Action taken

• From the outset the three tissue viability teams were clear that they wanted to work in partnership as equals with no one service taking the lead role.
• The tissue viability teams across the collaborative started meeting regularly to share their experience of delivering their own services. The three lead viability nurses bounced ideas off each other, looked into the data, and shared learning from each care pathway, which led to them taking the best parts from each other's service and bringing it all together.
• Based on these conversations, the mid Essex tissue viability team piloted an expanded service delivered by district nurses. The pilot showed very promising results, but the change in service had an impact on the district nursing team's already busy workload and it was agreed that there was a need for a dedicated ambulatory lower limb clinic.
• Members of the tissue viability team in mid Essex delivered by Provide Community Interest Company (Provide CIC) visited the ambulatory clinics being run by North East London NHS Foundation Trust (NELFT) and Essex Partnership University NHS Foundation Trust (EPUT) and observed how their clinics operated.
• This led to the mid Essex tissue viability specialists developing plans for dedicated ambulatory clinics which included six new members of staff who run three clinics a day, five days a week across mid Essex.

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