Transforming dysphagia care at Mildmay

Dysphagia - difficulty in swallowing, is a serious but often hidden issue for many of the people we support at Mildmay.

It can lead to weight loss, dehydration, chest infections and, in severe cases, life-threatening aspiration pneumonia. Just as importantly, it affects something deeply human: the comfort, dignity and enjoyment of eating and drinking.

For people living with HIV-related neurological conditions and other complex health needs, dysphagia can significantly increase the risk of complications and hospital readmission. When it is recognised and managed well, however, it can play a vital role in recovery and quality of life.

Learning from international best practice

Towards the end of 2025, while on annual leave in New York City, our speech and language therapist (SLT), Greer, took the opportunity to attend the Dysphagia Symposium, a leading international event for clinicians and researchers working in swallowing disorders.

Mildmay supported Greer’s attendance by covering the costs of the symposium and related expenses. As she was already in New York, this represented an efficient use of charitable funds while enabling access to cutting-edge research, innovation and clinical expertise.

"There were a range of talk and topics covered at the symposium, such as 'From innovation to implementation in dysphagia management' and 'Shaping the future of swallowing diagnostics: a holistic approach to tools, interpretation and clinical empowerment'. I felt inspired brushing shoulders with the big names in Speech and Language Therapy world and am now eager to bring my newfound knowledge back to Mildmay Hospital to share with my colleagues, as well as implement new processes to improve Dysphagia awareness with staff in order to benefit patient care."

What is dysphagia and why does it matter?

Dysphagia is the medical term for difficulties swallowing food, drink or medication. People may cough or choke when eating or drinking, feel that food is sticking in their throat or chest, or regurgitate food.

Over time, dysphagia can lead to malnutrition, dehydration and recurrent chest infections. It can also make mealtimes stressful, frightening and undignified.

 “When we manage dysphagia well, we’re not only preventing complications,” says Greer. “We’re helping people feel more like themselves again.”

The role of speech and language therapy

Speech and language therapists are allied health professionals who specialise in communication and in eating, drinking and swallowing.

At Mildmay, Greer’s work includes:

• Assessing how safely someone can eat and drink, and identifying the causes of swallowing difficulties

• Recommending strategies to reduce risk, such as changes in posture, swallowing techniques, exercises, and adaptations to food and fluid textures

• Working closely with our dietitian to ensure patients receive adequate nutrition and hydration

• Supporting people with communication difficulties so they can understand information and express their needs and choices

• Training staff to follow safe swallowing strategies consistently on the ward and after discharge

“In complex rehabilitation, speech and language therapy isn’t an ‘add-on’,” Greer says. “It directly influences medical outcomes, length of stay, and whether someone can return to a more independent life.”

A multidisciplinary approach to dysphagia care

One of the key messages from the symposium was the importance of multidisciplinary working – something that sits at the heart of Mildmay’s model of care.

Our multidisciplinary team includes doctors, nurses, psychologists, physiotherapists, occupational therapists, dietitians, social workers, art therapists, chaplaincy, substance misuse specialists, volunteers and speech and language therapy.

For someone with dysphagia, this joined-up approach may involve:

• Medical teams optimising treatment and managing risk factors affecting swallowing

• Nursing staff supporting safe positioning, recognising early signs of aspiration and applying swallowing strategies at every meal

• Physiotherapists and occupational therapists addressing mobility, seating and hand function to support safe self-feeding

• Dietitians tailoring nutrition plans to match both medical needs and swallowing ability

• Psychology and art therapy supporting emotional wellbeing during long or complex admissions

• Social workers planning for safe discharge with appropriate community support

Bringing learning back to Mildmay

The Dysphagia Symposium covered topics ranging from new assessment tools to service design and staff education. Key learning Greer has brought back includes:

• Updated, evidence-based approaches to bedside swallowing assessment, helping identify risks earlier

• Innovative use of instrumental assessments and outcome measures to track progress and demonstrate impact

• Practical strategies to empower all staff to recognise dysphagia and respond confidently

• Creative resources to help patients and families better understand swallowing difficulties

This learning is being incorporated into staff training, protocols and individual care plans. Over time, this can contribute to earlier identification of swallowing problems, more consistent care, fewer complications and a better overall experience for patients.

“The symposium confirmed that Mildmay’s approach is closely aligned with international best practice,” Greer reflects. “It also gave me new tools and ideas that I’m excited to put into action for the benefit of our patients.”

Reflecting on healthcare systems

Attending an international conference also provided an opportunity to reflect on differences between healthcare systems.

“I connected with a speech and language therapist from Ohio, and it was fascinating to compare caseloads, referral processes, resources and insurance-based billing,” Greer says.

“It reminded me how fortunate we are in the UK to have free healthcare, and how proud I am to work for the NHS and for Mildmay.”

Why charitable support matters

Around 90% of Mildmay’s income comes from NHS contracts. While essential, this funding does not cover the full cost of the specialist, holistic care we provide.

As a charitable hospital, we rely on donations and grants to invest in areas such as:

• Additional clinical capacity, ensuring timely access to therapies including speech and language therapy, dietetics, psychology and art therapy

• Innovation, including evidence-based approaches to dysphagia care that can be shared with partners in the UK and internationally

• Service development, from staff education and specialist equipment to patient-focused resources not covered by statutory funding

Greer’s attendance at the Dysphagia Symposium is one example of how charitable support directly strengthens patient care. The knowledge and connections gained are already shaping how we assess and manage swallowing difficulties at Mildmay.

If you believe everyone deserves safe, dignified, person-centred care, no matter how complex their needs, please consider supporting Mildmay.

Your generosity helps people living with HIV-related neurological conditions and other serious illnesses rebuild their lives with the best possible chance of recovery.

Please donate to Mildmay