Healthcare delivery


to participate more actively in their care. In this way, supporting patients who feel hesitant about self-care is not about persuading them to accept responsibility they do not want, but about creating the conditions in which confidence and participation can grow. Taken together, the principles explored across this series provide a foundation for translating lower limb self-care from an aspiration into a practical model of service delivery. A future article could build on these themes by presenting an implementation framework to help services develop approaches that are safe, consistent, reproducible and sustainable.


CSJ


References 1. Hallas-Hoyes, L., Williamson, S., Kerr, A., Andrews, T. and Calladine, L. (2021) An advanced self-care delivery model for leg ulcer management: a service evaluation, Journal of Wound Care, 30(9), pp. 751–762


2. Kerr A, Wood L, McDonagh L. (2026a) Achieving sustainability in tissue viability. Clinical Services Journal. Vol25, No1, pg54-58


3. Kerr A, Wood L, McDonagh L. (2026b) From nurse led to self-care. Clinical Services Journal. Vol25, No7, pg44-48


4. Felipe, S.A.P.D., Atrash, A. and Asken, M. (2026), Does the term “non-compliant” bias physician perceptions? A preliminary inquiry into a single internal medicine residency training program, Internal and Emergency Medicine. doi: 10.1007/s11739-026-04427-6.


5. World Health Organization (2003) Adherence to long-term therapies: Evidence for action. Geneva: World Health Organization. Available at: https://iris.who.int/items/bf8058c0-03b2- 4b47-838f-5534849927fb


6. NICE (2021) Shared decision making. NICE guideline NG197. Available at: https://www.nice. org.uk/guidance/ng197 (Accessed: 19 August 2026).


7. World Union of Wound Healing Societies (WUWHS) (2020) Optimising wound care through patient engagement. London: Wounds International.


8. NHS England (2019) Universal Personalised Care: Implementing the Comprehensive Model.


9. Hibbard, J. and Gilburt, H. (2014) Supporting people to manage their health: An introduction to patient activation. London: The King’s Fund. Available at: https://assets.kingsfund.org. uk/f/256914/x/d5fbab2178/supporting_people_ manage_their_health_2014.pdf


10. Perry, C., Atkinson, R.A., Griffiths, J., Wilson, P.M., Lavallée, J.F., Cullum, N. and Dumville, J.C. (2023) ‘Barriers and facilitators to use of compression therapy by people with venous leg ulcers: A qualitative exploration’, Journal of Advanced Nursing, 79(7), pp. 2568–2584. doi: 10.1111/


jan.15608


11. Rogers, C.R. (1961) On Becoming a Person: A Therapist’s View of Psychotherapy. Boston: Houghton Mifflin.


12. Vowden, P., Kerr, A. and Mosti, G. (2020) Demystifying mild, moderate and high compression systems – when and how to introduce “lighter” compression. London: Wounds International. Available at: https://woundsinternational. com/wp-content/uploads/2023/02/ d9fbe561f78e1320ca3f63cf4aa496f0.pdf


13. Goddu, A.P., O’Conor, K.J., Lanzkron, S., Saheed, M.O., Saha, S., Peek, M.E., Haywood, C. and Beach, M.C. (2018), Do words matter? Stigmatizing language and the transmission of bias in the medical record, Journal of General Internal Medicine, 33, pp. 685–691. doi: 10.1007/ s11606-017-4289-2.


14. Alkahtani, A., Dumville, J., Mott, L. and Armitage, C.J. (2026), Barriers to and enablers of prophylactic compression use by people at risk of venous leg ulcer recurrence: a qualitative study.BMJ Open. Feb 10;16(2):e111730. doi:


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,


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 across NHS, private, and commercial wound care settings.


Passionate about improving patient outcomes and supporting healthcare professionals, she maintains her NMC registration through a


longstanding honorary contract. Following her role as Clinical Strategy Manager at L&R Medical UK, where she led clinical strategy, education, evidence development, and stakeholder engagement, Lisa has recently taken on the role of Head of Clinical Services. She now provides strategic leadership for L&R’s clinical services, driving improvements in patient care, professional education, clinical evidence, and healthcare partnerships across the UK.


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.


October 2026 I www.clinicalservicesjournal.com 51


10.1136/bmjopen-2025-111730. PMID: 41667185; PMCID: PMC12911738.


15. Miller, W.R. and Rollnick, S. (2023) Motivational Interviewing: Helping People Change and Grow. 4th edn. New York: Guilford Press.


16. Almansour, M., AlQurmalah, S.I. and Abdul Razack, H.I. (2023) Motivational interviewing: an evidence based, collaborative, goal oriented communication approach in lifestyle medicine: a comprehensive review of the literature, Journal of Taibah University Medical Sciences, 18(5), pp. 1170–1178. doi: 10.1016/j. jtumed.2023.03.011.


17. Phung H, Arundel C, Dumville J, Soares M and Saramago P (2026), Compression systems for venous leg ulcers: a network meta-analysis and cost-effectiveness analysis. EClinicalMedicine, 104065. doi: 10.1016/j. eclinm.2026.104065.


18. O’Meara S, Cullum N, Nelson EA, Dumville JC. Compression for venous leg ulcers. Cochrane Database Syst Rev. 2012 Nov 14;11(11):CD000265. doi: 10.1002/14651858.CD000265.pub3. PMID: 23152202; PMCID: PMC7068175.


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68