Outcomes for patients starting a new treatment for inflammatory bowel disease (IBD) are characterised by uncertainty of treatment response. Although it is natural to hope that new treatments will be characterised by better efficacy, remission is still far from a universal experience for patients living with IBD. At times an apparent “glass ceiling” appears to constrain progress towards a goal of maximal long-term health-care related quality of life for all. There are a number of areas that can and should be addressed if we are to make significant progress.