Briefing on support and treatment services
Date: Tuesday 25 February 2024
Time: 9:00am
Location: Committee Room 29, Parliament Buildings
Chairperson: Philip McGuigan MLA
Minutes taken by: Finn McGrath, Chambré
Members Present
· Philip McGuigan MLA
· Maolíosa McHugh MLA
· Danny Donnelly MLA
Apologies
· Robbie Butler MLA
· Paul Frew MLA
· Timothy Gaston MLA
· Paula Bradshaw MLA
Minutes
1. Welcome
Philip McGuigan MLA welcomed members to the meeting.
2. Minutes of last meeting
Members agreed that the minutes of the last meeting (19 November) were a true and accurate representation of that meeting. This was proposed by Maolíosa McHugh and seconded by Danny Donnelly.
3. Matters arising
There were several matters arising from the APG’s last meeting. These were that:
· The secretariat will closely monitor developments with the introduction of statutory levy on remote gambling levy and look for further opportunities to raise the matter of NI receiving a share of this levy with the UK Government.
· The secretariat will look for further opportunities to press for immediate action on gambling advertising and promotion.
· Members to table Private Members’ Motion on ‘Supporting a Public Health Approach to Tackling Gambling-Related Harms’ in January.
· Members to request a meeting with the Education Minister in relation to a statutory requirement for schools to have in place a gambling policy in line with drugs.
· The secretariat to facilitate remote meeting on Friday 22 November with representatives from the Royal College of Psychiatrists, British Psychological Society, Gambling with Lives and Extern to discuss support and treatment for gambling related harms in NI.
4. Briefing on support and treatment services
Members were then briefed by Prof Henrietta Bowden-Jones, NHS National Advisor on Gambling Harms, Dr Donna Mullan, consultant psychologist with the Western Trust, and Dr Sharon McElroy, addictions lead at RC Psych NI.
Prof Henrietta Bowden-Jones began by saying that England now has 15 gambling clinics that are “working extremely well and building capacity”, and a young persons’ gambling service, as well as a National Centre for Gaming Disorders.
Prof Bowden-Jones reiterated her offer to have NHS England treat patients in NI due to the lack of provision of services. She said “I don’t think it’s justifiable, I think that no government can take this approach of no treatment. We know there’s a high risk of suicide, there’s a high risk of self-harm, the impact on families in enormous.”
She then talked about the introduction of the 1% levy on gambling operators in GB. She said the levy is a very good solution because it follows the ‘polluter pays’ principle, and because it gives service providers independence from the gambling industry. The levy will provide £60m a year for treatment, £20m a year for research, and £30m a year for prevention by OHID. This is a global first.
On the NICE guidelines, Prof Bowden-Jones said while they are illustrating the lack of high-quality research into gambling harms, they have provided a baseline on which to build.
APG Chair Philip McGuigan MLA asked whether remote treatment is an effective and viable option for NI. Prof Bowden-Jones said that the evidence from her work indicated that it is “just as good” as in-person treatment. She also noted that for gambling disorders, in-person treatment can be challenging because of the financial risks and the high level of stigma, leading to people missing appointments, whereas with remote treatment their did-not-attend rates have dropped to almost zero. She said while that face-to-face treatment is most appropriate for certain patients, as a temporary measure NHS England could set up a workforce to help people in NI. This would also help us to understand the level of need in NI.
Danny Donnelly MLA asked about the level of support provided by the gambling clinics. Prof Bowden-Jones said the clinics provide treatment mostly to those experiencing serious gambling disorders, but that it does not turn away those who present with lower levels of harm or are at risk of harm. She said there is a working group set up to develop a system for directing people towards the appropriate place to go for support, be that in the NHS or in the non-statutory sector. Danny Donnelly asked if setting up our own gambling clinic is an appropriate model for NI. Prof Bowden-Jones said it would, although she noted that it may take some time to set up, which is why using remote treatment in the interim is important.
Maolíosa McHugh MLA asked whether we should push ahead with introducing our own levy on gambling operators in NI and begin accumulating funds, even though the treatment services are not in place. Prof Bowden-Jones said yes, and stressed that the levy needs to be introduced immediately. She noted that there is strong evidence NI can take from England on the risk of suicide and the impact of families, etc, to give a justification for the introduction of a levy and the need to address gambling harms. Maolíosa McHugh also highlighted the fact while there have been successful campaigns to raise awareness around gambling harm, such as through the GAA, there needs to be somewhere to direct people to if they do need help.
Dr Sharon McElroy then spoke about the pressure on addiction services in NI. According to Dr McElroy, there are only two addiction psychologists across all 5 HSC Trusts in NI. She said that when someone does present with a gambling disorder in NI, they are directed towards their GP or primary care mental health services, neither of which are specifically trained or commissioned to deal with gambling disorder, particularly at the more severe level. People who are suicidal go through crisis services, but there are no high-level (Tier 3 and 4) follow-up treatment services for people with gambling disorder.
Dr McElroy spoke more about the effectiveness of remote treatment, spelling out in more detail the populations for whom it may not be effective for in NI. These include people with high risk, people with poor internet access (particularly in rural areas), and people who do not have a safe space to attend remote treatment such as those experiencing domestic violence. Therefore, Dr McElroy said a hybrid model with online also access to one-to-one would be best. Specific risk factors in NI include paramilitary involvement and local lottos.
Dr McElroy suggested that gambling services could be modelled on the recently set up Regional Trauma Network.
Dr Donna Mullan noted that addiction services in NI are mostly staffed by nurses, and that there are no multi-disciplinary teams (MDTs) for addiction services. According to Dr Mullan there are only 4 consultant psychiatrists in substantive posts in NI, out of 11 posts. Therefore, the problem lies with the lack of specialist, senior professionals who would lead on gambling services.
She also noted the lack of allied healthcare professionals, such as occupational therapists and pharmacists, working within the healthcare service. Dr Mullan said “I do think that gambling disorder needs a multi-disciplinary approach, similar to other addictions services.”
Dr McElroy and Dr Mullan both commented on the fact that when addiction services in NI have been expand in the past, it has been an expansion of nursing staff. They stressed that what is needed now is more highly trained specialists.
Picking up on the fact that Prof Bowden-Jones offered to train up staff in NI, Philip McGuigan asked who would be trained given the situation here. Dr McElroy answered that it would be primary care services and GPs, and added that all healthcare professionals need a level of training.
4. Next Steps
The Chair proposed the following actions:
· The secretariat will continue to press for the Department of Health to commission support and treatment services, informed by the previous briefing.
· Use the results of the Gambling Prevalence Survey to call on the Minister of Health to commission support and treatment services and on the Minister for Communities to introduce an industry levy on gambling operators.
· The Chair will respond to the Gambling Minister on behalf of the APG
· APG officers will seek a meeting with the Secretary of State for NI.
5. AOB
James Grimes was invited to briefly tell the APG about Chapter One, a new training and awareness project developed by Gambling with Lives in partnership with the Greater Manchester Combined Authority. Chapter One will have UK launch event in Westminster on 19 March and an NI launch event at Parliament Buildings on 27 May.
6. Next Meeting
The Chair informed the members present that the next meeting date would be confirmed soon.