Despite the rapid advance of technology which has been felt throughout society, the impact on healthcare delivery has taken much longer to be felt. The role of psychiatrists and clinical staff more widely in the design, delivery and development of clinical systems has similarly taken a long time to develop although there has been a significant shift in recent times. The development can be traced through a series of important events including several at national level. There are significant challenges to the current approach to training at all levels, and there remains an urgent need for a well-developed career pathway to make the most of the talent and experience which currently exists whilst providing opportunity for development and support of new staff interested in this work.