Making the case for social investment in palliative and end-of-life care: The Marie Curie Responsive Emergency Assessment & Community Team (REACT)

Published: 1 July 2025

Dr Clare Rayment, Consultant in Palliative Medicine, with patient Denise Wright in the Emergency Department at Bradford Royal Infirmary June 2025

The Marie Curie Responsive Emergency Assessment and Community Team (REACT) in Bradford is a flagship palliative and end-of-life care service launched in 2022 using social investment from the Care and Wellbeing Fund. Three years on there’s been a dramatic improvement in patient outcomes, with those in the last year of life spending 21 fewer days in hospital. REACT is now fully funded by Bradford Teaching Hospitals NHS Foundation Trust.

The experience for patients at the end of life who attend the Emergency Department has been transformed. The ability to keep these patients in their own homes, whenever possible, benefits both patients themselves and their families, and also — of course — supports the very stretched resource of hospital beds.

Dr John Bolton, Acting Chief Medical Officer, Bradford Teaching Hospitals NHS Foundation Trust

In 2019, palliative care clinicians in Bradford were facing a number of challenges in meeting the palliative care needs of patients at end of life:

Data showed patients in the Bradford area were more likely to have three or more unplanned admissions to hospital in the last 90 days of life than in other areas.
An estimated 1000 patients each year were not accessing palliative care through the Goldline telephone service (a dedicated 24 hour telephone service for people with a serious illness who are thought to be in their last year of life).
At the time, Bradford had no dedicated community face-to-face rapid response service for patients in the last year of their life.

In 2022, a unique partnership between Marie Curie, Bradford Teaching Hospitals NHS Foundation Trust, Social Finance, Macmillan Cancer Support and Better Society Capital enabled the launch of the Marie Curie Responsive Emergency Assessment and Community Team (REACT). Additional grant funding came from the National Lottery Community Fund’s Commissioning Better Outcomes programme.

Dr Sarah Holmes, Chief Medical Officer, Marie Curie UK – one of the clinicians who led on the development of REACT

REACT consists of two interlocking services

ED (Emergency Department) REACT – launched June 2022

An in-reach service, with REACT clinicians located in the Emergency Department (ED) of Bradford Royal Infirmary to identify patients thought to be approaching the last year of life. support their discharge to a dedicated, rapid response, multidisciplinary virtual ward for around 72 hours before their care was handed on to wider community services.

Community REACT — launched October 2023

A 24/7 rapid response and virtual ward service that cares for patients for around 72 hours until mainstream services can take over, led by a community nursing team with the support of a senior palliative care clinician. The service receives referrals directly from community services, including GP surgeries and palliative care services, and has enabled a ‘step up’ of care in the community avoiding unhelpful, costly, and often distressing admissions to hospital.

One of the reasons REACT was developed was in recognition of the unmet palliative care needs across Bradford. This partnership has not only helped patients receive quality, joined-up care tailored to their needs – it is also reducing the time they’re spending in hospital, often including crisis visits to A&E.

Dr Sarah Holmes, Chief Medical Officer, Marie Curie

The social investment funding model

REACT required a coalition of clinicians, operational managers, finance teams, and funders to come together and do things differently. Social investment was needed to make this happen – it enabled the service to be designed and adapted iteratively, allowing a level of agility and risk-taking that is not traditional in healthcare delivery.

It was funded through a Social Impact Bond (SIB) a form of outcomes-based social investment pioneered by Social Finance in 2010, where initial investment is repaid only if key outcomes are achieved. Outcomes are observable and measurable changes for service users and stakeholders, as opposed to change in activity and outputs. For REACT, the outcome metric is a reduction in unplanned hospital bed days for end-of-life patients.

The REACT service was funded by the Care and Wellbeing Fundwhich has developed and overseen investments in the health and social care sector since 2015.

The Care and Wellbeing Fund was set up to test whether social investment could be deployed to support improved health outcomes and be a tool for sustainable innovation and transformation in the health and social care sector.

The fund was developed and supported by a range of partners, including Macmillan Cancer Support, who provided half of the investment funds, with the other half provided by Big Society Capital. Social Finance oversees the Fund.

As the Fund built a portfolio of outcome-based contracts focused on end-of-life care, these were contracted through a single entity, the End of Life Care Integrator (EOLCI).

This was set up in 2016 as a special purpose vehicle run by Social Finance, along with a team of independent experts and advisors, including clinical and NHS staff with a wealth of experience in palliative care, healthcare management, strategy and finance. The Bradford REACT service is the last of the Integrator’s portfolio of investments.

Palliative Care Consultant, Clare Rayment

“The virtual ward enables people to return home with care being provided by our colleagues in Marie Curie and this has halved the number of days patients spend in hospital in the last year of their life. We know that the majority of patients, at the end of their lives, would prefer to be cared for at home, rather than in hospital. REACT makes their wishes possible.”

Over its first two years, the REACT service was clearly giving patients more agency over their care at end of life, with many choosing to spend more time at home, rather than in hospital. Bradford Royal Infirmary reported a significant drop in unplanned admissions.

Reduction in the average number of days a patient using the REACT service spent in hospital in the last year of life, compared to the pre-project baseline (over two years from June 2022)*

18,416

The total number of hospital bed days ‘saved’ (June 2022-Dec 2024)

1,282

The number of people given access to personalised palliative care (June 2022-Dec 2024)

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.
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.
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.
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.