There is an urgent need to improve transfusion services in the National Health Service. Current transfusion practice remains largely paper-based, labour-intensive and error-prone, contributing to rising adverse events. Inappropriate blood use is common, measures for the avoidance of transfusion are underutilised and both blood wastage and shortages are at unacceptable levels. There have been many national initiatives to improve transfusion practice over the last 25 years, but the implementation of their recommendations has been poor, as evidenced by the disturbing results of the annual national audits of compliance with the National Institute for Health and Care Excellence Quality Standards for Blood Transfusion. This article discusses these issues and argues for investment in the transfusion workforce, a modernised digital infrastructure and greater oversight of transfusion practice. It is now time to renew efforts to modernise transfusion practice to standards of safety, efficiency and clinical effectiveness, which our patients should reasonably expect.