Tissue viability
Achieving sustainability in tissue viability
Empowering patients through a self-care model in lower limb management has helped achieve improved sustainability at the Sandwell & West Birmingham Hospitals NHS Trust. In this article, Andrew Kerr, Lisa Wood and Lesley McDonagh provide an overview of this successful project.
Sustainability has become a defining priority for healthcare in the United Kingdom, driven by rising demand, workforce pressures, financial constraints, and the National Health Service (NHS) commitment to achieve Net Zero carbon by 2040.1
For the NHS, sustainability is not
confined to environmental considerations alone; it also encompasses the ability of services to deliver effective, safe, and equitable care in a way that can be maintained for future generations. Few areas illustrate this challenge more acutely than lower limb management. Chronic venous insufficiency, lymphoedema, and leg ulcers place a substantial burden on NHS resources, both financially and in terms of workforce deployment. Wound care overall is estimated to account for around £8.3 billion in annual NHS expenditure and with 560,000
individuals recorded as having venous leg ulcers (VLUs), the management costs exceed £3 billion per year.2
Lower limb wounds are the most
prevalent chronic wounds managed within NHS England, affecting over one million patients nationwide, approximately 2% of the adult population. Traditionally, lower limb wound care has been delivered exclusively by healthcare professionals, often requiring multiple home visits per week. This approach is highly resource intensive and financially unsustainable.2
Rising
prevalence, workforce pressures, and the increasing emphasis on patient-centred care underscore the need for alternative models that optimise efficiency while maintaining quality outcomes. Within this context, our Trust recognised the opportunity to deliver a model of
care that could maintain safety and quality while reducing dependence on routine nursing input. The development and implementation of a
structured self-care pathway for lower limb management offered a potential sustainable alternative. By empowering patients to undertake elements of their own care, with robust education and oversight, we sought to reduce avoidable clinical demand, improve outcomes, and contribute to environmental and workforce sustainability. Self and shared care approaches in chronic disease management are well established, yet their application in lower limb ulceration has been limited.3
Recognising both clinical and operational
challenges, the Sandwell and West Birmingham Hospitals NHS Trust (SWBH) tissue viability service supported the community nursing teams to implement a pilot programme to explore the feasibility, outcomes, and sustainability of a leg ulcer self-care model (LUSCM).4-7
The Sandwell self-care pilot: planning and implementation The initiative focused on creating a pathway that enabled selected patients with venous leg ulcers to adopt greater responsibility for day-to-day elements of their care. Rather than relying solely on community nursing teams for compression therapy, skin care, and wound monitoring, patients were provided with the tools and support, aligned with best practice, to undertake these activities themselves when they had the appropriate capacity and capability.5,7 The pathway established clear eligibility
criteria to ensure patient safety which was approved by the vulnerable adults committee and was fully supported by senior management. Suitable candidates included individuals with stable conditions, adequate cognitive function, and the physical ability and motivation to engage with self-care. The development of the LUSCM began with a service level audit across the SWBH community nursing teams. Using SystmOne data, the team
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www.clinicalservicesjournal.com I January 2026
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