One of the top priorities for the NHS in recent years has been to reduce unavoidable hospital admissions. An innovative digital solution developed in Stoke-on-Trent has been used by nearly 70,000 people and over 70 health and social care organisations, and continues to grow.
Florence (or Flo) is a telehealth platform to allow patients and their doctors to manage long-term health conditions such as asthma and diabetes effectively. Flo sends text messages to patients offering reminders and advice. Messages can also ask the patient to submit their readings, such as those relating to their blood pressure. All the patient needs is a normal mobile phone.
In the late 2000s, Phil O’Connell, a chartered IT professional with a background in telecoms and financial services IT systems, took an interest in the early NHS telehealth pilots. He contacted Stoke Primary Care Trust with his idea that used existing technology, rather than needing investment in new systems. With a small amount of funding from the PCT, Phil developed the application with clinical input from Dr Ruth Chambers, a local GP.
Recently the platform has been highlighted as a national case study by the Innovation Unit and The Health Foundation, and also by The King’s Fund. Flo’s effectiveness has been publicised by the National Institute of Health and Care Excellence (NICE) and a number of health journals.
Patients love the support that they get from Flo and become more confident about managing their condition and less likely to contact their clinician unnecessarily.
Clinicians are able to communicate securely with patients to remind them to monitor their readings and take their medication. The automated system can issue advice and raise the alarm if a patient’s condition deteriorates. Successful implementation of Flo can reduce the number of unnecessary appointments for patients whose conditions are stable, leaving more time for clinicians to focus on those who are struggling to manage their conditions.
Flo is particularly valuable to help patients with chronic obstructive pulmonary disease (COPD) to self-manage at home. They often need frequent appointments to review their treatment and ask for advice, but as their condition can reduce their mobility and increase their vulnerability to infection, it is not ideal to have to regularly travel to health centres or hospitals. Flo can issue medication reminders and offer advice, reducing the need for appointments, which in turn reduces overall anxiety and ultimately avoidable hospital attendances.
Stoke-on-Trent resident Pat was introduced to Flo after several trips to A&E via 999 and two hospital stays during a three month period. Flo prompts Pat to text in her oxygen saturation level and will then advise her if any further steps are necessary. Flo also ensures Pat takes the right amount of the right medication at the right time.
Flo has given Pat more confidence to manage her COPD and has improved her quality of life: “It gave me the assurance that if anything was wrong – if I didn’t answer – somebody was going to think ‘there’s something wrong somewhere’.”
As Pat is now in control of her COPD it has allowed her to use her exercise bike and identify the difference between when her breathlessness is safe and when it isn’t.
Dr Ruth Chambers, Clinical Chair at Stoke-on-Trent CCG added: “Patients using Flo to manage their COPD say that they feel much more in control of their health, are less anxious and know exactly when to take their rescue medication without having to contact their nurse or GP. Flo enables clinicians to catch the early signs of a patient’s condition worsening, and can keep these patients out of hospital.”
Self-employed Fraser was diagnosed with hypertension but was very anxious about the amount of time he would need to take off to attend GP appointments. Fraser and his GP used Flo to monitor his medication and blood pressure. Flo also prompted Fraser to book a phone consultation with his GP to review his readings and medication.
Fraser had no time off work, which reduced his anxiety. He felt conﬁdent in managing his blood pressure depending on his readings, supported by the self-management plan that he had agreed with his doctor.