An Outline Strategic Model - Creating Connectivity, Developing Capability and Maximising Capacity

Around ten years ago my life changed forever. Was I expecting this change? No.

What caused this change? Gambling harm.

I had no idea despite having some understanding about other addictions that gambling could lead to such devastation for some.

Over the last six years I have been on a journey learning more about gambling harm. A combination of reviewing research papers, listening, and speaking to both clinical and lived experience experts, meeting many individuals who have suffered gambling harm directly or indirectly, and through my own lived experience.

In the first four years, my journey was focused on helping my son to start and sustain his recovery and on helping my family and myself to come to grips with what had happened to our lives, and how we could help ourselves to cope and live with what I now know are legacy gambling harms.

During these four years and even prior to them, when looking back at the support my son and those who are affected others had needed, it was clear, that there were significant gaps in understanding, and in prevention, treatment, and sustainable recovery support services.

Whilst I was not an expert in gambling harm, I was an experienced CEO and non-executive director, who had over thirty-five years of experience working in the health service, engaging with social care, education, and voluntary sector groups, and I had seen how other public health challenges could be addressed.

So why was gambling harm a public health issue as I found out, not receiving the same structured systematic approach?

Part of the reason why, was because it was an emerging public health issue. Also, unlike other addictions it was mainly hidden or often invisible and combined with stigma and shame this was preventing this topic from being openly discussed.

Additionally, the actions by the gambling industry to normalise gambling with their marketing which implies gambling had no or low risk, meant that for many this was not a topic high on the agenda for those organisations who need to engage with delivering public health solutions.

If I looked back on smoking, I could see a parallel with gambling all those years back. For decades the smoking industry adversely impacted population health. Only after significant harm to many, including those who had never smoked themselves but were affected others, were systematic public health measures introduced.

I began to reflect on this situation and what I may be able to do, even if in only in a small way.

Initially this was to share my lived experience and engage with some of those individuals I knew within health systems. The aim being to start to increase awareness. The response from these was supportive but a lack of knowing what needed to be done at that point, inhibited actions.

Fortunately, for me around this time, Healthwatch Essex had identified gambling harm as an area of concern and this formed part of their addiction review programme. Chris, my son who was around 4 years into his recovery from gambling disorder at this point, offered his support to help them, and since that date Chris and I have established a close working relationship with them.

Their addiction review report, together with my own thoughts and those of my son Chris, led me to develop an outline strategic model for responding to gambling harm as a public health issue.

The aim of this was to develop a system approach for enabling the development and implementation of an integrated approach to prevention, treatment, and sustainable recovery.

At this point I was fortunate to be appointed to Gambling Harm UK (GHUK) as its CEO.

With the support of the charity's trustees, I was given the opportunity to use the charity’s own funds to work on piloting the outline strategic model.

At its simplest level it consists of three linked strands which are, creating connectivity within a system, whilst simultaneously helping to develop capability and maximise capacity. What this means is briefly described below.

Creating Connectivity

Bring the right people and organisations together, with the purpose of focusing on gambling harm as an important public health issue, and gain recognition that an integrated joined up approach is essential for delivering the required response.

Developing Capability

Help to support the development of capability through increasing awareness of gambling harms and their impact on local population health. Thus, enabling the right people and organisations to assess how they can best bring their knowledge, skills, and other resources to help to respond to the issue in question.

Maximising Capacity.

Help to maximise system capacity by:

- providing support to address any access barriers and to help reduce avoidable demand through assisting with prevention measures such as educating young people around risks of gambling.

- engaging the voluntary sector to assist with signposting of individuals with gambling harm to relevant support or treatment services and where relevant offer their own services to help with achieving sustainable recovery from gambling harm and

- developing a clearer understanding of need for services so that appropriate support can be commissioned.

It is also based on creating system ownership of the issue and not dependency on one organisation or us as a charity. This is important to achieve sustainable service delivery.

Three months ago, following a bid to the Essex Community Foundation, a small grant was awarded to our charity. This was to help us build on the work we had already delivered free to the system to date, and to enable us to grow and spread our work further across what is known as the Mid and South Essex Integrated Care System (ICS), which covers a population of around 1.2 million residents.

The work we are progressing involves the following:

Running awareness sessions for primary care practitioners at the Alliance Level. Within the Mid & South Essex ICS there are four of these.

Engaging with key system organisations such as the Mid & South Essex NHS Foundation Trust with over 15,000 employees.

Engaging with the Community and Voluntary Sector (CVS) via the various CVS district council organisations which exist across the ICS.

and

Providing access to free preventing gambling harm training to a group of schools within Braintree, Chelmsford, and Maldon. Also, to young people aged 17-24 years old at both the Anglia Ruskin University and Writtle College, all of whom form part of the Mid Essex Alliance.

In addition, a range of other activities are being run in parallel. These include GHUK individuals becoming Trauma Ambassadors with Healthwatch Essex thereby raising gambling harm awareness at Healthwatch events. My liaising with personnel within the new NHS East of England (EoE) Gambling Treatment service provider and having discussions with public health leads across the ICS.

Bit by bit this is helping us to create connectivity between organisations across the ICS. One recent example of this is us bringing together (Midlands Partnership NHS Trust (Inclusion) staff - part of the EoE NHS gambling treatment service) and Provide CIC staff, with GHUK to start work on developing content for the Essex Wellbeing Make Every Contact Count (MECC) system which will cover gambling harm.

There is still lots more to do, and the full value of these inputs will take time to fully assess.

However, early testimonials and feedback from those we are engaging with about our work and its approach, indicates that it is beneficial and seen of value. Examples of feedback received include:

1.Mid and South Essex NHS FoundationTrust:

John Gilham, Chief Executive of Gambling Harm UK, attended the Mid and South Essex NHS Trust’s monthly “5pm Improvement Club” on 6 September 2023, providing a virtual session to Trust and broader heath care system staff about gambling harm, what it is, some of the drivers and consequences, as well as some signs of harm, and why and how to support people affected.

John gave a passionate, informative, and insightful talk which was hugely valued by the audience, and feedback during and following from attendees was that the topic was very important, and they had learned a lot from the presentation.

Colleagues from clinical, corporate, and operational teams posed questions to John to better understand how we could improve both as a care system and an employer in raising awareness of gambling harm and reducing stigma.

As a result of this talk, a number of links and materials have been shared with the Trust and we will examine our current practice to identify where we can improve. We very much appreciated John’s contribution and are keen to support Gambling Harm UK in their vital work to help our population in this area.

Charlotte Williams

Chief Strategy & Improvement Officer

Mid and South Essex NHS Foundation Trust

2. Alliance Time to Learn Session’s for GP’s:

Over 50 practitioners who have attended the two “Introduction to Gambling Harm” awareness sessions to date, have said they will now change their practice as a result of the gambling harm training delivered by GHUK.

3. Maldon and District CVS

John speaks openly and informatively about his experience of gambling harm which resonates effectively with professionals in the voluntary sector. Often these professionals are well placed to understand the impact gambling can have on individuals and families.

He is a compelling advocate for driving change and through Gambling Harm UK is able to effect that change.

John has spoken at a community forum to the local sector which has led to opportunities to inform local asset mapping and signposting work, connections into mental health and men's health work and he is also able offer bespoke training.

Gambling harm is often hidden and resources to help people affected not as easy to come by as other addictions so the work being undertaken by John and the team at Gambling Harm UK has the potential to be vitally important.

Sarah Troop Director Maldon and District CVS

4.Castle Point CVS (CAVs)

Gambling Harm UK’s endeavours are dedicated to the prevention and reduction of gambling harm. John Gilham, Chief Executive presented to an audience of over 100 people from local community organisations, health and social care, the Leader of Castle Point Council and the Mayor of Castle Point at CAVS Community event on the 25th October 2023.

John’s presentation was compelling as he transparently spoke about the impact that gambling has not only on the person with the addiction but their family members, and others associated with them. The statistical detail that was presented, evidenced the scale of the challenge that faces our nation. Accessibility to on-line platforms, sophisticated and appealing marketing features strongly with not only the mature target audience but unfortunately with the rapidly growing younger population.

CAVS membership groups are influential in their community and provide assistance and support to so many. As enablers the learning from John’s presentation of further educating and influencing on the subject of gambling harm, will be invaluable.

Janis Gibson

Chief Executive Officer

Castle Point Association of Voluntary Services (CAVs)

5. Inclusion - NHS Midlands Partnership NHS Trust (EoE NHS Gambling Treatment Service)

Gambling is impacting so many lives across all of our communities and it will be critical, as with other public health matters that we work together to raise awareness, learn together and ensure support is as easy to access as possible should it be needed.

By working together with Gambling Harm UK and through the connections they are creating and opening, we can contribute more widely together in preventing the harm experienced and reducing any blocks that may exists for people who want to reach out for support.

Andrew Ryan

Operational Team

We are looking forward as GHUK to developing this work further over coming months. A number of additional events have already been arranged across the ICS, including delivering our second Real Patient Simulated Based Medical Education Programme to 120-year 3 medical students at Anglia Ruskin University School of Medicine in November.

With the increasing awareness and growing interest in the system, together with the presence of the new local EoE NHS gambling treatment service being delivered in Thurrock, there is now the foundation and the opportunity to further strengthen the connectivity, capability, and capacity within the system to help respond to those experiencing gambling harm as a public health issue.

This work and developing our outline strategic model would not have been feasible without the help and support from those within the Mid & South Essex ICS. I would like to thank all those individuals who have responded to our request to meet and to discuss gambling harm and for then enabling GHUK to create connectivity between key people and organisations within the ICS by introducing us to their networks and inviting us to their events.

Finally, I would also like to thank the following GHUK personnel who have contributed their time working with me within the Mid & South Essex ICS; my son Chris Gilham (Trustee), Dr Kishan Patel (Chair of Trustee’s), Lesley Buckland (Trustee) and Julie Martin (Associate).

John Gilham

CEO

Gambling Harm UK