Innovation, Health and Wealth, the report prepared by NHS South of England chief executive Sir Ian Carruthers, is a powerful and long overdue document.

Many from outside the UK are constantly surprised that we do not make more use of having one of the largest cohesive health services in the world. The ability of the NHS’s work to generate “real world evidence” is hugely significant and offers great potential to drive the development of new healthcare technologies.

There has long been some squeamishness in the service over working closely with the pharmaceutical and biotech sectors. It is time to put that aside. The NHS should not be embarrassed to help develop new technologies and therefore profits for these businesses. The important contribution to a shaky economy aside, the development of new medicines has slowed in recent years and a re-energised pipeline would benefit NHS patients and organisations.

With this in mind, however, it is vital any joint venture should have real and transparent benefits for the service. Learning how to do mutually beneficial deals with pharma and biotech businesses should be one of the priorities of the new education plans for managers and clinicians. The proposed academic health science networks should seek to learn and spread the lessons from successful centres in London, Cambridge and elsewhere.

NHS Confederation chief executive Mike Farrar has told HSJ: “People who innovate [need to] feel there is permission to try things. We need to promote more innovative and risk taking behaviour.” Sir Ian’s review, full of his typical optimism and ambition, goes a long way to solving this problem.

Not all the way, of course, because during a period of increasing central grip (see the HSJ100 supplement, launched Thursday 8 December), risk taking will not always be encouraged.

It is only a partial solution, too, because not all of the innovation review’s recommendations ring true.

One of the few dud notes is the suggested development of an “innovation portal” to showcase best practice. One of the iron rules of the internet is not to build something and automatically expect an audience to pitch up at its door. Better to generate the content and distribute it through the myriad existing public and professional media. The planned work with Which? to raise awareness of innovation is a much better idea.

There will also be concerns around formalising compliance with guidance from the National Institute for Health and Clinical Excellence. NICE chief executive Sir Andrew Dillon said the institute’s acceptance and influence on the NHS flowed from the non-mandatory nature of NICE’s recommendations.

Most significant, however, are concerns that attempts at encouraging innovation will mean providers and commissioners place too much emphasis on chasing the rewards and avoiding the penalties introduced into the system.

The nature of the system to bend to the latest set of incentives makes it vital the push on innovation gives as at least as much weight to the diffusion of best practice as to the pursuit of new ideas.

The increasingly influential NHS Atlas of Variation once again exposes how care across the country differs in a way that “cannot be explained by variation in patient illness or preference”.

The atlas suggests “no commissioner” has maximised the effectiveness of the money it is given and that resources tend to be allocated “on the basis of historical patterns” rather than best practice. Little wonder then that the atlas reveals, for example, a five-fold difference in liver disease emergency admissions or a seven-fold variation in 24-hour stroke care.

The innovation review is a timely reminder that the NHS should and can keep reaching for the stars. The atlas reminds us that some patients are being left in the gutter.