SMF Urges UK to Treat Gambling Harm as a Public Health Crisis

The Social Market Foundation (SMF) wants the UK to stop treating gambling harm as an afterthought and start managing it like alcohol, tobacco and drugs inside mainstream public health policy. In a report published on 13 July 2026, titled "Slipping Through the Cracks", the London think tank calls for a legal duty on local councils to tackle gambling harm, gambling questions built into routine NHS patient checks, and a national database to track who is treated and where. The core argument is simple: people are being spotted only when they are already in crisis, and the health system is not set up to catch them earlier.

The intervention lands at a sensitive moment for the industry. The UK has already introduced a statutory levy on operators to fund research, prevention and treatment, and regulators are pressing ahead with tighter affordability and financial risk assessments. The SMF report pushes the debate one step further, from how gambling is regulated to how the health service itself responds to the people it harms.

What is the Social Market Foundation proposing?

The SMF is proposing that gambling harm be embedded across UK public health policy rather than sitting off to the side as a licensing and culture issue. Its headline recommendations are a statutory duty on local authorities to address gambling harm, the inclusion of gambling screening questions in standard NHS patient questionnaires, and a national gambling database to monitor treatment pathways across Integrated Care Boards. The think tank frames prevention, not crisis response, as the goal.

What is the "Slipping Through the Cracks" report?

"Slipping Through the Cracks" is the Social Market Foundation report, published on 13 July 2026, that sets out the case for a public health approach to gambling in Britain. It draws on interviews with frontline staff across health services and the third sector, and argues that the current system leaves too many people undetected until the damage is severe. The report positions gambling alongside alcohol, substance misuse and smoking, all of which are already handled through established public health frameworks.

How many people in the UK are affected by gambling harm?

The report states that 2.7 percent of British adults, roughly 1.4 million people, meet the threshold for problem gambling on the Problem Gambling Severity Index. That headline figure sits at the centre of the SMF case for treating gambling as a population-level health issue rather than an individual failing. The think tank also points to rising pressure on clinical services as evidence that demand is outstripping the current response.

• 2.7 percent of British adults, about 1.4 million people, meet the problem gambling threshold on the Problem Gambling Severity Index, according to the SMF (2026).
• Nearly 130 percent increase in referrals to NHS England gambling clinics over a six month period in 2024, cited in the SMF report.
• Up to 100 million pounds a year is the harm prevention target of the UK statutory gambling levy that took effect in April 2025, per the UK Gambling Commission.

What legal duty would councils be given?

The SMF wants councils to carry a legal mandate to address gambling-related harm through local public health policy, in the same way they already act on other health risks. In practice that would mean gambling prevention becoming a defined local health priority with clear responsibility attached, rather than a discretionary activity that varies from one authority to the next. The report argues this would close the postcode lottery in how gambling harm is identified and supported.

Why does the SMF want gambling treated like alcohol and tobacco?

The think tank argues that alcohol, tobacco and drugs are already screened for and managed within public health systems, while gambling is not, despite causing comparable harm. Treating gambling the same way would mean routine screening, defined treatment pathways and prevention campaigns rather than leaving individuals to seek help on their own. The SMF says gambling has too often been viewed primarily as an economic activity to be licensed, rather than a health risk to be managed.

"Our interviews with frontline staff give a clear insight into the problems they face: there is a chronic lack of training and resources," said Niamh O Regan, Senior Researcher at the Social Market Foundation.

What did the report find about frontline health services?

The report found that frontline health and third sector staff are willing to help but lack the training, expertise and capacity to identify gambling harm reliably. It describes a knowledge-action gap, where staff may recognise a problem but have no clear route to act on it, compounded by long waiting lists that pile pressure on already stretched services. The SMF says these gaps are why many people are missed until they reach a breaking point.

"Too many people are only identified when they reach crisis point," said Professor Durka Dougall, Chief Executive at the Centre for Population Health.

How does this connect to the NHS and gambling clinics?

The SMF wants NHS England and the Department of Health and Social Care to guarantee adequate, accessible gambling treatment capacity across the country, backed by data. It highlights a near 130 percent rise in referrals to NHS gambling clinics over a six month window in 2024 as a sign that demand is climbing fast. A national gambling database tracking treatment across Integrated Care Boards would, in the SMF view, show where capacity is missing and let commissioners plan around it.

What international models does the SMF point to?

The report points to New Zealand and Norway as countries that already run gambling harm through their health systems. New Zealand has operated a Ministry of Health gambling harm strategy since 2003, funded and reviewed as a public health programme. Norway has run a multi-year national action plan that includes training for health workers and community staff to spot and respond to gambling harm.

Country	Public health approach to gambling
United Kingdom (current)	No statutory duty on councils, gambling screening not routine in NHS care, oversight historically split across departments
New Zealand	Ministry of Health gambling harm strategy in place since 2003, run as a funded public health programme
Norway	Multi-year national action plan including training for health workers and community staff
UK (SMF proposal)	Legal duty on councils, gambling questions in patient checks, national treatment database across Integrated Care Boards

How does this fit with the UK statutory gambling levy?

The SMF recommendations build on top of the statutory gambling levy, which already channels operator money into research, prevention and treatment. The levy took effect in April 2025 with a harm prevention target of up to 100 million pounds a year, according to the UK Gambling Commission. The SMF case is that funding alone is not enough if the health system lacks the duties, training and data to spend it where harm is actually occurring.

Why does this matter for gambling operators?

For operators, the report signals that the direction of UK policy is moving from licensing controls toward a broader health-led framework, which tends to bring wider scrutiny. A public health framing can support arguments for higher duties on higher-risk products, tighter advertising rules and stronger local powers, themes the SMF has raised in earlier work. Operators that already invest in safer gambling tools and data sharing are better placed if screening and treatment become standard parts of the system. The parallel with tobacco and alcohol policy is the part the sector will watch most closely, given how similar UK measures such as health warnings on betting ads have spread in other markets.

What are the risks and criticisms of a public health approach?

Critics of a public health model warn it can broaden restrictions and costs across the whole sector, including on lower-risk products and the racing industry that depends on betting revenue. There is also debate over prevalence figures, with different UK surveys producing different problem gambling rates, so the exact scale of harm remains contested. Supporters counter that screening and early support are low-cost, evidence-led steps that would help players before harm becomes severe.

What happens next?

The report is a recommendation to government, not law, so its impact depends on whether ministers and the NHS pick up the proposals. The SMF is adding to a growing body of UK work, including local council pilots and Local Government Association guidance, that pushes gambling toward a public health footing. Whether a statutory duty on councils or routine NHS screening follows will be the clearest test of how far the government is willing to go.

Frequently asked questions

Who published the "Slipping Through the Cracks" report?

The Social Market Foundation, a London-based think tank, published the report on 13 July 2026. It calls for gambling harm to be treated as a public health issue in the UK.

What is the main recommendation?

The main recommendation is a legal duty on local councils to address gambling harm, alongside gambling screening in NHS patient questionnaires and a national database to track treatment across Integrated Care Boards.

How many problem gamblers are there in the UK?

The SMF report cites 2.7 percent of British adults, about 1.4 million people, meeting the problem gambling threshold on the Problem Gambling Severity Index.

Is this new UK law?

No. The report is a set of recommendations to government and the NHS. Any statutory duty or mandatory screening would require government action to become law.

How does this relate to the statutory gambling levy?

The statutory levy, live since April 2025, funds research, prevention and treatment with a target of up to 100 million pounds a year. The SMF argues that funding needs matching duties, training and data to be effective.

Updated July 2026. Sources: Social Market Foundation, LocalGov, SBC News and the UK Gambling Commission statutory levy guidance.