Advice to the Gambling Commission on a statutory levy

This document summarizes the advice of Safer Gambling Advisory Board about the most effective approach to providing funds to reduce gambling losing. This advice includes three major proposals, indicating why the current approach is necessary. The main proposals are the following three points:

1. Provide legal collection for all gambling operators.
2. Set the collection rate to 1%and review it two years later.
3. Establish an independent Safer Gambling Levy Board and supervise the distribution of funds.

Changes in gambling damage require a new approach to survey, prevention, and treatment services. Gambling damage is a serious problem and has a negative effect on many people. It is recognized that the impact is now much more widespread than the estimated 340, 000, a gambler. To deal with these harm, you need appropriate and sustainable funds. The Gambling Committee and other stakeholders are striving to improve the current voluntary system, but they are still not suitable for that purpose. The drawbacks are as follows:

• Lack of transparency
• Lack of fairness between businesses
• Insufficient financing record
• Independent financing is unpredictable, hindering the distribution of funds to places that can be maximally effective, such as NHS.

We recommend that you replace 1 % of the total gaming yield (GGY) with a voluntary scheme. This provides a sustainable foundation for effective research, prevention, and treatment, and opens a wider amount of distribution and partnership opportunities.

We do not have no issues in these proposals, and we recognize that the impact of COVID-19 on the industry has not yet been quantified. However, these proposals will create a more fair and effective approach that will enable a greater progress rate to reduce gambling harm and have great profits to those affected by harm. Our advice includes proposals on the possibility of supporting this transition.

Section 1: Introduction

This book summarizes the advice of Advisory Board for Safer Gambling (Absg) regarding statutory collection 1. ABSG has previously overstated the support of legal collection that enables effective prevention and treatment of gambling addiction throughout the United Kingdom 2.

This advice reconfirms our opinion that statutory collection is the most effective option for funding for gambling addiction activities. It describes the reasons why statutory levy is required, evidence to support it, and the type of required levy. In addition, it is discussed the implemented issues, proposed a transitional option to ensure continuity of treatment support, prevention and independent research, and shows the mechanism of the levy.

The surpassing is helpful to accelerate the implementation of a national strategy to reduce the damage caused by harmful gambling. The main priority items have been confirmed in the strategic progress report announced in June 2020. We have a report on the All-PARTY PARLIAMENTARY GROUP, especially the House of Lords SELECT COMMITTEE ON THE SOCIAL ND ECONOMIC IMPACT OF THE We welcome the support of the raising bills that have emerged this year in Gambling Industry 4).

The configuration of this document is as follows:

• Section 2-Background
• Section 3-Case for reform
• Section 4 Overcomes the benefits that can help the statutory billing for the liability to achieve.
• Section 5-Explain the issues in implementation
• Section 6-Examination of shor t-term change promotion factors.
• Section 7-Conclusion

1 In November 2019, the Gambling Committee asked ABSG to give advice on the case of legal levy. The first draft of this advice was submitted in January 2020. In July 2020, the Gambling Committee reviewed ABSG to review the proposals in light of the recent situation, including COVID-19 pandemic, a group of aristocrats, gambling-related damage, and reports on gambling committees by the Public Accounting Committee. I requested you.

3. Progress report, more secure gambling advisory committee, June 2020

Section 2: Background

Gambling provision, promotion, and participation have changed significantly in the past five years. In the UK, more gambling is now available. According to NHS Digital's latest surveys (England only), 54%of adults have participated in somehow gambling in the past 12 months. Participation in gambling itself is not an indicator of harm, but more people are exposed to the risk of harm 6 and 7. 8th, 9, which is evidence that gambling is regarded as a solution to debt and economic difficulties. In other words, gambling is likely to be partly in the UK's overall health, income, and social inequality.

The UK is the world’s largest regulated online gambling market. Online activity accounts for 37% of the total market share. Between 2009 and 2019, operator returns from online gambling activity increased from £1 billion to £5. 3 billion. Since 2015, industry advertising spend has increased by 24%, with 45% of total advertising spend now online. This shift towards a more widely accessible market has led to increased political scrutiny and public concerns about the impact of gambling activity, particularly on children and young people. Since the start of the COVID-19 pandemic, the Gambling Commission has published evidence showing a shift towards online gambling, a trend that may continue in the long term. Finally, in Scotland, Wales and England, there has been growing recognition that gambling is a public health concern, and there have been major policy changes in the provision of treatment for gambling harm across the UK. For example, in 2019, NHS England’s Long Term Plan identified, for the first time, the need to expand national care provision for people affected by gambling harm. Plans were subsequently announced to create up to 14 new NHS treatment centres across England22.

Overall, these changes require new approaches to funding treatment, prevention and research. The current system of voluntary contributions cannot provide sufficient funding to develop a sustainable and integrated approach to reducing gambling harm. Tackling gambling harm as a public health issue requires a different level of investment.

6 The changing epidemiology of gambling disorder and gambling-related harm: public health implications, Abbott, 2020

11 Online gambling review, Gambling Commission, March 2018

12 Gambling industry statistics, Gambling Commission, May 2020

The fact that gambling is not a risky product has been consensus from evidence in many areas. Gambling can cause serious harm 23, 24, 25. In the relationship between suicide and suicide and gambling, evidence is increasing 26. Gambling is 27, 28, which is increasing among children and young people. In addition, there is a negative relationship between gambling and domestic violence 29, gambling and debt 30, gambling and crime 31. In addition, various people have received various people, including parents who have died in suicide, stress, anxiety, and collapse of human relationships, even if the harm of gambling is not gambling. Children who have been abandoned mentally and economically by their parents. Gambling is the most serious example of gambling harm 33.

Section 3: The case for change

Gambling related harm has serious negative consequences to individuals and society – activity to reduce it requires adequate funding

In addition, gambling addiction is likely to affect a wider wider proportion of population confirmed by a medical survey. An Australian survey in Victoria states that 85%of the gambling harm occurred in lo w-risk to mediu m-risk gamblers. In Australia and New Zealand, gambling harm is estimated to be the same as alcohol abuse, addiction, and depression disorder. These studies suggest that the conventional approach that reports only the percentage of gambling is underrated the true scale of gamblin g-related harm.

36, 37, which is concerned about gambling scope, ease of use, and gambling, especially for children and young people who grow in a digital environment where gambling can be used at any time. Recent studies have shown that 17 to 20 years old is particularly prone to gambling addiction, and that the percentage of gambling addiction between the ages of 17 and 20 is more than tripled. < SPAN> Gambling is not a risky product, which has been consensus from evidence in many areas. Gambling can cause serious harm 23, 24, 25. In the relationship between suicide and suicide and gambling, evidence is increasing 26. Gambling is 27, 28, which is increasing among children and young people. In addition, there is a negative relationship between gambling and domestic violence 29, gambling and debt 30, gambling and crime 31. In addition, various people have received various people, including parents who have died in suicide, stress, anxiety, and collapse of human relationships, even if the harm of gambling is not gambling. Children who have been abandoned mentally and economically by their parents. Gambling is the most serious example of gambling harm 33.

In addition, gambling addiction is likely to affect a wider wider proportion of population confirmed by a medical survey. An Australian survey in Victoria states that 85%of the gambling harm occurred in lo w-risk to mediu m-risk gamblers. In Australia and New Zealand, gambling harm is estimated to be the same as alcohol abuse, addiction, and depression disorder. These studies suggest that the conventional approach that reports only the percentage of gambling is underrated the true scale of gamblin g-related harm.

The current funding model is no longer fit for purpose

36, 37, which is concerned about gambling scope, ease of use, and gambling, especially for children and young people who grow in a digital environment where gambling can be used at any time. Recent studies have shown that 17 to 20 years old is particularly prone to gambling addiction, and that the percentage of gambling addiction between the ages of 17 and 20 is more than tripled. The fact that gambling is not a risky product has been consensus from evidence in many areas. Gambling can cause serious harm 23, 24, 25. In the relationship between suicide and suicide and gambling, evidence is increasing 26. Gambling is 27, 28, which is increasing among children and young people. In addition, there is a negative relationship between gambling and domestic violence 29, gambling and debt 30, gambling and crime 31. In addition, various people have received various people, including parents who have died in suicide, stress, anxiety, and collapse of human relationships, even if the harm of gambling is not gambling. Children who have been abandoned mentally and economically by their parents. Gambling is the most serious example of gambling harm 33.

In addition, gambling addiction is likely to affect a wider wider proportion of population confirmed by a medical survey. An Australian survey in Victoria states that 85%of the gambling harm occurred in lo w-risk to mediu m-risk gamblers. In Australia and New Zealand, gambling harm is estimated to be the same as alcohol abuse, addiction, and depression disorder. These studies suggest that the conventional approach that reports only the percentage of gambling is underrated the true scale of gamblin g-related harm.

36, 37, which is concerned about gambling scope, ease of use, and gambling, especially for children and young people who grow in a digital environment where gambling can be used at any time. Recent studies have shown that 17 to 20 years old is particularly prone to gambling addiction, and that the percentage of gambling addiction between the ages of 17 and 20 is more than tripled.

In the UK, funding for gambling research, prevention, and treatment has been provided mainly through voluntary donations to designated charity (now Gambleaware). These donations are widely distributed to third sector, academic institutions, and two NHS providers. The target of voluntary donations is 10 million pounds, equivalent to 0. 1 % of the total game revenue (GGY) in 2018/19, and Gamblewear received a donation of £ 9. 6 million. More than half that was used for treatment.

The current agreement is different from the UK, but there is no standardized mechanism to provide funds for research, prevention, and treatment. In some states in Australia, such as New Zealand, New Southwales, and Victoria, the tax for 40 is used. Canadian states tend to have a lot of spending on gambling losing paid from general taxes. However, in these states, a specific gaming tax accounts for the total income. In Europe, Spain is an example, and general tax revenue has covered almost all expenditures for treatment, prevention, and research. In other countries, a stat e-owned monopoly company can use a part of its profit. In Denmark, regulatory authorities are responsible for providing funds to public health campaigns.

(i) There is a lack of transparency and perception of a lack of independence from industry

According to a recent report of International Association Association (International Association of Gaming Regulators), tw o-thirds of the country and regions that were investigated in search of forced contributions to deal with gambling losses. 41. This suggests that the British rely on the independent system is out of international regulations.

As shown in the final review of the nationally responsible gambling strategy from 2016 to 2019, there was almost no systematic evidence to reduce harm 42. This report also pointed out the need to increase funds for both prevention and treatment in order to deal with harm.

As a lon g-term sustainable model to provide funds for research, prevention, and treatment of gambling harm, there is no voluntary donation agreement. Let me give some reasons based on evidence in the UK and other law:

The harm of gambling is widely recognized as a problem of public health, but the provision of funds to research to improve understanding, prevention, and treatment is out of the established infrastructure, and research in other fields and public health. The current situation is that it is not subject to the same transparency and accountability principle as the service 43.

Although research governance protocols and processes around voluntary funded initiatives are improving, there is a perception that the nature of voluntary arrangements means that control over funding flows remains largely in the hands of industry, who can choose to fund, withdraw or allocate funding to specific projects at any time.

(ii) There is a lack of equity across operators

The recent announcement by the Guarantee and Gaming Council (BGC) is the most prominent example of this trend. 44 In June 2020, the BGC, representing the so-called “Big Five” gaming operators, committed to hand over to GambleAware the £100 million of funding pledged to the Chadlington Committee. A few weeks later, the BGC announced that the Chadlington Committee would receive £100, 000.

This shift in funding highlights concerns about industry influence in voluntary schemes. These concerns were summarised in an open letter written by a group of UK-based academics to 45 Secretaries of State.

At a time when trust in the gambling industry is declining and public concern about gambling harm is growing, these negative perceptions arising from the way voluntary schemes operate are deep-rooted and persistent, affecting public trust in the scheme.

(iii) Funding for research and prevention is neither sustainable nor sufficient

Any form of gambling can cause harm. All those responsible for providing gambling products to the general public (whether directly or indirectly) have a responsibility to invest in the prevention and treatment of these harms.

Voluntary schemes create inequalities between providers. In 2018/19, 64% of licensed gambling operators contributed to 47 voluntary schemes. In 2019/20, more than 600 individual donations were made to GambleaWare, with 10 companies contributing 63% of all funds (see Figure 1). The largest single donation was £552. 000. 70% of all donations were less than £1000. Some donations were as low as £10. The average donation was £250. 48 This distribution of donations indicates a high degree of relative “free riding” within the current system.

Figure 1: Number and value of donations to GambleAware in the 2019/20 financial year49

In order to work on gambling addiction as a public health problem, it is necessary to continue a large amount of investment in research and prevention services. Independent schemes are more predictable due to their nature. It is not possible to secure the dedicated funding source required to establish research funds and effective preventive strategies every year.

Despite the hard work of the Gambles, it is difficult to achieve 0. 1 %, an annual target of voluntary contributions, despite its hard work. If the European Commission did not intervene during the Cobid 19 epidemic, it was impossible to continue to provide funds to the established project. For many years, spontaneous donations to Gunblare wear have gradually increased, but remained below their goals. We have not yet confirmed when and how the recent additional funding contribution pledges were realized.

Other behaviors that harm health, such as alcohol abuse and misuse, have received a lot of funding for health research. But gambling is not. The gambling method in 2005 has not regarded a specific responsibility for government health services, as gambling is positioned as recreation. As a result, gambling research and preventive activities have struggled to compete with more widely recognized health damage among public health funding and social surveys.	Table 1 shows the number of research funded by the National Health Research Institute (NIHR) and the British Research Council (RCUK) related to alcohol and gambling, and inequality between them.	Table 1: Providing NIHR and RCUK funds related to alcohol and gambling
greeting	151	1
Alcohol research	540	Research on alcohol and gambling

(iv) Treatment services are not comprehensive, nor sufficiently integrated with the NHS

NIHR (after 1991)

RCUK 51 (after 2006)

22 52

Despite the increase in evidence of treatment effects 53, 54 (see appendix 1 for psychological treatment examples), the treatment services that can be used by the victims and their families are currently very limited. There is. In 2017, among the estimated 340. 000 hig h-risk gamblers in the UK, less than 3 % of the gamblers have been treated, mentioning 500, 000 risk gamblers found in recent surveys. Not 55. Conversely, according to recent estimates (England only), 18 % of alcoholic patients use services 56.

There are only two centers in which NHS and Gamblin g-Awear jointly invest, and only two thir d-sector resident centers provided by Gordon Moody. Gambling care provides treatment services through the Beacon Counseling Trust, Aquarius, Addiction Recovery Agency, and many other organizations nationwide networks. GAMCARE also offers a nationwide helpline that has been operating 24 hours a day since October 2019. Third sector other support services include Gamblaz Annimus 58, Adfum 59, Gambling with Lives 60, Ygam61, Fast Forward 62, and 64.

To provide a completely integrated treatment service, you need NHS experts and thir d-sector provisions, as well as primary care services throughout the GB. Early detection, early intervention, and further introductions to those who need treatment will only succeed after the GP clinic involved. Currently, GB has no NHS primary care services for gambling people or their families. Instead, people with drugs and alcoho l-related issues provide a nationwide primary care system. Scotland and Wales have implemented a variety of systems approaches, and new evidence will be obtained about integrated services and success in improving local services. This requires sustainable lon g-term investment.

This is the main reason we propose that the voluntary system that provides funds for the prevention and treatment of gamblin g-related damage is no longer suitable for the purpose. Legal collection can deal with many of the issues of transparency, independence, fairness, sustainability, and the trust of the people. It may also be possible to significantly raise the necessary funds to tackle the harm of gambling throughout the United Kingdom.

26 Gambling Survey-Outline (Open on the new tab), Heather Wardle, Sally McManus, Simon Dymond, Ann John, July 2019

27 Youth and Gambling Investigation 2019, Gambling Committee, October 2019. Gambling, 11 to 1 6-yea r-olds, are more likely to play six times smoking, seven times the use of drugs, and four times the use of alcohol, compared to those who do not gamble.

29 Probleming systematic reviews on violence from gambling and intimate partner (open on new tabs). TRAUMA VIOLENCE ABUSE, Dowling et al

37 (Page 78) Gambling Har m-Time for Action (Opens in New Tab), House of Lords Select ON The Social and Economic Impact of the Gambling JULY 2020 Gambling Industries Special Committee on Social and Economics , July 2020

39 Gambleaware, Annual Report (Opens in New Tab), 2017/18. 2019/20 data has not been obtained

40 Problem Gambling (Opened on a new tab), New Zealand Ministry of Home Affairs

43 Excluding some remarkable exceptions. Research funds from NIHR and other subsidies, two NHS subsidy clinics: NHS National Clinic in London and Lee's NHS subsidy clinic

44 News Update (Open on a new tab), Gambling Gambling Committee, June 2020

47 This number is based on 1. 766 of the 2. 753 active operators. This number has the following precaution s-based on the date of the donation, not the date that the operator reported the donation to the gambling committee. Based on the average active operator from April 01, 2001 to April 31, 2009. If a group business is contributed, all businesses in that group will be counted as a contribution. No operators have donated by a profit organization on behalf of a profit.

49 Donation Gambleaware data

51 RCUK includes AHRC, BBSRC, EPSRC, ESRC, Innovate UK, MRC, NC3RS, NERC, STFC, UKRI.

52 nih r-https: // www. Journalslibrary. Nihr. AC. UK/Programmes/? It was confirmed, but in the reviews, most of them are related to gambling, and only 22 cases include "gambling" in the abstract.

Section 4: What could a statutory levy achieve?

57 cases at the time of writing

A sustainable independent infrastructure for research

64 Updated action maps (open on a new tab), national strategy to reduce harmful gambling harm, July 2020

66 Play with our health (open on a new tab), Wales' Supreme Medical Officer, Annual Report 2016/17

Requirements of mainstream health and social care funding councils

• In this section, the main benefits are useful for realizing the levy. This is not intended for complete needs evaluation. Explains the main activities, processes, and services that can be introduced if there is sustainable funds, and indicate the range of profits that can be provided.
• The current recognition that gambling research is affected by the gambling industry may hinder research results and hinder the interests of health researchers and health policies. In drug abuse and alcohol research, the fact that industrial world provides direct funds to research is obviously a conflict of interest. There are a strong evidence from other fields that research in providing funds in the industry is more likely to have more preferred results than other research. However, gambling research has not yet been considered.
• The statutory levy will be useful for the establishment of a joint subsidy relationship with the major subsidies for medical and social welfare, such as NIHR, ESRC, welcome trast, and health foundation. Health and medical care and welfare care partners have established a process for ethics approval, reviewed, and independent research and supervision, the process of involvement of experienced people in the design and implementation of research, and a framework that supports researchers with little career as a roll model. I am. These governance and ethics frameworks provide quality guarantees, guarantee the involvement of experienced experts, and provide new frameworks for the matchfund revenge program. These will be applied to all gamblin g-related research under the statutory levy, increasing the standard, and gathering academic experts in this field.

Ethical Standard s-Research conducted in NHS requires approval and ethical compliance. HRA is a no n-statutory public institution (NDPB) that has received funding from the Ministry of Health, providing powerful ethical and legal governance, supporting the transparency of NHS research, such as public registration of all research. I'm doing it.

Participation of user s-The participation of the general public and other stakeholders in joint production and implementation of research is the basis of all activities of NIHR, and UK Research and Innovation (including seven research councils) is researcher. 72, which focuses on the participation of users in the research, and seeks to deepen the relationship with unpopular groups. The current awareness that gambling research is influenced by the gambling industry may accept the results of research and inhibit the interests of health researchers and health policy planners. 69. In drug abuse and alcohol research, the fact that industrial world provides direct funds to research is obviously a conflict of interest. There are a strong evidence from other fields that research in providing funds in the industry is more likely to have more preferred results than other research. However, gambling research has not yet been considered.

The statutory levy will be useful for the establishment of a joint subsidy relationship with the major subsidies for medical and social welfare, such as NIHR, ESRC, welcome trast, and health foundation. Health and medical care and welfare care partners have established a process for ethics approval, reviewed, and independent research and supervision, the process of involvement of experienced people in the design and implementation of research, and a framework that supports researchers with little career as a roll model. I am. These governance and ethics frameworks provide quality guarantees, guarantee the involvement of experienced experts, and provide new frameworks for the matchfund revenge program. These will be applied to all gamblin g-related research under the statutory levy, increasing the standard, and gathering academic experts in this field.

A sustainable funding stream for prevention

Ethical Standard s-Research conducted in NHS requires approval and ethical compliance. HRA is a no n-statutory public institution (NDPB) that has received funding from the Ministry of Health, providing powerful ethical and legal governance, supporting the transparency of NHS research, such as public registration of all research. I'm doing it.

Participation of user s-The participation of the general public and other stakeholders in joint production and implementation of research is the basis of all activities of NIHR, and UK Research and Innovation (including seven research councils) is researcher. 72, which focuses on the participation of users in the research, and seeks to deepen the relationship with unpopular groups. The current recognition that gambling research is affected by the gambling industry may hinder research results and hinder the interests of health researchers and health policies. In drug abuse and alcohol research, the fact that industrial world provides direct funds to research is obviously a conflict of interest. There are a strong evidence from other fields that research in providing funds in the industry is more likely to have more preferred results than other research. However, gambling research has not yet been considered.

A sustainable funding stream for treatment provision

The statutory levy will be useful for the establishment of a joint subsidy relationship with the major subsidies for medical and social welfare, such as NIHR, ESRC, welcome trast, and health foundation. Health and medical care and welfare care partners have established a process for ethics approval, reviewed, and independent research and supervision, the process of involvement of experienced people in the design and implementation of research, and a framework that supports researchers with little career as a roll model. I am. These governance and ethics frameworks provide quality guarantees, guarantee the involvement of experienced experts, and provide new frameworks for the matchfund revenge program. These will be applied to all gamblin g-related research under the statutory levy, increasing the standard, and gathering academic experts in this field.

Ethical Standard s-Research conducted in NHS requires approval and ethical compliance. HRA is a no n-statutory public institution (NDPB) that has received funding from the Ministry of Health, providing powerful ethical and legal governance, supporting the transparency of NHS research, such as public registration of all research. I'm doing it.

Participation of user s-The participation of the general public and other stakeholders in joint production and implementation of research is the basis of all activities of NIHR, and UK Research and Innovation (including seven research councils) is researcher. 72, which focuses on the participation of users in the research and seeks to deepen the relationship with unpopular groups.

For example, the MRC supports the development of independent researchers through fellowship schemes and MRC New Investigator Research Grants73, and the NIHR supports ECRs in their fellowship programmes (NIHR Academies), project funding streams, research infrastructure (Applied Research Collaborations (ARCs)) and research delivery (Clinical Research Networks (CRNs)74).

A sustainable funding stream for increasing workforce capacity

Statutory levies also encourage innovation in research and development. The future of safer gambling will be increasingly linked to technological advances, as developments in game design and communications infrastructure change the form, nature and sale of products. These may increase the risk of harm for some, but also provide opportunities to understand consumer behaviour. Understanding such processes and how best to harness them to protect consumers will require significant and independent investment in data science combined with the skills of public health prevention experts.

Statutory contributions will help to build such partnerships, increase the amount of research resources and build an independent research and development environment (see Appendix 2 for details of the areas of research required and Appendix 3 for examples of Research Council funded research in comparable areas).

A sustainable approach that addresses the social and health costs to society

A key objective of the National Strategy to Reduce Harmful Gambling is the creation of an independent data repository to which all operators would be obliged to submit data for research purposes. Both the House of Lords report75 and the APPG report76 highlight the importance of this work in understanding harms. This approach has precedent in other countries. In France, the online gambling regulator, the Autorité de Regulation des Jeux en Ligne (ARJEL), requires disclosure of transactional and customer behaviour data as part of the licence. 77 In the UK, an initial scoping study by the University of Leeds provides details on how a data repository could be set up and how much it would cost. Statutory funding would enable the long-term investment needed to create and maintain a world-leading independent repository, which is essential to building a reliable and comprehensive evidence base on gambling harms. 78

We know from other sectors that prevention and public health interventions can reduce future costs associated with ill health. Cost-benefit projections suggest that every pound invested saves £14. 3079. The UK government has recognised the importance of prevention for the future health of its population and the sustainability of the NHS80, 81, 82.

Legal taxation could contribute significantly to a public health prevention approach. Investment in gambling research would bring investment into other public health priorities that are important for preventing non-communicable diseases (NCDs) and reducing the health impacts of smoking, obesity and poor air quality. In contrast to gambling, these sectors are key priorities in current research funding streams for prevention research, including the Prevention Research Relationships funding initiative. It is a partnership of funders (including Ukri Research Councils, NIHR and charities) investing £50 million in a five-year primary research consortium and NIHR network, with £12 million annually in prevention and population health research outside the NHS.

The statutory levy will enable funding for a range of effective, regulated treatments, embedded in established NHS organisations working with the third sector.

Despite recent efforts to expand helpline and treatment services, such as the opening of 24-hour helplines, 85 there are large disparities in geographic availability and inequalities in access between different groups and communities. This means that those who need it most have less access to services.

The NHS England long-term plan suggests the need for up to 14 centres across England that can provide a range of treatments. 86 In addition to these specialist centres, system-wide intermediate integrated services (IIS), modelled on those that exist across multiple mental health departments, will be needed to provide appropriate treatment. Drawing on the success stories of other addiction services 87 , these IIS would ideally be multidisciplinary services that are primary care LEDs and can identify, assess, manage, prescribe, treat and refer several players to other specialist treatment providers in the NHS and third sector.

Such services will build a bridge between third parties and specific sectors. Only with the involvement of such services in primary care can services be delivered at scale, providing routine screening, assessment and appropriate levels of support to people affected by gambling and their families. 88 Learning from other services in the mental health sector, approaches to scale up service provision should be developed to create more sustainable and systematic delivery models across different providers. The forthcoming evidence review by Public Health England will be crucial as the long-awaited NICE guidelines are developed in 2021. 89

Increased provision of treatment and prevention also means greater awareness of gambling harms, which may lead to increased demand for services as more individuals and their families seek help. Care systems need to respond and build capacity, including in the primary care workforce, where 1 million people currently seek care every day.

Section 5: Challenges to implementation

Establishing the required level of funding, and the size of the levy

All GPs need to be equipped with the skills, knowledge and support to identify players, intervene early and guide them appropriately (through digital solutions, training programmes and support systems). In addition, medical, nursing and mental health professionals need to develop skills to identify problem gambling patients who may present to accident and emergency, maternity and mental health services. Part of this capacity development could be linked to existing training programmes, such as the NHS IAPT (Improving Access to Psychological Therapies) programme and other local counselling service providers. Peer training programmes at recovery colleges90 would also form an important part of this training, as would training provided by third sector organisations with expertise in this area. Both require additional funding.

Recent reviews in the UK regarding evidence of gambling addiction on the social and health costs have no research published before the 1990s and concluded that it is a new research field. However, the report publishes a review of a country that has performed a wide range of analysis about the cost of gambling social damage. The Australian Productivity Committee estimates that the social cost of gambling is £ 2. 5 billion to 4. 4 billion pounds a year, except for medical services. In Germany, the survey has shown that the annual medical expenses for gambling addicted patients are £ 185 million. In the United Kingdom, it has not yet made a completely comparable cost estimation, but it has been suggested that it is between £ 120 million and £ 1. 1 billion, according to various social cost estimates.

Research and funding from the 68 gambling industry (open on a new tab), Collins et al, journal of gambling studies, 2019

69 Impact on funding and research in gambling research (open on new tabs) Nikkenden et al, Nordic Drug and Alcohol Studies, 2019

73 Support for early career researchers: (Open on a new tab) Transition to Independence, Medical Research Council

• 75 HARMBLING HAR M-Time for Action (Open on a new tab), the Special Committee on the Gambling Industry Social and Economic Delivery, July 2020
• 79 Public hygiene intervention Investment interest rate: a Systematic Review (Opens in New Tab), Masters, Anwar, Collins et al, Journal of Epidemiorogy And Community Health, 2017
• 87 GERADA C, TIGHE J, Barretton J, Barretton J, Barretton J, Barretton Service-The First Five Years of An Integrated Team-Bassed Primary CARE g and alcohol service. Drugs: Education, Prevent and Policy, 2000. Based on this service The cost of services is estimated to be £ 15 million per year, but to fully evaluate the IIS service for gamblin g-addicted patients, the following is required:

90 recovery college provides lo w-cost support and training to people with various needs. Support and training courses are c o-designed and guided by living experts and experts. Services are held online, individuals and groups. There are currently 81 recovery college in the UK, and NHS and third sector are jointly funding. Most of them provide support for suicide prevention, all of which are strongly focused on mental health and wellbies. This is an example of an existing infrastructure that can be used to support gambling addicted patients and their families.

The main advantage of statutory levy is to significantly increase funds to provide effective research, education, and treatment strategies, leading to a change in approach to reducing harm.

There are issues in determining taxation levels. The House of Lord's report shows the options to achieve this.	To understand the total amount required, use data in other jurisdiction areas to clarify the scope of the necessary NHS and third sector services by comparing the cost of other equivalent treatment services in the UK. Can (see Appendix 2). The information from Evodens Review, which PHE will be implemented soon, will also help with this needs 95, 96. < SPAN> 90 recovery college offers lo w-cost support and training to people with various needs. Support and training courses are c o-designed and guided by living experts and experts. Services are held online, individuals and groups. There are currently 81 recovery college in the UK, and NHS and third sector are jointly funding. Most of them provide support for suicide prevention, all of which are strongly focused on mental health and wellbies. This is an example of an existing infrastructure that can be used to support gambling addicted patients and their families.	The main advantage of statutory levy is to significantly increase funds to provide effective research, education, and treatment strategies, leading to a change in approach to reducing harm.	There are issues in determining taxation levels. The House of Lord's report shows the options to achieve this.
To understand the total amount required, use data in other jurisdiction areas to clarify the scope of the necessary NHS and third sector services by comparing the cost of other equivalent treatment services in the UK. Can (see Appendix 2). PHE's information from Eviden s-Review, which will be implemented soon, will also help with this needs 95, 96. 90 recovery college provides lo w-cost support and training to people with various needs. Support and training courses are c o-designed and guided by living experts and experts. Services are held online, individuals and groups. There are currently 81 recovery college in the UK, and NHS and third sector are jointly funding. Most of them provide support for suicide prevention, all of which are strongly focused on mental health and wellbies. This is an example of an existing infrastructure that can be used to support gambling addicted patients and their families.	19	The main advantage of statutory levy is to significantly increase funds to provide effective research, education, and treatment strategies, leading to a change in approach to reducing harm.	There are issues in determining taxation levels. The House of Lord's report shows the options to achieve this.
To understand the total amount required, use data in other jurisdiction areas to clarify the scope of the necessary NHS and third sector services by comparing the cost of other equivalent treatment services in the UK. Can (see Appendix 2). The information from Evodens Review, which PHE will be implemented soon, will also help with this needs 95, 96.	368	To date, a broad range of 1% of the GGY is the most widely proposed framework for GB. This approach would avoid the delays and complexities inherent in so-called "smart levies" (whose formulas are contested across sectors and operators). Moreover, unlike the "smart levy" on sugar, it is unlikely that a smart levy on gambling would encourage operators to offer lower-risk products, as its effect would be to encourage producers to find ways to reduce sugar content. Evidence from longitudinal studies does not support the proposition that there are clear differences in the incidence of gambling problems between different products and cannot serve as a basis for formulating a tax. One study found that the frequency of scratch card purchases was a strong predictor of subsequent long-term gambling problems. Indeed, this type of gambling may act as part of a pathway to more harmful gambling behaviour. 97 Contributing a fixed percentage of the GGY would avoid such difficulties and create a clearer and more equitable approach to determining the amount each operator should contribute. At current prices, the GGY levy would be £144 million per annum98. This may be the most widely proposed figure, but it is important to note that:	It is essential that the industry does not consider this level of contribution to have met its full obligations in terms of preventing and treating losses from gambling problems99.
Experience with other contributions shows that once set, levels tend to persist. We therefore recommend that the levy level be capped in response to new evidence, with the system open to formal review after two years. This review should take into account factors such as the results of evaluations of what works and surveys of needs in geographical areas and demographics.	329	Operators of businesses offering gaming products do not generate gross gaming revenue, but they do generate profits from their products. A lawful levy should be able to draw contributions from such businesses.	Despite challenges, a 1% GGY levy would provide a necessary incremental change in funding. The UK lags behind other jurisdictions in terms of investment in reducing gambling losses. Jurisdictions with established government infrastructure and sustainable funding through public health agencies and research councils have significantly higher spending per high-risk (problem) gambler100. Table 2 shows the relative spending per capita in three comparable jurisdictions101. Table 2: Expenditures on research, education and treatment in four jurisdictions (2018)102
Jurisdiction	413	RET expenditure per problem player	RET expenditure (million pounds)

Estimated number of problem players

United Kingdom

8. 26

430. 000

Australia 103 (3 provinces)

Ensuring an independent governance infrastructure:

36. 58

92. 138

Canada 104 (8 provinces)

43. 94

145. 847

Ensuring that levy funding is only used for gambling-related harms

New Zealand

9. 70

235. 000

• Rates set in other jurisdictions vary. For example, in Ontario, Canada, 2 percent of gross revenue is dedicated by the Ministry of Health and Long-Term Care to fund research and treatment; in New South Wales, Australia, 2 percent of gaming revenue; and in Victoria, it is currently 0. 68 percent. In New Zealand, the Gaming Act includes a formula to calculate the levy for each sector, using player expenditure and the number presented for treatment as part of the calculation; for example, the tax rate for casinos is 0. 56% and for non-casino gaming machines is 0. 78%. 105 As mentioned earlier, data from other jurisdictions suggest that the harm from gambling is of a similar magnitude to the harm from alcoholism. Gambling addiction is now classified as a behavioural addiction in the World Health Organization's International Classification of Diseases. It may co-exist with other addictions. However, the financial resources for gambling treatment are poor compared to the financial resources allocated to alcohol treatment, as shown in Figure 2. Figure 2: Addiction Treatment Costs in England 2016/17 Figure 2 shows that only £15 per person is spent on treating gambling disorders, compared to £370 for alcoholics and £380 for drug addicts. If these two public health issues relating to gambling were given similar financial parity, the expenditure on treatment alone would be £1. 25 billion compared to the current expenditure of £5. 5 million. Moreover, this only focuses on one aspect of spending - treatment.
• The UK government has also committed to funding alcohol and drug misuse prevention, stating that every pound spent on drug treatment will result in a social return on investment (over 10 years) of £4 for every pound spent on drug treatment and £3 for every pound spent on alcohol treatment106. Building on the example of the Alcohol and Drug Dependence Strategy, prevention should be considered a priority with significant investment to develop this evidence base. Research that improves understanding of inequalities in participation and harm is a key part of this. Equally challenging is estimating the funding required for research. As noted in Table 1 above, NIHR and RCUK funded research on alcohol outnumbers research on gambling by 31 to 1. Significant investment is also required to achieve equity in alcohol research.
• In accordance with current legal requirements, the administration of statutory levies is the responsibility of the Gambling Commission. The Gambling Commission should therefore set up the infrastructure for the distribution of these funds. We recommend that it be overseen by a new, independent Safe Gambling Levy Board, which could share characteristics with the National Lottery Distribution Fund, the National Community Lottery Fund, 107 and the Horserace Betting Levy Board. 108, 109 A requirement for this board should be that its members should have no ties to the industry, whether recognized or not, and should not be recipients or potential recipients of donations. The Safe Gambling Levy Board should include at least one experienced professional. 110 Commissioners should have the necessary subject matter expertise to support effective allocation of funds in accordance with the European Commission’s National Strategy for the Prevention of Gambling Harm.
• The Safe Gambling Levy Board could also play an oversight role in the governance and coordination of regulatory settlements, one of the Gaming Commission’s enforcement tools for addressing operators’ regulatory breaches.
• The Safer Gambling Levy Board should use public sector infrastructure to help distribute funding. For treatment and prevention, this includes NHS primary and secondary care services, public health, education and third sector provision. For research, this should draw on applied expertise in other sectors and include distribution through research councils. However, the Safer Gambling Levy Board will also need the capacity to critically assess research gaps and challenges in using existing infrastructure and propose independent ways of addressing these gaps. For example, funding through independent research committees is more appropriate for larger, longer-term projects. Smaller funding (or a rapid response research fund) may be needed to enable this type of work, particularly for gaming research and insights to respond to rapid changes and technological developments in the industry.

Making it a continuing regulatory requirement to enforce safer gambling:

The above approach has been used to address other important public health issues in the UK. For example, the NIHR's PHR programme has a rapid funding stream to facilitate a rapid response process. It is generally accepted in all areas funded through the NIHR that digital research requires forums and rapid processes to respond to behavioural changes. This is linked to the NIHR's new approach of making research more real-world, systems-based, and relevant to local and national policymakers. Oversight and distribution of this small amount of funding could be distributed to funding committees or by the DHSC in England and the Department of Health in Scotland and Wales. Finally, the Safer Gambling Levy Board would have a public register of all gambling-related research and record its findings, where applicable.

Some have argued that funding from general taxation, rather than levies, would be preferable111, 112. In New Zealand, this has been addressed by a "tax and collect" model, where funding for research, prevention, and treatment is channeled to the Ministry of Health through funding from general taxes, while costs are recovered by the Treasury through a tax on industry. This allows for further separation of industry contributions and expenditure.

As required by current UK law, the statutory levy is paid to the Gambling Commission. However, the principle of structural decoupling could be implemented in other ways. For example, research could be funded through an independent infrastructure such as the existing Research Councils.

In our assessment, it is unlikely that gambling will receive all the resources it needs from general taxation to effectively reduce losses, given competing resource priorities. Notional duties and levies are increasingly being used to restrain public spending, not only in the UK but also in other countries. Representative examples include:

Sugar tax - the entire amount of which is used to fund school sport and other activities to promote health 113 .

Car tax - from 2020 onwards, it will fund the majority of the Highways England budget 114 , 115 .

Apprenticeship levy - companies pay 0. 5% of turnover for apprenticeship training.

Illegal Moneylending Levy - paid by banks and other financial institutions to fund their fight against illegal moneylending 116 , 117 .

Community Infrastructure Levy - Developers pay a percentage of funding for community infrastructure projects to the local government.

The challenge in introducing a statutory levy is to ensure that the industry is not seen as having discharged its full responsibility to protect and protect against gambling harm. Some operators have invested in internal processes and procedures to strengthen their ability to reduce harm, but they need to ensure that all parts of the industry are involved in this.

The Commission will continue to impose licensing requirements on operators to invest in safer gambling practices and to carry out internal audits to ensure they comply with safer gambling standards. The levy will not replace the investments necessary to maintain this. The statutory levy should be an external element of the industry's responsibility, while at the same time maintaining the industry's commitment to its internal responsibility to promote safer gambling for customers and take measures to reduce risk. The introduction of a statutory levy requires careful context and communication to ensure that both external and internal responsibility are maintained.

94 (Page 142) Gambling Harm - Time for Action (opens in a new tab), House of Lords Select Committee on the Social and Economic Impact of the Gambling Industry July 2020.

98 Gamble GGRs in the UK have shown rapid growth in the last decade, which is due to changes in consumption license, which has been raised every year. Since then, the growth has not been able to keep up with inflation, and last year's GGR has decreased slightly on the name basis. Therefore, the real level of the initial resources created by the levy changes over time.

We are constantly convinced that the 99 voluntary schemes have a proof, proof positive effect on other safe gambling activities in the gambling industry.

Section 6: Transitional arrangements

102 (page 7) Review of research, education, and treatment (RET) (opened on a new tab), the gambling committee, and statistics from February 2018. Note-Some precautions are applied to the data in Table 2, as described in the Gambling Committee's review documents. For example, it has not captured the fund donated to the GB to recipients other than gamblin g-away. In addition, the cost of medical systems in each jurisdiction is not covered in order to support people who have concurrent diseases. The numbers are for explanation.

103 numbers represent composite symptoms

104 numbers represent composite symptoms

107 National Lottery Distribution Fund (NLDF) was established to receive and hold the funds generated by the National Lotry when the National Lottery was founded in 1994 for good intentions. The funds stored in the NLDF are allocated based on the set percentage in detail in the National Lottery etc for the purpose of art, sports, national heritage, and local communities. It is. 1993 Law (open on a new tab). Each distributed organization operates many subsidies to distribute funds to beneficiaries/ profits. The NATIONAL COMMUNITY Lottery Fund, which receives 40 % of the funds, is an example of a distribution organization. The National Community Lotto Foundation is operated by the chairman (chairman of the British Committee), the chair of each of the four countries, and a board of directors consisting of up to seven members. It is an institution. The Board of Directors sets a strategic framework of the fund, and each committee in this framework has been authorized to determine the program implemented in each country. In addition, each committee agrees to make a subsidy decision or to make a subsidy decision in each program.

109 (Page 142) HARMBLING HAR M-ACTION TIME (Opens in New Tab), House of Lords Committee on the Social and Economic IMPACT OF THE GAMBLING INDUSTRY JULY 2020 Gambling Industry Special Committee on Social and Economic impacts, July 2020

The 110 Levy Committee should link with the structure built in Scotland, Wales, and England, and include a wide range of networks of experts from experiences of implementation of the state gambling harm.

Section 7: Conclusions

111 Gambling research and industrial financing (open on new tabs), Collins et al, journal of gambling studies, 2019

• 112 Gambling research and the impact on research (open on new tabs), Nikkenden and other Nordic Drug and Alcohol Studies, 2019
• 115 Automotive item tax (open on a new tab), House of Common Library, November 2017
• 118, 119, 120, which recognizes that the current system that distributes funds for research, treatment, and prevention has weaknesses. Despite recent initiatives to enhance the system by the Gambling Committee, etc., the independence, transparency, fairness, and sustainability of funds is still inadequate.

Advisory Board for Safer Gambling – Our role 125

The aristocratic report emphasized the government's authority to provide forced 121 dictations based on Article 123 of the Gambling Act. In order to deal with some of the current issues on the financing of existing services, some provisions can be provided. for example?

• All existing research funds due to spontaneous donations are redistributed to British fund subsidies such as ESRC, NIHR, RCUK, and other thir d-sector organizations, and can significantly reduce the time frame for outsourcing research. 。 This includes ring fencing funds for independent data lipjitri. GambleaWare can remove all research funds formula and transfer all the remaining funds to the new levy committee, without reducing the number of existing researchers and projects currently under funded. The existing funding project is maintained during the contract period.
• The European Commission could create a time-limited "shadow" period as a precursor to a more secure board for the funding and management of regulatory settlements. Appointments to the board would include individuals with experience in distributing public funds and reflecting the principles of transparency and accountability. 122 At least one member of the board would be an experienced professional. 123 Operators would no longer pay regulatory settlements directly to researchers, but would submit them to the Levy Board for allocation decisions. This would effectively create inadvertent research funding and the type of structural decoupling established elsewhere. 124
• 121 This would be achieved by implementing section 123 of the Gambling Act 2005 (opens in a new tab).
• 123 The Levy Board should also link with structures being developed in Scotland, Wales and England and include a broad network of experts with experience in implementing national gambling harm reduction strategies.

Appendix 1: Summary of psychological treatment approaches

Summary of psychological treatment approaches

This advice considers the evidence on the introduction of a statutory levy to fund research, prevention and treatment of problem gambling across the UK. Such a levy would benefit the public, the government and the industry.

For the public, it would enable predictable, sustainable and fully integrated service delivery, timely identification and better collaboration with established third sector organisations that are currently struggling to provide the required level of service.

1.1 Cognitive Behaviour Therapy (commonly referred to as CBT)

For government and society, it would benefit from economic returns on investing in reducing the social costs of gambling losses and a culture of independent research and innovation.

1.2 Motivational Interviewing Therapy

It would create fairness in the industry as all gambling operators contribute to harm reduction investments. This could help address the decline in public trust in the gambling industry.

1.3 Mindfulness-based interventions

The Safer Gambling Advisory Council provides independent expert advice with the aim of achieving a UK free from gambling related harm. Our role is to:

1.4 Other Psychological Therapies

Support the delivery of a national strategy to reduce gambling losses.

2.0 Treatment Effectiveness

2.1 National Institute of Clinical Excellence (NICE) Recommendations

Help improve research capacity and capability through engagement with a wide range of experts.

2.2. Cognitive Behaviour Therapy, Motivational Interviewing, Twelve Step facilitated group therapy

Share insights on best practice to drive impact.

Help resolve policy dilemmas where research evidence is lacking or ambiguous.

This appendix is ​​a summary of the current psychological treatment, generally psychological factors (cognitive and cognitive dissatisfaction), emotional factors (emotional dysfunction), and behavioral factors (eg． CBT) is currently the most powerful evidence base for intervention, but other forms of intervention also shows effective results.

COWLISHAW et al.

2.3 Mindfulness-based interventions

Cognitiv e-behavioral therapy currently has a powerful evidence, which is probably because randomized clinical trials are available. The CBT is composed of partnerships between clients and therapists, and reconstructed client (random gambling, r e-evaluation of misunderstandings on the ability to identify victory and recovery systems), guidance on problem solving training, and social skills. Aim to be involved in training. Recurrence prevention includes enhancing recurrence conditions or recurring conditions and incorporated adaptive measures strategies. Based on the available evidence, cognitive behavioral therapy is considered to be the best practices at this time.

Motivation interview therapy currently has some effectiveness evidence, but the available evidence is for a gambling that is not so serious. Motivation interviews are a clien t-centered style counseling, trying to increase the cost of behavior and benefits in no n-critical conversations. In addition, the motivation balance is shifted from a double value to a story that promotes changes in the form of sel f-motivation remarks, and recognizes the client's awareness of the perception of the client and the confidence in the potential of changes. It tries to create a dissatisfaction. Motivation interviews include motivation enhanced therapy. < SPAN> This appendix is ​​a summary of the current psychological treatment, generally psychological factors (cognitive, cognitive dissatisfaction), emotional factors (emotional dysfunction), and behavioral factors (eg The behavioral therapy (CBT) currently has the most powerful evidence base as an intervention, but the intervention of other forms is also effective.