A response to the gambling reform policy paper

" . . . profit continues to be placed ahead of health and life itself." A response from Consultant Psychologist Matt Gaskell to the government's gambling reform policy paper.

Matt Gaskell, clinical lead of the NHS Northern Gambling Service

After repeated delays the government’s white paper on gambling was finally published on 27 April 2023.

The liberalisation of our gambling laws in 2005 has had devastating consequences to millions of individuals and families, as well as our local communities, including hundreds of gambling-related suicides estimated every year.

This has been felt most acutely by the revolution in online gambling, which encourages intense engagement with addictive continuous forms such as slots, roulette, in-play football, and virtual sports, accessible 24/7 while ‘on the go’.

So, what does it promise from a health perspective, and where does it fall short? While there are signs of progress, there are fundamental problems that remain unaddressed, meaning people will continue to needlessly suffer. Of concern, most of the important measures have been put out to further consultation, when the government has all the evidence it needs to act now.


Signs of Progress

Reformers, led by those with lived experience of gambling harm, and politicians courageous enough to stand up for our communities, have succeeded in focusing the government’s attention on relevant policy areas, and they have taken the public with them, who demand action.


The statutory levy will end gambling industry influence into information, research, education and treatment, which has deliberately impeded progress for so many years. There will be engagement with research councils, and we can finally set a programme of policy relevant research, focusing on the source of harm, industry products and practices, and their consequences.


The levy should be overseen by the Department for Health and Social Care (DHSC), and this will mean we will get meaningful prevention activities, such as national public health campaigns. This will put an end to the damaging and industry-friendly ‘responsible gambling’ campaigns and messaging. There will be no more ‘when the fun stops, stop’ or ‘take time to think’.


The public should hear the unvarnished truth about gambling harm, but how will this fair against the £1.5bn of gambling advertising which normalises the product? There will also be a significant increase in the availability of evidence-based integrated treatment and support through the NHS, for individuals and affected loved ones. But the levy is not enough, we need to prevent the harm in the first place through evidence-based policy.


The white paper acknowledges that the product is harmful to health and must be regulated. A significant step and should lead to an increased role for DHSC for health-related matters. If the consultation focuses on evidence rather than appeasing vested interests, we will see stake limits of £2 per spin on online slots (only 6% of spins are above this), and significantly slower speed of play.


This would see a meaningful reduction in harm including loss chasing, as it did with land based fixed odds betting terminals (FOBTs). However, many of our service users, including women, play for time rather than money, sucked into a mindless dissociated state for prolonged periods, and there is concern they are not being protected. Many overseas jurisdictions do not allow online casino gambling for good reason, and we have failed to act sufficiently here.


There are other potential signs of progress. The possibility of mandatory deposit limits rather than the current voluntary arrangements. This needs to be delivered rather than considered. There are more resources for the Gambling Commission to track compliance, which is clearly needed. The government will introduce an ombudsman for customer disputes and redress, which has been sorely lacking until now.


It will only matter if the industry is not able to influence the make-up of this, and it lacks statutory powers which is another example of a missed opportunity. There will also be data sharing across operators, which will stop those suffering significant harm being able to move to other operators when an account is restricted or closed down. Category D machines have been a gateway for many children into addiction, and the government will mandate that these machines are for adults only. There will also be increased powers for local authorities, who have been powerless to prevent the gamblification of our deprived communities.


The not so good

The white paper does not set a public health policy framework, and the framing of gambling harm (e.g. suffered by a minority of vulnerable individuals) by government continues to set the wrong tone for effective policy. There is no action on gambling advertising, and children as well as those harmed will continue to be exposed. Advertising is a common threat to our service users’ recovery, and the gateway into an unsafe industry. A market to be tolerated in its current state, not stimulated. Many European countries have imposed significant curbs on advertising, and this represents a major failure of the white paper to reduce harm.


The gambling industry will continue to profile and use marketing to access customers engaged in gambling harm – to prompt, nudge, incentivise, send offers and even money into accounts. Our service users enter gambling mostly through sports (for men) and bingo (for women) and then they are cross-sold the addictive online casino content. This has not been stopped and this is another missed opportunity to prevent significant harm. Online casino content should be completely separate from lower risk sports gambling, and there is nothing in the white paper about this. Most alarming, the culture of VIP programmes for the biggest loss-making customers looks set to continue.


Our national sports will continue to be hijacked by gambling advertising and sponsorship. The recently announced voluntary ban on front of shirts advertising in football sends a confusing message, as advertising will continue on shirt sleeves, the perimeter of stadiums, on TV, radio and online. How can it be harmful on a shirt front, but not elsewhere? Children will continue to be exposed, and sport will continue to be a major gateway into harmful forms of gambling.


Cross-operator independent and real-time affordability checks hold so much promise to prevent gambling harm. The principle of affordability checks has been won by reformers and for the first time mandatory thresholds will be set. However, the threshold guidance within the white paper means that they would only kick in if £1,000 is lost within 24 hours, or £2,000 over 90 days. This would not impact the vast majority of those experiencing harm and addiction, and the culture of allowing unaffordable losses looks set to continue.


There will also be a significant increase in the number of gambling machines in smaller casinos and the relaxing of rules to allow higher stake machines in casinos generally. Gambling machines are the most addictive product on the market. Wasn’t this supposed to be an evidence-based review? The review seems to have ignored the harm of land-based gambling. These measures are not subject to consultation.


The government seems to struggle to understand that gambling harm and addiction is not the product of a minority of so-called flawed, weak, vulnerable people. The industry is creating addiction and its business model appears to be reliant on those harmed and addicted.


We are mass advertising and marketing an addictive product which could ensnare anyone at a given time. The source of the harm is the industry, its products and thirst for profit over the wellbeing of its customers, as well as our undercooked laws and regulations.


Reports suggest that 60-90% of industry profits are coming from the 5% most harmed. The government calculates that the white paper will reduce industry profits by 3-8%. This is instructive in terms of how far reforms will go. The white paper focuses too much on trying to catch those who are becoming or have become addicted (a failed enterprise using current methods), and does too little to prevent harm in the first place. These proposals lean too much towards being a responsible gambling white paper, rather than the public health policy framework that is required. The industry will be relieved this didn’t go much further.



There is progress and if the consultations deliver the maximum towards harm reduction, the white paper will be significantly strengthened. However, this is not guaranteed, and the industry continues to be considered an important stakeholder in areas for which it has no place.


How can the industry be allowed to consult with the regulator on how to police itself? The delays while 12 consultations happen beg the question “when will meaningful reform be delivered”?


Conflicts of interest, including the ability of the industry to access and influence policymakers and the Gambling Commission, are an impediment to progress. Does the Gambling Commission have the resources to do these consultations in a timely manner, and will they be able to focus on the evidence rather than be unduly influenced by the industry? Why hasn’t the government acted when it has all the evidence from the review?


These proposals didn’t need new legislation – they had the powers to implement new regulations today.


A Statutory Duty of Care on operators, a ban or at least significant curbs on advertising, marketing and sponsorship, bolder moves against online casino gambling, and preventative affordability checks were desperately needed.


I’m not expecting referrals into our clinics to be affected by these proposals. The financial impact of the white paper on the industry may well be less than when the single FOBT stake reduction measure was implemented in 2019. The gambling sector is protected by these measures. Reformers will not give up and will continue to fight against this social injustice, where profit continues to be placed ahead of health and life itself.


Matt Gaskell

Matt Gaskell is a consultant psychologist and the clinical lead at the NHS Northern Gambling Service, hosted by Leeds and York Partnership NHS Foundation Trust.