A telehealth system using text messages

Stoke-on-Trent Clinical Commissioning Group (CCG) has developed a telehealth system that has been widely rolled out across the UK with a robust independent evidence base across a wide range of conditions supported by an active clinical community of practice. Designed to be condition agnostic but used extensively for patients with chronic obstructive pulmonary disease (COPD), asthma, hypertension and diabetes, the system - Florence -  allows patients to take responsibility for the shared management of their condition.


In 2010, the Healthcare Without Walls report predicted that telehealth could save the NHS over £2bn per year. Previous opportunities of using telehealth systems to support patients within the NHS have been rarely adopted, not used at scale, and have had limited success. However, the newly-developed system aims to overcome these issues.


Stoke-on-Trent CCG wanted to develop a telehealth system that can be used at scale to support patients in taking responsibility for the monitoring and shared management of their condition, and cut down on the number of appointments they have to attend.

Solution and impact

Florence is used by NHS hospitals, general practice, mental health and community teams. It uses targeted, behavioural, psychology-based smart messaging to help engage patients and change behaviour. Florence brings a human element to remote healthcare with friendly interactions which support patients to make positive behaviour changes to manage their health better, as agreed with their healthcare team. Florence transforms patients from passive receivers to active partners in their healthcare management.

Florence interacts with friendly and familiar SMS text messaging to the patient’s own mobile phone, with patient-reported readings and/or symptoms available to clinicians. It can be used in almost any healthcare setting where a clinician takes responsibility. Florence is used in general practice, acute hospital, community and mental health settings, as well as by social care professionals, education and public health.

Florence is condition agnostic and suitable for patients at home who could benefit from improved motivation and prompting towards better healthcare engagement or health literacy; or reporting symptoms and home measurements including blood pressure, weight and oxygen saturation, for example. Florence’s technology can be linked to a wide range of illnesses and healthy living services, including asthma, diabetes, hypertension, smoking cessation and weight management.


Clinicians create a patient profile via the Florence web-based portal and decide the interactive protocol of messages  that the patient will receive according to their self-management plan. All patient responses are linked back to the clinician’s system so that they can review, monitor, intervene or escalate where necessary. Florence also links with other Technology Enabled Care Services (TECS) systems including Interactive Voice Response, smartphone and tablet telehealth systems and various other devices.


Florence can:

  • encourage patients to take responsibility for their health and change their behaviour from passive to active in relation to shared management
  • improve patient health literacy and confidence to self manage
  • motivate patients to follow their agreed shared management plan outside of face-to-face care
  • receive patient-reported readings and/or symptoms (such as blood pressure, blood glucose, weight, mood, pain) and offer clinically agreed advice for them to act on;  collect patient-reported readings and/or symptoms for discussion at next face-to-face appointment and/or as part of the treatment planning process
  • provide opportunity for earlier clinical intervention and reduce clinical inertia


Improves adherence to self management guidance remotely using psychology based interactions targeted at improving patient confidence and motivation to self manage better. Improved engagement and adherence to self management consequently improves the clinical outcomes for patients and creates efficiency for the NHS.

Key figures/quotes

“The importance of what we are trying to help teams deliver cannot be overstated. Demands on our services are continuing to increase. Utilising technology will not only enable us to shape services to suit the needs and preferences of individual patients; embracing it will also help us take on the challenges we face every day.”
Dr Ruth Chambers OBE, GP principal, Stoke-on-Trent and clinical lead for long-term conditions, WMAHSN.

Find out more

Find out more from Florence’s website

Review independently published case studies, patient stories and evaluation via the Simple Telehealth Community of Practice website

You can get more information about Florence on The Health Foundation website here

“Home and Mobile Health Monitoring Evaluation - Economic Case studies” by Digital Health & Care Scotland, who have previously published their National 3-year evaluation "Towards Scaling Up Home and Mobile Health Monitoring 2015-2018"

The Academic Health Science Network website has more on the Midland region’s adoption of Florence

NHS England and NHS Improvement website has a case study of Florence here

Find out more details on Florence on the Clinitecs website

Read about Stoke CCG’s use of Florence in its news article here

Key contact

Lisa Taylor, Deputy CEO, Simple Shared Healthcare Ltd. (Florence member organisation)