Medicine has historically advanced during conflict, but military medical services have consistently regressed during peace. As over a decade of campaigning in Iraq and Afghanistan draws to a close, securing the legacy of hard won clinical lessons and retaining flexibility to adapt to new patterns of illness and injury during contingency is critical. Central to sustaining exceptional outcomes for future operations and to maintaining the current position of the Defence Medical Services as providers of clinical excellence is retaining the capability to innovate. This capability must extend across the spectrum of clinical innovation-concepts, guidelines, equipment (invention and adoption), curricula (design, assessment and refinement), research and Defence diplomacy. To achieve this requires a strategy, a 'roadmap', with a clear vision, end state and centres of gravity (core strengths that must be protected). The direction for innovation will be guided by emergent analysis of the future character of military medicine. Success will be determined by ensuring the conditions are met to protect and enhance the existing 'winning culture'.
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