Ethical considerations 
The Oxford University Clinical Trials and Research Governance /Joint Research Office classified the preliminary patient public involvement (PPI) activities as ‘pre-research’ not requiring formal regulatory approvals or research governance (decision on 25.06.2021).
For the clinical pilot, the Medical Research Council and the NHS Health and Research Authority research decision support tool (7) was used to determine that this project was not a formal research project as the HaNC-RC-v2 was a standard tool used in telephone triage of USHNC at the trust. This was confirmed with the trust’s Associate Medical Director for Research in March 2022. Trust information governance and data sharing processes were approved in April 2022 (IG 2021-214).
All patients at the beginning of their telephone consultation were verbally consented by their clinician to undertake an automated conversation as part of their consultation.