Innovation in mental healthcare services – Oxevision and SIM

The StopOxevision campaign focuses on Oxevision as an individual healthcare product, however, we are aware this type of surveillance in mental health settings is part of a far wider picture. Oxevision is allowed to thrive amongst a context of increasing digitalisation and privatisation of healthcare where aspects of staffing roles are outsourced to private companies offering tech-based solutions. Oxevision is sold on the basis of financial and time savings as it frees up staff from patient observations. However, we have heard from patients who have found remote observations prevented them from having interactions with staff, leaving them isolated and having few opportunities to request items needed. This speaks to broader questions faced in society today where technological advances are developing rapidly, often with minimal consideration of the implications.

Both SIM and Oxevision received funding from the NHS Innovation Accelerator, a publicly funded fellowship program which provides financial and mentoring support to expand the implementation of new healthcare products across the NHS. It describes itself as having a dual focus on the innovation and the individual [1]. The NHS Innovation Accelerator was launched in 2015 and is commissioned by the Accelerated Access Collaborative at NHS England, delivered in partnership with Academic Health Science Networks [2]. From an external perspective, this structure appears convoluted, making it hard to understand where responsibility lies – and perhaps accordingly, easier to skirt accountability where required. This is further complicated by the innovations supported by these organisations being for-profit private companies which are in turn less transparent than public institutions.

Many of the other mental health related innovations awarded funding include technology based interventions which are designed to provide support for patients with less staff involvement. For example, Limbic is an artificial intelligence chatbot for triaging mental health referrals described as “saving clinicians precious time, leading to less burnout” [3]. In the context of the challenges facing the NHS, digitalised innovations which save resources and staff time may seem appealing however this must not come at the expense of the quality of care patients deserve. Undoubtedly, an AI app lacks the nuance and sensitivity of in person therapeutic support and raises concerns about how patients will be safeguarded and risks mitigated where machines are used as a quicker and cheaper alternative to human interaction. This type of technology also raises significant concerns related to the processing of sensitive patient data by third-party companies.

Other products supported by NHS Innovation Accelerator include s12 Solutions and Thalamos which are both digital apps supporting arrangements for Mental Health Act assessments. As with SIM and Oxevision, where Academic Health Science Networks and NHS Innovation Accelerator have failed to conduct the required scrutiny prior to providing funding and endorsement, Gooding (2023) highlights concerns relating to s12 Solutions and Thalamos and how these may compromise best practice and increase costs through outsourcing to private for-profit providers [4].

In March 2023, after 18 months developing a joint policy with NHS England in response to the failings of SIM, the StopSIM Coalition announced this policy will no longer be published due to attempts from The Academic Health Science Network to block publication, given this policy highlighted failings related to The NHS Innovation Accelerator and the Academic Health Science Networks [5]. Where public funds were used to fund legal challenges to prevent accountability being held for the actions of these organisations, it is clear there is a gross failure to operate with the transparency and accountability required of a publicly funded institution. Further, where it’s apparent there have been numerous failings to conduct sufficient scrutiny into harmful innovations funded, and repeated platforming of products which prioritise digitalisation and privatisation of healthcare over patient safety, dignity and satisfaction, we suggested these organisations are not fit for purpose.

Despite the high risk nature of innovations supported by The NHS Innovation Accelerator, there is a lack of scrutiny and robust evidence to ensure the safety of these. In the case of SIM, the figures used to promote the healthcare model relied on falsified information [6] and a complete lack of evidence [7]. Additionally, academic papers relating to the effectiveness of Oxevision fail to declare involvement of those with financial interests in the company as a conflict of interest [8]. Despite these clear issues with the marketing of both products, the NHS Innovation Accelerator went on to provide support, suggesting either a lack of scrutiny was conducted initially or officials within the organisation were aware of concerns about the products but continued to provide support and funding regardless. Indeed, an independent review commissioned by the Academic Health Science Network into their involvement in the expansion of SIM models highlights concerns around a lack of clarity as to the stage of development an innovation should be at the point of receiving funding and the existing evidence base to support the safety and efficacy of the innovation [9]. In response, The Academic Health Science Network point to failed attempts to secure grants for further researching SIM but don’t discuss their failure to identify issues within the existing ‘evidence base’.

The same independent review of The Academic Health Science Network’s involvement in the expansion of SIM identifies a need to ensure there is patient and public involvement at each stage of development and support for innovations. The StopSIM Coalition highlighted concerns about a lack of meaningful patient involvement in the development of SIM [10]. Oxehealth list 3 experts by experience on their team, although none of these people are described as having experience of Oxevision itself [11].

Much of Oxevision’s marketing focuses on the experiences and perspectives of staff rather than patients [12] and a report summarising patient surveys, interviews and focus groups appears to have selected quotes relating to positive experiences without discussing those who reported negative experiences. This highlights the ethical issues and conflicts of interests where patient experience research is conducted by the private company with financial interests in the outcomes of such research where a desire to market the product may influence the way in which research is conducted and disseminated. We suggest the NHS Innovation Accelerator and Academic Health Science Network must develop robust plans to ensure patient experience research and involvement doesn’t rely solely on the outputs of the private for-profit company given the risk this information can be manipulated to be more favourable, serving the market interests of the company. We are preparing a separate, forthcoming blog post to discuss patient and public involvement in Oxehealth.

Additionally, where health products or models have been awarded funding through the NHS Innovation Accelerator and received awards, this has been used by trusts employing these products as rationale for not having conducted their own analysis of the safety and ethics of the model, relying on the assumption this has been completed already [13]. For example Kent and Medway have had Oxevision in place since 2019 but reportedly do not have any risk assessments, data protection assessments or equality impact assessments in place [14]. Similarly, South London and Maudsley mental health Trust rely on the assessments completed by Oxehealth rather than having their own policies and data impact assessments [15]. This highlights concerns both in relation to a lack of initial due diligence of innovations, as well as failings in the implementation of innovations at an individual trust level.

Given the significant concerns relating to the safety, legality and ethics of both SIM and Oxevision, it appears the NHS Innovation Accelerator has failed to adequately scrutinise the products it has funded and endorsed resulting in the expansion of dangerous and unethical practices. This raises the question of whether the NHS Innovation Accelerator is fit for purpose. We echo the calls of the StopSIM Coalition and The Royal College of Psychiatrists [16] for an urgent review into the practices of the NHS Innovation Accelerator and Academic Health Science Networks.