This project is linking social care data with healthcare and third-sector data to improve our understand of how health and social care systems work together for people living with COPD, using dashboards, predictive analytics, machine learning, AI and a co-designed theory of change to develop and test optimised care pathways within a regional health and social care partnership. Project Summary COPD is a progressive condition and the third leading cause of death worldwide, with UK mortality among the highest in the EU. It commonly occurs alongside multiple long-term conditions, contributes to health disparities, and carries serious consequences in an ageing population, including cardiovascular risk, respiratory failure and lung cancer. Early diagnosis and timely interventions addressing unmet health and social care needs are critical for quality of life. Social care is particularly important, enabling more effective self-care and reducing reliance on healthcare resources, yet it remains undervalued and underfunded relative to healthcare. A key barrier is the lack of data-driven insight into how health and social care systems work together for people living with COPD. This project will address this gap by linking newly available social care datasets with existing healthcare and third-sector data to understand how well the system operates as a whole, and what this means for optimising pathways of care. Using this integrated data, we will develop innovative dashboards and novel predictive analytics to inform a co-designed theory of change, supporting earlier detection and more effective intervention. Optimised care pathways will then be tested and iteratively improved within a regional health and social care partnership testbed.The full name of this study is: Novel Integrated Health and Social Care Data Enabling Earlier Detection of COPD and Intervention Delivery Through Optimised Care Pathways (CarePath-COPD) Primary Contact Principal Investigator and Project Lead | Professor Julie Jackojulie.jacko@ed.ac.uk | carepath@ed.ac.uk Key People NameRole Julie JackoPrincipal Investigator and Project LeadUsher Institute, University of EdinburghGourab ChoudhuryProject Co-LeadNHS Lothian / University of EdinburghPauline MastersPublic Member Tim WalshCo-Lead of Workstream 1Usher Institute, University of EdinburghElouise JohnstoneContributor to Workstream 1Midlothian Health and Social Care Partnership in ScotlandKathy HarrisonCo-Lead of Workstream 1DataLoch, Usher Institute, University of EdinburghAhmar ShahCo-Lead of Workstream 2 and Capacity Building LeadUsher Institute, University of EdinburghClaire YerramasuCo-Lead of Workstream 2NHS Lothian / University of EdinburghJack FarquharContributor to Workstream 1Midlothian Health and Social Care PartnershipPaul OkrojContributor to Workstream 3, PPIE expertiseChest Heart & Stroke ScotlandPeter SimpsonContributor to Workstream 3Chest Heart & Stroke ScotlandTracy JacksonPPIE Lead and Contributor to Workstream 3Usher Institute, University of EdinburghArif BudiartoPDRAUsher Institute, University of EdinburghPeyton BuettnerProject ManagerUsher Institute, University of EdinburghAnnika ChambersProject ManagerUsher Institute, University of Edinburgh Key Collaborations NHS Lothian Partners Chest Heart and Stroke Scotland DataLoch Midlothian Health and Social Care Partnership Funders NIHR-Research Programme for Social Care (RPSC)This study/project is funded by the NIHR Research Programme for Social Care (Award ID NIHR209588). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.National Institute for Health and Care Research (NIHR) website Project timeline This project is funded for 36 months from April 1, 2026 – March 31, 2029 Scientific themes COPD; Integrated Health and Social Care; Health Inequalities; Care Pathways; Multimorbidity Methodology keywords Secondary administrative linkage and analysis; Dashboards; Predictive Modelling; Co-design and Theories of Change; Real-world testbeds Related Links Project page on NIHR website This article was published on Friday 2 October 2026