The medical world is looking to managers and surgeons to unlock the benefits of clinical innovation - and training is again the key.

Last year, Lord Darzi lamented the fact that more than a decade after his team performed a ground-breaking operation, too few had taken the technique up.

Now John Black, the newly installed president of the Royal College of Surgeons, has told HSJ the NHS needs to recognise the difference in outcomes between merely good surgery and the best in the world. He argues robustly that the benefits from investing in such techniques offer far better value for money than many drug therapies.

As the government publishes clinical outcomes for individual teams, those teams will press the case that they need state of the art training to match the performance of the best. It will take more than patient choice to drive improvement; a culture which welcomes the new and invests in innovation and training will be key.