Reducing gambling-related harms in Southampton

8. The Scrutiny Inquiry Panel undertook the inquiry over 5 evidence gathering meetings. The Panel received information from representatives of a wide variety of organisations, including NHS Southern Gambling Service, Gambling Commission, University of Southampton, University of Glasgow, ADPH North East, Betknowmore UK, GamFam, Greater Manchester Combined Authority, London Borough of Haringey, Office for Health Improvement and Disparities, Aston University, Citizens Advice Southampton, NHS Hampshire and Isle of Wight and Southampton City Council. A full list of those who provided evidence is attached as Appendix 2.
9. The inquiry was fortunate to be able to utilise the findings from the Gambling-Related Harms in Southampton Health Needs Assessment that was published in November 2024.  This resource proved invaluable during the inquiry and will be referenced throughout this report. The assessment brings together the best available local and national evidence to describe the extent and impact of gambling related harms and, if you would like a detailed analysis of the subject, it is recommended that you read the assessment alongside this report.
10. The key findings, conclusions and recommendations from the inquiry are detailed succinctly later in this report.
11. Members of the Panel would like to thank all those who have assisted with the development of this review, in particular the following individuals who have provided the Panel with invaluable advice throughout the inquiry:
    • Bryan Dimmick – Southampton resident with lived experience
    • Kate Harvey – Consultant in Public Health, Southampton City Council
    • Jennifer Clynes - Public Health Specialty Registrar, Southampton City Council who authored the Gambling-Related Harms in Southampton Health Needs Assessment

12. Gambling has long been a popular recreational activity in Great Britain.³ According to the Gambling Commission’s report on gambling behaviour trends (based on collated Quarterly Telephone Survey results between 2015 and 2023), overall gambling participation amongst British adults (aged 16+) fluctuated in the 40-48% range, averaging 45%, during the period. Men were more likely to have gambled than women (48% vs 42%) and there was significant variation by age group: those aged 45-64 were most likely to have gambled, whilst those aged 16-24 were least likely.⁴
13. Common forms of gambling (which may be accessible online and/or in-person at physical premises) include bingo; casinos; sports betting; betting on electronic gaming (or gambling) machines (EGMs), such as fixed-odds betting terminals and fruit machines; lotteries; instant win games; scratch cards; and amusement arcades.
14. In-person gambling declined over the 2015-2023 period whereas online gambling rates steadily increased over the same period, from 15% in 2015 to 26% in 2023, with participation increases observed for all age groups.⁵
15. The total gross gambling yield of the Great Britain gambling industry (April 2022 to March 2023) was £15.1bn.⁶

16. Many people gamble and experience no adverse consequences. Many others, however, experience harms from their engagement with gambling.
17. According to Wardle et al, gambling-related harms are ‘the adverse impacts from gambling on the health and wellbeing of individuals, families, communities and society’.⁷
18. The most commonly used scale to measure gambling harm severity is the Problem Gambling Severity Index, or PGSI. It has four categories:
    
19. A person may transition between stages, over a long period of time or rapidly at a crisis point. Harms can be experienced episodically or chronically and can have generational and intergenerational harm.⁸
20. The 2023 Gambling Survey for Great Britain (GSGB) reported that 2.5% of the population aged 18 years and over living in Great Britain participate in 'problem gambling', with an additional 12% of the survey population participating in gambling with an elevated risk of harm.
21. Alternatively, based on 2018 Health Survey for England (HSE) data, it is estimated that 0.5% of the population reached the threshold to be considered experiencing problem gambling and that 3.8% of the population are classified as gambling at elevated risks. The HSE data also identified that an estimated 7% of the British population are negatively affected by someone else’s gambling.

22. The legal age for gambling in the UK is 18 (except for football pools, society lotteries and category D gaming machines such as penny falls or crane grabs). National surveys report that 11% of 11-16yr olds have spent their own money on gambling in the past week. This compares with 16% who had drunk alcohol, 6% who had smoked a tobacco cigarette and 5% who had taken illegal drugs.⁹
23. Approximately 55,000 children aged 11- 16yrs in the UK are estimated to be experiencing gambling disorder or addiction¹⁰. Of all age groups, young people aged 16-24yrs have the have the highest prevalence of ‘at risk’ gambling despite having the lowest participation in gambling.¹¹

24. Gambling related harms can have serious consequences for finances, relationships, and health, as well as feeling of shame, stigma, and helplessness. These harms are inherently complex and individualised. For many, gambling related harms leave a lasting legacy beyond initial recovery from gambling disorder and may be experienced for many years after the event.
25. Evidence shows that people with higher levels of gambling involvement and more severe gambling disorder experience the greatest degree of harms.¹² Gambling related harms are complex and will be experienced differently dependent upon individual circumstances. Although harms are categorised in Figure 1 by their impact on health, relationships, finances and criminal behaviour, they are frequently interlinked and entwined.
26. All harms are felt equally by the person who gambles and people affected by someone else’s gambling (which can include but is not exclusive to): friends, parents, partners, children, siblings).
27. The excess costs to the NHS, wider public sector and society have been estimated to be between £1.05 to £1.77 billion annually in 2021 to 2022 prices¹³. This is likely to be underestimated due to a lack of available evidence.

28. The 2021 Public Health England Gambling Related Harms evidence review identified that anyone can be harmed by gambling, however harms are not evenly distributed. People at the greatest risk of harm from gambling are more likely to be unemployed, living in more deprived areas, have poor health, low life satisfaction and wellbeing, and have an indication of probable psychological health problems. Particular populations, such as migrant communities and people with learning disabilities are at more risk of harm.¹⁴

29. There is limited local data on the numbers affected by gambling-related harms but the Gambling-related Harms in Southampton Health Needs Assessment does include estimated numbers experiencing, or affected by, harmful gambling in Southampton. Whilst recognising the limitations associated with extrapolating local data from national surveys, the harmful gambling estimates are based on national prevalences, derived from the 2021 Health Survey for England and the 2023 Gambling Survey for Great Britain. Affected Others estimates are derived from 2023 Annual GB Treatment and Support Survey.

30. The estimated number of adults experiencing harmful gambling in Southampton is between 6,160 and 31,900. An estimated 15,053 adults in Southampton are adversely affected by someone else’s gambling.
31. The HSE is considered to produce a more conservative estimate of problem gambling as it excludes people living in institutions such as student halls of residence, prisons, or experiencing housing instability. All prevalence estimates which are reliant upon self-reported data will underestimate true prevalence, particularly at the lower end of the scale, due to concerns disclosing ‘socially undesirable’ behaviours.¹⁵

32. The total excess cost associated with gambling-related harm in Southampton is estimated to be in the range of £4.7m to £7.9m.¹⁶ Costs are likely to be underestimated due to partial (or no) costing for some harm categories.

33. Public Health analysts in Southampton City Council’s Data, Intelligence and Insight team have modelled Harmful Gambling Risk Index scores for each Southampton LSOA (neighbourhoods containing between 400 and 1,200 households, with a resident population of between 1,000 and 3,000 persons) to help predict which areas of the city are most susceptible to harmful gambling.
34. Risk scores are comprised of indicators (covering health and social domains) associated with groups most vulnerable to harmful gambling, as informed by the current evidence-base.
35. The wards in Southampton that contain the highest numbers of neighbourhoods at greatest risk of harmful gambling in the city are Coxford, Woolston, Bevois, Millbrook and Swaythling.
36. An LSOA decile map of harmful gambling risk scores for Southampton is presented at Figure 5, predicting areas of the city at greatest and least risk of experiencing harmful gambling (coloured red and blue, respectively).
37. The index is predicated on the assumption that all indicators are independent and weighted equally.

38. With the scale, impact and local position with regards to gambling-related harms established at the inaugural meeting of the inquiry, the remaining meetings were focussed on opportunities to prevent harms in Southampton.
39. Meetings three to five of the inquiry were structured around the three types of prevention recognised by Public Health as central to addressing poor outcomes:
    • Primary prevention: taking action to prevent the onset of harmful gambling/gambling-related harm, through whole-population measures or those targeting vulnerable groups (i.e. those at greatest risk of harm).
    • Secondary prevention: early identification of those who have recently started experiencing harmful gambling/gambling-related harm, to prevent escalation of (and ideally reduce) harm.
    • Tertiary prevention: measures to lessen the impact on those already experiencing harmful gambling/gambling-related harm.
40. Due to the complexity and range of factors that can influence gambling-related harms, meeting two of the inquiry focused on the importance of adopting a broad and co-ordinated multi-sectoral approach based on public health principles to reducing gambling-related harm.

41. The diagram shown at Figure 6, presented to the Inquiry Panel by Professor Heather Wardle, summarises the determinants of gambling and gambling harms.

Figure 6 - Determinants of gambling and gambling harms

Source - The Lancet Public Health Commission on gambling, Wardle, Heather et al. The Lancet Public Health, Volume 9, Issue 11, e950 - e994

42. The determinants are complex, and the greatest burden and risk of harmful gambling is experienced by socio-economically deprived, disadvantaged and minority groups. However, anyone may be vulnerable to gambling harms at some point in their lives therefore an equitable and effective solution cannot be focused around clinical or individual intervention but on the structural, contextual and commercial drivers of gambling harm.¹⁷
43. Action to prevent harm from gambling is required across the whole population, not just directed at those most at risk or most vulnerable.¹⁸ A public health approach that looks at the needs of the population as a whole rather than solely at an individual level is required.¹⁹
44. Equally, as gambling harms impact so many areas, including crime, work and employment, cultural, financial, relationships, mental and physical health, the approach also needs a multi-sectoral response to address it.
45. The comprehensive approach required is described in Greater Manchester Combined Authority’s Gambling Harm Action Plan as being a ‘place based whole system population health’ approach.

46. The Inquiry Panel were fortunate to have the opportunity to speak with representatives from a number of combined authorities / local authorities / regions that have developed gambling harms reduction programmes.
47. In her presentation Professor Wardle informed the Panel that, in the absence of a fully realised national public health prevention strategy, through co-ordinated action it is possible for regional and local approaches to make in-roads into gambling-related harms in the immediate term.²⁰

48. In the North East it is estimated that 4.9% of the population (aged 16+) are at-risk gamblers, where they experience some level of negative consequences due to gambling. This is the highest regional prevalence of at-risk gambling in England and was the catalyst for seeking funding to co-ordinate action across the region.
49. The Association of Directors of Public Health in the North East (ADPH NE) were awarded £750,000 of funding from the Gambling Commission’s Regulatory Settlements Fund. The funding is hosted by Middlesbrough Council and has been used to develop and implement a 3-year regional gambling-related harms programme.
50. Over the last year, the ‘Regional Office for Gambling Harms’ has worked to provide strategic direction, leadership, support to the 12 local authorities and produce resources to support ADPH NE’s approach to gambling related harms.
51. A whole systems approach has been adopted with multi-agency membership and key stakeholders engaged, including Public Health, Newcastle University and people with lived experience. The governance structure for the gambling-related harms programme is shown below:

Figure 8 - ADPH North East (NE) Whole Systems Approach

Stakeholders include:

• Public Health colleagues
• Academia
• University wellbeing services
• Planning & Licensing
• Financial inclusion
• VCSE organisations
• Treatment & support providers
• MECC NE

52. A Lived Experience Forum has been established so that people from across the North East who have direct experience of gambling harms or are an affected other can help shape the public health approach. The forum has become a place for new ideas and feedback on resources and pilots to be shared and it has contributed towards the Regional Health Needs Assessment.
53. The regional approach is built on 8 pillars and is based on the regions approach to alcohol and tobacco.

Figure 9 – The North East Approach

54. Progress has been made against each of the pillars. Alice Beadle, Public Health Specialist for Gambling Related Harms working across the North East of England, identified employing dedicated resources to help co-ordinate activity and having a Research Associate at Newcastle University to lead on research and evaluate health and well-being outcomes caused by gambling-related harms in the North East, as being key to the progress.
55. As a result of the Research Associate role, research and evaluation has been embedded from the outset, ensuring that the programme is driven by evidence-based practice.
56. The programme evaluation will be undertaken by researchers from the NIHR (National Institute for Health and Care Research) Applied Research Collaboration (ARC) North East and North Cumbria (NENC) at Newcastle University.
57. In her presentation, Alice Beadle outlined the first steps that local authorities could take to reduce gambling-related harms that does not require the level of funding ADPH NE received from the Gambling Commission:

Figure 10 - First steps local authorities can take to reduce gambling harms

58. Approximately 1 in 7 residents in Haringey are affected by gambling harms.²¹ The London Borough of Haringey are utilising the Health in All Policies (HiAP) approach in their development of a Gambling Harms Reduction Programme, with the aim to prevent, reduce, and mitigate the negative consequences associated with gambling activities on individuals, families and communities.
59. Haringey are delivering this through six core elements, shown in Figure 11. With four crosscutting themes: partnership (a multi-agency Gambling Harms Reduction Partnership), improving data and evidence, communications, strategic work and policy change where needed. The programme addresses the needs through co-producing with residents and people with lived experience and affected others, who are at the core while Haringey shape and embed the works.

Figure 11 - Haringey's Gambling Harms Reduction Programme

60. Haringey were not awarded funding from the Gambling Commission to support their programme. Despite this, Marlene D’Aguilar, Health in All Policies Strategic Lead at Haringey Council, in her presentation to the Panel, outlined how the programme is transforming the lives of residents, service users and young people by addressing gambling harms comprehensively.
61. The HiAP approach has been very effective in building partnerships and gambling harms is now reflected in the refresh or development of strategies such as the corporate plan and Local Plan.

62. The Yorkshire & Humber Association of Directors of Public Health (Y&H ADPH) gambling harm prevention and reduction programme was funded between 2021 and 2024 by regulated settlement via the Gambling Commission.
63. Y&H ADPH relaunched framework adopts a public health approach to gambling harms that aims to prevent and reduce harms by supporting local action to protect the population across the life course – A Public Health Framework for Reducing Gambling Harms in Yorkshire and the Humber
64. This is underpinned by taking action based on:
    • The most up to date evidence base and research
    • Working in partnership across different areas of public health and beyond, including across the social determinants (housing, employment etc) to bring together different skills and resources and taking a whole-person approach.
65. The Y&H ADPH framework is split into six different topic areas for those working to prevent and reduce the effects of gambling harms:

Figure 12 - Y&H ADPH framework

66. A summary of the key outputs from the programme was provided by Simone Arratoonian, Health and Wellbeing Programme Manager, North East & Yorkshire Region at the Office for Health Improvement and Disparities (OHID).²²
67. Highlights include Insight into gambling behaviour and perceptions along with a review of the evidence-base; Mapping of online gambling harm information sources; Development of a regional marketing campaign; and an assessment of training needs, and development of independent training offer.

68. The Inquiry Panel had the opportunity to speak with representatives from local authorities / combined authorities / regional bodies that are recognised as leading the way nationally in the development of approaches to reduce gambling-related harms. From the discussions with these representatives, it was evident that they shared a number of features that have contributed to the progress that has clearly been made in these areas and the strong foundations that have been laid. These include the follow key aspects:
    • The approach has been led by Public Health and the harm reduction programme is multi-agency which works with others to reduce gambling prevalence and harms.
    • The engagement of those with lived experience of gambling harms to help inform and shape policy and actions.
    • The commitment to collecting data, conducting research, evaluating outcomes and strengthening the evidence base.
    • In recognition that the way to reduce gambling harms with the biggest impact is at national level, these bodies continue to advocate for changes in gambling policy at a national level to protect populations.
69. These key findings have informed the recommendations that are presented later in this report.

70. At the 16 January 2025 meeting the Inquiry Panel considered opportunities for primary prevention - taking action to prevent the onset of harmful gambling/gambling-related harm, through whole-population measures or those targeting vulnerable groups. The detailed report to the Inquiry Panel and the accompanying briefing paper on the role of planning is linked below:
    Primary Prevention
    Appendix 1 - Role of Planning.docx.pdf
71. Following the recommended areas of focus in the Gambling Related Harms in Southampton Health Needs Assessment,²³ the Panel considered opportunities to reduce the uptake of gambling and to reduce gambling supply and exposure.

72. Approximately 55,000 children aged 11- 16yrs in the UK are estimated to be experiencing gambling disorder or addiction.²⁴ Of all age groups, young people aged 16-24yrs have the have the highest prevalence of ‘at risk’ gambling despite having the lowest participation in gambling.²⁵
73. The Young People and Gambling 2024: Official statistics published in November 2024 reported that just over one quarter (27 percent) of 11 to 17 year olds had spent their own money on any gambling activity in the 12 months prior to completing the survey. The most common types of gambling activity that young people spent their own money on were legal or did not feature age restricted products, namely:
    • playing arcade gaming machines such as penny pusher or claw grab machines (20 percent)
    • placing a bet for money between friends or family (11 percent)
    • playing cards with friends or family for money (5 percent).
74. However, around 1 in 5 (21 percent) young people spent their own money on regulated forms of gambling in the past 12 months, this broad definition includes playing arcade gaming machines which are legally accessible to young people. If we remove arcade gaming machines from the definition, then 6 percent of young people spent their own money on regulated forms of gambling. This is an increase from 4 percent in 2023.
75. Over half of young people had seen or heard gambling advertising via online or offline platforms (online: 62 percent; offline: 64 percent). This represents a significant increase in exposure to gambling advertisements since 2023 (2023 findings: online: 53 percent; offline: 55 percent). Young people were most likely to report seeing gambling advertising on television (54 percent) or on an app (52 percent).
76. Given the vulnerability of children and young people to gambling harms and the increase in gambling activity and exposure to gambling advertising, the delivery of education programmes providing young people with the skills and strategies to think critically about gambling and the risks it poses is a sensible approach. Yet, unlike other risky behaviours such as alcohol and drugs, gambling is a topic rarely covered in schools.
77. The Gambling Related Harms in Southampton Health Needs Assessment identified that free GamCare sessions were offered to some secondary schools across Southampton. However, no industry-independent programmes were identified from discussions with stakeholders.²⁶

78. The Inquiry Panel had the opportunity to consider evidence presented on gambling harms information and awareness programmes delivered to children and young people.

79. GamFam is a charity set up by those who have experienced first-hand the devastating effects that gambling can have on family and friends. Its vision is to empower individuals and families to alleviate the impact of gambling harms and move towards a positive future. It does not receive funding from the gambling industry.
80. GamFam deliver accredited information and awareness sessions in Norfolk, Suffolk and Essex to schools, colleges, professionals and other support services. They have recently launched a Key Stage 2 programme and a grassroots football programme.
81. The sessions are delivered by people with lived experience. Feedback demonstrates significantly increased awareness and understanding of gambling harms following the sessions.
82. In his presentation to the Panel, Steve Watts – GamFam Chief Executive, explained that delivering sessions in schools and colleges can be challenging. If lessons are delivered by teachers through PSHE (Personal, Social, Health and Economic education) it can result in an inconsistent message and that sessions should be delivered by a gambling harms specialist.

83. The Red Card Gambling Support Project is a not for profit organisation that has a vision to make sure that people from all backgrounds and cultures are educated about the dangers of gambling harms and the impact it can have on our lives.
84. Red Card, led by their CEO, Tony Kelly and team of lived experience facilitators, have delivered workshops covering gambling, gambling within gaming and their harms to secondary schools and youth hubs within Haringey.
85. For many, this is the first-time teachers and other school staff have gained an understanding of gambling within gaming including ‘skins gambling’ and 'loot boxes' and students understand the implications.
86. All school leads and students rated the workshops very highly and the approach has ensured that a high level of student engagement is consistent across all schools and youth venues.²⁷

87. The gambling industry spends millions of pounds each year to advertise and market their products. The findings from the 2024 Young People and Gambling Survey highlighted in the previous section demonstrates how pervasive gambling advertising has become.
88. However, research evidence has highlighted that industry-funded messaging that promotes narratives of personal responsibility (“when the fun stops, stop” and “take time to think”) is insufficient at preventing harm, and can contribute to stigma.²⁸
89. To raise awareness of how gambling products and practices can cause harm a number of local authorities have developed their own public health campaigns.

90. Odds Are: They Win was the first gambling harms prevention campaign in Greater Manchester and one of the first in the UK. The campaign sought to move the message away from personal responsibility messaging - ‘safer gambling’.
91. The campaign initially ran before, during and after the 2022 Football World Cup with a target to reach men aged 18-40 with harms messaging and to raise awareness of work taking place in Greater Manchester. The campaign utilised outdoor advertising and social media and GamHive, a lived experience group, provided feedback on the advertising campaign.
92. The World Cup concluded in December 2022. The first 6 weeks of 2023 saw the same number of people seek gambling addiction support on the GMCA website as for the whole of 2022.
93. When resources reduced a new evidence informed approach to the Odds Are: They Win campaign was used. There was an increased focus on gateway events, In-play betting, online slots, gamblers attempting to make money from gambling, gambling sponsorship when ad hoc when opportunities arose. Some organic content performed better than paid for advertising, demonstrating that small pots of money can be used in a very cost effective way.
94. To support the awareness raising campaign Greater Manchester Combined Authority, in collaboration with ADPH Yorkshire and the Humber and ADPH North East created a language guide for gambling harms – ‘Words can hurt’.
95. The guide acts as a tool to double check your language choices on publications, reports, websites and strategies to ensure language is not stigmatising and frames harm from a population health approach. 
96. Ellie Caddick, Senior Communications and Engagement Manager at Greater Manchester Combined Authority, when addressing the Panel, referenced the value of the language guide and the importance of having resources in place prior to commencing an awareness campaign so that you are ready for when people ask for help.
97. To help deliver this, GMCA, in partnership with Gambling With Lives, created Chapter One, an initiative dedicated to providing clear, accessible information and support for everyone affected by gambling.
98. Nationally, gambling harms awareness campaigns are expected to benefit from the government announcement that 30% of the expected £100m to be raised annually by the Statutory Levy on gambling operators²⁹ is to be spent on a comprehensive approach to prevention across Great Britain. This could include measures such as a national public health campaign and support for education, information and awareness initiatives.

99. Licensing authorities have a statutory role regulating local gambling premises and various tools to try to prevent gambling related harm occurring in premises. Planning policy can also play a role in relation to local gambling outlets.

100. Southampton City Council adopted a new Statement of Licensing Principles, commencing 31^st January 2025 at a meeting on 27 November 2024 - Gambling Act 2005 - Statement of Principles.
101. Whilst it is recognised that the current statutory ‘Aim to Permit’ duty severely limits a council’s ability to prevent the opening of gambling venues, even when the community is unequivocally against it, with the support of Public Health, the new policy is much stronger at protecting children and vulnerable people from gambling harms. The policy is underpinned by a local profile that brings data and evidence together to inform decision making. 
102. A risk assessment has to be completed by each venue in relation to the local area profile. This is the key document for Licensing Officers when they inspect premises.
103. The policy is limited by the availability of data on harmful gambling within the city, but the intention of the Licensing Team is to work closer with venues on identifying risks and highlighting support services.

104. Evidence submitted by Amber Trueman, Southampton City Council’s Strategic Planning Manager, informed the Panel that it is possible to create targeted planning policies that seek to control the proliferation of gambling outlets. Such a policy would also need to be adopted as part of the new Local Plan for the city, known as the Southampton City Vision, in order for it to be used in deciding planning applications. The current suite of Local Plan documents does not include such a policy.
105. A new policy controlling the proliferation of gambling outlets would not be applied retrospectively and would need to be justified through a robust evidence base.
106. Notably, there are examples of other local authorities having successfully adopted a policy controlling the proliferation of specific types of gambling outlets. Whilst these policies take different approaches there are some commonalities. For example, specifying that there must be a certain number of units with other uses between the types of gambling outlet they are seeking to control.
107. Analysis of Southampton City Council’s 2023 Centres Survey indicates that the percentage of gambling outlets in each centre is relatively low. More specifically, at present, the percentage of gambling premises in the district centres is between 1.98% and 3.23%, other than Lordshill which has a result of 12.5% due to the low number of commercial units. As such, a percentage threshold would likely not be the most effective option. However, further detailed analysis would be needed before reaching any firm conclusions or decisions as to which approach should be taken, if a policy is deemed necessary.

108. Out of 330 councils, for the number of people per gambling premises, Haringey has the 13th highest concentration of gambling premises relative to population.³⁰
109. Public Health respond to all licensing and planning applications in Haringey for gambling premises and have been successful in having applications refused.
110. For license applications Public Health’s response is always based on the licensing objectives in the Gambling Act 2005 (usually protecting children and vulnerable residents). In Planning the response will tie in with planning policy. For both, priorities in the Corporate Plan and Health & Wellbeing Strategy are referenced and they use Business Intelligence Teams, Public Health Intelligence, crime data, mapping and benefits data to support the response.
111. Reflecting the importance of updating and adding to data and evidence, Haringey are working with universities to get students to improve local data about gambling in the London Borough. Data is sought from gambling services and local treatment centres to evidence vulnerability.
112. The new Haringey Local Plan is in development, and it will feature a strengthened approach to reducing gambling harms. Work is underway with Licensing on drafting a new Gambling Policy, Local Profile and Needs Assessment.

30 - https://www.southampton.gov.uk/modernGov/documents/s77685/3%20-%20Marlene%20DAguilar%20-%20Haringey.pdf

113. Consideration of the evidence presented to the Panel on opportunities to reduce the uptake of gambling and gambling supply and exposure have enabled the following key findings to be identified:

Education

• Evidence presented to the Panel demonstrated the benefits of delivering information and awareness sessions to children and young people (and parents) on gambling harms that is evidence-based and robust, independent from gambling industry influence, and preferably delivered by specialists.

Gambling Harms Awareness Campaigns

• An important part of prevention and protection of gambling harms is to raise public awareness about the risks of gambling products, the potential harms from gambling and where to access help.
• The importance of having resources in place prior to commencing an awareness campaign so that you are ready for when people ask for help – For example ensure that your linked website is informative and up to date.
• The value of the ‘Words can hurt’ language guide to avoid stigma when discussing gambling and gambling related harm.

Influencing the regulatory environment

• Working in partnership across Public Health, Licensing and Planning can help to prevent and reduce gambling harms. There exist opportunities to ensure that Southampton City Council’s licensing and planning policies reduce gambling supply and exposure by controlling the proliferation of gambling outlets.
• The importance of collecting, analysing, using and sharing local gambling harms data.

115. At the 13 February 2025 meeting the Inquiry Panel considered opportunities for secondary prevention - early identification of those who have recently started experiencing harmful gambling/gambling-related harm, to prevent escalation of (and ideally reduce) harm. The detailed report to the Inquiry Panel is linked below:
     Secondary Prevention
116. Following the recommended areas of focus in the Gambling Related Harms in Southampton Health Needs Assessment,³¹ the Panel considered opportunities to identify and support those experiencing gambling-related harms.
117. Gambling harms have a direct impact on areas that local government is responsible for addressing – Poverty, health and wellbeing, economic growth, inequalities and community safety. Those who are most vulnerable to gambling harms are also more likely to be in contact with or receiving support from council services, and the wider public sector. These include:
     • Homelessness services, given the high prevalence of gambling harms among the homeless population.
     • Wider housing services, given that gambling harms can be a contributory factor in rent arrears.
     • Financial inclusion services, including Citizen’s Advice, given that harmful gambling can be a contributory factor in financial problems.
     • Children’s services and adult social care, where harmful gambling may be a contributory factor to family breakdown or domestic abuse.
     • Criminal justice services, reflecting the link between gambling and crime.
     • Drug and alcohol treatment services, given high rates of co-morbidity between these addictions and gambling harms.
     • NHS services, due to the relationship between harmful gambling and mental and physical health.
118. There are steps that councils and partner organisations can take to help identify residents experiencing gambling-related harms, and affected others, and assist and encourage them to access the support that is available.
119. The joint LGA and Public Health England publication – ‘Tackling Gambling Related Harm: A whole council approach’ published in 2018, indicates that council’s should:
     • Ensure that frontline staff are provided with training on harmful gambling so they recognise potential cases.
     • Help local residents access support by signposting to gambling support services.
     • Seek to work with local partners and build links with support organisations to help develop specific local referral pathways and ensure these can be accessed from across the full range of local services.
     • Capture data about it, to help understand the extent of harmful gambling, impacts and costs associated with it.
120. NICE (National Institute for Health and Care Excellence) published guidance on identifying, assessing and managing harmful gambling on 28^th January 2025.³² The guidelines have been produced for:
     • Commissioners and providers of gambling treatment and gambling support services
     • Healthcare professionals and social care practitioners in all settings, including the criminal justice system
     • People who experience gambling-related harms or who use gambling treatment and gambling support services, their families and affected others.
121. The guidelines on ‘case identification, initial support, referral and assessment’ (1.1) are particularly relevant to identifying and supporting those experiencing gambling-related harms. The guidelines include encouraging the adoption of the Making Every Contact Count (MECC) very brief intervention approach that promotes, in this case, healthcare professionals or social care practitioners to ask standardised questions about gambling in a range of settings with locally agreed signposting to support.

122. The Panel sought to understand efforts being made in Southampton to identify residents experiencing gambling-related harms and to assist and encourage them to access the support that is available.

123. Kirsty Rowlinson, Chief Officer at Citizens Advice Southampton and Teresa Hadwick, Accredited Debt Caseworker at Citizens Advice Southampton informed the Panel that Citizens Advice helped almost 8,000 people in Southampton with over 27,000 problems last year. Gambling harms is encountered in all parts of the service.
124. For every debt case that is opened the Citizens Advice database asks advisers to raise questions about gambling. Citizens Advice advisers ask questions, check bank statements and advise clients about the effect of gambling on debt options.
125. A six part on-line training course is provided to advisers by National Citizens Advice. The training helps advisers to act on the gambling prompts on the Client Management System and use the referral tool to refer clients for specialist help with their gambling harms, either through GamCare, or, on occasions their GP. Funding models do however limit the amount of gambling support Citizens Advice can offer.

126. A limited survey was conducted by the Scrutiny Manager of various service leads at Southampton City Council and the Safe City Partnership to help ascertain if frontline services in Southampton were actively identifying and supporting those experiencing gambling-related harms and whether they had received training to perform this role.
127. There was a limited response:
     • Children’s Services refer and signpost on a case by case basis, or parents are encouraged to self-refer. It was recognised that the Conversation Model, introduced by Children’s Services in January 2025, may also assist in identification and support.
     • For Public Health commissioned services gambling is considered in assessments and in reviews for drug and alcohol services.
     • Homelessness Services do not ask questions about gambling, it is not recorded. It may be identified when bank statements are analysed. Individuals may be referred to support following an internet search as no referral pathway has been identified.
     • The Welfare Rights Service, a service that supports City Council tenants, does not use gambling harms screening questions, keep statistics on gambling harms or have a framework to refer tenants to.
     • A new Housing Strategy is currently being developed. There is an opportunity to include identification and support for gambling harms across Housing Services.
     • No gambling-harms training for council employees was identified.

128. Whilst recognising the limited action being employed by Southampton City Council to help identify residents experiencing gambling-related harms, and affected others, and assist and encourage them to access the support that is available, the Panel were provided with a number of examples of proactive practice from other local authorities and regions.

129. Birmingham City Council (BCC) had identified harmful gambling behaviours as a key and growing factor in tenancy loss. To improve understanding of the links between gambling harm and tenancy insecurity, and to help develop intervention strategies to prevent tenancy loss as a result, BCC worked on a 2-year project with the Centre for Personal Financial Wellbeing (CPFW) at Aston University. The project was funded by the Gambling Commission’s Regulatory Settlements Fund.
130. A survey of BCC tenants identified that 1 in 5 of tenant respondents were affected by harmful gambling; 4 in 10 ‘problem gamblers’ were currently in rent arrears, compared to 2 in 10 of the other gamblers (harmful gambling cited as main reason for rent arrears); 30% of ‘problem gamblers’ say gambling spending reduced their ability to pay their council rent; 13.5% of problem gamblers received eviction notices.
131. Qualitative interview findings highlighted issues like the concentration of bookmakers in deprived neighbourhoods, the ease of gambling online and the exposure to TV and social media gambling advertising as well as heightened cultural stigma for women of different nationality backgrounds.
132. As the direct result of this work a number of key interventions and changes to the practices with BCC have been created or enhanced. These include:
     • 116 housing officers across different service departments have received harmful gambling awareness training.
     • 8 BCC tenants (some with lived experience) received harmful gambling training.
     • New harmful gambling webpages linked to cost-of-living support webpages have been created and widely advertised.
     • Changes have been made to the Council’s housing management system (Northgate) to enable specific recording of harmful gambling and referral support to enable better tracking of interventions and the outcomes of interventions to support specific managerial oversight of the impact of harmful gambling related activities going forward as new KPIs.
     • Changes have been enacted within the (TSS) housing department’s letting system to add harmful gambling as a targeted vulnerability option to support provision by frontline officers of improved early identification of where harmful gambling is contributing to tenancy financial challenges going forward, and to signpost the need for download and completion of harmful gambling referral forms with the express aim of reducing tenancy loss related to gambling behaviours, but also reduction in the growing levels of rent arrears resulting from harmful financial impacts of gambling.
     • 8 tenants have been referred to BCC’s local harmful gambling support charity, Aquarius, in the previous 6 months (compared to none in previous two years) for harmful gambling support through this project.
     • A large set of data on the connections between harmful gambling and BCC tenants has been collected, analysed and provided to BCC for further use in developing and enhancing their strategic support of tenants.
133. Further details of the project led by Dr Halima Sacranie and Professor Andy Lymer can be accessed here: https://www.aston.ac.uk/sites/default/files/2024-03/harmful_gambling_and_tenancy_security_bbc_aston_uni_executive_summary.pdf

134. Betknowmore UK is part of the National Gambling Support Network and has a mission to provide support and training services that prevent and address personal and societal harms caused by gambling.
135. Betknowmore UK delivered a WorkSafe session to Islington Council staff members from across departments to better equip them in having conversations around gambling harms and awareness around the topic.
136. Betknowmore have been holding sessions at Access Islington Hubs. These centres offer local people the opportunity to access early intervention and prevention services that support their needs.
137. At the time of the Matt Smith’s, Director of External Affairs at Betknowmore UK, December 2024 presentation to the Inquiry Panel, Betknowmore UK had held 18 Hub sessions and facilitated 348 brief interventions. Betknowmore UK is now widening its engagement with Islington Council services in addition to attending Hub sessions.

138. Haringey Council have facilitated bespoke training on gambling harms to organisations across the London Borough. The Council Leader and Lead Members were the first to be trained followed by the remaining Councillors.
139. 244 Staff had been trained across Haringey Council, GP Federation, wider primary care teams and voluntary and community sectors. There is a rolling programme of training delivered by GamCare and supported by the Council’s Learning and Development team.

140. Chapter One, the partnership established between GMCA and Gambling with Lives to pilot an integrated treatment and support pathway in Greater Manchester, offers free training to professionals, in person or online to provide them with the tools and information they need to provide the right support to people experiencing gambling-related harms.
141. GMCA have also created an employee support policy which helps workplaces to embed best practice for gambling harms to support their colleagues.

142. Programme outputs from the Gambling Harm Prevention and Reduction programme in Yorkshire & the Humber include the assessment of workforce training needs, and the development of an independent training offer to support conversations and signposting.
143. These online sessions aim to increase awareness and understanding of gambling-related harms and guide staff to have sensitive conversations and signpost or refer to support. Working with local authority partners and services across the region, this will be available to key frontline staff in communities who may encounter people affected.
144. Y&H ADPH have also updated their Y&H MECC Gambling Harms guidance to complement the training offer and share understanding of how to have a brief conversation about gambling harms.
145. Y&H ADPHs Public Health Framework for Reducing Gambling Harms in Yorkshire and the Humber supports workplaces to introduce a gambling harms policy or guidance to support employees, including guidance for managers.

146. The joint LGA and Public Health publication – ‘Tackling Gambling Related Harm: A whole council approach’, published in 2018, identifies 4 key actions, referenced in paragraph 119, that councils should be doing to help identify and support those experiencing gambling related harms. Consideration of the evidence presented to the Panel indicates that the guidance provided in 2018 remains as relevant today as it was then. The key findings identified therefore draw heavily on the 2018 advice and are as follows:
     • The importance of providing gambling harms training to key frontline staff and members to increase awareness and understanding of gambling-related harms and guide staff to have sensitive conversations and signpost or refer to support.
     • The value of very brief interventions to complement the training offer on gambling harms.
     • The contribution that collecting, analysing and sharing data can play in developing and enhancing support for gambling harms.
     • Most public sector organisations will have a workforce alcohol and drugs policy. To support employees with gambling harms there is clear merit in introducing a gambling harms policy or guidance.
     • The refresh of the Council’s Housing Strategy presents an opportunity to reduce gambling prevalence and harm amongst Southampton City Council’s tenants and those that contact Housing Services.
147. These key findings have informed the recommendations that are presented later in this report.

148. At the 6 March 2025 meeting the Inquiry Panel considered opportunities for tertiary prevention - measures to lessen the impact on those already experiencing harmful gambling/gambling-related harm. The detailed report to the Inquiry Panel is linked below:
     Tertiary Prevention
149. Following the recommended areas of focus in the Gambling Related Harms in Southampton Health Needs Assessment,³³ the Panel considered opportunities to improve access to treatment and lessen the impact of gambling-related harm.

150. The Office for Health Improvement and Disparities (OHID) commissioned researchers at the University of Sheffield and the University of Glasgow to produce estimates of the number of adults who gamble in England who might benefit from treatment or support.
151. The researchers concluded that in England, excluding the estimated 7% of the population that are negatively affected by someone else’s gambling, there are almost 1.6 million adults who gamble who may benefit from some type of treatment or support for harmful gambling.³⁴
152. Extrapolating the OHID data and treatment figures for 2022/23, Chapter One references that, excluding early interventions or the provision of advice, only 1 in 200 people experiencing gambling harms who would benefit from help are currently accessing treatment and indicates that it’s not easy for people to find information about what help is available and how to access it.^{35 36}

153. In 2024 OHID published an assessment of the existing adult gambling treatment system in England to improve understanding of the system’s strengths, weaknesses and areas for improvement.³⁷ The reviews key findings are outlined below:

Characteristics of the gambling treatment system in England

• Gambling treatment in England is primarily commissioned by 2 bodies, GambleAware and NHS England (NHSE). GambleAware is a charity operating across Great Britain that commissions research, gambling harm education and treatment services.
• Gambling treatment is provided in clinical settings by the NHS and in community and residential settings by the third sector. The National Gambling Helpline is the most common route into treatment and mostly sends referrals to third sector providers. Self-referral is the second most-reported route.
• In 2021 to 2022, the median time people in a treatment episode reported gambling before presenting to treatment was 10 years.
• In 2021 to 2022, for treatment episodes that had a recorded exit reason, 92% of treatment episodes that completed scheduled treatment recorded an improvement in their Problem Gambling Severity Index (PGSI) score.

System strengths

• A wide range of treatment options for people who gamble and affected others, including some culturally or socially specific services, connections to other parts of the treatment pathway like aftercare and recovery, and to services such as debt management.
• Good examples of strong working relationships between some providers as well as the wider health, social care and justice services and increasingly made gambling a health priority in terms of resources.

Challenges and areas for improvement

• Data collection and reporting
• Structure of the gambling treatment model and referral pathways - There is a lack of clarity about referral pathways to gambling treatment and inadequate links with wider services, which is a problem particularly for service users with complex needs.
• Co-ordination in the gambling treatment system - Relationships between NHS and third sector providers were poor, partly due to different beliefs about the current funding model for treatment. The lack of communication between NHS and third sector services prevented strategic co-ordination.
• Governance - Some stakeholders had concerns about service governance structures and their transparency.
• Awareness of gambling harm, support and prioritisation - There was a lack of knowledge about gambling harms and available treatment options among professionals in wider health care, social care and justice services.

Suggestions for improving the treatment system

• Data collection and reporting - There needs to be standards developed for all treatment providers on data collection and reporting and improved longer term monitoring of service user journeys.
• Structure of the gambling treatment model and referral pathways - It would be beneficial to develop a standardised triage system with clear referral criteria, while still allowing flexibility for service users.
• Co-ordination in the gambling treatment system - Changing the funding model to remove reliance on gambling industry donations could help improve relationships and system co-ordination between NHS and third sector providers.
• Awareness of gambling harm, supports and prioritisation - Training and awareness about gambling harm and available support could be introduced or increased for non-gambling frontline professionals.

154. The NICE guidance for identifying, assessing and managing gambling-related harms³⁸, published in January 2025, has reflected on the challenges identified in the OHID report.
155. The NICE guidelines make specific recommendations relating to:
     • Models of care and service delivery
     • Improving access to treatment
     • Treatment of gambling-related harms
     • Relapse and ongoing support
     • Interventions and support for families and affected others.
156. If implemented consistently the guidelines should help inform the future model of care, reduce stigma and barriers to access, and improve standards of provision and service delivery.
157. To fund gambling treatment and support services, in November 2024, when the Government announced that it was going to bring forward a statutory levy on gambling operators to generate £100 million for the research, prevention and treatment of gambling harms, the accompanying Ministerial Statement³⁹ identified that treatment and support will be allocated 50% of levy funding and be overseen by NHS England, and appropriate bodies in Scotland and Wales. They would be charged with commissioning the full treatment pathway, from referral and triage through to aftercare. Following the announcement of the abolition of NHS England, clarification is awaited on the body in England that will oversee treatment for gambling harms.

158. The research undertaken by the University of Glasgow and the University of Sheffield estimating the number of adults and children who might benefit from gambling treatment and support has been extrapolated to local authority areas. In Southampton, gambling treatment need and prevalence statistics⁴⁰, indicate that 9,131 adults might benefit from gambling treatment and support and 5,320 children living in the same household as adults, might benefit from some type of treatment or support.⁴¹
159. Given the figures above, service-provider data presented in the Gambling Harms Needs Assessment⁴² suggests significant unmet need in Southampton:
     • 0.1% - 0.6% of people experiencing gambling harms in Southampton called the GamCare National Helpline in 2022/23, with even lower proportions entering treatment via the National Gambling Support Network (0.07% - 0.34%)
     • Between Sept 2022 and June 2024, the Southern Gambling Service received 208 referrals from people living in the Hampshire and Isle of Wight area.
160. Chapter 4 in Southampton’s Gambling Related Harms Health Needs Assessment summarises the main treatment and support services currently accessible to people living in Southampton. The assessment concludes that:

‘There are numerous treatment and support services available to people living in Southampton, either directly or indirectly linked to harmful gambling/gambling-related harms. Services are a mixture of local and national, provided by the NHS and other providers (including the voluntary sector), funded independently or directly/indirectly by the gambling industry. An ICB-commissioned regional specialist service is also in place (the Southern Gambling Service).’ ⁴³

As of Monday 7^th April 2025, all services are now under the Statutory Levy.

161. The discussion with service providers, commissioners and residents with lived experience at the 6 March meeting of the Inquiry Panel concurred with the assessment. There was recognition that the range of services in Southampton was fairly comprehensive and that the city was fortunate to host the NHS Southern Gambling Service (SGS). SGS provides a range of specialist therapies and treatments for adults experiencing gambling harms, including affected others. The service supports a journey of recovery providing access to resources and peer support groups provided by GamFam.
162. It was recognised that the diverse range of support and treatment services available provided choice to those requiring support. The more choice the greater the likelihood that there will be a service that meets an individual’s needs.
163. The value of the entire network of support and treatment services was raised. It was recognised that SGS cannot address gambling issues in Southampton acting alone. It requires a co-ordinated range of support and specialist treatment services to provide the level and type of support required by those experiencing gambling harm.

164. A number of barriers to accessing treatment and support services were raised at the meeting. Stigma was recognised as a significant barrier and gambling harms awareness needs to be delivered to reduce stigma. There is an opportunity for the NHS Hampshire and Isle of Wight communications to be utilised to help breakdown the barriers and associated shame and guilt.
165. Greater awareness of the support and treatment that is available, and clarity regarding referral pathways and effective links with wider services, such as mental health and substance misuse services, would help those impacted by gambling harms and those wanting to refer people to support and treatment.

166. If the NICE guidelines are followed by NHS, Criminal Justice and Social Care practitioners it should result in more brief interventions and timely referrals to support and treatment services, improved co-ordination, and more consistent treatment standards. This must be encouraged.
167. However, it was recognised that capacity to treat and support residents impacted by gambling harms would be stretched if the level of unmet need decreased. NHS Southern Gambling Service is currently accepting 480 referrals a year (it is funded for 350). It can manage this workload, waiting lists are limited and demand is stable, but could not support a surge in referrals without additional resource.

168. Whilst there has been no confirmation, and the NHS is undergoing considerable upheaval, it is likely that some responsibilities for commissioning the full treatment pathway, from referral and triage through to aftercare, will be devolved to NHS Hampshire & IOW. There is an opportunity for Southampton to advocate for a local approach that meets the needs of our communities.

169. The NICE guidelines recommend that healthcare professionals and social care practitioners discuss with people experiencing gambling-related harms practical self-exclusion techniques that could be used to prevent gambling, including:
     • Blocking software or tools to prevent online gambling
     • Blocking marketing messages
     • Self-exclusion systems for land-based gambling such as casinos, arcades and betting shops
     • Systems that block gambling payments through the person's bank account
     • Methods to limit access to money, for example, agreeing that a family member will take control of finances⁴⁴
170. Evidence relating to the effectiveness of harm-minimisation tools (also referred to by industry as ‘responsible gambling’ tools, including self-exclusion techniques) in lessening the impact of gambling harm is summarised in Southampton’s Gambling Harms Health Needs Assessment as being potentially effective tertiary prevention measures.⁴⁵
171. The importance of self-exclusion measures was identified by residents with lived experience and Dr Konstantinos Ioannidis, Lead Clinician and Consultant Psychiatrist, NHS Southern Gambling Service, at the 6 March meeting.

172. The available statistics and the discussion with residents with lived experience and providers and commissioners of gambling harms support and treatment services, have enabled the following key findings to be identified about opportunities to improve access to treatment and lessen the impact of gambling-related harm:
     • Residents of Southampton impacted by gambling harms currently have a choice of support and treatment services available to them. The landscape of providers is potentially complicated to navigate.
     • The complexity of the provider landscape and stigma can present a barrier to accessing services. Gambling harms awareness campaigns, with NHS support, could help reduce stigma.
     • NICE guidelines, if implemented, present a clear opportunity to improve the identification, assessment and management of gambling-related harms, lessening the impact of gambling-related harms on those already engaging in harmful gambling behaviours and their affected others.
     • There is an opportunity for Southampton to engage the NHS, particularly if responsibility is devolved to local NHS commissioners, to advocate for a local referral pathway that meets the needs of the city, funded by the NHS.
     • Local leadership from the Council and partners would be required and there would be a need to develop relationships with providers and engage people with lived experience.
     • Consideration must be given to scaling up support and treatment services to meet the significant level of unmet need.
173. These key findings have informed the recommendations that are presented later in this report.

174. A summary of the key evidence presented at each of the inquiry meetings is attached as Appendix 3. All the reports, presentations and minutes from the inquiry meetings can be found here:

Browse meetings - Scrutiny Inquiry Panel - Reducing Gambling-Related Harms in Southampton | Southampton City Council

175. Evidence presented to the Panel has clearly outlined the harm that gambling causes in Southampton. As so expertly put by Greg Fell, Director of Public Health at Sheffield City Council in the foreword to the Yorkshire and the Humber Association of Directors of Public Health Framework for Preventing and Reducing Gambling Harms:

‘The harms are a consequence of the products in use, how these products are promoted, and the environment in which these products are presented, encouraging intensive and prolonged consumption. The harm caused is physical, medical, social and financial. It is not equally distributed in society. Children and young people are increasingly exposed to gambling products, not only causing harm now, but creating the next generation of consumers. The gambling industry is a sophisticated one, employing a well-used playbook to maximise profits. We have seen this before with other health harming industries; the tobacco industry being a recent example. This means we know how to respond, we know what works to reduce harm.’⁴⁶

176. This inquiry has shone a light on the extent and nature of the harm caused to our residents and it is now time for Southampton City Council to acknowledge that gambling harm is present and has a strategic intent to use the tools that it has available, and the best practice identified from the vanguard authorities, to reduce the harm that comes from gambling.
177. In line with the response to tobacco and alcohol, it is the recommendation of the Scrutiny Inquiry Panel that Southampton requires a multi-agency gambling harms reduction programme. The partnership delivering this programme will seek to:
     • Understand and evidence the harm that comes from gambling
     • Communicate that understanding to partners and populations
     • Introduce and influence policies that seek to prevent and reduce that harm
     • Develop projects that will engage with and reduce the harm.
178. The Scrutiny Panel has identified four ways that this can be done, and these four themes should form the basis of the strategy/action plan, which will be developed as evidence and practice evolves. Themes, partners and action plans are to be updated as gambling related harm work evolves to ensure the best local approach for the people of Southampton.