Five years ago, Paul Wallace’s life changed after emergency surgery revealed not just spinal issues, but that his heart was functioning at only 10%. With intensive treatment, his heart function improved to 40%, but managing multiple chronic conditions became his new reality.

That changed when Paul joined the SMILE Programme, a HSE remote monitoring initiative supporting patients with chronic diseases through daily self-checks and virtual care.

“The SMILE programme has changed the way I manage my health condition, it has given me a regime,” according to Paul.  “I check my vitals—blood oxygen, heart rate, blood pressure—every day. It’s helped me feel in control of my health.”

SMILE 2 is part of the Enhanced Community Care (ECC) programme, delivered in partnership with Caredoc and Chronic Disease Community Specialist Teams in the South East. Covering Carlow, South Tipperary, Kilkenny, Waterford and Wexford, it serves over 500,000 people and was developed in direct response to a need from patients.   

Using connected devices and the ProACT digital platform, patients monitor their health at home. Real-time data is sent to the SMILE nursing team, who can escalate concerns to specialists if needed.

“Their readings come to our screens daily,” explains Niamh Ann Flanagan, SMILE Clinical Lead Nurse. “If anything is off, we call them straight away to prevent deterioration.”

This proactive, integrated approach improves care while reducing pressure on hospitals and GPs. For patients enrolled in SMILE 2 for a period of six months, the project saw a 55% reduction in emergency department visits; 75% fewer hospital bed nights, and an 81% drop in GP visits.

Some 94% of patients reported improved wellbeing, while 72% saw stabilisation in symptoms—more than double the original target. Patients feel informed and supported, a sentiment echoed by healthcare professionals.

“SMILE empowers patients to manage their own care because they have access to their own information,” according to Dr Anna Marie O’Brien, GP at Abbey Medical based in Wexford Primary Care Centre. 

For Cardiovascular Nurse Specialists like Liz Murphy, part of theWexford Integrated Chronic Disease Team, the ability to access live patient data is a game changer: “I can look at the data, make a clinical decision, confirm with the patient over the phone that it is accurate and send a prescription to their pharmacy. I would estimate that it’s probably reduced their amount of clinic visits they require by 80%.”

Liz tailors her consultations to each patient’s needs, using telephone or the Attend Anywhere online video platform to check in, adjust care plans, and provide reassurance—all without requiring patients to travel.

SMILE 2 covers eight chronic diseases, including heart failure, diabetes, COPD, and asthma. It offers a scalable blueprint for integrated chronic disease management nationwide.

 “The future of my health feels less uncertain,” Paul explains, adding that  “SMILE helps catch problems before I even know they’re there.”

Speaking about the impact of the initiative, Martina Queally, Regional Executive Officer (REO), HSE Dublin and South East, said she was “thrilled to see the impact of the SMILE 2 project on patient health and wellbeing across HSE Dublin and South East in the counties of Carlow, Kilkenny, Tipperary South, Waterford Wexford. By empowering patients through innovative self-management tools and integrated care, we are not only enhancing their quality of life but also achieving a remarkable reduction in the demand on hospital services. With a 55% decrease in emergency department visits and a 75% reduction in hospital bed nights, SMILE 2 demonstrates the transformative potential of collaborative, patient-centred care and sets a new standard for chronic disease management. SMILE 2 represents a sustainable and replicable model for efficient healthcare delivery.”

Watch Paul outline how he benefited from SMILE