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East Midlands Regional Network Meeting - December 2017

posted 8 Feb 2018, 01:09 by Hollie O'Connell

Simple Shared Healthcare 

08 February 2018 

Firth Park Library played host to the December Regional Network Session dedicated to supporting the use of Flo, which enables attendees to share their experience and ideas, as well as promoting best practice in their areas. 

The day began with Lisa Taylor and Karen Moore sharing developments across the wider Simple Telehealth community, including the latest additions to www.simple.uk.net, such as example pathways, case studies & blogs and emerging outcomes from across the UK.  Lisa and Karen also highlighted the development of supported clinical networks across the community to enable the sharing of best practice regardless of geographical location; the first of these being maternity care focused with the inaugural national special interest group call set for February 2018.

Focus: Early pulmonary rehabilitation management of patients with Chronic Obstructive Pulmonary Disease following acute exacerbation in Sheffield 

Cath O’Connor, Clinical Specialist Physiotherapist in Sheffield, discussed her service evaluation of the implementation of Flo in early pulmonary rehabilitation management of patients with Chronic Obstructive Pulmonary Disease following acute exacerbation.  Cath focused on patients who had experienced acute exacerbations of COPD (AECOPD), and were taking part in Early Pulmonary Rehab (EPR).  In Sheffield, 1 in 3 patients admitted to hospital with AECOPD is readmitted, despite often being asked to participate in EPR; patients may not be receiving the support they require to successfully complete EPR, and this may be a factor in the number of readmissions.  Cath, with some support from Karen, developed a pathway supporting this cohort of patients, which focused on symptoms before and after exercise to understand how the patient felt.  Results from the evaluation showed that:
  • Patients found Flo acceptable
  • Patients felt safe, supported, motivated to exercise. 
  • Patients felt more confident about self-managing their health. 
  • Some patients developed new skills in sending text messages that they now use in other areas of their lives, reducing their isolation.

Focus: Community Neurology Team – Improving adherence to physiotherapy in Stroke, MS, Parkinson's Disease and Head Trauma

Following on from Cath, Ed Rimmer, a Physiotherapist within the Community Neurology Team at Nottinghamshire Healthcare Foundation Trust, discussed his plans for a project integrating Flo across several pathways.  The team currently manages patients with a wide variety of conditions, including stroke, MS, Parkinson's Disease and head trauma.  Given the range of conditions and the varied demographic of their patients, a diverse multidisciplinary team of healthcare professionals has developed.  The team recognise that their patients can experience condition led challenges to adhere to prescribed medication and rehabilitation, noting the adverse effect that this reduced adherence has on the recovery of their patients. 

Therefore, Ed is leading the development of pathways aimed to support an improvement in both motivation and adherence to treatment.  Ed hopes that Flo will also help patients to improve their confidence and ability to self-manage, reducing reliance on the team.  The plan is to recruit a minimum of 20 patients over the course of 6 months, and then evaluate with both staff and patients with results informing the recruitment of more patients going forward.
Focus: Virtual Wards in Sheffield

The session was led by Rebekah Matthews, Integrated Pathway Manager, who gave an overview of Sheffield Teaching Hospitals implementation of Virtual Wards and the “Okay to Stay” plan.  The Virtual Wards demonstrated a decrease in admissions over winter months in 2015/16, leading to a pilot project being launched during winter 2016/17 aiming to improve the integration of health and social care, as well as reduce the number of inappropriate admissions.  Patients over the age of 65 who scored the highest on the frailty index were targeted, and through the combined use of a person-centred care plan, the “Okay to Stay” plan & Virtual Wards unnecessary admission were again avoided.  Patients on Virtual Wards are typically offered Flo to support awareness, both to the patient and clinicians of vital signs.  The combination of being able to monitor patients remotely, and Flo’s prompt advice motivates patients to seek appropriate intervention at the right time, and that any admission that occur are necessary and appropriate.

NHS England: Stoke-on-Trent rated Outstanding for diabetes services with Flo

posted 6 Feb 2018, 02:30 by Philip O'Connell   [ updated 6 Feb 2018, 02:34 ]

NHS Stoke-on-Trent 
Clinical Commissioning Group 

5 February 2018 


Flo cited in latest "Outstanding" rating by NHS England for Services for patients with diabetes in Stoke-on-Trent.

“Because lifestyle is key to control of most adult diabetes it is a real partnership between clinicians and each patient. Education is vital, as a patient who is properly informed about their condition can more effectively take control and manage it.”

Stoke-on-Trent and North Staffordshire are recognised as leaders in the way new technology is being used to help patients monitor and control a number of conditions including diabetes.

Florence (or Flo) is a locally developed mobile phone based platform. It allows clinicians to communicate securely with patients to remind them to monitor their readings and take medication. It can issue advice and raise the alarm if a patient’s condition deteriorates.  It 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.

Successfully scaling innovation in the NHS - Flo

posted 29 Jan 2018, 00:40 by Hollie O'Connell   [ updated 30 Jan 2018, 01:23 by Philip O'Connell ]

30 January 2018 


Innovation Unit and The Health Foundation have come together in the "Against the Odds" research project and identified 10 UK innovations which have demonstrated "successful scaling", one of which is Florence.  From these case studies, they were able to highlight eight key enablers for scalability of new innovations within the NHS.  

Peered alongside other respected innovations such as Dose Adjustment for Normal Eating (DAFNE), Enhanced Recovery After Surgery (ERAS) , Implantable Cardioverter-Defibrillators (ICDs), Improving Access to Psychological Therapies (IAPT) and Rapid Assessment Intervention and Discharge (RAID) the report teases out key insights into Flo's adoption and spread. 

  • "The flexibility of the platform and capability support model enables adoption in a wide variety of contexts, as well as co-production of the way in which Florence is adopted in each site with clinicians and patients."
  • "The input of clinical perspectives has been a cornerstone of the design and development process of Florence."
  • "Florence’s central team invest in organisations for the long term, supporting them to implement the system by providing unlimited support to build protocols and adapt the structure and messaging of Florence to fit their specific clinical focus areas." 
  • "The business model is explicitly not-for-profit, and has a strong narrative that focuses on a desire to satisfy the goals that clinicians are passionate about: better patient outcomes and effective use of NHS resources."
  • "The Florence team highlight the importance of gathering evidence on how Florence is used in a particular context, or with a focus on a particular cohort and their clinical outcomes."

You can read the full report here.  Look out for Florence starts on pages 50, 51, 52, 53.


Improving Patient’s Understanding: A Contribution from "All Together Better Sunderland"

posted 22 Jan 2018, 02:47 by Hollie O'Connell

NHS Sunderland 
Clinical Commissioning Group


Rachael Forbister 
TECS Programme Manager and Florence Enthusiast 

26 January 2018 

Supporting our patients confidence to access tools aimed at improving their self-management is paramount as a vital first step toward patient engagement and health literacy.  At NHS Sunderland we have developed a number of resources and we are now delighted to be able to share them with the Simple Telehealth Community.

In 2017 we were able to access NHS England’s New Care Models Programme funding, and chose Flo as the ideal subject matter given the progress we have already had in Sunderland.  This funding facilitated the production of patient leaflets that have been designed to be used with, and are applicable to, a multitude of patients and conditions.  It is with great delight that "All Together Better Sunderland" is able to share this resource for use within the Simple Telehealth Community.  

Please feel free to adopt and use these leaflets to support your patients, we hope that you all get great benefit out of them and a big thank you goes to Hannah Mountford at Simple Shared Healthcare for the fantastic content.  

The King's Fund; “Florence is a low-cost, low-risk innovation with a strong track record.”

posted 18 Jan 2018, 09:19 by Hollie O'Connell   [ updated 19 Jan 2018, 05:31 ]

 Adoption and spread of innovation in the NHS 
 16 January 2018 

This latest independent publication by Ben Collins of The King's Fund discusses the challenges of innovation adoption in the NHS and draws on “eight examples of successful spread of innovation”. We’re delighted that our own Simple Telehealth Community of Practice including, ‘Florence’ and ‘Annie’ have been selected as one of the eight examples.

Some of our favourite quotes from the study; 
  • “Florence is a low-cost, low-risk innovation with a strong track record.”
    • The benefits Florence can deliver are wide ranging
    • Florence is an enabler rather than a solution for clinicians and their patients.
    • Its greatest strength is offering a simple, adaptable framework for clinicians to work more effectively with patients and for patients to take a greater role in managing their conditions, without the need for costly investments
    • “Florence can contribute to a dramatic improvement in quality of life for patients with long-term conditions”
    • “It fits within and can be adapted for existing work processes rather than requiring substantial redesign.  It doesn’t require staff to develop new skills or very different ways of working.”

    Click to read the full publication or the Florence case study.

    NHS England's "Challenging Health Inequality" report cites Flo as 'Soft Tool' for intervention

    posted 20 Dec 2017, 07:54 by Hollie O'Connell

      Flo identified as tool to reduce health inequality in England through self-management

    The "Challenging Health Inequalities" October 2017 report compares emergency admissions and unplanned hospitalisation inequality throughout England, and has identified Flo as a successful intervention tool in supporting the reduction of health inequality.  

    # TotallyUnique

    NHS Western Isles take top QuDoS Accolade

    posted 14 Nov 2017, 07:41 by Hollie O'Connell

    Congratulations to
    QuDoS in MS special award WINNER Rachel Morrison of the NHS Western Isles MS Service.  We're all thrilled that Rachel's good work has been recognised with such a prestigious national accolade and we're proud to support the NHS Western Isles MS service with Florence.

    #NHS Western Isles #TotallyUnique 

    Igniting Clinical Innovation

    posted 6 Nov 2017, 02:29 by Hollie O'Connell   [ updated 6 Nov 2017, 07:33 ]

    06 November 2017 

    Inaugural Shropshire & Wales Regional Network Event 

    The Shropshire and Wales Regional Network has recently become the latest collaborative event facilitating the sharing of best practice amongst the Simple Telehealth Community, hosted by Powys Teaching Health Board (PTHB) at The Victoria Memorial Hospital in Welshpool on 26th of September 2017.

    Lisa and Karen kick started the day by offering an insight into developments; an overview of all things Flo!  Attendees welcomed an update on various new and exciting developments.

    Vic Deakins, Head of Therapies and Health Sciences, and Kath Lloyd, Service Development Manager for Therapies and Health Sciences, from Powys Teaching Health Board (PTHB), shared their experiences and learning from the beginning of their journey with Flo in October 2016.  In just 12 months, a number of pathways have been developed, including diabetes, pulmonary rehab, and falls prevention.

    Patients with poor glycaemic control received motivational messages to support education sessions that they were attending.  Feedback collected showed positive health improvements for patients; 90% lost weight, 57% saw a reduction in diastolic BP, and 76% saw a reduction in HbA1c.  Additionally, patients also gave positive feedback about using Flo, with 88% of patients finding Flo easy to use, 64% commenting that Flo helped them to manage their health better, and 87% stating that they would recommend Flo to friends and family.

    Positive feedback was also received from those patients on the pulmonary rehab and falls prevention protocols.  Moving forward, due to the positive outcomes demonstrated in the first 12 months Vic and Kath are aiming to secure dedicated funds to support further expansion of Flo across Powys.

    Following a quick break for lunch, Niall Salisbury, Florence Telehealth Administrator from Shropshire Doctors Cooperative (Shropdoc), spoke to the room about a new innovative model of care recently launched.  Shropdoc is offering a managed service to their local GP practices to administer and monitor patients referred to them for Flo’s support with their COPD, hypertension, asthma, diabetes, as well as offering some support for lifestyle and medication reminders.  To expedite the referral process, Shropdoc have developed a secure EMIS form, designed to facilitate simple and quick referrals using a process familiar to the clinician.  Patient evaluation questions are integrated into all of the protocols in use, and so far Shropdoc has seen positive patient feedback which they hope to continue to build on.  Additionally, Niall is responsible for producing Shropdoc’s monthly “Florence Telehealth Newsletter”, with the Regional Network event being featured in October’s edition.

    Kath Fackrell, Voluntary Services Coordinator at Shropshire Community Health NHS Trust, also took some time to discuss some future plans around supported early discharge at the Princess Royal Hospital in Telford supported by Flo.  The idea was inspired by an existing supported discharge protocol in use in South Tyneside which previously saw the team awarded as winners of the ‘Regional Enterprise Collaboration’ award as part of the Charity Achievement Awards (read more about this here).  Patient feedback in South Tyneside was positive, with 97% of patients stating they would recommend Flo.

    Given this success, Kath is hoping to replicate a similar project with patients from her area, and is well on the way to achieving this.  We are looking forward to hearing more about this project once it is up and running, and hope that it will be as well received as its counterpart in South Tyneside.

    The last portion of the day was an inspiring and passionate discussion amongst members, sharing ideas on different topics and learning points.  One timely topic was how Flo could support organisations with imminent winter pressures during the colder winter months where the NHS faces increased pressures from more “seasonal” illnesses, such as flu and norovirus, compounded by accidents such as slips and falls if the weather turns icy with those patients already suffering from respiratory and cardiovascular conditions becoming more vulnerable as the temperature drops.  Members discussed how Flo could support the delivery of routine care to free capacity for those in greater need and could support patients to manage their own condition through these challenging months seeking support at the right time, and the right place.

    • Patients with respiratory or cardiovascular conditions can access Flo to help manage their health, facilitating time appropriate interventions – reducing the likelihood of admission or appointment capacity much needed at this busy time. 
    • Flo can support respiratory patients in particular (who are more prone to catching colds and flu which can easily become more severe in nature), avoiding having to visit the hospital or GP as often, thus keeping them away from environments which pose a risk to their health.

    Innovative Clinicians Drive 20x Growth in Maternity: Supporting Mums and Mums-to-be

    posted 20 Oct 2017, 08:02 by Hollie O'Connell   [ updated 23 Oct 2017, 05:04 ]

    23 October 2017

    Driven by the growing independent evidence base underpinning a Totally Unique approach, diverse clinical teams continue to innovate with Flo, adapting and adopting her as an integral tool, to help their patients to self manage better. 

    Maternity continues to be an area of creative innovation with clinicians inspired to integrate Flo into new pathways beyond their primary implementation; since 2012 patients supported by Flo within maternity pathways has increased steadily and in 2016 we saw almost a 20 times increase in use of Flo than in 2012!

    Click image to enlarge

    Pregnancy Induced Hypertension (PIH) and Gestational Diabetes Mellitus (GDM) 
    In 2012, Flo’s support was focused towards mums-to-be diagnosed with either pregnancy induced hypertension (PIH) or gestational diabetes mellitus (GDM) with organisations in the North East delivering compelling evidence that Flo’s integration has been beneficial for staff, and most importantly patients.

    Patients reported: 
    • Feeling more in control of their condition. 
    • Reduced anxiety due to knowledge of baby’s wellbeing. 
    • High levels of satisfaction and ease of use using Flo. 
    • Women who had previously developed PIH during previous pregnancies stated that their latest pregnancy experience, supported by Flo, was ‘better’ compared to previous before.

    Clinical Outcomes: 
    • Where Flo was used in GDM pathways, clinicians found that fewer babies were being born in extreme weight percentiles, and pregnancies were lasting longer where they may have previously been induced due to complications of GDM. 
    • For use with PIH, Flo’s notifications as a result of increased symptoms resulted in appropriate admission of patients, who subsequently had labour induced.  Both mothers and babies kept healthy and safe as a result.

    Cost Effectiveness: 
    Based on Sunderland City Hospital’s pilot project using Flo for PIH & GDM, some estimated cost savings were calculated by the team.  These were done by comparing the treatment and contact Flo patients received, compared to the normal non-Flo care pathway (for example number of appointments etc.). 
    • For PIH, based on a cohort of 79 patients, predicted savings of £7,745.82 could be made over the course of pregnancy (£40,002 non-Flo, £32,256.18 with Flo). 
    • For GDM, based on a cohort of 119 patients, predicted savings of £11,624.73 could be made over the course of pregnancy (£153,189.99 non-Flo, £141,565.26 with Flo). 
    • In addition to this, fewer appointments with patients will free up time for clinicians and improve capacity
    Positive patient and clinical outcomes were supported City Hospitals Sunderland’s 2014 CQC visit who cited the application of Flo to support the GDM pathway as an area of outstanding practice.

    These successful pathways spread further across the North East region to South Tees NHS Foundation Trust, the West Cumbria Antenatal Services, Newcastle-upon-Tyne Hospital and Gateshead.  The proven pathways then spread even further to the University Hospital of North Midlands, Poole and Bournemouth NHS Trust, who have recently begun supporting mums to be with PIH during pregnancy via Flo.  While Great Western Hospitals are also accessing similar best practice PIH protocols moving forward.

    The West Cumbria Antenatal Service have delivered some solid outcomes from their implementation of Flo within their outpatient pathway supporting mums to be with type 1 diabetes, or those who develop GDM: 
    • 15% reduction in preterm deliveries in type 1 diabetic pregnancies. 
    • 25% reduction of macrosomia in type 1 diabetic pregnancies. 
    • 8% reduction of macrosomia in pregnancies with GDM. 
    • 20% reduction in cesarean sections in type 1 diabetic pregnancies. 
    • 34% improvement in achieving HbA1c targets at 28 weeks.

    As well as great clinician outcomes, patient feedback was also positive: 
    • 90% of respondents found Flo to be beneficial for managing diabetes during pregnancy. 
    • 90% of respondents found Flo’s advice messages useful
    • 90% of respondents would recommend using Flo to others. 
    • 100% of respondents found Flo easy to use.

    More Clinical Innovation 
    Moving forwards into 2017, the number of maternity pathways supported via Flo continued to diversify: 

    Breastfeeding support 
    Similar to PIH and GDM, Flo’s development towards supporting mums with breastfeeding emerged from an innovative pathway developed in the North East, and recognising the impact has now been adopted in other maternity units across the country, increasing the number of patients supported; emerging as the 2nd most commonly accessed maternity pathway. 

    Outcomes reported by mums of improved reassurance and support but that those supported by Flo for breastfeeding support were more likely to continue breastfeeding at 6 weeks when compared to those mums without Flo’s intervention. 

    Lauren, a new Mum who hoped to breastfeed her baby featured in the award winning “The Power of People” 
    video, commissioned by The Health Foundation to highlight the impact of 5 successful innovations. 

    More information around breastfeeding support pathways here.

    Type 2 Diabetes in Pregnancy
    Sandwell and West Birmingham Hospitals are developing an innovative pathway for mums-to-be already diagnosed with type 2 diabetes pre-natally.  The pathway reinforces support to self manage whilst receiving a new treatment regimes due to pregnancy and offers opportunities of timely intervention and reassurance for mums to be outside of the traditional clinic environment aiming to deliver improved clinical outcomes and more efficient use of capacity. 

    Scottish Health Boards have embraced the opportunity to support women pre and postnatally and have developed a range of emerging new pathways, below. 

    • Foetal movement monitoring 
    Pathways helping mums become more aware of their baby's movements during pregnancy, improving awareness of their own daily movements and what normal level of movement is to be expected; and if necessary who to contact and when to support intervention. 

    • Perinatal, postnatal and antenatal care for mums and their babies 
    Pathways supporting new parents and their babies.  Flo offers relevant, timely advice and guidance to support parents and their babies in having the best start in life. 

    • Smoking cessation 
    Pathways adapted from best practice smoking cessation design, tailored towards key techniques helping expectant mums quit smoking

    Seven months of Flo in Powys; 'Florence and the [Telehealth] Machine'

    posted 11 Oct 2017, 06:58 by Hollie O'Connell   [ updated 16 Oct 2017, 04:19 ]

    NHS Wales   
    Powys Teaching Health Board   

    Seven months after receiving training on Flo, this is a fabulous video summary of how Flo has helped with weight management, diabetes and respiratory patients in Powys, Wales.   We hear from a number of patients and staff about their experience and how they plan to expand the use of Flo. 

    #Wales #Powys #Diabetes #Weight Management #Respiratory #TotallyUnique

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