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<h3></h3> Spinal Cord Injury (SCI) is often complicated by ventilation. SCI centres may fully/partially wean 50–80% of ventilated patients. This charts the ventilatory, weaning, communication and swallow outcomes over 1 year in a UK SCI centre. Do we offer value to patients and the NHS? <h3>Method</h3> Consecutive adult patients requiring domicilary set-up or ventilation or tracheostomy status changes were included. Legacy patients, CPAP/oxygenation only requirements, those admitted for other reasons were excluded. <h3>Results</h3> 23 patients were included. Most were male, aged 50+ and had traumatic, motor complete cervical injuries. 25% had no tracheostomy cuff deflation pre-admission, mean 85 days. 56% had partial deflation (range 45 mins to 12 hours per day). Once admitted, all had plain tubes inserted in 1–7 days. 16 required SLT investigations. 2 commenced normal oral intake before admission. 56% recieved FEES and 1 recieved videofleuroscopy (VF). After admission, 88% had FEES, VF, or both. Silent aspiration improved, but laryngeal pathologies and dysphagia persisted. 11/14 progressed to taking normal oral intake with targeted treatment and chest care, likely resulting in cost savings compared to enteral intake. All demonstrated improvements. Time to admission averaged 71 days. 6 patients who subsequently weaned spent 92 days average in another facility costing approximately £173,052 per patient. They weaned in 16 days average and decannulated in 35 days at a cost of £1,533.61 per patient in the SCI centre. Tracheostomised only patients were decannulated in 20 days average, leading to significant cost savings. 17/21 had signs of infection at admission and 5 had failed weans or decannulations. All of these showed improvements in ventilation status except 1 apnoeic high tetraplegia patient. Mental health conditions were most common comorbidity. A total of 12/23 were weaned and decannulated.1 remained fully ventilator dependent. 2 died during their admission. <h3>Conclusions</h3> SCI rehabilitation produced advantages for ventilated patient outcomes and health economics. There was increased prospect of ventilator weaning and decannulation, rapid return to vocalisation and progression of oral intake without negative chest consequences due specialised and integrated team working. There are long waits for beds. Improvement could further enhance cost and clinical outcomes.