The changes proposed to enable sustainable innovation need the right environment in which to occur. Politicians, the media, ethicists, public and patient debate, funding agencies, and investors can all play a major role in supporting the future of medical innovation. Public–private partnerships and life science clusters are vehicles in which the new precision medicine can flourish. However, we need a new ‘social contract’ to underpin the innovation enterprise. Countries that wish to lead in the new era of precision medicine will need to unite their health and innovation policy agendas, be prepared to provide finance to achieve proof of concept, encourage public–private partnerships and the development of life science clusters, set up constructive public and ethical dialogues, invest in developing regulatory science and in bringing patients fully into policy development.