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NHS: Gambling Treatment Services

Volume 820: debated on Monday 28 March 2022


Asked by

To ask Her Majesty’s Government, further to the announcements that the NHS (1) will no longer accept money from GambleAware, and (2) is establishing two additional NHS gambling clinics to meet demand, what plans they have to agree a long-term independent funding settlement for NHS gambling treatment services.

In 2019, the NHS committed to establishing 15 specialist gambling clinics by 2023-24. Five clinics are now operational across England, with a further two to open by May. This rollout carries a budget of £15 million, including £6 million allocated for 2023-24. After this, NHS England will provide recurrent annual funding of £6 million. The Department of Health and Social Care and NHS England and NHS Improvement are currently undertaking a review to ensure there is a coherent pathway of advice and treatment for those experiencing gambling-related harm.

I thank the Minister for his reply, but it is quite extraordinary that, at a time when the NHS is in such dire straits, with such financial pressures, we are picking up the costs incurred by an industry. This announcement has shown that far more resources are needed to deal with the outcome of problem gambling, and that the current voluntary levy is simply inadequate to provide the level of independent research, education and treatment that we need. Will the Government commit to introducing a compulsory levy of, say, 1% of gross gambling yield on the polluter pays principle, so that taxpayers are not picking up the huge bills being created by this problem that exists right across society?

I thank the right reverend Prelate for his follow-up question and for raising the issue in the first place. He is absolutely right that we must think about this across government; DCMS leads the policy, but the Department of Health and Social Care is co-operating with it to look at the health issues. Gambling used to be considered a syndrome, but it is now recognised as an addiction. We are committing resources to it through our long-term plan, and will open 15 NHS specialist gambling clinics by 2023-24, with £15 million of funding over the period.

My Lords, do we not need a mandatory levy now? The Government should be setting up a body made up of independent experts, charities and the NHS to decide what services are required and where they should be provided.

The former Public Health England, now the Office for Health Improvement and Disparities, works closely with us, particularly on this issue. We understand the call for a compulsory levy. Indeed, as I am sure many noble Lords will be aware, DCMS recently conducted a review of the Gambling Act 2005. The DHSC was part of that, looking at the impact of gambling on health. Gambling is now recognised as an addiction, as opposed to any other issue. We are looking at this and considering all options. The Government received 16,000 responses to the consultation; we are looking at that and will publish the White Paper soon.

My Lords, with respect, the Minister did not really answer the question about the financing of these services. Does he accept, or understand, that those who treat and research gambling conditions are reluctant to accept funds that are voluntarily provided by the gambling industry?

I completely recognise the noble Lord’s point, which is why we welcome the fact that GambleAware will no longer fund the two clinics in London and Leeds. NHS England has stepped forward on that, but we are reviewing this overall, in a holistic way. When we have an issue that is considered across government, we must make sure that it is all joined up. The Department for Digital, Culture, Media and Sport has been leading the review into the Gambling Act 2005, and has asked the Office for Health Improvement and Disparities and the Department of Health and Social Care to feed into it, along with all the other stakeholders.

My Lords, Public Health England says that around 246,000 people are likely to have some form of gambling addiction, but last year, only 668 people—with the most severe addiction issues—were referred to the gambling clinics because of a lack of resources. Even with the extra clinics over the next three years, will this number of clinics be able to treat the top 10% of patients, which is 24,000 people? If not, when will the service expand to help them too?

The noble Baroness makes an important point and there is recognition that we must do far more on this. That is why we held a review of the Gambling Act in the first place. As noble Lords will be aware, when the work is cross-government, the Department of Health cannot lead in this area; it can contribute when it comes to the health and addiction impacts of gambling but we are doing this in a joined-up way. The White Paper will be published soon and we are continuing to have conversations with the Department for Digital, Culture, Media and Sport on this issue.

My Lords, I echo the point made by the right reverend Prelate. The polluter pays principle is really important, particularly when we think that the gambling industry continues to offer customers VIP packages and streams live sport, which are equally damaging. This badly affect the lives of families and has an impact on individuals’ struggles. I welcome the NHS clinics but we always seem to tackle issues once the horse has bolted. I want my noble friend the Minister to address the issues of prevention and working much more closely with the gambling industry and others in government.

I am very happy to take two questions at once; I will even take three, if noble Lords want, and try to answer them.

The important point that a number of noble Lords are making is that many want to see a polluter pays principle. In economics, this goes back to negative externalities, where you tax things that are considered bad. Some people call them bad; others call them negative externalities. However, when you say that the polluter should pay, who is that? People sometimes say that it should be users but, if you do that, users will end up paying more. Others say that it should be the industry, but will the industry then pass on those costs to users and put those people into even more distress? This is why we want to look at this issue in a joined-up way. Yes, it is about the gambling industry, and this may well be the option we land on, but we want to make sure that we tackle the issue in a completely holistic way.

My Lords, I welcome the Government saying that there needs to be a range of treatment and not just the hard-end clinics. I declare my interest, as in the register, having recently become a trustee of GambleAware; I did that because I want those people who are scared of going for treatment and frightened of the stigma to be able to access early intervention, which means much more work for the voluntary sector. Can the Minister commit to the Department of Health ensuring that the pathway is very clear and will involve early intervention, particularly for women, so that they do not have to end up in heavy-end treatment?

The noble Baroness makes a very important point: people must be treated as individuals—they will have come to addiction from different pathways. We have been engaging with the Department for Digital, Culture, Media and Sport on a number of issues. Additionally, the Office for Health Improvement and Disparities regularly engages with NHS England working-level counterparts, including recently on the establishment of a joint task and finish group on integrating the gambling treatment pathway. Referring directly to the question asked by the noble Baroness, there is no one simple pathway into gambling, and there is a stigma. By putting it at the forefront of some NHS services, we are showing that we are taking it seriously, and that it is not just an affliction but an addiction. We recognise that we must do more to tackle that.

My Lords, I declare my interest as chair of Peers for Gambling Reform. The Minister has talked a lot about treatment, but does he accept that by adopting a public health approach, we would reduce harm in the first instance? Can he give us an absolute assurance that his department is co-operating on all aspects of the gambling review that is currently taking place and that it will be involved in the writing of the White Paper that will, I hope, come before us very soon?

We take the public health aspect very seriously. Public Health England did some work with the DCMS on looking at gambling from a public health perspective, and the Office for Health Improvement and Disparities continues to do that work. While the Department for Digital, Culture, Media and Sport is looking at the gambling industry, we are also looking at this as a public health issue via the Office for Health Improvement and Disparities. I see that the seconds are running out, so I will give the Labour Front Bench time to ask a question.

I thank the Minister for that.

GambleAware recently announced a new major public health campaign to raise awareness of the gambling harms that women experience and to highlight the warning signs and the support that is available. It is particularly focusing on women between the ages of 25 and 55 who gamble online. Can the Minister reassure the House that such vital campaigns will continue to be supported through the long-term funding settlement for NHS gambling treatment and support services?

I am afraid that I cannot answer on the specific initiative that the noble Baroness refers to, but I know we take very seriously that this is a public health issue that we must tackle in a holistic way. We are looking at how we can allocate funding in the NHS long-term plan to tackle gambling addiction and to ensure that we focus more on prevention rather than simply dealing with people once they have a problem.