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RCNi Primary Health Care; Being tech savvy-enhances the care you give

posted 15 Nov 2017, 02:05 by Hollie O'Connell

15 November 2017 

“ Technology works as a link, providing extra support and building confidence. ”  
Ann Hughes 

As a practice nurse herself, Ann understands the questions that those new to using technology may have which is something she addresses in her article.

Ann Hughes, a Practice Nurse with North Staffordshire CCG’s has recently been published in the RCNi’s Primary Health Care Journal (October 2017).  Ann tackles how embracing technology – including Flo – can enhance the care you are able to give to your patients.

“I don’t like change”
For many clinicians, change can be unsettling, especially given the rate of rapid transformation that the NHS is experiencing.  Ann asks readers to consider how they can continue to give the best level of care to their patients, many of whom are living longer with combinations of long term conditions (LTCs).  Her answer to the issue of dealing with change is simple; introduce things slowly so that confidence can be built up gradually.  Eventually, using new technology becomes simple and second nature!

“My patients won’t be able to do it”
It is often assumed that older patients won’t have the knowledge required to use technology to help them self-manage their health.  However, as Ann points out, using technology is the norm, and many older patients use a mobile phone or tablet, and we shouldn’t underestimate our older population.  Ann also adds that for those not using technology, introducing it can be a great boost, as secondary benefits such as now being able to contact friends and family, becoming less isolated in the process.

“How can technology provide a better service than I can personally?”
Clinicians are, of course best placed to provide care to their patients, so for some there may be the concern that health technology will reduce the quality of care patients receive.  However, as Ann suggests, it is important to see technology as an addition to the care that clinicians provide, rather than a substitute for it.  As Ann puts it, technology relies on a clinician’s professional knowledge first and foremost.

“What benefits does it have for the patient?”
Ann reminds us that for many patients, it can be diffi
cult to retain all of the information they are given during a face to face consultation, especially if their condition is new to them and they are feeling overwhelmed.  This is where Flo can help.  Technologies used in healthcare ensure that the real time guidance received by patients is current and correct, resulting in patients with increased confidence and capability to self-manage; and the motivation to do so.
“What proof do we have that this works for our patients?”
It is one thing to be told that technology is helping to improve patient’s lives, but another to see real life examples of this.  Ann provides us with two of her own first hand experiences, both of which showcase how Flo is helping patients.

Firstly, Ann talks about a patient who used Flo to help monitor their pre-op blood pressure.  The patient’s initial cataract surgery could not proceed due to elevated blood pressure, but, with Flo’s support, within three days the patient demonstrated enough stable readings sent via Flo from home for this to go ahead.  The patient’s quality of live has improved greatly since her surgery, demonstrating how technology such as Flo really can improve patient’s lives.

The second patient that Ann discussed was struggling to cope with managing her COPD, resulting in numerous calls to paramedics, A&E admission and two inpatient stays within only 2 months.  The patient was introduced to Flo and replied when prompted with her oxygen saturation levels and sputum colour readings daily.  Depending on the patient’s condition that day, they would receive advice from Flo according to the shared management plan they agreed with their clinician.  Over the first 12 months using Flo, the patient only attended her GP surgery once!  The patient is now living a more active life, and her condition is far more controlled.

Ann believes that technologies, such as Flo, can benefit both patients and healthcare teams:
  • Improve patient confidence. 
  • Improve quality of care. 
  • Help to avoid unnecessary surgery attendances. 
As you can see, having first-hand experience Ann really does believe in using technology such as Flo to improve the quality of care that can be given to patients.  Ann has previously described herself as a “technophobe”, so to see her embracing and recommending technology in healthcare is inspiring!

Flo joins the 'Free Condoms No Fuss' C Card Scheme

posted 11 Oct 2017, 03:41 by Hollie O'Connell   [ updated 23 Nov 2017, 04:55 by Hannah Mountford ]

Janet Robison
Project Co-ordinator for C-Card Schemes
NHS Lanarkshire

11 October 2017

The Blood Borne Virus and Sexual Health Promotion Team operate the Condom Distribution Schemes (CDS) within Lanarkshire and are hosted within the Health Improvement Department.  Improving the visibility of sexual health, especially amongst younger populations is a key concern; in 2015 68% of all diagnoses for chlamydia were amongst individuals under the age of 25.  Young people under 25, especially females, define the cohort most at risk of being diagnosed with an STI (FPA, November 2016).  In addition to contracting an STI from unprotected sex, the risk of pregnancy also increases.  ISD Scotland July 2017 data tells us that women under 20 living in the most deprived areas have up to five times higher pregnancy rates than those living in the least deprived areas compounding the importance of ensuring that contraception is easily accessible to the younger population.

The team conducted a pilot “Condoms by Post” project whereby service users could receive a packet of condoms via the post by completing a request form online.  The purpose of the pilot was to highlight Lanarkshire’s C Card Centres where members of the public can visit to obtain supplies of free condoms, and encourage service users to access these areas.  The next stage of the pilot project was to evaluate and understand the experiences of our service users.   

How did you meet Flo?
Working within Health Improvement Department you hear about a number of new programmes or processes that are becoming available for staff to utilise.  A member of the BBV and Sexual Health Promotion Team had reported that there was a tool named Florence (or Flo) being used across Lanarkshire to support patients with aspects of their health using their own mobile phones to engage via text messaging.  These service users reply to Flo with, for example, their blood pressure readings to improve their confidence and ability to self-manage and be remotely monitored by clinicians.  The CDS initially made contact with our local Telehealth Programme Manager to discuss the best way to drive this opportunity forward.

What did you want to achieve?
Initially, our main aim for Flo was to make sure that we received enough data to evaluate the “Condoms by Post” project.  We hoped to maximise the likelihood of receiving feedback by harnessing Flo’s ability to engage with patients offering us an ideal opportunity to harness a proven tool to engage patients and service users which seemed perfect for our cohort who did not like to communicate in person, particularly in relation to a sensitive subject.

Previous feedback suggested that people feel embarrassed talking about any areas of sexual health, which also includes condoms.  Introducing Flo seemed like an ideal opportunity to break down this barrier.  We realised that Flo could be used to remind our service users about the help that was available to them.  We therefore developed a secondary aim, which was to provide extra support and information to our service users in a convenient and discrete manner.

How was Flo introduced to service users and the team? 
It was important early on to ensure that we had consent from our service users to join in with Flo, so during the planning stage before the development of the protocol, the following information was added to the online form to maximise the responses from service users.  This ensured that the team had the appropriate permissions to contact service users:

The CDS team members received a training session from our local Telehealth Programme Manager to understand how to add service users to Flo and assign the agreed protocols, allowing Flo to interact and understand how service users felt about the service. 

To ensure the CDS team received the meaningful feedback to support project evaluation, the CDS team and Telehealth Programme Manager developed a protocol with a small number of questions for Flo to ask service users within an 8 week timescale.

We agreed the timescale to ensure that Flo kept the service users attention avoiding lengthy questions, and also to ensure enough time was given for the service users to use the service by visiting a C Card centre and obtaining additional supplies of condoms.

What happened next?
The CDS team made good use of the protocol to benefit the service.  At the 4 week period a message was sent from Flo to service users reminding them that free condoms are available from C Card centres, and also motivating service users to use the BBV and Sexual Health Promotion Team’s existing website to gain additional knowledge and resources.

In the end, Flo not only helped us to evaluate the project, but we also recruited her as a useful and discreet reminder to service users of additional services available to them.

The Telehealth Programme Team was a tremendous support to the CDS team when creating and implementing this work.  The guidance the team offered was invaluable, alongside the support and advice they provided whenever required, this made a huge difference to implementation.

I would absolutely recommend using Flo to other colleagues who are considering integrating her within the workplace.  Through consultation with users in relation to the work within the BBV and Sexual Health Promotion Team, the feedback being received is that people are in fact communicating more online due to its convenience and accessibility.  To support this, there is now published literature available demonstrating that a high number of people access their information online and also on the go via their mobile phones.

Using Flo is a method of communicating in a way that backs up this evidence and research.

Integrating Flo meant that the CDS team efficiently received the information we needed to evaluate the “condoms by post” pilot helping us to deliver the best service possible to our service users.  85% of our service users also responded that they found Flo easy to use.

For more information please contact janet.robison@lanarkshire.scot.nhs.uk

Five steps to Florence

posted 7 Sep 2017, 01:41 by Hollie O'Connell   [ updated 16 Oct 2017, 05:12 ]

Shona Burge 
Home Mobile Health Monitoring Development Manager 

12 September 2017 

What a service team’s journey with Flo looks like in Tayside “We are one big team” 

" Thanks to funding from the Scottish Government Technology Enabled Care Fund, Angus, Dundee and Perth and Kinross Health and Social Care Partnerships (HSCP) together with NHS Tayside began their journey with Florence or ‘Flo’ in September 2016.  As the newly appointed Health and Mobile Health Monitoring Development Manager for the hosting organisation Angus HSCP, I began one of the steepest learning curves I’ve faced.  This has also turned out to be one of the most satisfying and enjoyable.  Aside from the unfaltering support of my manager Sally Wilson, one of the main reasons for this is the enthusiasm and commitment of the first wave of teams to trial Flo across Tayside.  Being new to Flo we decided to engage as many services as were interested in trying out this innovative way of working.   We loved the idea of using everyone’s best friend, the mobile phone to welcome Flo – ‘The clinician in your pocket’.  Sally had already been speaking about Flo and extolling her virtues to others before I came onboard so we had a group of interested parties ready and waiting for me to hit the ground!  Thankfully Sally had me on a kind of umbilical bungee cord and was always on hand to pull me in for that steadfast support and encouragement. 

We have started with five services those being: Weight Management, Smoke Free Pregnancy Services, Oral Nutritional Support, Heart Failure and Edzell Health Centre who wanted to use Flo to monitor hypertension.  We have a bit of a process we follow with services, some steps need more input from us, others require the teams to free up a bit of capacity to get ‘Flo ready’.  The process as always has evolved as we have moved through it.

Step 1: Clinical Engagement 
The role of promoting Flo has been undertaken by both Sally and myself.  Sally sends out the message to senior colleagues and I follow up with the practical stuff.  So either we send relevant case studies and/or links to www.simple.uk.net or we gave short informal or more formal, invited presentations to services that have heard about Flo and were interested to hear more about how Flo works, what Flo can do and how Flo can help people self–manage their condition.  Basically we talk about Flo most of the time. 

Step 2: Planning 
If a service team is interested and thinks they would like to try Flo we arrange a visit.  In preparation for this the team is provided with relevant, example protocols where possible or protocols that could help thinking – i.e. hypertension protocols to demonstrate how readings can be taken by patients at home and fed-back to clinicians for decision-making. 

We found health behaviour change protocols, around weight management for example useful for other topics as well as the essence of the messages remain the same, only the topic changes.  The team also receives the ‘Scoping Document’ and are asked at this stage to just have a think about how Flo could integrate with their existing pathways; what their intended targets and cohorts would be; how Flo would assist self-management and patient support while freeing up clinician and patient time rather than building in extra work. 

At the visit we go over the scoping document as a tool to discuss ideas in more detail, what their specific protocol might look like and importantly discuss whether there is capacity and confidence in technology for the team to designate a member to become a System Administrator and be able to add protocols to Flo or if indeed this is required by me. 

In cases where the protocol is fairly simple I would have capacity to build it, however if the protocol is likely to be more complex, or specialised and have many iterations I do request a team member dedicates time to this as it generally needs specialist experience to complete this.  Team administrators who have a good understanding of the service and close contact with clinicians tend to be the key personnel here and this is something that can be identified fairly quickly in negotiations. 

Sometimes there is no administration support available; however there is usually a key member of the team that identifies themselves as suitable for the System Administrator role.  At this stage we also consider evaluation and agree timetables for implementation.  I explain what information we can gather from Flo and what we will need from the services.   By this stage the team knows what will be required in terms of input upfront and this is usually balanced out by the team understanding the long-term advantages that Flo can bring.

Step 3: Developing Protocols 
The team will then identify which members will require training to use Flo; this is either provided on-line from the team at Simple Shared Healthcare or delivered locally with live support from them.  Some time is then required to develop protocols – this interim ‘work period’ is very important and can require careful monitoring so that Flo doesn’t fall off the radar due to other work pressures, but so far we have found teams are generally keen on making Flo work and excited to put her into practise so keep apace with agreed schedules. 

At this stage I will act as ‘super user’, set up the ‘TEST’ groups for teams and provide access for System Administrators to access protocols to work on if appropriate.  During this stage I work closely with team System Administrators to get test protocols ready for testing with staff members. 

Steps 4 & 5: Going Live and Evaluation 
Once the team is happy with their protocols and have tested on colleagues we ‘go live’ in accordance with the integration to pathways agreed at Step 2.  Monitoring and data collection takes place on a monthly basis according to the reporting periods of the National Technology Enabled Care Team in Scotland and to meet any service requirements. 

During our journey I cannot stress how invaluable the support from the National Action Group and from Simple Shared Healthcare themselves has been, and continues.  Resources are shared; happily and easily, there are many questions - but none are ever ‘daft’; sometimes we excel ourselves and come up with a new question – but someone always finds the answer.  The sharing and learning is real and crucial on a practical level.  We are one big team.  "

NHS Scotland Event - Working Differently Across Boundaries: Transforming Health and Social Care

posted 12 Jul 2017, 09:40 by Hollie O'Connell   [ updated 16 Oct 2017, 05:12 ]

Lisa Taylor 
Hannah Mountford 

14 July 2017 

The national NHS Scotland Event took place on the 20th-21st June in Glasgow.  This is the foremost healthcare event in Scotland is now in its twelfth year, and continues to aim to promote best practice and innovation

The theme for this year’s event was “Working Differently Across Boundaries: Transforming Health and Social Care” focussing on the development of services to meet the increasing demands of an aging population whilst improving patient experiences and satisfaction. 

Innovation is key, and NHS Scotland’s continuing implementation of its TEC strategy is highly important to this.  Flo continues to be a sustainable innovation now adopted by two thirds of Scottish Health Boards, evident by the number of our Simple Telehealth Community Members selected to showcase their outcomes delivered via a combination of existing adoption of evidence based practice and new innovative approaches.

NHS Tayside
Sally Wilson, (Locality Integration Improvement Manager) and Shona Burge, (Home Mobile Health Monitoring Development Manager) described how they have led the way bringing Flo to NHS Tayside supporting people with long term conditions to better self-manage their health.  Although it’s early days in terms of the implementation of Flo, feedback from patients so far has been promising: 

The service has altered my life, I feel supported… it’s great ” 

I now feel that I am not on my own ” 

I was astonished at how ‘Flo’ Changed my medication habits  

Jacqueline Walker, Nutrition Managed Clinical Network Manager and her colleagues, described the development of NHS Lothian’s new Oral Nutritional Support Pathway (ONS) supported by Flo for personal health support and home monitoring.  Flo’s integration is brand new to the pathway however, the team has a long term view with expected outcomes by 2020 that will focus on creating co-produced pathways to improve diagnosis, treatment and review of ONS.

NHS Lothian
Meanwhile, Mary Paterson, (e-Health Research Group, Centre for Population Health Sciences) Brian McKinstry, (e-Health Research Group, Centre for Population Health Sciences) Grahame Cumming (Innovation Lead) and Elizabeth Payne (Telehealth Lead -Home Monitoring) from NHS Lothian presented on how they have been using Flo to help patients to self-manage their blood pressure at home.  The poster describes positive results, receiving great feedback from patients and healthcare professionals alike.  Patients feel that using Flo is convenient, while staff appreciate having access to reliable home readings to inform treatment decisions earlier A significant reduction in the number of appointments has been demonstrated, creating capacity in primary care.

Parallel Session: Delivering Care in the Digital Age – Embracing Technology and Data Intelligence to Transform Health and Social Care
In addition to those who shared their posters, two further members of the Simple Telehealth Community took part in a parallel session held on both days of the event.  Michelle Brogan (Service Development Manager)  described the impact demonstrated by Home and Mobile Health Monitoring (HMHM) and the potential benefits.

NHS Lanarkshire’s Morag Hearty (TEC Programme Manager)  shared her experience of implementing TEC solutions, namely Flo, at a local level.  Morag discussed both the enablers and challenges that had arisen during implementation, as well as an overview of the outcomes from NHS Lanarkshire’s BP Monitoring Early Rapid Improvement Study, in summary:
  • NHS Lanarkshire now have over 40% of their practices active 
  • 3,868 clinical contacts have been avoided 
  • Average cost per patient of £6.72  
  • 100% of GPs asked (n=104) agreed that their patient being supported via Flo to manage their blood pressure at home helped their clinical decision-making 
  • 99% of patients found Flo easy to use 

Morag also shared some of her top implementation tips with the audience, including:
  • Listening to the staff and patients alike, taking their views in to account 
  • Keep it simple to start with – look for a quick win to help convince people that what you want to implement really does work 
  • Be creative and communicative 

Morag also used this opportunity to promote Fraser – a figure who is well known to the Simple Community!  Have you #FoundFraser yet?  Visit the website here.

Caring for Carers

posted 6 Jul 2017, 08:55 by Hollie O'Connell   [ updated 16 Oct 2017, 05:13 ]

NHS Sunderland 
Clinical Commissioning Group 

Rachael Forbister 
TECS Programme Manager 

11 July 2017 

Sunderland Carers Connect Service 

For those who don't know me, my name is Rachael Forbister, and I’m based at Sunderland CCG.  My role involves developing and leading on a number of TECS projects across the city, including Flo.  I've been very privileged to be involved in this work for over 5 years; every day I'm grateful, and every day I learn something new.  It certainly gets me out of bed on a morning!  Believe me, it's not a perfect world, and I've made plenty of mistakes along the way but that's how we learn and grow.

Over the past 18 months we have had the opportunity to develop a fantastic Carers pathway which incorporates Flo.   The idea came from some of our nursing team who contribute to a palliative care group.  They often found that the carers struggled with their caring role, and felt it would be great to do something for them.  With a readymade network in Sunderland and our local commissioned service, Sunderland Carers' Centre, we were able to set up a group of carers who shared their stories, and then used those stories in to design a service that would help them to look after their own health whilst being a carer.

It took a few sessions, with a few hiccups in the middle, to help develop the concept.  The group was made up of 8 carers, most of whom looked after their elderly relatives, although we did have a mental health and learning disability focus as well.   Pulling together their ideas, the working group was able to map out a pathway which could be used to build a protocol using Flo that matched their requirements.  The protocol was made up of education and motivational messages, sign posting for additional services, as well as questions to monitor the mood of carers.
The second key element was the engagement with the local authority as a key stakeholder.  The main concept of the system was that anyone who reported a low mood score would want a phone call back for additional support.   The local authority was able to provide this service through their telecare team on a 24 hour response.  Using the local authority’s call alarm system, Jontek, we were able to get Jontek and Flo to talk to each other.  Although it may be a buzz word, “interoperability” was vital in allowing us to achieve our goal.

Once the protocol was built one of the carers fully tested it to make sure it worked in the way we wanted it to.  This included generating alerts, and then subsequently checking on how the staff responded to these.  The user testing then allowed us to further improve the protocol and make some essential tweaks.

We went live with the service on National Carers Day in November.  A celebration event with tea and cakes was held for all of those involved with the development of the protocol in Flo.  We were also shortlisted for an award at Sunderland City Council Star Awards.

The service has since been reviewed; we have improved the evaluation element of it and created triggered questions to make it easier for carers using it.

It’s now part of the Carers' Centre service offering, and offering it to carers is handled as “business as usual”.  I’m immensely proud of the work everyone has put in to making this happen, especially our carers.

East London patient's receiving "seamless service" to support self management with Flo

posted 28 Jun 2017, 01:13 by Hollie O'Connell   [ updated 16 Oct 2017, 05:13 ]

East London 
NHS Foundation Trust 

Raguraman Padmanabhan 
PGDip (Lond), BPT (Ind), MCSP, MAACP - Clinical and Operational Lead 

29 June 2017 

As the Clinical and Operational Lead for Telehealth at East London NHS Foundation Trust (ELFT), I have been leading on the partnership between ELFT and Florence since 2013 to support people with chronic physical illness, improving their treatment adherence, engagement and self-management.  The number of pathways, innovation ELFT are developing is expanding, an increase in positive outcomes is being delivered and there is growing recognition for the teams involved.

ELFT is committed to facilitating integrated care and accessing best practice technology to support patients being managed in the community.  Examples of current pathways where Florence is supporting patients to self manage their condition include diabetes, chronic obstructive pulmonary disease and hypertension, to name a few.   From local evaluation of outcomes, Flo has proven to have a significant and positive effect on patients as they are provided the opportunity to experience the benefits of supported self-management and receive a seamless service.  Patients report back that they “ love Flo .

Overall Flo has also been used successfully in ELFT to monitor patients with long-term conditions and in mental health settings and plays an important role in facilitating and integrating care in the wider community.

HRH The Prince of Wales Award for Integrated Approaches to Care Award

At the end of 2016, we were honoured to be shortlisted for the HRH The Prince of Wales Award for Integrated Approaches to Care as part of the Nursing Times Awards.

The teams’ nomination was in recognition of ELFT’s innovative Telehealth Service including Flo helping patients manage their diabetes and other long term conditions better, maintain their health and live independently at home.

This prestigious award sought to reward nurses whose work is reducing the burden on the health service by preventing ill health and/or offering truly holistic care to patients who have long-term conditions or complex needs.

Created specifically to reflect HRH The Prince of Wales’s long commitment to holistic healthcare, the award identified those nurses from the community or hospital sector who have joined forces with other organisations, such as those from the voluntary and/or third sector, to help promote public health and prevent disease and/or manage long-term conditions in a holistic and integrated way that improves patients’ quality of life and independence.

From almost 200 applicants the team were shortlisted to only 8 and following an interview process were invited to Clarence House where HRH Prince Charles was keen to find out more around how digital empowerment via Flo worked in an integrated model.

What our patients are telling us - Diabetes Pathway

The Diabetic Specialist Nurse Team in East London have recruited Flo as part of their team for some time now to motivate their patients to better engage with their diabetes in between scheduled contacts.

Patients benefit from a daily message from Flo as a reminder to take their blood glucose measurement, with Flo sending advice back depending on the patient’s reading.  The team now has access to their patient’s daily readings which they would not have had otherwise offering not only the opportunity for earlier intervention should the patient’s diabetes exacerbate, but the additional patient reported measurements have proved to enable a more effective consultation either face to face or via Skype.

Evaluation with patients demonstrated that the appointment felt more focussed, took less time and the patient felt that they received more attention and had an increased feeling of control over their diabetes.

A short video of the team’s approach is available here and you can hear patient, Yvonne explain the difference that Flo has made to her 

I used to forget to take my blood glucose in the morning, now I have a reminder as soon as I get up and I can keep an eye and regulate what I’m doing.  Flo is definitely part of our family now

As an example, another one of our diabetes patients who has been using Flo for a while commented that he "prefers sending in the blood glucose readings via Flo".  The patient mentioned that it "gives him the confidence" knowing that someone is able to keep an eye on things.  The patient reported that he ‘loved’ the option of having a print out of readings from his Diabetic Specialist Nurse, if needed.

The patient also finds it reassuring to get a call from his Diabetic Specialist Team if they have identified up anything that requires early intervention from the readings that he has been reporting from home to Flo.  The patient also enjoys being able to speak to someone right away if Flo has advised him to contact the team due to his diabetes needing further review.

The patient’s GP is also happy that the team is provided with access to the patient’s readings in Flo as and when needed for review and initiation of further management.

The patient fed back that he would recommend this service to friends and family and is happy to be part of this service for the foreseeable future.

Another patient had a technical issue with one of the network providers and since it could not be solved despite several attempts, changed his phone so that his Flo connectivity remained intact.  The patient reported it was "the best thing ever for him to be in touch via Flo to self-manage his diabetes" and that didn’t want to lose Flo.

The service users also pointed out that Flo is well placed within a preventative and public health arena and is also accessible to patients.

Pressure ulcer prevention and management 

Another area that Florence is used to help support patients at ELFT is those patients are at risk of developing pressure sores or those who have a recently healed pressure area.   Patients identified by their District Nurse, Allied Health Professional or Tissue Viability Team; due to the volume of referrals the patent is referred to the Telehealth Team as a single point of access.  The Telehealth Team are co-located with the District Nurse Teams and will fast track a visit to address issues coming via Flo from the patient, providing a safe and coordinated pathway onwards.

Using a combination of targeted prompts, condition education and motivation; Flo interacts with patients around key areas such as positioning, equipment, nutrition, eating/drinking and the health of the patient’s skin and pressure area.  If a need is indicated, Flo will prompt the patient to make contact with the team as further intervention is required.

What has been the Impact?

The use of Flo to support patients in this cohort has proven to reduce the pressure on our community services with time being released to focus on patients with more acute and complex needs.

The teams have noticed how patients and carers have embraced this simple technology in shaping their care and also how Flo has improved compliance to agreed self-care arrangements.  In addition, with Flo providing remote support determined by their clinician, patients report feeling that they having access to a clinician when needed.  This gives patients the confidence to report to us any issues or concerns with their pressure area round the clock, knowing interactions with Flo will be reviewed and triaged accordingly, which also complements business continuity.

Supporting Service Users with Mental illness

The Mental Health team were selected by The Health Foundation to be part of its £1.5 million innovation programme, Innovating for Improvement supporting twenty health care projects in the UK with the aim of improving health care delivery and/or the way people manage their own health care by testing and developing innovative ideas and approaches and putting them into practice.

Flo is already used in Newham in supporting people with chronic physical illness to improve treatment adherence, patient engagement and self-management but this will be the first time it has been tested in a controlled trial for people with a severe mental health condition. 

Led by Professor Frank Röhricht ELFT’s REFRAME project is a feasibility randomised control trial using Flo to support service users with severe mental illness.  The research aims to understand if Flo’s interactive text messaging intervention can improve the care and self-management of patients with severe mental illness.  This is an ongoing project, we can’t say too much now, but watch this space!

North East Regional Network Event 2017 Overview

posted 16 Jun 2017, 02:47 by Hollie O'Connell   [ updated 16 Oct 2017, 05:13 ]

Simple Shared Healthcare 

Lisa Taylor 
Hannah Mountford  

23 June 2017  

Sharing best practice, igniting collaboration and building relationships 

The 2nd annual North East Regional Network Event was held on 16th May 2017, hosted by Sunderland CCG and proved to be a day of sharing knowledge, building relationships and extending existing good practice.  The event hoped to capitalise on the success of the previous year’s event, and this was certainly the case!

Regional events take place across the UK to provide community members with the opportunity to meet and discuss their current and proposed pathways, share best practice and offer the potential for future collaboration with organisations also using Flo nearby.

Regional events are a great opportunity to share and celebrate the clinically driven innovation taking place across the region.  The day was kicked off by Lisa and Karen, who warmly welcomed attendees to the event and gave an update of recent news and events from around the Simple Telehealth Community; including introducing our new team members Hollie O’Connell and Hannah Mountford.

Ann Hughes, Practice Nurse and Flo Facilitator (Stoke-on-Trent) – A Day in Life
Following this, the Simple Shared Healthcare team made the most of today’s technology by dialling in with Ann Hughes, Practice Nurse and Flo Facilitator in Stoke-on-Trent, via Skype.  Ann shared her “on-the-ground” experiences of implementing the use of Flo in her own medical practice.  Ann’s dedication to her role and patients shone through, and the audience were captivated by her can-do attitude.  Ann’s belief in the benefits of using Flo was obvious to all, as she put it Flo really changed patient’s lives completely.  Furthermore, Ann gave us examples of how using Flo had really had a positive impact on the lives of her patients:

The patient was quite lonely, so she loved the texts from Flo. She actually wanted more texts! 
Flo made her feel like she was closer to everyone at the surgery 

Patients on Flo are really tuned in to if there’s a problem with their health. 
Sometimes they will contact me before I even have chance to check their readings!

Ann’s video session ended with members of the audience putting their questions to her; many of these focused on how to best implement the use of Flo in a Primary Care environment.  Ann’s top tip to get other healthcare professionals and patient’s to start using Flo?

Start simply and build things up from there!

Delivering the Regional TECS Strategy in the North East
After Ann’s video call Jackie Smart from the North East and North Cumbria Academic Health Science Network gave a brief overview of her regional strategic role, and how this will be supporting the development of TECS across the North East including our Flo.  For more information you can contact Jackie at jackie.smart1@nhs.net.

A Text Message Intervention to Support Medicines Adherence Mobilised through Community Pharmacy (TIMELY) 
Gemma Donovan MPharm MSc Academic Practitioner University of Sunderland & NHS Sunderland CCG
Next up was Gemma Donovan, who is currently studying for her PhD.  Gemma answered our call for submissions when the event was announced; she presented her research proposal to us focussing on Flo’s role in motivating and engaging patients to improve their adherence to prescribed medicines.  Gemma began by talking us through some of the background research and information that had informed her own research subject.  According to Gemma, Flo seemed like a great subject for her research, as it utilises the most accessible form of technology we currently have – text messages via a mobile phone.  Gemma aims to really delve into what makes Flo work, and perhaps identify areas that could be improved upon further. To do so, she will focus on both qualitative and quantitative data from a variety of sources.  Indeed, Gemma has requested that anyone who may have case studies, patient stories etc. that focus on using Flo to improve medication adherence, would consider sharing these with her.  If you would like to know more about Gemma’s research, or think you would like to contribute, you can email her at Gemma.Donovan@sunderland.ac.uk

Supporting the Simple Telehealth Community

Lisa and Karen then discussed some new additions to the Member’s Resource Area at www.simple.uk.net to help support our member’s to access and share their best practice.

Some highlights were the new online Clinician and System Administrator Training Guides, expanded protocol resources for the new Example Pathways area produced by Hollie and Hannah respectively.

Lisa and Karen discussed some new developments with Flo and also introduced some of the new organisations that have joined the Simple Telehealth Community recently.

Antenatal Clinics and Flo – Improving Outcomes, Experience and Capacity
Technology once again came into play after lunch, when the West Cumbria Specialist Diabetes Team who manage the antenatal diabetes service in West Cumbria with the support of the obstetric department of West Cumberland Hospital dialled in using Skype for an interactive discussion around how Flo has significantly improved both clinical outcomes and released clinic capacity.

Consultant Chandi Idampitiya, Specialist Diabetic Nurse Carol Wardynec, and Dietician Victoria Armstrong spoke to the audience about the positive impact that integrating Flo has had for both the team and their patients.  Audit findings demonstrated that:

  • Patients approved of Flo 
  • Patients like that they had to travel less as they had fewer appointments 
  • Patients felt supported 
  • 34% improvement in achieving HbA1c targets at 28 weeks 
  • 20% reduction in caesarean sections in Type 1 diabetes 
  • 15% reduction in pre term deliveries in Type 1 diabetes

The team also commented how being able to integrate Flo into their pathway has greatly impacted on their ability to provide quality care to a growing number of patients, especially as the team is relatively small and operates from a small area of a larger hospital.

 Flo has helped us by reducing the number of face to face appointments we have. If we didn’t have Flo our clinics would increase.

Similar to Ann’s earlier video call, the team rounded off their session with a question and answer section.  Their input on the day was well received, and this was reflected by the comments made and questions asked afterwards.  The team’s findings will hopefully be published soon.

Sunderland’s Carer’s Connect Service
Rachael Forbister then gave us an overview of Sunderland’s Carer’s Connect Service developed ‘with carers, for carers’ which recruited Flo as a supportive tool.  Carers receive a mixture of support, information and motivational messages from Flo, as well as being asked about their mood or how they feel from time to time.  Rachael also showed us a short film about the Carer’s service, which you can watch here.

I think the texting service is a fantastic idea, and it’s something that is really, really needed. I’ve been a carer myself for 5 years now, 
and I know from my own experience how beneficial it would be to just have someone at the end of the phone; it’s invaluable.  
Carer’s comment from the Carer’s Connect Service Launch video

Rachael also announced that excitingly, Sunderland CCG has undertaken a project to have a Flo character designed as part of their Vanguard programme.  A local graphic design company was commissioned to create a cartoon likeness of Flo for use on information posters, leaflets and so on.  Watch this space for more information on this exciting development!

A key aim of regional network events is to give those who attend the chance to discuss Flo with other health professionals allowing questions on a variety of subjects to be asked and answered. The discussions proved to be very productive for all, with contributions from various fields of healthcare, including South Tyneside’s Learning Disabilities Service, Gateshead’s Talking Therapies and the Regional Ambulance Service. Many comments were made highlighting how Flo has, and continues to make positive improvements for both patients and healthcare professionals.

West Cumbria have really flown with Flo. We have one practice who use Flo for all of their hypertension protocols and they love it. ” 
Miriam Baird, Commissioning Officer with North of England Commissioning Support

Flo is amazing, something that we should be using more often. ” 
Jan Gorman, Health Support Worker with Community Learning

The feedback about Flo has been amazing, no complaints at all .” 
Kathryn Sumner, Safe Care Lead with STFT Talking Therapies

Much like the previous year, the North East Regional Network Event proved to be a great success.  We heard some amazing stories about how Flo is really making an impact for both patients and healthcare professionals alike.  We would like to say thank you to all those who were involved and helped to make the day the success it was, and also thank you to everyone who attended the event and contributed so much to the community discussion sessions.  We look forward to next year’s 3rd annual North East Event!

Supporting carers through loneliness and isolation with Flo

posted 1 Jun 2017, 01:58 by Hollie O'Connell   [ updated 16 Oct 2017, 05:14 ]

Madeline Martin 
Carer Coordinator - Edinburgh Carer Support Team 

05 June 2017 

Helping carers to care through loneliness 

It is estimated that there are seven million people in the UK who are caring for older, sick or disabled loved ones.  In Edinburgh, the Scottish Health Survey (2013) estimated there were 65,084 unpaid carers.  From this number, 36% of carers provide 20 or more hours of unpaid care per week and 21% provide over 50 hours or more of unpaid care. 

Caring for a family member or friend can be a positive life experience but this can also be a cause of loneliness and isolation which can affect the carers own health and wellbeing.

Chief Executive of Carers UK, Heléna Herklots said in the report ‘Caring Alone’

Caring for a loved one can be hugely rewarding but without support to have a life outside of caring, it can also be incredibly lonely.  Pressures on finances, a lack of support to allow carers to have a break and a lack of understanding from friends and colleagues, mean many carers feel that their world is shrinking. "

In 2015 Carers UK published a report called 'Alone and Caring' to highlight the issues carers struggle with due to their feelings of loneliness and isolation.

The key findings in the report were as follows:
  • 8 out of 10 carers (83%) have felt lonely or isolated due to their caring role 
  • 57% have lost touch with family and friends as a result of their caring role
  • Over a third (36%) feel uncomfortable talking to friends about caring, adding to feelings of loneliness and social isolation 
  • 45% couldn’t afford to take part in social activities 
  • 49% have experienced difficulties in their relationship with their partner because of their caring role 
  • 55% of carers felt that they were unable to get out of the house much due to their caring responsibilities

The Edinburgh Carer Support Team, based within the Department of Health and Social Care offers one to one support to carers who either self refer or are referred internally by a health or social care professional.  Our contact with carers varies depending on their situation and personal requirements.  Support workers can be involved for a short period of time or in more complex cases, they support carers over a period of months.  In both cases, staff were always aware that when their involvement with a carer comes to an end, the caring role often continues and can change, at times, becoming more difficult.  When this happens we were aware there was a ‘gap’ as carers don’t always remember they can still contact the team, or any partner agency for further support and this could lead to feelings of loneliness or isolation.

In 2015, through NHS Lothian, we were given the opportunity to use a Telehealth App called Florence, as a way to ‘keep in-touch’ with carers who had used our service but were no longer actively receiving support from a worker and we felt this could help us bridge the ‘gap’. 

How does Florence work? 
Carers give consent and are enrolled by their carer support worker to Florence which is essentially a text message based system. The carer then receives a series of texts over nine months which offers reminders, motivational prompts and relevant carer support information on a variety of issues. The texts to the carer are generally free and the carer can opt to stop receiving these texts at any time.

When asked what they thought of ‘Florence’ a carer said, 

I love getting all these Flo messages. I think it’s a great idea. It makes me realise I’m not the only one with problems. It gives me a little prompt and makes me think of my Carer Support Worker when I receive a text from Flo.  

One of the texts prompted this carer to look into a Mindfulness course which was being run by a local carers organisation.

Another carer commented,

Flo lets me know what is available and what is coming up. It prompted me to check in with my local carers centre and as a result I am hoping to get back to bingo with my sister. 

Person Shaped Support takes pressure off GPs in Liverpool

posted 4 May 2017, 00:55 by Philip O'Connell   [ updated 16 Oct 2017, 05:16 by Hollie O'Connell ]

Lee Lewis 
Liverpool Digital Health Service Manager 

4 May 2017 

Assisting the diagnosis and management hypertensive patients outside of the GP surgery 

The Digital Health Service in Liverpool are currently managed by Person Shaped Support (PSS). The primary purpose of the service is to introduce people to technology, empower people to use Florence to self-care and take more of a leading role in managing their blood pressure. They also aim to educate members of the local community about issues surrounding blood pressure, predominantly in primary care settings.

What is Liverpool’s Digital Health Service? 
The approach we take is similar to the one we originally took as Health Trainers, in that individuals are referred to us from their GP surgery. However, the focus now is on blood pressure, rather than lifestyle as a whole as it was previously. People often respond differently when being given lifestyle advice than when they are being told they have high blood pressure. With blood pressure, most people know something about it, know some of the risks it entails, and they respond better to this. 

To support people with their knowledge of blood pressure we have developed our own service user booklet which provides key information around how to use Florence, and includes the patient’s management plan and some basic lifestyle advice.

How does Flo feature? 
When a patient is referred to us, we are able to set them up on Flo to monitor their blood pressure. We frequently use the AIM 01 protocol designed to prompt patients to take their blood pressure twice a day, as per NICE guidance, to collect sufficient readings for a GP to diagnose or exclude hypertension. We can offer this to patients without a referral from their GP. The readings we receive are shared with the surgery, and then the GP is able to decide if further action is required to treat the patient's blood pressure. They often refer the patient back to us so that we can enrol them on the AIM 02 protocol to measure their blood pressure over a longer period aiming to improve hypertension control. 

You would assume that most people are having their blood pressure checked, but this isn’t always the case. Many people only have their blood pressure taken during a health check or if the clinician needs to investigate something further, but generally most people who present at their surgery don’t have it taken. At the moment in Liverpool there is quite a long waiting list for ambulatory blood pressure monitoring, so the GP surgeries really like the idea of referring patients to us, as an alternative.


What benefits have you seen so far since Flo’s introduction?

With the help of Flo, we are able to provide information that will help GPs to diagnose hypertension, which saves them time, as well as reducing the anxious wait that a patient may have if they are on the waiting list for blood pressure monitoring. Additionally, we can use Flo to help clinician’s determine what medication and the dosage a patient requires to bring their blood pressure under control.

We have also found that a number of patients want to continue using Flo as it reduces their concerns about their blood pressure; they have increased knowledge and awareness of blood pressure and they therefore feel more in control of their own health.

What’s next for the Digital Health Service? 
We have been working hard to make sure that The Digital Health Service becomes more visible. We have been engaging occupational workplaces, such as the police force, to support staff and pick up on issues surrounding blood pressure. We now feel that due to PSS’s work within primary care settings over the last few years, we have built a lot of trust with the primary care services in the city. The GPs and clinicians know that we are capable; we can support patients, we are professional and everything we do is done in the correct manner. Liverpool is lucky; there are a lot of great clinicians here, and they have opened doors to engaging with both the communities and services in the city. They recognise that a medical approach is not the only option available, and that holistic approaches offer something just as valuable too. 

The key really is to talk to as many people as you can and promote what you do, be that at conferences, or just by attending meetings with different organisations. Flo is a great example to use for us, as we can engage patients with the benefits and how Flo has helped patients. We found that being able to talk about these real situations that relate to patients made a difference to how willing some GP practices were to be involved with us and engage with the service we can offer their patients. 

Going forward, we would like to develop the use of hubs across the city. These will create access routes into the service for primary care. The aim is to reach out to as many people as we can; be that working with other services to improve care, or just making ourselves more visible to the local communities. We want to help as many people as we possibly can, and Flo is tremendously important to this. 


We recently helped a young man reach a diagnosis of high blood pressure using Flo. The patient was suffering with ongoing headaches, however despite having quite a strong family history of high blood pressure, he hadn’t linked the two together. We enrolled him with Flo to monitor his blood pressure and discovered that it was quite high, especially given that he was only in his early 20’s. From that point, we were able to pass on the information to his GP, who referred him back to us to put him on to the AIM 02 protocol to continue to monitor his blood pressure. The patient has since been sent to a specialist hypertension clinic to help him further with his blood pressure.

This isn’t an uncommon example when it comes to younger patients; we find that a lot of younger people aren’t as engaged with their health, especially when its things like hypertension which are traditionally associated with older individuals. However, once we sat him down and gave the patient the necessary education about his situation, he took it up and started to follow the advice and guidance.

There are many scenarios like this where we, helping people to engage with their healthcare, and Flo is a really helpful tool for us. We don’t just engage people in primary care settings, but also work closely with community and occupational settings.


More recently we have just engaged with a patient who was a 50 year old male, who had suffered from a stroke within the past 18 months. The patient was found by the surgery using the EMIS Flo searches, which our service provides; these were developed for the surgery with the support of Informatics Merseyside and Liverpool CCG. The client had previously been diagnosed with hypertension in 2015 but his readings were still high, especially his diastolic, even with the patient being on medication.

The patient was put on AIM 01 for one week to monitor and get a more accurate measurement of his blood pressure at home. The patient was a bit apprehensive at first about coming in to see the Digital Health Advisor (DHA) as he was not 100% sure why he was there. The DHA explained the service, what Flo was and how it was being used to monitor the blood pressure of patients. After discussing this, the patient divulged that directly after his stroke he was regularly seeing his practice nurse, having a variety of checks including blood pressure, but after 6 months the visits ceased. He felt strongly these routine visits should have continued, particularly as his blood pressure was not being monitored by the practice, which really concerned him.

The DHA explained to the patient that by using Flo we were able to monitor his blood pressure at home without the need for him to physically come to see the nurse (unless needed), and his results/readings would be put on to his records for all clinicians to see. The DHA also gave lifestyle advice on how to help manage his blood pressure better. After using Flo for one week the patient improved his compliance with his medication; he had noticed that on days when he took his medication as he should, there was the desired effect on his blood pressure. Previously the patient hadn’t been taking his medication as instructed, but as he started to use Flo he could see that it was actually helping.

The patient’s initial blood pressure on AIM 01 was 127/91mmHg, and his blood pressure at the end of the week was 122/79mmHg; this was an average across the 7 days, taken twice a day. The client is now fully complying with taking his medication as instructed. The patient asked if he could continue to be further monitored, as he felt reassured that his blood pressure was constantly monitored and fed back to the surgery. We discussed this and put the patient on AIM 03; he is now sending in his blood pressure once a week for 13 weeks. Since using Flo the patient’s blood pressure has improved with once weekly readings showing 135/85mmHg, 133/85mmHg, 130/84mmHg, and 112/73mmHg respectively. The first three readings were all taken between 16:00 and 18:00, with the final reading being taken at 22:00.

Across the UK, inclusive Flo helps patients regain control of their diabetes

posted 11 Apr 2017, 04:25 by Hollie O'Connell   [ updated 16 Oct 2017, 05:16 ]

For patients, not profit 

Hannah Mountford 
Assistant to Director of Services and Community 

25 April 2017

Friendly Flo helps patients regain control of their diabetes

Flo has been helping patients with diabetes to manage their condition for sometime now, and since being introduced to Flo, patients have since seen improvements in their health and clinicians report improved productivity and efficiency. It is useful to take an overview across all diabetic pathways that Flo supports to understand the differences that Flo has made to people’s lives, as well as what makes her so helpful to both patients and the clinicians.

Many of the patients that Flo now supports had been experiencing difficulties in managing their diabetes before becoming acquainted with her, or were at particularly high risk of further complications or exacerbation if their diabetes remained uncontrolled. Patients and clinicians reported experiencing a number of self management challenges: 

  • Adherence to blood glucose monitoring and self management advice
  • Titration of insulin
  • Understanding diabetes for newly diagnosed patients and how dietary and lifestyle changes can significantly impact on clinical outcomes
  • Compliance with the administration of prescribed medications, including insulin
  • Increased secondary care admissions due to complications caused by uncontrolled diabetes
  • Management of comorbidities associated with diabetes such as diabetic foot care

Compounding patient’s present challenges with managing their condition, the trajectory toward further complications when diabetes remains poorly controlled is inevitable . Poorly controlled diabetes increases the risk of amongst others cataracts, glaucoma, various foot complications, cardiac and kidney complications are also more likely. All of these complications can be avoided or have the date of onset delayed by maintaining stable blood glucose levels. The reduction in cost implications and clinical impacts are significant

Since meeting Flo, patients demonstrate that her relevant, real time advice, aligned to their shared healthcare management plans is helping them to become more engaged and regain a feeling of control over their diabetes and lives again, along with reducing their HbA1c significantly improving their future clinical outcomes. 

Flo has been helpful for younger patients with type 1 diabetes also. Younger patients have the additional challenge of accepting their often lifelong diagnosis at a young age which often leads to disengagement with self care resulting in uncontrolled blood glucose. This feeling of overwhelment is compounded by needing to engage with their condition to manage their diabetes with competing pressures, such as school and socialising. 

Many patients who use Flo report that they now feel more engaged and in control of their diabetes and are now adherent to their self management guidance resulting in more stable blood glucose levels. This improvement in blood glucose control supported a reduction in hospital attendances and demonstrated an overall improvement in patient's general health and wellbeing. 

“ Flo has helped to tighten the control I have on my diabetes and check my blood levels more regularly. As a result I’m more careful with lifestyle choices in the absence of exercise while I am continuing to recover, and I am thrilled that I have been able to stop injecting insulin. ” Brenda Greaves.

It isn’t just patients who are finding Flo useful; many of the health professionals who care for patients with diabetes are reporting the benefits of enlisting Flo as a member of their team. Feedback from clinicians demonstrates that Flo not only improves their patients health and well being, but is time and cost effective. Furthermore, they are reassured knowing that the safety of their patients is improved when away from face to face care.

“ We’re getting less calls from women who just require reassurance, they're getting that from Florence. The calls that come through are the ones that really need the support. So we’re able to counsel women who need some more advice, or maybe some treatment, and that’s reducing call times. It’s also reduced the cost in prescriptions, less women are needing prescription because they're managing their diabetes better. ” Victoria Bowman, midwife.

Key to patients engagement with Flo is how simple and convenient she is to use. Patients only need a simple mobile phone and to be able to open and send texts messages. What’s more, provided patients take any equipment they need to take their measurements with them, they can respond to Flo from wherever they are that day without the need for a mobile data contract or WiFi. This is convenient as it means patients are not tied to staying at home to monitor their diabetes and therefore more likely to take a more active role. In addition to convenience and ease of use, Flo reassures patients if there are any concerns with the readings reported with clear advice and guidance from their agreed health care management plan.

Flo has a unique friendly, human-like persona. Patients respond well to this discreet interaction and come to see her as a friend on hand to help them self care. Flo empowers patients by giving them the confidence to take responsibility for their own health and wellbeing.

 Flo has made such a big difference to my life. I would definitely recommend it to everyone. ” Naomi

" I recommend it be rolled out absolutely everywhere. Josh

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