Action Alliance (DAA)