“It is such a simple system and within the first day I was receiving text messages to prompt me to test my blood sugar and all I have to do is send a text message with my blood glucose five times a day. I would urge people to use this system, if it can change my life, it can change anyone’s life”.
Josh, diabetic patient, Nottingham

What was the problem?

Telehealth technology has too often had a patchy record of adoption and success in the NHS, and using this technology at scale is not common in the NHS. Florence (Flo) Simple Telehealth uses SMS text messages on mobile phones to communicate with patients. Flo actively supports the model of patient self-care management and compliance, while also delivering productivity gains for services, enabling larger caseloads to be managed within existing resources. Flo is owned by the NHS, and was created in Stoke-on-Trent CCG. At around 8p per text, Flo is cost-effective to administer and free for patients.

It is also in use within the North East and North Cumbria and West Midlands AHSNs and nationally. it’s reaching over 70 health and social care organisations with 33,000 patients registered for a wide range of conditions using clinically approved pathways. Evidence suggests that Flo increases levels of adherence through education and creating good habits in users, and health professionals have noticed a reduction in consultation time.

What we did and why

Over 15 million people in the UK live with a long-term condition (LTC). Flo offers innovative ways to manage this problem. In addition to LTCs, technology-enabled care services (TECS) can empower patients with self-management in a range of other areas where, for example, before and after an operation or during pregnancy. Sir Bruce Keogh has stated that “This (TECS) is the future of healthcare.” Flo is a cost-effective and efficient solution and fits with the ambitions of the Five Year Forward View.

Flo has been written into all six Nottinghamshire Clinical Commissioning Group contracts and other local strategies. Flo and Assistive Technology is integral to the Better Together Programme in Mid Nottinghamshire and the Digital Roadmaps.

Flo provides a useful tool to improve the health and wellbeing of people living with long term conditions as they are able to manage their conditions more effectively. It decreases unnecessary clinical and patient contact and frees capacity within the system for appropriate appointments and referrals.

Which national priorities does this work address?

  • Funding and Efficiency, Health and Wellbeing
  • Medicines optimisation and self-care
  • Spreading best practice
  • Using digital technology in the NHS
  • Providing community-based, patient-centred care


  • Service user Josh

    Josh, a Flo service user

    By the end of the 2014-15, 2,000 patients were enrolled onto Flo in Nottinghamshire.

  • A health economics report assessing 2014-15 data has been shared. Early indications are that Flo is an effective tool, showing a decrease in patient contact and high levels of patient satisfaction and ability to self-manage and evaluation continues.
  • Monitoring of oxygen saturation levels resulted in a 40% decrease in expected hospital admissions.
  • Heart failure nurse teams home visits reduced by around one third. One home visit costs £67. Flo, including all equipment costs £70 per year.
  • Patients with Asperger’s reported an improved quality of life, improved independence, reduced fatigue on family/carers and reduced service user care packages by a combined 34.5 hours per week.
  • Over 3500 patients have now used Flo across Nottinghamshire and it is part of local digital roadmap for Nottinghamshire.
  • A number of services are now utilising Flo within primary, community and mental health. In two acute providers in the East Midlands, the focus is on:
    • Sherwood Forest Hospitals Foundation Trust (SFHFT):
      • Orthopaedics
      • Stroke Early Supported Discharge Team
    • Nottingham University Hospitals NHS Trust (NUH)
      • Hepatology
      • Parkinson’s Disease Team
    • CircleNottingham (the largest NHS Treatment Centre in Europe, part of CircleHealth)


Josh is working with the Flo team in the East Midlands to spread the word to more patients about the service; this film shares his story.

These resource publications also contain useful information about integrating care with Flo Telehealth:

Tips for implementation

Link Flo telehealth programmes into existing pathways of care, for example, management of ‘white coat’ hypertension. Instead of redirecting them to primary care, wasting time and resource, they could be enrolled to monitoring on Flo for week. That patient then sends in their readings once a day in their normal environment: it will confirm either normal blood pressure or high blood pressure. This process needs to be written into existing policies and procedures, and referenced in the guidance embedded in the system.

Clinical engagement is essential. Ensure that you have a clinical lead or champion for Flo as it’s more effective to engage clinician-to-clinician: they are a useful resource to speak to their peers. If you are looking at different protocols, they are also able to support the development of new protocols and to give a good clinical view.

Ensure that you are able to collect good evaluation data to prove the worth of Flo. The ability to evaluate telehealth is very important, as measuring success is still largely defined as the ability to attribute a positive return on investment, and some qualitative benefits can be difficult to capture financially, while some clinical outcomes will take some time to be realised. You can do this using a telehealth value model, which provides a practical framework to identify and measure value within a 6–18 month timeframe, to reflect the full cost benefit analysis.

Next steps and spread

  • Increase patient usage across Nottinghamshire.
  • Continued evaluation of effectiveness and added value to care pathways.
  • Plans to integrate Flo Simple Telehealth with TPP SystmOne and Emis are now underway and this will enable the mainstream use and uptake of Flo in other settings.

Find out more

For more information, please see our main Adoption of Florence Telehealth page, which features films and other resources.

Visit the East Midlands AHSN website.

Contact for help and advice

Chris Taylor, East Midlands Academic Health Science Network
E: chris.taylor@nottingham.ac.uk

Programme duration: July 2015 – present