It is not just surgery where the NHS must speed up its innovation. Imaginative approaches to commissioning exist and early indications from Northern Ireland suggest significant cost savings are available to those prepared to embrace them.

For some years Northern Ireland's Northern health and social services board has realised the benefits of commissioning acute "high tech" admission prevention services delivered at home rather than in hospital. A recent NI health economics group working paper has indicated this model could deliver savings of up to 80 per cent when commissioned appropriately. The study also showed high levels of patient satisfaction with the service.

This study is not a defining evidence base for home healthcare. But it does demonstrate that where commissioners and health professionals use their imagination, there could be some valuable lessons from across the Irish Sea.

Ciaran O'Neill, school of medicine and dentistry, Queen's University Belfast