Rao’s account of innovations to reduce alcohol related harm among older people is a welcome reminder that much can be done in clinical practice to support people to make changes that benefit their health.1 2 It also shows the gap between this important work and NHS policy agendas. We agree that identifying and replicating examples of good practice is an important step forward and that this should be supported by investment in rigorous evaluation. We urgently need to develop an evidence base to support development and implementation of new approaches in health services, but the scale of the challenge should not be underestimated.