Commentary: Dundee home health monitoring success

Dundee Voluntary Action’s Jimmy Black on how technology is changing care across Tayside  

Thursday 30th May 2019

Rebecca Strong, a former pupil of Florence Nightingale, was matron at the Dundee Royal Infirmary during the 1870s.

Responsible for implementing Nightingale’s pioneering block apprenticeship regime for nurses, this way of teaching students was subsequently adopted across Scotland, the US and beyond.

Today in Dundee, a different but no less pioneering legacy in care is being constructed under the nurse’s name.

Jimmy Black – Dundee Voluntary Action’s communications officer for technology enabled care – explains how Florence, a simple text messaging service, helps people in Dundee measure their blood pressure at home, and promotes smoking cessation.

Measuring blood pressure is one of the most common reasons for attending primary care appointments – over one in four adults in the UK have high blood pressure, taking up around 1.2 million appointments every year in Scotland. 

“One thing in particular that we have been promoting recently is at home health monitoring with Florence,” Mr Black says.

“There is a national campaign to increase blood pressure monitoring at home, promoted by the Scottish Government and launched a few months ago. My colleagues in the Angus health and social care partnership won some funding from the Scottish Centre for Telehealth & Telecare to promote blood pressure monitoring at scale in Tayside, across Dundee, Perth and Angus.”

Mr Black’s colleagues have recently been praised for their efforts. An evaluation report commissioned by the Scottish Government, focusing on the use of Florence in Tayside, highlights that 448 people have been supported to monitor their health conditions at home, improving their care and preventing hospital admissions.

“It’s really, really simple,” Mr Black tells “You have a blood pressure monitor at home and you take your blood pressure readings. All you then do is text in your results through a mobile phone to Florence – a computer system that receives the results and creates a chart which is then available for clinicians to look at.

“It does more than that though, because it reminds you to do things, it sends you texts. For example if you are meant to take your blood pressure every week, it will remind you and when you submit results you will get a response either to say the results are okay, or to say perhaps that your blood pressure has gone up a bit and you need to adjust the dose of your medicine for that day.

“These kinds of things will have been agreed in advance with the GP or clinician from the hospital so the patient knows what to do.

“If it rises in such a way as to cause concern, then an alert will be triggered, and the clinician will be alerted and somebody will contact the patient.

“The advantage of measuring blood pressure at home is not getting any white coat syndrome – you don’t need to get the bus to the doctor or get flustered trying to get to your appointment. You can avoid the factors that might make your blood pressure go up.

“The measurements are then reckoned to be much more accurate, so that’s good for the patient and it means your blood pressure is likely to be monitored more regularly over a longer period and the results will be more typical.

“One of the killer statistics for this is that 1.2 million GP appointments in Scotland alone are just for blood pressure monitoring and if we could cut a large portion of those and get better results, that would be a massive boost because it would enable resources to be freed up to deal with other more pressing matters.”

Florence has also been deployed to help Dundonians stop smoking, monitor their diet and prepare for surgery.

“Florence reminds you about not smoking and sends you motivational messages and you send reports of your progress back: you develop a relationship with Florence and although she is just a computer, people go on to feel that it is more than that.

“It’s a way of keeping in touch with human beings as well because there are human beings at the other end and that’s comforting for people to know.

“One of the early uses of Florence in Dundee involved cystic fibrosis patients who could use it to keep a track of whether they were eating enough to maintain their weight at a healthy level.

“…Florence reminds patients of some of the things they need to do before they get into hospital for surgery and it has been saving time for the theatres in Stracathro – staff there have seen fewer missed appointments as a result of people being ready before they come in.”

An independent charity supporting third sector organisations to improve their resilience and services, Dundee Voluntary Action holds a contract with the Dundee health and social care partnership to promote technology enabled care.

The contract, Mr Black explains, “is about finding new ideas that further the Scottish Government’s agenda [around technology enabled care] and taking these ideas back to Dundee and try and get people to be enthusiastic about them, because it’s very hard to create change.

“It’s difficult when people are under pressure and delivering services – they don’t have time to get their heads up and look around and see the new methods that are coming in.

“But none the less, we have to change. The realistic medicine agenda that Dr Catherine Calderwood put forward is in part about changing to meet the needs of our ageing population; more care is required and current resources are stretched already.

We have seen problems with GPs for example, in not being able to find enough to keep surgeries open – we had a closure not all that long ago in Dundee.

With all of that, its necessary to find new ways of working.

With Florence, people take charge of their own healthcare and to a certain extent how they manage their conditions. It helps them gather information so they can do this and also means clinicians have better information to work with.”