Collaborating to provide care at home for terminally ill patients

Overview

A collaborative programme between Marie Curie and Bradford Teaching Hospitals NHS Foundation Trust is keeping patients with terminal illnesses out of the hospital and providing care in the comfort of their own homes.

What the organisation faced

The Marie Curie Responsive Emergency Assessment and Community Team (REACT) was introduced in the Bradford area in June 2022, in response to data that suggested Bradford patients spend more time in hospital in their last three months of life compared to other areas and that there were around 1,000 patients a year who did not access palliative care.  

The aim of the three-year funded programme was to address several challenges in palliative care, including time spent in hospital in the last year of life, improving resource use and the quality of life for patients with terminal illnesses. 

The improvement

The programme is a collaboration between Marie Curie and Bradford Teaching Hospitals NHS Foundation Trust with funding and support from organisations such as Social Finance UK, Better Society Capital, Macmillan Cancer Support, and the National Lottery Community Fund’s Commissioning Better Outcome Programme.

The REACT team of Marie Curie nurses provides palliative care out of hospital, in the patient’s own home, providing short-term crisis support, medical care and emotional support, until mainstream services are able to take over.

Palliative care clinicians visit the emergency department at Bradford Teaching Hospitals NHS Foundation Trust daily to assess patients’ needs and decide if they could be better cared for out of hospital. 

Once these patients have been identified, they can be discharged into the REACT virtual ward, with the aim of stabilising them at home and avoiding unnecessary hospital admissions. 

Outcomes

This programme has had a major impact on palliative care in the Bradford area:

1. Improving the experience of patients with acute palliative care needs and their families. The programme has enhanced the overall experience of patients and their families through personalised, holistic care. 
2. Reducing time spent in hospital has increased capacity and flow within the hospital allowing staff to better focus on those who need acute medical care. 
3. The integrated care approach of the programme has allowed coordinated care for patients through effective collaborations between various healthcare providers, including GPs, district nurses, hospice services and hospital trusts. 
4. The presence of the REACT team in the emergency department led to patients who could receive help from palliative care being identified earlier in their illness, which has been shown to improve outcomes overall for patients.  

By December 2024, the programme had supported over 1,200 patients, with the average number of hospital bed days for palliative care patients in their final year of life seeing a reduction from 38 days to 17 days. REACT supports patients to receive earlier access to palliative care, in 35 per cent of patients REACT is the first contact with any palliative service. It also reduces inequity of access to palliative care. REACT patients mirror the age, ethnicity, deprivation and disease profiles of those who die in Bradford.

Many patients and their families have shared positive feedback about the programme including, improved comfort and appreciation to have care at home, reduced pain and better peace of mind. 

The programme has also contributed to changes in palliative care practices at Bradford Teaching Hospitals NHS Foundation Trust.  It has helped ensure seamless and coordinated patient care through an integrated approach with other healthcare providers, including GPs, district nurses, and hospice services.

Marie Curie REACT is committed to the continued improvement of the programme and palliative care; they regularly review its processes and outcomes to ensure they maintain its high quality and its adaptability to meet patients’ needs. As well as continuous patient and family feedback which helps shape the direction of the programme.

The Marie Curie Bradford and Bradford Teaching Hospitals NHS Foundation Trust REACT programme has been recognised for its innovative approach to palliative care and was highly commended in the HSJ Partnership Awards 2025 for the Best Contribution to the Improvement of Urgent and Emergency Care.