Tissue viability services are under increasing pressure to demonstrate that they provide value for money and a quality service. With the quality agenda, defined end-points need to be established against which tissue viability service providers can measure the quality and value of their services. This paper discusses the difficulties in achieving this in a multidisciplinary service where care crosses provider boundaries, wounds are often slow to heal and patients have multiple comorbidities. Data from the Bradford and Airedale wound care audit illustrates service delivery and how quality of tissue viability services can be enhanced and equitable across the district.