This paper explores the challenges of the changing face of the NHS with specific relation to the challenges for community-based tissue viability services following the publication of government documents that identify the need to provide a quality service for all patients in health-care settings. Patients receiving care in the community is paramount to the success of the NHS going forward; service redesign, improvements in quality, outcome tracking, seamless discharge and patient satisfaction/responsibilities has been heralded as the core prerequisites of successful services. Tissue viability is a relatively young specialism, with most services being nurse led and established less than 15 years. It is argued that in order to continue to be successful as a specialism, tissue viability has to challenge traditional patient and nursing beliefs and values.