Tissue viability


To address this, we invested time in engaging staff early in the process. Nurses were invited to shape the pathway, contribute to the development of resources and trial the model with carefully selected patients. When early successes were observed, with patients maintaining or even improving outcomes, scepticism was replaced with confidence. Many clinicians later reported that being able to focus their skills on more complex cases was both rewarding and professionally fulfilling. Thirdly, structured support materials, clear escalation pathways, and consistent follow up are essential to ensure safety and maintain clinical outcomes. Building on the initial success, SWBH Trust plans to further expand the boundaries of self-care, extending its application across the wider wound care arena and diverse patient groups. Finally, cultural change is required at both patient and staff levels, challenging traditional notions of professional responsibility while emphasising empowerment and shared care. For many clinicians, wound care practice has


historically been shaped by ritualistic behaviours and entrenched routines, with a strong paternalistic ethos underpinning nurse patient interactions. This culture positions the clinician as the primary decision maker and caregiver, often leaving limited space for patient autonomy. Conversely, many patients hold a deeply


rooted, often subconscious expectation that the NHS exists to care for them, relying on professional expertise rather than perceiving a personal role in the healing process. Shifting these perspectives requires focused education, reassurance, and consistent messaging, helping clinicians feel confident in enabling self-management and supporting patients to view themselves as active partners in their care.3


cultural barriers can sustainable adoption of self- and shared care models be achieved.


Conclusion The implementation of a self-care model in lower limb management has shown that sustainability and quality of care are not mutually exclusive but mutually reinforcing. By empowering patients, reducing unnecessary clinical demand, and making more efficient use of resources, we are striving to deliver a model that is safer, more person centred and more sustainable. The initiative demonstrates that patients are not only capable of self-care when adequately supported but often thrive on the independence it brings. Clinicians, in turn, benefit from being able to direct their expertise towards cases where it has the greatest impact. While self-care is not appropriate for every


58 www.clinicalservicesjournal.com I January 2026


patient, our experience shows that with careful selection, robust education, and strong support systems, it can deliver meaningful benefits across clinical, operational, and environmental domains. In an era when the NHS faces unprecedented challenges, initiatives such as this highlight the potential of innovation to deliver lasting change. Crucially, the lessons learned here extend beyond wound care. Embedding self and shared care principles into the management of other long-term conditions could help relieve pressure on frontline services, enhance patient experience, and strengthen system resilience.4


If embraced more widely,


such models may be instrumental in ensuring that the NHS remains sustainable, responsive, and accessible for generations to come. CSJ


References 1. NHS England, 2020. Delivering a ‘Net Zero’ National Health Service. NHS England. Available at: https://www.england.nhs.uk/greenernhs/ [Accessed 11 Sept 2025].


2. Guest, J.F., Fuller, G.W. and Vowden, P., 2020. Cohort study evaluating the burden of


About the authors


Andrew Kerr is a Director at Lower Limb Consultancy Services. After qualifying at the University of Brighton in 1999 and beginning his career in a vascular unit,


Only by addressing these behavioural and


he developed a strong interest in innovation and improving patient outcomes, which led him to specialise in Tissue Viability. With over 25 years of NHS nursing experience and 10 years in combined clinical and commercial roles, he now provides specialist consultancy services that integrate deep clinical expertise with commercial insight to advance wound care and lower limb management. He also holds a Tissue Viability Honorarium at Sandwell and West Birmingham Hospitals NHS Trust, working closely with community services to improve patient outcomes.


Lisa Wood is a registered nurse with over 20 years of specialist experience in Tissue Viability, working across NHS, private, and commercial wound


care settings. Passionate about improving patient outcomes and supporting fellow


healthcare professionals, she maintains her NMC registration through a longstanding honorary contract. She recently took on the role of Clinical Strategy Manager at L&R Medical UK, where she leads the UK clinical strategy to support assisted patient self-care, enhance patient outcomes, deliver education to healthcare professionals, develop evidence for key brands, and strengthen stakeholder relationships.


Lesley McDonagh qualified in 1987 and spent a significant part of her early career in acute nursing before moving into Tissue Viability in 2004. With


extensive experience across both community and hospital settings, she has developed a strong interest in leg ulcer management and the challenges facing community nursing. Lesley is passionate about innovative practice and supporting service changes that enhance NHS sustainability. She currently holds the role as Service Lead and Clinical Lead Nurse for Corporate Nursing at Sandwell and West Birmingham Hospitals NHS Trust, with responsibility for service development and improving patient outcomes.


wounds to the UK’s National Health Service in 2017/2018: update from 2012/2013. BMJ Open, 10(12), p.e045253.


3. World Union of Wound Healing Societies (WUWHS), 2020. Consensus Document: Optimising Wellbeing in People Living with a Wound. London: Wounds International.


4. National Wound Care Strategy Programme (NWCSP), 2022. Lower Limb Recommendations. NHS England. Available at: https://www. nationalwoundcarestrategy.net/ [Accessed 11 Sept 2025].


5. O’Meara, S., Cullum, N., Nelson, E.A. and Dumville, J.C., 2012. Compression for venous leg ulcers. Cochrane Database of Systematic Reviews, (11), CD000265.


6. Greenhalgh, T., Wherton, J., Shaw, S. and Morrison, C., 2020. Video consultations for covid-19. BMJ, 368, m998.


7. Hallas-Hoyes L, Williamson S, Kerr A, Andrews T, Calladine L. An advanced self- care delivery model for leg ulcer management: a service evaluation. J Wound Care. 2021 Sep 2;30(9):751- 762. doi: 10.12968/jowc.2021.30.9.751. PMID: 34554835.


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