FEES - Fibreoptic endoscopic evaluation of swallowing

RCSLT FEES competency framework and training logs

The competency framework and training logs are for SLTs working with patients with dysphagia who are referring for a fibreoptic endoscopic evaluation of swallowing (FEES) assessment and/or performing FEES.

Download it either as a Word document or a PDF:

• Word version
• PDF version

This is a UK-wide document and is an adjunct to the RCSLT FEES position paper and RCSLT dysphagia competency framework.

Sustainability actions when utilising FEES/EEL

RCSLT’s vision is “to be a profession that actively engages in supporting environmental sustainability” (RCSLT, 2025). The RCSLT statement of sustainability was published in 2025 and sets out areas of consideration to improve the environmental sustainability of SLT services. As part of this work the RCSLT endorsed the ENT UK guidelines on sustainability within nasendoscopy (ENT UK, 2024). Building on this work, the following is a (non-exhaustive) list of areas for SLTs to evaluate and action to improve the  environmental impact and sustainability of their EEL/FEES service.  

Actions

• Use of PPE – ENT UK guidelines state that gloves are not a necessary component for all nasendoscopies “unless there is expected direct contact of the hands with blood, bodily fluids or mucosal surfaces” (2024). SLTs should work with their infection prevention and control departments to establish what level of PPE is required during EEL/FEES with the aim of reducing unnecessary use. Examples to consider include gloves, masks and aprons, considering alternatives to plastic where possible e.g. biodegradable, fabric. Reusable PPE is recommended over disposable with appropriate decontamination 

• Use of lubricants – lubricants are not necessary for all patients. Their use should be determined by clinical need e.g. where a patient has dry nasal mucosa which would restrict the easy insertion of a scope. In accordance with ENT UK guidelines, water may be a suitable alternative for many patients. The reduction in the use of lubricants may also impact on additional cleaning supplies needed to remove residue from scopes. 

• Nasendoscopes – prioritise reusable nasendoscopes over disposable single-use nasendoscopes.  

• Decontamination – consider shifting from traditional washers to more sustainable methods, such as UV-C light which uses less water and fewer chemicals or wipes. 

• Food wastage – when preparing food or drink items for FEES procedures, consider how much needs to be prepared and if this can be reduced. Auditing food wastage is suggested. 

• Use of disposable cups and straws – consider replacing these with reusable cups and single patient use straws. Consult with the infection prevention and control department and highlight to managers for resource allocation.  

• Paper information – paper information provided to patients or used during assessments may be unnecessary and other alternatives should be evaluated e.g. links to websites, Apps, digital record keeping systems or laminated reusable information sheets.  

• Packaging – consider working with manufacturers and suppliers regarding packaging and disposal of materials and equipment used during procedures including dysphagia and voice assessments. 

• Optimise equipment life span – proper care and maintenance of nasendoscopy equipment will reduce unnecessary energy consumption, ensure the maximum life-span of kit is achieved and reduce the need to replace equipment more frequently. 

• Institutional change – discuss with leadership the need for promoting sustainability, reducing waste and support for implementing sustainable and eco-friendly solutions in practice.  

SLTs involved in EEL/FEES should use the above action points to implement an action plan for sustainability improvements. 

References 

ENT UK (2024) Environmental sustainability guidance – Outpatient ENT metal instruments. (accessed 14th November 2025) 

Authors

• Professor Sarah Wallace OBE FRCSLT, Consultant Speech and Language Therapist
• Dr Margaret Coffey PhD, NIHR advanced fellow and senior clinical academic speech and language therapist
• Karen Esposito, Advanced Specialist Speech & Language Therapist

Resources

Supervision and training

• Facilitating FEES supervision and training guidance

Resources for SLTs practising FEES

• Sample FEES consent form (Word)
• FEES: Aphasia friendly information leaflet/consent form (Word)
• FEES rating scales (Word)

Sample rating forms

• FEES report: NEFLT NHS Foundation trust (Word)
• FEES sample rating form (Word)
• FEES sample rating form: Charing Cross Hospital, ICHT (Imperial College Healthcare Trust) (Word)
• Laryngectomy endoscopic evaluation of prosthesis and swallow report: ICHT (Word)
• Cough assist report: Wythenshawe Hospital, Manchester Foundation NHS Trust (PDF)
• Speech Voice & Swallowing FEES Report: Wythenshawe Hospital, Manchester Foundation NHS Trust (PDF)
• Mechanical Insufflation-Exsufflation (MI-E) Visualisation report: Wythenshawe Hospital, Manchester Foundation NHS Trust (Word)

Other resources

• FEES protocol (Word)
• FEES equipment list (Word)
• FEES suitability and safety checklist (Word)
• Indications for selecting FEES and videofluoroscopy (Word)
• FEES patient information (Word)

Please contact us if you have any suggestions or feedback on these pages.