Reference: FOI 27719 BNSSG 15C Subject: Facial Nerve Palsy I can confirm that the CCG does hold some of the information requested; please see responses below: QUESTION RESPONSE Bristol, North Somerset and South Gloucestershire CCG does not hold this 1. Of those with facial nerve palsy who have information. The provider trusts may be able to not made a full or nearly full recovery at provide this information. If you would like to 12 weeks following onset, can you redirect your Freedom of information request provide an estimate of the percentage of please follow the links. such patients who are referred for rehabilitation of persistent facial University Hospitals Bristol NHS Foundation pain/discomfort and dysfunction? Trust North Bristol NHS Trust Persistent facial nerve palsy – most common presentation (outside of surgical complication, in which case referral would come from the surgical team, not primary care) – the CCG would follow the National Institute for Health and Care Excellence (NICE) Clinical Knowledge Summaries (CKS) as below: Refer urgently to neurology or to ear, nose, and throat (ENT) if there is: o Any doubt regarding the diagnosis. o Recurrent Bell's palsy. 2. If a patient with facial nerve palsy is o Bilateral Bell's palsy. routinely referred to secondary care for If the cornea remains exposed after rehabilitation therapy, which hospital(s) attempting to close the eyelid, refer urgently and department(s) do you refer to? to ophthalmology. If the paralysis shows no sign of improvement after 1 month, or there is suspicion of a serious underlying diagnosis (for example, cholesteatoma, parotid tumour, malignant otitis externa), refer urgently to ENT. If there is residual paralysis after 6–9 months, consider referral to a plastic surgeon with a special interest in facial reconstructive surgery. Depending on the specific nature of the problem the patient can be referred to Neurology, ENT, 1 Ophthalmology or Plastic Surgery. Depending which route they follow, they can be seen at the following facilities: ENT – Southmead Hospital (North Bristol NHS Trust) and Bristol Royal Infirmary (University Hospitals Bristol NHS Trust) Ophthalmology – Bristol Eye Hospital (University Hospitals Bristol NHS Trust) Neurology – Southmead Hospital Oral and Maxillofacial – Plastic Surgery – Southmead Hospital The patient can also be referred to a specialist facial nerve palsy physiotherapy clinic in Southmead Hospital, which provides a rehabilitative approach. There is not a specific specialist facial therapist 3. If routinely referring a patient with facial clinic available via E-Referral System in Bristol, nerve palsy for therapy, do you refer to a but there is a specific facial nerve palsy specialist facial therapist or to a local physiotherapy clinic in Southmead Hospital via general physiotherapy team? direct referral. The Specialised Physiotherapy department at a) Do you have specific centres that you Southmead Hospital has a facial nerve palsy refer to? If so please indicate which ones. clinic. This data is not available in a manner which is able to identify how the service is provided and therefore an average cost of treatment per b) What is the average cost of a course of course. Any activity that is provided is physical rehabilitation therapy? undertaken on the clinical management of each patient and will be provided for as long as clinically appropriate. 4. Does the decision making panel for individual funding requests differentiate between referral to a specialist facial This treatment is routinely funded and therefore therapist (i.e. with a postgraduate does not go to an Individual Funding Request qualification) and a general panel. physiotherapist or speech and language therapist? 5. Is specialist physiotherapy or facial therapy freely available to patients with This service is routinely funded facial nerve palsy or is it funded on an individual basis? 2 a) If not routinely funded, what is the Not applicable reason? 6. How many individual funding requests have you received to access specialist 0 physiotherapy or facial therapy in the last 12 months? a) How many were agreed? Not applicable b) How many were declined? Not applicable c) If declined, on what basis were they Not applicable declined? 7. Is Trophic Electrical Stimulation (TES) No, this is not part of locally commissioned freely available to patients with facial pathways and we have not been requested to nerve palsy or is it funded on an provide either as a service development or on an individual basis? individual funding basis by local providers. a) If routinely available, where do you refer Not applicable patients to for TES? b) What evidence do you use to support Not applicable routine funding of TES? This data is not available in a manner which is able to identify how the service is provided and therefore an average cost of treatment per c) If routinely available, what is the average course. Any activity that is provided is cost of a course of TES? undertaken on the clinical management of each patient and will be provided for as long as clinically appropriate. The information provided in this response is accurate as of 12 September 2018 and has been approved for release by Lisa Manson, Director of Commissioning for NHS Bristol, North Somerset and South Gloucestershire CCGs. 3 .