Michael White on gambling with public health

But did you spot a more unusual cry of pain from within the NHS? The pioneering National Problem Gambling Clinic, established with a fanfare of publicity last November, appropriately enough in London's Soho, has just done an audit of its customers.

They are the people (over 16) who turn up seeking help, which they get via cognitive therapy or group discussion. And guess what? The survey finds that government reforms in the 2005 Gambling Act have exacerbated their problems by easing restrictions on high stake gaming machines - up to£500 payouts on stakes as low as 25p.

Hang on there, I hear you murmur, what's gambling to do with the NHS? Well, there is an academic debate among psychiatrists and their ilk as to whether it is a medical addiction.

Parallels of addiction

But many seem to regard excessive gambling like drink and drugs problems, the same cycle of excitement, escape, loss and depression among socially isolated people. Gaming machines are like "crack cocaine", says one critic.

I rang Hugh Bayley, Labour MP for York and the only health economist in the Commons. "I would have thought that gambling is a mental health problem. Where else would you turn except to the NHS?" was his reply.

There is some dispute about the scale of the problem. The Gambling Commission, whose regulatory website strikes me as pretty pro-punter (FAQ: "Do I need a licence to have a fruit machine at home?" No), says there are only 250,000-300,000 UK addicts.

Critics claim two million are at risk. Let's put it another way. I know a teenager who can make£50,000 a year playing online poker. I also know a 50-year-old who has just lost his house by betting the stock market would rise the next day. Something unexpected happened and it fell.

Increasing pressure

Dr Henrietta Bowden-Jones, who runs the Soho clinic on behalf of the Central and North West London foundation trust, seems to be in the concerned camp. She told The Times that fixed-odds betting terminals intensify pressure on the kind of people who can lose£1,000 in half an hour.

That figures. I rarely bet, but I have inspected the vast, football pitch size gambling dens of Las Vegas and Louisiana, watching people tip quarters into fruit machines like zombies. It is scary stuff and as usual the poor are the most vulnerable.

New Labour's super-casinos (remember how they were meant to "rejuvenate" inner cities?) were set to introduce such places here until Gordon Brown cancelled them. But expansion - "liberalisation" is the word - continues. Only last week the Lords passed a minor change which will allow bingo halls to have eight fixed-odds terminals instead of the current four because the industry is in economic trouble - 100 of the total 700 have closed.

Muddled agenda

I remember ex-public health minister Tessa Jowell explaining to me during her stint as culture (sic) secretary, that ministers had to act to regulate online gambling and had provided safeguards for problem gamblers. I was unconvinced. Like much of Tony Blair's social reform agenda it seemed a muddle. Ban fox-hunting but encourage gambling. Extend licensing hours while fretting about excess drinking. Regulate kids' snowball fights, but let the bankers gamble away our pension pots.

Chancellor Brown encouraged fixed-odds terminals when he abolished tax on individual bets and taxed bookies' profits instead. But David Cameron recently accepted£200,000 from Lancashire slot machine tycoon Trevor Hemmings, around the time a Tory culture spokesman was urging higher stakes and payouts on yes, fixed-odds terminals. No one has spotless hands.

Hugh Bayley says there is a case for making the industry pay for addiction therapy. The industry says it pays enough tax. I know it is tricky. People like a flutter and bingo, for instance, is regarded as a safe form of "soft" gambling. But what's hurting bingo? Why, other forms of gambling, including the state's own lottery.