The Gambling Commission is responsible for the licensing and regulation of an industry which is increasingly recognised as having a major impact on the mental health and wellbeing of its customers.
At the beginning of this month the commission launched a drive to better understand the gambling harms experienced by children and young people. This is part of the national strategy to reduce gambling harms. The commission’s chair is well known to the NHS and vice-versa. Bill Moyes was Monitor’s first leader, leaving in 2010. He is also chair of the General Dental Council.
(Re)Introducing ‘The Bedpan’: The Bedpan is HSJ’s weekly interview series with influential figures from (usually) outside the health world who nevertheless have interesting views on the challenges facing the NHS. The Bedpan is named after Nye Bevan’s apocryphal quote and pays particular attention to how politics impacts the NHS and vice versa. The series began in October and has featured interviews with Spectator editor Fraser Nelson, Institute of Fiscal Studies director Paul Johnson and Dr Sarah Wollaston MP, among others.
“You’ll be surprised to see how much you’re spending on gambling related conditions”, Bill Moyes warns NHS leaders.
The Gambling Commission chair says the NHS “lacks the kind of knowledge that it ought to have” about an addiction which is present in 10 per cent of suicides and often presents (and is hidden) by other co-morbidities.
No stranger to the pressures on the NHS budget, Mr Moyes acknowledges it is perhaps inevitable that the “gambling part” of patients’ problems tend to get “side-lined”. However, the ex-NHS regulator suggests it both desirable and timely for the service to take a closer look – starting with primary care.
“I suspect people turn up to their GP and say: ‘My self-esteem is collapsing because gambling is taking over my life’ and many GPs are probably a bit puzzled as to what to do, it’s not something they were trained to do… it’s not just a case of referring someone to psychiatrists, psychotherapists or inpatient treatment, there’s got to be a whole range of different modalities.”
He says there is a need to help health professionals “think through” how to tackle gambling related problems, adding that many are actively asking for advice.
“Even within mental health trusts” says Mr Moyes, lack of awareness and training will mean that “quite often the focus will be on the co-morbidities to gambling rather than gambling itself.”
This equates to the need for “quite a lot of work” to “tease out” what part the NHS should play in tackling gambling addiction and how that is applied in “the clinic, surgery [and] trust”.
The NHS Long-Term Plan states: “We will invest in expanding NHS specialist clinics to help more people with serious gambling problems. Over 400,000 people in England are problem gamblers and two million people are at risk, but current treatment only reaches a small number through one national clinic. We will therefore expand geographical coverage of NHS services for people with serious gambling problems, and work with partners to tackle the problem at source.”
Speaking specifically about the role of Public Health England, Mr Moyes says: “I will hope to focus them on what works, what pattern of care should we engineer in this country? At the moment there is a very small number of residential facilities [for gambling addicts], there’s some telephone counselling lines, but the scale of provision doesn’t match the scale of need.
“One of the things I will be encouraging the public health contributors to do is to try to [analyse] what kind of interventions are appropriate in which circumstances and to get a sense of what is cost effective. We’ve got to be realistic about that. We’ve got to understand the economic impact of gambling harm and we’ve got to try to get some balance between what we spend on that and intervention, prevention and treatment. I think there’s also quite a lot of work to do to find out what kind of messaging works.
“This is a serious attempt to come together and tackle [the] problem. We want the NHS to be really thoughtful about the kind of things it should and could offer for different types of problem gambling.”
Claiming that NHS England chief executive Simon Stevens is “bought in” to the need for the NHS to act, Mr Moyes says his message for other local and national NHS leaders is “take it seriously, and lead in the areas you have the expertise to lead.”
Gambling wrecks families
Mr Moyes is all for a “vibrant” but “well-regulated” gambling industry. However, he says the public have now “begun to take very seriously the damage gambling addiction can do”, including its potential to “wreck families and careers”.
As result, the commission chair suggests “politicians” want to see changes that result in “an industry where people can enjoy [themselves], have a flutter, but not an industry where people suffer serious harm from which they cannot recover.”
Making this change is going to cost and Mr Moyes calls for more sustainable funding for gambling harm services.
“This [gambling harms] strategy will play out over a decade or more, and for it to be really effective you have to have the right kind of funding and a sustainable level of funding so people on the ground can plan.”
Gamble Aware, the country’s main gambling harms charity, is funded by voluntary donations. It relies either on the goodwill donations from companies or fines levied by the commission on those who have seriously breached their licence. The latter has brought in around £28m in the last 12 months for GA.
NHS England last year called upon social media giants to pay for the harm their sites cause to the mental health of children and young people. Mr Moyes says: “Our position is that the government has the powers to introduce a statutory levy [on the gambling industry] and we think they should now give that some thought – but if they’ve got better ideas, fine.
“Whatever system of funding we introduce has to be capable of flexing over time to meet the need in the system.”
‘We don’t know everything’
Despite this call for a new funding route, Mr Moyes does not appear to want a heavy-handed regulatory approach from government.
As the first chief of Monitor he was never a fan of political intervention. Mr Moyes clashed regularly with health secretary Alan Johnson on who should take the lead on responding to the Mid Staffs crisis, for example.
Nine years later, now within an industry much less affected by politics, his stance has softened but still carries that anti-interventionist thread.
“I think the message we are trying to get across to companies and to government is we are breaking new ground, we don’t know everything by any means, [and] that’s why we are placing a lot of emphasis on evaluation. So, try this, work out what good would looks like, measure it, test it, if it’s not working do something else.
He says the current approach from ministers to the new gambling harms agenda is “pretty much what I was hoping for”.
The commission chair says they are “taking an interest, questioning us, challenging us at the right time”. He adds government is “giving out a message that says this [gambling addiction] is a problem which cannot be ignored, but not pretending there’s a recipe which can just be put on the ground, and just do that and get on with it”.
Mr Moyes continues: “Matt Hancock certainly recognises he should encourage where he can, encourage us [the Gambling Commission], encourage Public Health England, encourage NHS England [to address the problem], but I don’t detect Matt wants to go beyond that. I mean he’s got enough to do with other things.
“We’re very comfortable with that kind of approach, it gives him space from time to time, to say, let’s just take stock, but it doesn’t put him in the driving seat to tell people what to do and I think that’s just about right.”