A scheme which aims to help keep patients with a terminal diagnosis out of hospital and cared for in the comfort of their own homes has been nominated for a national healthcare award.
The Marie Curie Responsive Emergency Assessment and Community team (REACT) virtual ward has been working with Bradford Royal Infirmary (BRI), part of Bradford Teaching Hospitals NHS Foundation Trust, since June 2022 after receiving funding for a three-year project from Social Finance UK. It is underpinned by social investment from Better Society Capital, Macmillan Cancer Support and the National Lottery Community Fund’s Commissioning Better Outcome Programme.
The scheme – which was recently shortlisted for the ‘Best Contribution to the Improvement of Urgent and Emergency Care’ award in the Health Service Journal’s (HSJ) Partnership Awards – sees palliative care clinicians proactively visiting the BRI’s Emergency Department (ED) every morning to identify patients who might benefit from the service and are in their last year of life. This work offers patients an alternative to hospital admission as data showed that end-of-life patients spent an average of a month in hospital in the last year of their life.
With the right plans in place, patients can be discharged into the care of Marie Curie’s REACT virtual ward for short term crisis support, until mainstream services can take over.
The project – which is running from June 2022 to June 2025 – has attracted the attention of the HSJ judges as REACT has more than halved the number of days palliative care patients are in hospital in the final year of life, ensuring that people are treated in the comfort of their own home, where they tell us they want to be.
Palliative Medicine Consultant, Dr Clare Rayment, said:
We know that those living in the most deprived areas are more likely to attend ED, and be admitted to hospital, than those living in the least deprived areas.
Bradford is the thirteenth most deprived local authority in the country with inequity in access to palliative care and an estimated 1,000 patients a year not recognised by healthcare professionals as being in the last year of life and because of this, these patients then miss out on appropriate palliative care.
We instigated REACT because we recognised that there was a lack of access and lack of palliative care support in a crisis, resulting in patients spending a longer time in hospital in the last year of life, and that a service to support palliative care crises would improve patient care, reduce unplanned admissions and length of stay and therefore improve patient flow.
We are forever grateful to the social investment partnership, which provided up-front funding so Bradford Teaching Hospitals and Marie Curie could deliver the service.
The service model is the first of its kind nationally and we are delighted to have been shortlisted for this prestigious award. REACT provides acute, high-quality palliative care for patients, their families and carers in crisis, either in ED or at home, and it can support their discharge to a dedicated, rapid response, consultant-led multidisciplinary ‘Virtual Ward’ for around 72 hours before handing on to existing services.
The programme also sees Marie Curie REACT accepting direct referrals from community services avoiding patients transferring to ED in the first place.
Marie Curie UK’s Chief Medical Officer, Dr Sarah Holmes, who is based at Bradford’s hospice, stated:
We are delighted to be involved with this innovative service which, very quickly, has made a real difference to our patients’ lives and are honoured that it has been shortlisted for the national HSJ Partnership Awards.
One of the reasons it was developed was in recognition of the unmet palliative care needs across Bradford. This has proven very much to be the case as many of those REACT has helped over the past year had previously been struggling to access appropriate care, for a variety of reasons.
This partnership has not only helped them receive quality, joined-up care tailored to their need, it is also reducing the time they’re spending in hospital, often including crisis visits to the hospital’s ED.
By REACT being present where patients are seeking help we are:
- Widening the reach of palliative care services: in 35% of patients REACT was the first introduction to palliative care services.
- Widening access for those in deprived communities: 66% of the REACT cohort live in the most deprived IMD bands 1–3, compared to 48% of the deceased population in Bradford.
- Reducing the ethnic and health inequalities in access to palliative care services: the ethnic distribution and palliative diagnosis of the deceased population in Bradford, matches well to the ethnic distribution and diagnoses of people who access REACT.