How Flo came to life An interview with Phil O’Connell

Phil O’Connell was named NHS innovator of the year in 2012 for his work developing the Florence Simple Telehealth system (Flo). He is now Chair for nhssimple, with a focus on spreading the impact of Flo far and wide. From a vision for how simple technology could be used to change patient behaviour, to the Simple Telehealth system which is now being used across the UK and in the States, we spoke to Phil about the improvement journey which helped bring Flo to life.

Where did Flo come from?

I was working on a short term contract in Stoke, looking at ways to use telehealth to reduce hospital admissions. My background is in business and IT, and I could see that lots of the so called solutions on offer were very expensive and didn’t seem to be delivering results.

We took a step back and figured the best thing you can do to avoid unnecessary admissions is to support people to stick to the treatment plans set by their doctor. And that’s about behaviour change.

I had this idea that using text messages in a targeted way could really help with this. I believed it could work, but I had no idea how to get the idea off the ground. Luckily, a director at Stoke on Trent Primary Care Trust, Terry Hawkins, who was a visionary really, put his trust in me. I also had help from the West Midlands NHS innovations hub (Midtech) who helped me to get the right people involved.

Patients seem to feel real affection for Flo, was that always part of your plan?

Flo is more than just a text messaging system. It’s a way of encouraging patients to change their behaviour in order to live healthier lives.

Psychology has always been a big part of Flo, the way the patient gets encouragement or feedback is vital. When I think back to our original idea all those years ago, it was really important that patients would engage with Flo as if she was a real person, someone they feel is part of their care, rather than just a technological system.

Text messaging is a technology that people are used to. I just don’t think it would work as well if it was a fancy app. Shiny baubles and widgets and gadgets... it’s just not what we’re about. We’re about engaging people and helping them to manage their own health care. The technology is just about finding the most effective and convenient way to connect with people.

What are the biggest challenges Flo has had to overcome?

The majority of health professionals aren’t so keen on the idea of using technology to provide health care, but that changes when they see the impact a system like Flo can have.

A couple of influential people saw potential in what we were doing and really helped us to develop Flo. It was Dr Ruth Chambers OBE who encouraged us to do some more formal evaluation using clinical trials. This gave us the evidence we needed to start to engage with health professionals and was a real turning point.

Where next for Flo?

Flo is now used in over 70 health and social care organisations in the UK, including four health boards in Scotland and two in Wales. Central Scottish teams are currently looking at how to introduce Flo into all health boards in the country.

We’ve also been working with the Veterans Health Administration to introduce a version of Flo in the US, and we’ve had keen interest from Australia and Japan, and from some European countries as well.

To support organisations using Flo, we’ve set up a social enterprise, nhssimple. The fact that we’re a social enterprise is really important. It means that every penny is reinvested in what we do, encouraging the spread of systems like Flo and supporting health professionals to develop new ideas.