EPSRC Centre for Doctoral Training in Digital Health and Care

Society is battling with an explosion of health conditions that need long-term management. These chronic conditions occur at all ages: UK children have some of the world's highest levels of both asthma and type 1 diabetes and, with a third of the UK's school children leaving primary education obese, there are huge concerns over type 2 diabetes at all ages; in any year, working age men and women in the UK have a 12% chance of a diagnosed mental health issue such as anxiety, depression and post-natal depression; conditions including dementia, Parkinson's disease and frailty are rapidly increasing in later years.

Low-cost, connected, digital technologies are increasingly seen as vital to the understanding, prevention, diagnosis and management of these conditions for months and years in the community. These digital technologies, such as smartphone apps, wearables, blood sugar monitors - and a near future of Internet of Things (IoT) devices such as smart home systems (e.g. Echo), smart meters and connected appliances - offer an unprecedented opportunity to monitor a patient's condition within their community. With the data processed by artificial intelligence they will deliver decision support to health and care professionals; predict or detect a patient's symptoms worsening; support independent living; deliver behavioural and even pharmaceutical interventions; and allow the efficacy of treatments to be monitored.

This cannot be business as usual for doctoral education since a digital health technology is likely to require a highly multidisciplinary understanding of technologies spanning software engineering, microelectronics, data communication, signal processing, machine learning and visualisation. Achieving actual patient benefit requires user-centred/driven design, a broad understanding of health and care, psychology, physiology, ethics, regulation, health economics and the design of clinical trials.

To meet the challenge and seize the opportunity, the UK needs to nurture leadership that will span this hugely multidisciplinary space - combining technological depth with broad appreciation of the health landscape; empathy with the patient's needs with an eye to business models that underpin adoption; ambition to accelerate innovation with a principled commitment to ethics, inclusivity, regulation, data security and privacy.

The opportunity and the challenge for this Centre for Doctoral Training (CDT) in Digital Health and Care is to be bigger than the sum of its parts; to physically co-locate a cohort of students from Engineering & Computer Sciences and Health & Life Sciences; to bridge the disciplinary gaps, work with key external partners, foster better understandings and activate peer-to-peer learning within the cohort itself. Bristol is the perfect place to train future leaders at this disciplinary interface, building on £30M of digital health research at the University since 2013.

Our proposed CDT will develop team-players with the skills to work effectively with experts from other disciplines, with patients and with the public. In a space where issues of trust, privacy, transparency, accountability and inclusion are absolutely fundamental, the CDT will not only embrace Responsible Innovation but influence and lead best practice nationally and internationally.

The CDT will build on a variety of established relationships; with small and medium sized businesses, technology companies, big pharmaceutical companies, charities, universities, one of the UK's largest public science centres (WeTheCurious), Bristol City Council, and with the public. This CDT is therefore envisaged as a multidisciplinary community of students and academics that will create exciting research projects and will build networks of individuals across academia, industry and the NHS at all levels. It will sow the seeds of future collaborative research and of commercialisation activities.

Impact on Health and Care
The CDT primarily addresses the most pressing needs of nations such as the UK - namely the growth of expenditure on long term health conditions. These conditions (e.g. diabetes, depression, arthritis) cost the NHS over £70Bn a year (~70% of its budget). As our populations continue to age these illnesses threaten the nation's health and its finances.

Digital technologies transforming our world - from transport to relationships, from entertainment to finance - and there is consensus that digital solutions will have a huge role to play in health and care. Through the CDT's emphasis on multidisciplinarity, teamwork, design and responsible innovation, it will produce future leaders positioned to seize that opportunity.

Impact on the Economy
The UK has Europe's 2nd largest medical technology industry and a hugely strong track record in health, technology and societal research. It is very well-placed to develop digital health and care solutions that meet the needs of society through the creation of new businesses.

Achieving economic impact is more than a matter of technology. The CDT has therefore been designed to ensure that its graduates are team players with deep understanding of health and social care systems, good design and the social context within which a new technology is introduced.

Many multinationals have been keen to engage the CDT (e.g. Microsoft, AstraZeneca, Lilly, Biogen, Arm, Huawei ) and part of the Director's role will be to position the UK as a destination for inwards investment in Digital Health. CDT partners collectively employ nearly 1,000,000 people worldwide and are easily in a position to create thousands of jobs in the UK.

The connection to CDT research will strongly benefit UK enterprises such as System C and Babylon, along with smaller companies such as Ayuda Heuristics and Evolyst.

Impact on the Public
When new technologies are proposed to collect and analyse highly personal health data, and are potentially involved in life or death decisions, it is vital that the public are given a voice. The team's experience is that listening to the public makes research better, however involving a full spectrum of the community in research also has benefits to those communities; it can be empowering, it can support the personal development of individuals within communities who may have little awareness of higher education and it can catalyse community groups to come together around key health and care issues.

Policy Makers
From the team's conversations with the senior leadership of the NHS, local leaders of health and social care transformation (see letters from NHS and Bristol City Council) and national reports, it is very apparent that digital solutions are seen as vital to the delivery of health and care. The research of the CDT can inform policy makers about the likely impact of new technology on future services.

Partner organisation Care & Repair will disseminate research findings around independent living and have a track record of translating academic research into changes in practice and policy.

Carers UK represent the role of informal carers, such as family members, in health and social care. They have a strong voice in policy development in the UK and are well-placed to disseminate the CDTs research to policy makers.

STEM Education
It has been shown that outreach for school age children around STEM topics can improve engagement in STEM topics at school. However female entry into STEM at University level remains dramatically lower than males; the reverse being true for health and life sciences. The CDT outreach leverages this fact to focus STEM outreach activities on digital health and care, which can encourage young women into computer science and impact on the next generation of women in higher education.

For academic impact see "Academic Beneficiaries" section.