Project completed as part of the National 2025 Green Nursing Challenge by the Birmingham Community Healthcare NHS FT team.
Team Members
Alexandra Anderson, Advanced Professional Lead
Natasha Jones - Goulding Professional Lead
Amanda Fitzsimons, trainee Advanced Clinical Practitioner
Issue
Patients requiring long-term condition management in community settings often face significant challenges in accessing timely and effective care. These individuals, many of whom are older adults or individuals living with chronic conditions such as diabetes, heart failure, or complex wounds, are particularly vulnerable to deterioration when care is delayed or fragmented. Missed opportunities for early intervention can lead to complications, unnecessary hospital admissions, and increased reliance on urgent care services.
The delay in care also has social and emotional consequences. Patients may feel isolated or anxious about their health, especially when they are unsure whether symptoms warrant attention. For those with mobility issues or limited access to transport, attending frequent appointments can be burdensome, leading to missed visits and further delays in treatment. From an environmental perspective, the traditional model of care, reliant on travel for both patients and staff, contributes significantly to carbon emissions. In community nursing services, where visits are often made by car across wide geographic areas, the cumulative environmental impact is substantial.
Intervention
Birmingham’s Adult Community Services nursing team introduced the Isla Health app, a secure digital platform that allows patients to share photos, videos, and clinical information with their care team remotely. This digital innovation supports earlier diagnosis and more responsive care by enabling clinicians to assess changes in a patient’s condition between scheduled visits. For example, a patient with a deteriorating wound can submit images for review, allowing nurses to intervene sooner and potentially prevent complications or hospitalisation.
The introduction of the Isla Health app in Birmingham’s Adult Community Services was expected to improve outcomes while reducing pressures on staff and the service. It supports NHS England’s strategic priorities, including the shift from hospital to community-based care, the adoption of digital tools to streamline services, and a focus on prevention and early intervention. By enabling remote consultations and digital monitoring, the app not only facilitates more proactive and personalised care, but contributes to the NHS’s commitment to environmental sustainability and achieving a net zero health service.
Outcome
Clinical
The introduction of the Isla app has improved the standard of the care that patients receive by ensuring a more timely response to patient concerns. Sending a photograph through the use of the App to clinicians resulted in patients being triaged remotely. This has improved clinical decision-making and management and led to more efficient, timely care that is patient centred.
Home-visits by clinicians are reduced, patients avoid un-necessary admissions to hospital, and the app has led to a reduction in the number of ambulance journeys carried out for patients - meaning clinical time and ambulance journeys can be re-allocated to those which are necessary.
Environmental
In the first 4 months, the ISLA App was used 416 times leading to greenhouse gas (GHG) emissions of 28.74 kgCO2e. In the same period, the use of the ISLA App prevented 24 visits by the urgent community response team and 19 hospital admissions, leading to savings of 128 kgCO2e and 6,703 kgCO2e respectively. The high savings of avoided hospital admissions are due to the avoidance of non-emergency patient transport, 150 kgCO2e, and inpatient bed days, 6,553 kgCO2e assuming that on average patients stayed 9.1 days.
Assuming that the ISLA App use and avoidance of urgent community response team call outs and hospital admissions of the first 4 months are representative for the rest of the year, the ISLA App use could lead to annual net GHG emissions saving of 20,406 kgCO2e.
Economical
During the first 4 months of use (February to May), 24 home visits and 19 hospital admissions were avoided, equating to £26,000 of savings in 4 months, or £78,000 per year.
Social
Staff and patients were survyed. All responses outlined that the App had prevented hospital admissions - half adding that its use had reduced ambulance journeys and helped staff provide appropriate responses to patients. All staff reported other benefits which included improved decision-making, faster diagnosis and increased ability to decide appropriateness of care.
While not captured in the survey, there are potential additional benefits to patients such as preventing disruptions to him care packages and impacts on patient stress, wellbeing, daily routines, etc. Reduced disruption will also support families and carers.
Key Learning Point
Digital tools like the Isla Health App can significantly enhance clinical decision-making, reduce unnecessary hospital admissions and home visits, and contribute to environmental sustainability. The project demonstrated that with strong clinical leadership, collaborative implementation, and a user-friendly platform, remote care can be effectively integrated into urgent community response pathways, aligning with NHS priorities for digital transformation and carbon reduction.
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