Financial Risk Checks for Gambling

Christina Rees Excerpts

Monday 26th February 2024 Westminster Hall

[Christina Rees (Neath) (Lab/Co-op)]

I beg to move,

That this House has considered e-petition 649894 relating to financial risk checks for gambling.

It is, as always, a pleasure to serve under your chairmanship, Sir Edward.

The petitioners ask the Government specifically to stop the implementation of affordability and financial risk checks, saying:

“We want the Government to abandon the planned implementation of affordability checks for some people who want to place a bet. We believe such checks—which could include assessing whether people are ‘at risk of harm’ based on their postcode or job title—are inappropriate and discriminatory.”

The Government have responded:

“We are committed to a proportionate, frictionless system of financial risk checks, to protect those at risk of harm without over regulating. The Gambling Commission will set out plans in due course.”

There are, however, a number of perspectives on the purpose and delivery of such checks. I will do my best to present those to the Chamber today.

For context, the Gambling Act 2005 regulates gambling in Britain. On 8 December 2020, the Government published a review whose purpose was to examine whether the Act provided the right balance of regulation in the digital age. The review had about 16,000 responses. The Government response, in the form of the White Paper, “High stakes: gambling reform for the digital age”, was published on 27 April 2023. The proposals for the reform of online gambling included new obligations on operators to perform financial risk checks

“if a customer’s gambling is likely to be unaffordable and harmful.”

The documented stated that three types of risk would be targeted: binge gambling, significant unaffordable losses over time, and financially vulnerable customers.

The arguments for and against the implementation of the checks can be categorised according to three stakeholder groups: industry, reformers and consumers. I will present the case of each in turn, following several extensive evidence sessions with a range of individuals and organisations including the petition creators, the Jockey Club, the Betting and Gaming Council, Charlie Ritchie from Gambling with Lives, Dr James Noyes and the Gambling Commission.

Taking the gambling industry first, I understand the concerns that operators might have about the impact of checks on profits, not least because the top 10% of gamblers deliver 80% of operator revenue. In horseracing, the numbers are even more stark, with 85% of operator income coming from about 5% of online betting accounts. Operators argue that affordability checks are inappropriate and discriminatory, that in theory punters would be prevented from betting more than £1.37 per day, and that such checks push vulnerable gamblers into the black market. It has been suggested that online turnover is down 20% since non-statutory checks have been in place.

The issue of affordability is not a new one, though. The industry itself pushed for measures back in 2019 and has continued to recognise the need for regulation and markers of harm. The Government flagged an affordability check as a priority long before the White Paper, and the Gambling Commission has already consulted on it and accommodated it within changes to regulation. What is new is that since the White Paper was published, the Government and the Gambling Commission have proposed actual figures for such checks. Affordability is no longer abstract; it is tied to precise thresholds.

What are those thresholds? The Gambling Commission has consulted on two forms of check: first, background checks for financial vulnerability at moderate levels of spend, with proposed thresholds of £125 net loss within a month or £500 net loss within a year; and secondly, checks for harmful binge gambling or sustained unaffordable losses at higher levels of spend, with proposed thresholds of £1,000 net loss within 24 hours or £2,000 net loss within 90 days. In other words, the checks are threefold: for financial vulnerability, for significant losses over a short time, and for significant losses over a long time.

Background checks for financial vulnerability will be frictionless, using publicly available information such as credit reference data and negative indicators such as county court judgments or insolvency notices, while higher risk accounts will have enhanced checks using open banking and other options, with increasing degrees of intrusion the further into the journey that someone goes. It is said that the enhanced checks will be narrowly targeted, with only around 3% of online gambling accounts being affected; the vast majority of these checks will be frictionless, with the Gambling Commission advocating light-touch assessment, applying the data minimisation principle and focusing on publicly available data. Only 0.3% of account holders would be expected to hand over additional financial information. Industry bodies and operators point to checks that are already happening and suggest that they are far from frictionless, but these checks were introduced voluntarily by individual operators, and tare not necessarily the frictionless procedures being developed by the Government.

The second group of stakeholders are reformers, and they include researchers, campaign groups and the Government themselves. They have long supported the call for affordability checks on the most vulnerable gamblers and harmful betting, saying they are needed. The reformers point to the research showing the disproportionate nature of gambling, whereby 80% of profits come from 10% of accounts, and highlight the well-accepted belief that disproportionate profits lead to harmful losses. In addition, campaign groups are keen to point out that different forms of gambling carry different risks. Activities such as playing bingo or the national lottery, or even the vast majority of horserace betting, are vastly different from activities such as gambling in online casinos in terms of the experience and potential for harm.

[Philip Dunne (Ludlow) (Con)]

I congratulate the hon. Member on securing this significant debate; she can tell from the number of Members here in Westminster Hall today that there is a great deal of interest in the subject from across the House.

The hon. Member just mentioned horseracing. Will she press the Minister to give what reassurances he can to the horseracing community—I speak for Ludlow racecourse, which is an important employer and source of entertainment in my constituency, well known to Opposition Members—that this industry will not inadvertently be threatened by measures to introduce the affordability checks for vulnerable gamblers that I think we all want?

[Christina Rees]

I thank the right hon. Member for making that very valid point. I am sure that the Minister is listening, as he always does.

[Chris Grayling (Epsom and Ewell) (Con)]

I am grateful to the hon. Member for giving way and allowing me to reinforce the point just made by my right hon. Friend the Member for Ludlow (Philip Dunne). I represent Epsom Downs racecourse and more particularly the training industry in Epsom. In a smaller centre, in which the owners are not wealthy Arabs but simply people who enjoy participating in racing, the impact on the trainers of measures that really damage the industry would be enormous. It is not just about the racecourse; it is about the livelihoods of the people who do the training and who operate the training stables. Will the hon. Member impress on the Minister that there are genuine problems around things like online casinos, but tackling those must not come at the expense of the racing industry, which is so important to so many communities across the country?

[Christina Rees]

I thank the right hon. Member for making another valid point. I am sure the Minister listened and will respond in due course. The number of hon. Members who have turned up to speak is an indication of how important this topic is to our constituents and constituencies.

As I was saying, activities like playing bingo or the national lottery, and even the vast majority of horseracing betting, are vastly different from online casinos and fruit machines in terms of the experience and potential for harm. Researchers understand the importance of carefully considering the figures around the threshold for checks. They need to be appropriate, but also meaningful and preventative. Campaigners rebut the claim that such checks are inappropriate by pointing out that checks that reduce harm are highly appropriate. An example often cited is that people would not want to produce documentation to purchase a gin and tonic; that is true, of course, but there are many examples where the family of a harmful drinker might ask their local shop not to sell alcohol to them or, indeed, where someone is refused another drink because they are drunk. Nor are the checks discriminatory: they are no different from the checks undertaken almost instantly when a consumer clicks to purchase a product online using the Klarna three-payments procedure.

Finally, we must consider the voice of the consumer—the punter. Most gambling is not harmful and most bets are small, proportionate and affordable, such as a lucky dip on the lotto, a lucky 15 on the horses or a flutter once a year on the grand national.

[Kate Kniveton (Burton) (Con)]

Many of my constituents enjoy the time-honoured tradition of having a bet at the races at the fantastic Uttoxeter racecourse in my patch. They are concerned that the proposals for an annual £500 net loss threshold, which, as the hon. Lady has already said, equates to just £1.37 a day, will lead to intrusive checks, limiting their freedom to spend their money on an activity of their choosing. Does she agree that if affordability checks are to be implemented, they should be carefully and deliberately targeted at those who are most at risk of harm?

[Christina Rees]

I thank the hon. Member for her intervention. I am getting a tour of constituency racecourses—this little woman from Wales is learning all about geography today. I agree that the proposals should be measured.

The proposed checks will not affect such customers at all. It is important not to conflate the views of industry with the views of consumers. Affordability checks are not about attacking consumer rights or curbing individual liberties, but about upholding consumer protections and curbing operator excess.

[Sir Bill Wiggin (North Herefordshire) (Con)]

The hon. Lady says it is not about anything other than protecting consumers, but can she think of any other activity where the Government check how much money someone has?

[Christina Rees]

Payday loan sharks might be an example, but I am sure the Minister will respond in due course—I think I slipped out of that one, or I tried to. The responsibility lies with industry and operators, not customers.

In summary, it is understandable that industry bodies, operators and the horseracing community have concerns about the introduction of financial risk checks, but the idea of introducing checks is not new, and the need for regulation against harmful betting is supported by industry and consumers alike. The issue seems to be that such checks need to be frictionless, without negative impact on punters or operator revenue, and without pushing vulnerable gamblers into the black market. It would be useful if the Minister took this opportunity to outline how frictionless checks will work and when pilot schemes will be introduced.

[Sir Edward Leigh (in the Chair)]

I remind Members that they should bob if they wish to be called. We have three hours, which is quite a long time, but I want to get everybody in and I do not want to impose a time limit at the moment. Perhaps, those who are called early can look around them, see that a lot of people are trying to take part in this debate, and keep their speeches brisk, which is always the best policy, and certainly not take more than 10 minutes. I am sure that I can rely on the first Member I call, Philip Davies, to give a brisk speech.

--- Later in debate ---

[Christina Rees]

Very briefly, and on behalf of the Petitions Committee, I thank all right hon. and hon. Members for their very valuable contributions.

World Sepsis Day

Christina Rees Excerpts

Wednesday 13th September 2023 Westminster Hall

[Christina Rees (Neath) (Ind)]

I beg to move,

That this House has considered World Sepsis Day.

It is always a pleasure to serve under you in the Chair, Ms Fovargue.

Dame Cheryl Gillan stood down as chair of the all-party parliamentary group on sepsis in March 2021, and I felt so humble when she asked me to become chair. I had always admired Dame Cheryl, who became a dear friend and treated me with respect and dignity. It was a tragedy when she died in April 2021 only a month after standing down as chair. I miss her wisdom and guidance, but most of all I miss her friendship.

I have done my very best to lead the APPG and have had enormous help from the UK Sepsis Trust, particularly from Sarah Hamilton-Fairley and Dr Ron Daniels. I could not have carried out my duties as chair without their constant support, advice and good humour. We have become close friends.

Why did Dame Cheryl choose me? Perhaps it was because she knew that I initially became a member of the APPG in 2017 because I am a sepsis survivor. One day we had a cup of tea together because she wanted to know my sepsis story. In summer 2013 I went to New Zealand to visit my daughter Angharad, who was living and working in Te Anau, South Island. On the flight over I started to have what I thought was toothache in my lower right jaw. After a few days in Te Anau, it did not improve, so I went to the emergency dentist, who took X-rays and could not find anything, but gave me antibiotics and painkillers. There was still no improvement after about a week and the right side of my face became swollen, so I went back to the dentist, who thought it might be an abscess and gave me stronger antibiotics and painkillers.

I got on the flight home. During a short stopover at Singapore airport, I started being sick, but I thought it might be travel sickness. I just wanted to sleep. By the time I landed at Heathrow I was in a bit of a mess, but I managed to get to Paddington and get on the train back to Wales. The pain and swelling had increased, but I was so exhausted I just fell asleep.

I got home, took more painkillers and slept. I live alone. When my friend Jen called to see me, she was really concerned, so she drove me to my dentist, who could not find anything. They thought it was an abscess and replaced the filling. I was on the ceiling with the pain, which I felt through the many injections, which also put me into orbit. The dentist gave me more antibiotics and more painkillers. Nothing improved and I continued to be sick. I had not eaten anything in days and became extremely dehydrated.

Jen called to see me again and took me to the local A&E. The emergency doctors rehydrated me, but did not diagnose anything and sent me home. I continued to be sick and Jen took me back to my dentist, who sent me immediately to the dental hospital at the Heath Hospital in Cardiff. I must have lost consciousness on the journey because I do not remember anything more. Jen told me later that they admitted me to A&E and the duty surgeon, Dr John Jones, identified sepsis. He told Jen that if he did not operate immediately I would die. He asked whether it would matter if he had to cut my face to get rid of the poison and Jen told him, “Just make sure she doesn’t die.”

After some time in intensive care and on a ward, I had recovered enough to be discharged, but it took me years to recover my strength physically and mentally. How I caught sepsis remains a mystery. I was fortunate to survive and I owe my life to Dr John Jones, who correctly identified sepsis and acted immediately, to all the wonderful NHS staff who cared for me, and to my friend Jen.

[Seema Malhotra (Feltham and Heston) (Lab/Co-op)]

I pay tribute to my hon. Friend’s courage, the contribution she has made and her tribute to Dame Cheryl, and congratulate her on securing this debate on World Sepsis Day. Through her story, she has shown the importance of raising awareness and recognising symptoms of sepsis early. Will she join me in recognising the vital work of the UK Sepsis Trust, whose support made such a difference to my constituent Kamaldeep Sandhu and her family after her brother Rick, whom she describes as the perfect brother, husband and father, tragically lost his life to sepsis last year, aged 42? The family believe that the hospital spotting the signs too late meant that he died more quickly than he would have done otherwise. I also pay tribute to Kamaldeep’s campaigning to try to ensure that what happened to her family does not happen to anybody else.

[Christina Rees]

I thank my hon. Friend for her important intervention and I am very sorry to hear of her constituent’s loss. My heart goes out to Rick’s family and friends. I will speak a lot about the UK Sepsis Trust, because it helped me enormously and I want to highlight its work in fighting sepsis.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Lady on securing this debate and for the very personal story she has conveyed to us all—we are very much moved by it. To reinforce what the hon. Member for Feltham and Heston (Seema Malhotra) said in her intervention, sepsis claims some 11 million lives globally each year, or five lives every hour in the United Kingdom. That is more than the deaths from bowel, breast and prostate cancer combined. To give a Northern Ireland perspective, sepsis affects around 7,000 people yearly in Northern Ireland, of whom 1,240 lost their lives to it in 2021. Does the hon. Member for Neath (Christina Rees) agree—I suspect the answer will be yes—that there must be more awareness of the earliest symptoms, to ensure that death from this dangerous and life-threatening disease is reduced as much as possible across all of the United Kingdom of Great Britain and Northern Ireland?

[Christina Rees]

I agree with the hon. Gentleman. He must have seen my speech, because he has quoted some of the stats that I am going to come on to later.

What is sepsis? It is a life-threatening condition that arises when the body’s response to infection causes injury to its tissues and organs. It is a global health concern, but today I will focus on its prevalence, the challenges and some potential solutions in the UK. Sepsis is indiscriminate. While it primarily affects very young children and older adults and is more common in people with underlying health conditions, it can readily occur in those who are otherwise fit and healthy.

Sepsis can be triggered by an infection, including chest and urinary tract infections. It is not known why some people develop sepsis in response to those common infections whereas others do not. Sepsis is often referred to as “the silent killer” because of its ability to strike swiftly and unexpectedly. In the UK, sepsis is a significant public health problem. Each year around 240,000 cases are reported, leading to more than 48,000 deaths.

Sepsis is the leading cause of avoidable death in the UK, claiming more lives than breast, bowel and prostate cancer combined. Unlike data for heart attacks, strokes and cancer, sepsis data is imprecise, because it relies on coded administrative data rather than the granular clinical data of patient-level registries. Moreover, this striking deficit means that not only do we find it necessary to estimate the burden of disease, but we are decades away from precision medicine for sepsis. However, therein lies a paradox, as the UK’s unique healthcare infrastructure means that we are well placed to change that for the world.

Around 40% of people who develop sepsis are estimated to suffer physical, cognitive and/or psychological after-effects. For most people, those will only last a few weeks, but others can face a long road to recovery and develop post-sepsis syndrome. One of the biggest challenges in tackling sepsis is early diagnosis. Sepsis can mimic other common illnesses, making it difficult to spot in its early stages. Symptoms such as fever, increased heart rate, rapid breathing, confusion and extreme pain can be attributed to various conditions. This leads to delayed treatment, which significantly worsens the patient’s chance of survival.

To combat sepsis effectively, awareness is the key. The UK and devolved Governments, healthcare professionals, and organisations such as the UK Sepsis Trust have been working tirelessly to educate the public and healthcare providers about the signs and symptoms of sepsis. Public awareness campaigns and training for healthcare workers have been instrumental in improving early detection. Timely intervention is crucial in sepsis management. The UK Sepsis Trust’s “Sepsis 6” care bundle and treatment pathway includes administering antibiotics, providing fluids and monitoring vital signs, and has been implemented in 96% of hospitals across the UK and in 37 other countries worldwide to ensure rapid and effective treatment. Early recognition and swift action can save lives and reduce the severity of sepsis-related complications, but despite such work, there remain many cases of avoidable death every year.

[Rachael Maskell (York Central) (Lab/Co-op)]

I am grateful to my hon. Friend for securing today’s debate, and for the very powerful speech she is making. My constituent, a teenager, tragically lost his life. Not only did he display so many signs, his parents were screaming for help, but those calls for help—for further investigation and better treatment and management—were just not heeded. Does my hon. Friend agree that it is now crucial that we introduce Martha’s law, so that parents can be granted a second opinion when they ask for one, in order to save lives?

[Christina Rees]

I am very grateful for my hon. Friend’s intervention. I think she must have been looking over my shoulder, because I am just about to come on to Martha’s law. As always, her timing is impeccable.

Over the past couple of weeks, significant media attention has been given to the tragic case of Martha Mills, who died of sepsis aged 13. Martha’s grieving parents have advocated for the establishment of Martha’s rule, which would empower patients to request an immediate second opinion if they feel that their medical concerns are not being addressed adequately. Other preventable deaths include UK Sepsis Trust ambassador Melissa Mead’s son William. The then Health Secretary, the right hon. Member for South West Surrey (Jeremy Hunt), apologised to William’s family after a report found that clinicians missed four opportunities to save his life, and to Jason Watkins, who lost his daughter Maude when she was only two and a half years old.

In order to end these preventable deaths, parents need to feel empowered to advocate for their child—to just ask, “Could it be sepsis?”—and clinicians must be given clear guidance on the appropriate care pathway in cases of suspected sepsis. At the moment, there is room for improvement on the clinical side, because of the confusion created by delays in updating the National Institute for Health and Care Excellence clinical sepsis guideline, NICE guideline 51. In addition, research plays a pivotal role in understanding sepsis better and developing more effective treatments. The UK has a rich history of medical research, and ongoing studies are dedicated to improving our understanding of sepsis. Advances in genomics, microbiology and immunology are shedding light on the complexities of sepsis, paving the way for innovative therapies. Technology is also proving to be a game-changer in the fight against sepsis, with AI-powered algorithms being used to interpret patient data and identify sepsis risk factors early on.

The UK Sepsis Trust is a charity founded by an NHS consultant, Dr Ron Daniels BEM, in 2012. It has led the fight against sepsis after Ron witnessed the tragic and preventable death of Jem Abbots, a 37-year-old father of two. The UK Sepsis Trust aims to end preventable deaths from sepsis and improve outcomes for sepsis survivors. It also strives to raise public awareness of sepsis and works to support anyone affected by this devastating condition with its free, nurse-led support service. It raises awareness by educating healthcare professionals and by instigating political change.

The UK Sepsis Trust aims to protect people by enabling the prevention of severe infection and the treatment of sepsis, while helping to ensure that antibiotics are used responsibly. Its clinical tools are used by healthcare professionals across the country and have been formally endorsed by NICE.

The trust contributed to feedback on a draft update to the NICE clinical sepsis guideline—NG51—in March this year. The final version was due to be released in June, following a request by NHS England to update it in the wake of a statement from the Academy of Medical Royal Colleges about the timing of using antibiotics. However, the publication was pulled at the last minute without any obvious reason. The result is that we are left with a NICE guideline from 2016 that conflicts with the position statement from the Academy of Medical Royal Colleges. This has caused confusion among clinicians, which could lead to patient harm.

[Sarah Owen (Luton North) (Lab)]

I thank my hon. Friend for giving way, and for her powerful and personal speech today. We have heard about the UK death rates from sepsis, but it is really important for us to bear in mind that sepsis is a global killer; one in five deaths globally are attributed to sepsis and one person dies from it every 2.8 seconds somewhere in the world. A lack of access to medical treatment is often a reason for those figures. Because the symptoms of sepsis are often similar to those of other illnesses, as has already been discussed, it is vital that we increase not only public awareness of it but awareness in clinical settings, too. Does she agree?

[Christina Rees]

I thank my hon. Friend for her very important intervention, and what she says is why World Sepsis Day is so important. Sepsis deaths are a global phenomenon and we need to do our bit in the UK to fight sepsis, as well as working globally.

Sepsis is a critical healthcare challenge in the UK and across the world, but it is one that we can tackle with determination, awareness and innovation. Early detection, rapid intervention, research and support for survivors are the cornerstones of our battle against this silent killer. I urge everyone to take sepsis seriously, to educate themselves and others about its signs and symptoms, and to support the ongoing efforts of the healthcare professionals and organisations working tirelessly to save lives and improve outcomes. Together, we can make a significant impact and reduce the devastating toll that sepsis has on our society.

On World Sepsis Day, we remember those who have lost their lives and those whose lives have been affected by sepsis. We stand by their families and friends, and we try to support them in any way we can. Their stories must be told. I ask the Minister to meet me, Dr Ron Daniels and Sarah Hamilton-Fairley from the UK Sepsis Trust, to discuss the help she can give to set up a national sepsis register.

When will the updated NG51 guideline be published? Can the Minister update us on the recent announcement by the Health Secretary in the main Chamber that he is exploring the introduction of Martha’s rule? He referred to Ryan’s rule, which has been successfully established in Queensland, in Australia, and which has prevented several potential tragedies. Ryan’s rule provides patients and their families with the opportunity to request a clinical assessment from a doctor or nurse when the patient’s health is deteriorating or not showing expected improvements. When will Martha’s rule be implemented?

The Swiss Government have recently announced 10 million Swiss francs of state investment—around £9 million—over a five year period for implementing sepsis improvement across five workstreams. The best possible way to mark World Sepsis Day would be for the Minister and the Government to commit to a similar investment in sepsis improvement work in the UK and, in so doing, prevent the UK from falling rapidly behind the international curve, when it should be leading.

[Yvonne Fovargue (in the Chair)]

The debate must conclude by 4.55 pm.