CQC’s assessment of gambling treatment services: End of programme report

Access to services

People were able to access the free support services quickly and efficiently. They described the whole process, from initial assessment to intervention as “very timely and professional” and said that they did not have to wait long to access the services. This is supported by data from NGSN which shows that on average people waited around 1 day (ranging between 0.8 and 1.3 days) from referral to initial contact. Short waiting times meant people could start their support and recovery journeys more quickly and prevent gambling harms from getting worse.

Many staff felt that this was really important as, from their knowledge and lived experience, gambling harms remain hidden for a long time before people actually seek help. As a result, prompt assessment and interventions are important to make the most of people’s motivation in contacting the service.

We found that waiting times could be slightly longer for residential services. This was again supported by data from NGSN which showed that the average wait time from referral to contact for tier 3 treatment was between 1.5 to 3 days, and the average waiting time from assessment to treatment for tier 3 services was around 3.5 to 5.5 days. While people were waiting, services communicated with them well to make sure they were risk assessed and received the support they needed.

Treatment and support options

There were a variety of in-person and online support options available. These included, for example:

• webinars
• podcasts
• support groups – face-to-face and online
• cognitive behavioural therapy
• one-to-one counselling
• therapy sessions
• peer support
• self-help tools.

People often told us that it was up to the individual to decide which support options they wanted to use, and that they were able to engage with these at their own pace. There was no pressure to engage if the support options did not suit their needs. The length of treatment and support was also flexible depending on people’s needs.

Services recognised how gambling harms could affect people’s friends and family. In response, they offered the same support to friends and family as well as bespoke programmes, couples support and routine wellbeing monitoring.

Overall, people were very positive about the support offered by both remote and residential services, including the standard of accommodation at residential services. At one residential service we heard that improvements to the therapy schedule and access to fitness equipment could improve people's experience.

Aftercare

People who use services, especially those using residential support, described how difficult it can be to return to everyday life, and how vulnerable they felt, when trying to stop gambling. People described how important aftercare was in helping them to transform their lives, keeping them accountable and stopping them from engaging in harmful gambling behaviours.

This was recognised by the gambling treatment services. Services provided good aftercare, with people able to access aftercare quickly and easily if they were experiencing a relapse.

We found that services regularly checked in with people as part of their aftercare. This was supported by the NGSN data which showed that around 4 in 5 (76% to 86%) of people were contacted for follow-up post-treatment. People also told us they felt they would be able to access support at any point in the future should they need it.

Continuity of care

Continuity of care, where people receive care that is consistent and coordinated over time, and they have a continuing relationship with their practitioner, is important to ensure progress is maintained.

Services understood the importance of this and ensured that people had the same counsellor and/or practitioner to support them through their gambling treatment journey.

People told us how having the same counsellor and/or practitioner built familiarity and trust, and was essential in allowing them to be open and honest about their struggles. Building a close relationship through continuity of care helped people and their practitioner to create a support plan that was based on their health and wellbeing, as well as their gambling histories.

Services had good information and records management in place, which supported a joined-up approach to care. People’s records, data and information was stored securely. Services sought people’s consent to share personal information across different services to inform care decisions and make sure that the person was at the centre of their treatment and support.

Partnership working

Services were quick to identify and signpost or refer people to other gambling treatment and wider support services where required. They worked well with other providers to coordinate people’s care, including:

• Housing services – on first contact, services completed a holistic assessment of people’s needs, including housing.
• Mental health services – staff developed risk management plans for people with mental health needs to ensure they were safeguarded and, where necessary, referred people to other services, such as the NHS and/or local charities that supported individuals at risk of suicide.
• Addiction and substance misuse services.
• Employment services.
• Local food banks.
• Women’s and children's support services.
• Domestic violence support services.
• International partners who could support people in their region.

Improving outcomes for people

Services worked well with other organisations and/or services to improve the outcomes for people experiencing gambling harms and their friends and family. This included, for example, hosting regular referral review meetings.

People could be easily referred to other services that were better placed to support their needs. In addition, they did not have long waits for these referrals to be made, which could have left them without help and support at critical time periods, such as when they were in crisis.

We found that services were not driven by how many referrals they received, but ensuring that people got the best outcomes and support they could.

This was supported by feedback from people who use services. For example, one person told us how they did not feel like “just another number” and that their interactions with the service felt “genuine”.

People who use services also described how partnership working enabled them to engage with a variety of different people in spaces that worked for them. This showed them that they were being treated holistically and their struggles and experiences with gambling harms were not being seen in isolation.

Services placed significant value on educating people in the wider community about recognising gambling harms. We found examples of services working with other organisations to improve awareness and understanding about gambling harms in their communities and promote access to support. For example, several services had ‘champion’ and/or ‘community connector’ roles. These were individuals from other organisations that were trained and supported by the service to help raise awareness about gambling related harms. These roles also helped to identify people experiencing gambling harms earlier and support them with referrals into the service.

We also found examples of services delivering training to third sector organisations, as well as developing and delivering specialist programmes for specific communities with higher risks and other groups of people including:

• children and young people
• prisoners
• armed forces veterans
• people from ethnic minority groups.

These programmes helped people to understand what gambling-related harms look like, what effect these harms can have on people and how people can get support. They gave certain groups of people, particularly those where cultural or religious beliefs may discourage open discussions about gambling, access to information they might otherwise not have had.

Other services focused on developing knowledge about gambling harms in the health care sector. For example, one service we assessed had co-designed an accredited course that took a public health approach to gambling harms, which focused on education and early intervention. The course, “Bet You Can Help”, which is now delivered by a number of NGSN providers, has been delivered to a wide audience, including local authorities and healthcare professionals. Through the course, the service increased awareness of gambling related harm across many communities and professional settings, including organisations such as housing providers and services, with a view to supporting more people through increased referrals.

Another service provided training on gambling harms for general practitioners (GPs). This provider had also worked with the Royal College of General Practitioners to develop a national competency framework that aimed to:

• increase GP awareness around gambling harm
• build GP knowledge of support and treatments available
• provide accreditation for GP practices.

A stakeholder told us that the programme addressed a major gap in early identification and intervention for gambling related harms, and represented a big step forward by giving primary care staff in England the necessary skills to assess, treat and manage gambling related harms. At the end of October 2025, there were 558 accredited GP practices.

Services also worked with universities on research projects to deepen their knowledge and understanding of gambling-related harms. Services then used these insights to change the way they delivered treatments to ensure that people received the most effective treatment possible that was rooted in evidence.

These academic partnerships also helped providers ensure people received the right support. For example, one service worked with a university to develop a framework that brought together assessment of gambling harms and wider wellbeing needs, to support providers and other agencies to measure and respond to the impacts of gambling harms more effectively.

All the initiatives and programmes outlined show how services are actively involved in shaping the gambling harms treatment, support and care landscape. As well as recognising the importance of identifying gambling harms early, services worked in partnership with other organisations and community groups well to widen understanding among communities and other professionals, promote their services and reach more people.

Person-centred help and support

Gambling treatment services ensured support was flexible and tailored to people’s needs. From the start of their journeys, providers focused on understanding people’s treatment and support needs.

People were involved in their treatment and support. We found that support plans were co-created and regularly reviewed with people who use services and that plans focused on the person’s goals. Services understood that everyone’s journeys are different, and that a one size fits all approach would not support them to progress.

Keeping people safe

Services made sure that people were kept safe when receiving treatment and support. Staff had regular meetings to reflect on safeguarding practice or any incidents. As a result, we found that services had a strong learning culture, which supported continuous service improvement.

A few services needed to improve their health and safety checks of buildings and premises, and how they recorded this information.

We also found that in some services that were otherwise safe, governance needed to be improved but we did not find that this was causing any harm. For example, in some cases governance structures were not embedded as well as other health and social care systems. However, it was recognised that some services had either recently developed or expanded their services and, as a result, at the time of assessment were still developing strategies to improve their governance systems.

Experienced and caring staff

People were grateful to the staff who supported them. Respondents to our survey often described staff as being crucial in helping them to engage successfully with the service. They spoke of their support being “truly life changing”, not only for the person experiencing gambling harms but also their friends and family. People found staff to be sincere and invested in their recovery journeys.

Staff were well trained and qualified to deliver treatment, help and support. Most staff were required to have a level 3 or above health and social care qualification or equivalent, but what was required depended on the support provided by the service and their role, for example counsellors had to have the correct qualifications. Services provided comprehensive induction programmes for staff to ensure they understood gambling harms and how to deliver safe support and manage associated risks. We found that staff had received training in a number of areas including:

• safeguarding
• suicide and self- harm awareness
• health and safety
• fire safety
• equality, diversity and inclusion, and human rights
• stress management
• mental health
• infection prevention and control measures.

Services worked proactively with commissioners to establish training requirements, and which areas they needed to prioritise. For example, at one service where they had not completed all the training set out by the commissioners, the provider was having ongoing discussions with the commissioners about what required training was expected.

In addition, services prioritised professional development for staff and often provided them with opportunities to grow their skill sets through additional training opportunities. As a result, services had staff with a range of skills and areas of expertise, meaning that they could cater for a variety of different needs.

Services and staff used monitoring tools effectively to support people’s treatment and support. Core tools and systems included:

• Wheel of life – this monitors people’s progress against their agreed goals, including areas like personal wellbeing, physical health, debt and self-care.
• The Problem Gambling Severity Index (PGSI) – this helps staff to look at problematic gambling behaviours, identify risk and measure performance against set measurements.
• Psychological assessment tool CORE 10 – this helps to assess psychological distress.

Staff used the tools continuously, often at the end of sessions. The scores and outcomes helped staff to see how well people were progressing and amend people’s treatment and support as needed, especially if referrals were required. This is supported by data from the NGSN which suggests that these tools were helping services to monitor if they were achieving good outcomes for people (see also the section on impact on people).

Leaders of the services also provided good, person-centred support for staff. While some services needed to improve their governance processes and supervisory support (see the section on keeping people safe), overall staff commended the services on how they were supported. This included:

• Safe recruitment practices – such as carrying out thorough pre-employment checks and ensuring that all staff, including agency staff, had enhanced Disclosure and Barring Service (DBS) checks and Protecting Vulnerable Groups (PVG) scheme checks in Scotland.
• Effective induction processes – including a focus on relevant training, clinical supervision, peer support and shadowing opportunities.
• Clear policies and procedures.
• Manageable workloads – for example, at one service new cases were discussed before they were allocated to ensure that this was manageable and staff felt supported by managers if they felt unable to take on new cases.
• Whistleblowing guidance and channels.
• Wellbeing support – for example, at one service structured support mechanisms were in place to monitor the wellbeing of staff with lived experience and proactively respond to any signs of relapse. Where needed, individualised support measures were implemented. The provider was in the process of formalising this approach to ensure staff were fully aware that support would be available and that they would not be penalised in such circumstances.”
• Seeking regular workforce feedback and acting on this.

1. Creating and preserving supportive workplaces, helped staff to deliver informed, kind and compassionate care to people who use services. Staff involved in the assessments who participated in our focus group noted the passion that all staff felt in delivering care and being part of a good service.

Services recognised the value of staff with lived experience and people told us how this experience helped to support their recovery as they could relate to the people they were supporting and understand their needs. A shared understanding of gambling harms helped people to develop trust. Staff with lived experience brought openness about their experiences and the recovery process, which helped people to approach their treatment and support with optimism.

Safe spaces

Respondents to our people’s experience survey said that staff created safe spaces for them to have open and honest conversations about their experiences of gambling and gambling harms. They described how staff acted professionally and were empathetic and patient. From what people told us in the people’s experience survey, we found that these safe spaces were characterised by the following elements.

• Understanding – Services understood the people they were supporting, and managers used this understanding to help shape the service. Providers took a continuous improvement approach to co-developing their services, seeking regular feedback from staff and people who use services to understand what was working well and what needed to improve, and to ensure that the help and support they offered was rooted in direct experience and understanding of gambling harms.
• Confidentiality – Services had data sharing and records management processes in place to protect people who use services. Consent was obtained from people before sharing any information, but it was noted that if there were any safeguarding concerns this information was shared with the appropriate agencies to protect people’s safety and wellbeing.
• Respect – People who engaged with the services said they were treated respectfully throughout the process, from their initial consultation through to their support or counselling sessions.
• Non-judgemental – The stigma and judgement people said they received from other people was not present within the services. People often said this was as a result of staff members having lived experience themselves.
• Active listening – People who use services felt listened to throughout the process especially during their support or counselling sessions. In addition, people said that they could access support from coaches when they needed it and that coaches were responsive if they needed more support outside of scheduled sessions. Staff also said leaders of the services were supportive and that they felt comfortable and felt listened to when they raised concerns.

Equality, diversity and inclusion

Providers embedded equality, diversity and inclusion (EDI) throughout the culture of their services. This ensured that the needs of people with protected characteristics were considered and understood.

Services’ approach to EDI was variable. While all services had clear EDI policies, some had more established EDI strategies than others. For example, one provider we inspected had an Equal Opportunity, Diversity and Inclusion Strategy 2022 to 2025. This set out objectives to help ensure that they were an inclusive workplace, including objectives around education, empowerment and support. This helped to nurture a culture that encouraged individuals’ development around diversity and inclusion, ensuring a responsive training plan was in place and celebrating diversity.

Services that did not have an established EDI strategy still actively sought to make EDI a priority. An example of this was where one provider told us about some of the steps they had taken to reduce bias within its practices. For example, a member of staff explained that the organisation had previously given all staff a day off at Christmas for shopping, but later recognised that not all staff celebrated Christmas. In response, this was replaced with a culturally-competent day that staff could take at any point in the year, allowing the benefit to be inclusive of all cultural and religious backgrounds.

The same provider told us about the Cultural Competency Change Group they had established. This was made up of staff from across the wider organisation, such as board members, managers and volunteers, including those from protected characteristic groups. The group led on work to strengthen cultural competence by shaping policy, guiding practice and promoting organisational learning. This helped the provider ensure the service continued to develop and apply culturally-informed approaches, making it more responsive, inclusive and accessible for all people using it.

Most staff had completed EDI training. At the time of our assessments, across the providers we assessed we had no concerns about discrimination based on the evidence we gathered, such as interview with staff and people with lived experience. One service had EDI staff leads who helped to review the service and experience for both staff and people to ensure that it was accessible for all. Services continuously asked both staff and people who use services to provide feedback on how they delivered their services. We heard that this was essential in helping them to improve how they embedded EDI and how they engaged effectively with people whose voices are seldom heard. Examples of improvements services had made included improving:

• communication and access for neurodiverse people
• communication and access for people whose first language was not English
• communication with the LGBTQ+ community
• the inclusion of people’s pronouns on electronic recording system.

Services were aware of the diverse cultural and social needs of the communities they supported. Where there was a known need, services had produced written materials in a range of languages and offered interpretation services to ensure information was clear and accessible. In areas where such needs had not previously been identified, services told us they would respond on an individual basis and arrange translation or interpretation support when required. The availability of these resources varied between services, often influenced by location and the level of identified local need.

Staff were also aware that different engagement styles can affect how people are able to access the service, particularly for autistic people and neurodiverse people. This allowed staff to tailor how they communicated with people by, for example, sending documents in advance or allowing people extra time to complete tasks to ensure they could participate effectively.

In addition, we saw how services provided specialist support and engagement while working alongside community partners. For example, one service was working with the charity Investing in People and Culture to reach Czech and Roma communities through mentoring, interpreting and bespoke materials.

Residential services ensured that they provided accommodation that was accessible and met people’s physical, spiritual, social and cultural needs. This included, wheelchair access, dedicated spiritual spaces, and adjustments and adaptations.

Peer support groups, such as women’s support groups, were often identified as being key to encouraging inclusion in the services and ensuring people’s needs were met. The women who attended them told us how much of a support the groups were in aiding their recovery.

These groups were often created with people who use services, showing how they valued co-creation and lived experiences to drive their support systems and initiatives.

Some services reported finding it difficult to reach people from ethnic minority groups. To address this, they used community links and worked with external partners to effectively engage with people whose voices are seldom heard.

Innovative engagement approaches have allowed services to extend their reach. This both contributed to improving the services overall and ensuring that individuals got the help and support they need.

Value of the services and the impact on people

Respondents to the people’s experience survey described how the support they received from the services was life changing. Before engaging with these services people often told us they felt hopeless and isolated, with one person describing how they felt that nothing was going to help when they first entered the service. Some people also said they were at very low points in their lives.

However, once they started to get treatment and support through the services their outlooks on life and ability to overcome gambling harms significantly altered. The help and support the services provided gave people new senses of empowerment and hope.

People described how the services had helped them to rebuild their lives and take ownership of their recovery by providing them with the tools they need to support their wider mental health.

People affected by gambling harms, either directly or indirectly, can be plagued by the stigma associated with gambling, and we heard how the support they received had boosted their self-confidence and showed them that they did not need to be ashamed.

People described the positive effects that using the services had on their gambling habits, highlighting how valuable these services are to ensure that people affected by gambling harms can lead happy and healthy lives.

Valued services

From the responses to the people’s experience survey, many of which feature throughout this report, it is evident that people valued and had a positive experience of gambling harm treatment services. People praised the service they had engaged with and said that they would recommend their service to others seeking help and support with their gambling harms. Respondents often said that they did not have any comments or suggestions on how they would improve the service, and they wished for the services to continue their valuable work.

This feedback was supported by the findings from our assessments. Providers had their own feedback mechanisms that were equally positive about the effect of their work. We found that partner organisations valued their work and could see the positive effects on people.

The services we inspected were at different stages of their development. However, the commitment to supporting people experiencing gambling-related harms was consistent across all services. In addition, despite uncertainty about future commissioning changes, services remained committed to providing treatment, care and support for people experiencing gambling harms.