Anna Dixon
MP for Shipley · Labour · United Kingdom
“I commend the organisers of the national emergency briefing, which I attended last year, as well as the local organisers of the people’s emergency briefing in Shipley. The climate and nature crisis is an emergency.”
“I thank my hon. Friend for securing this debate. She has spoken about some of the impacts of this issue. My 80-odd-year-old mum was recently admitted to Airedale hospital with acute respiratory issues. She had to wait in a chair for over 12 hours, alongside my dad, in a very undignified way. Does my hon.”
“I absolutely agree with my hon. Friend that it is not about fixing the problem at the front door; it is about fixing the problem at the back door. Does she agree that closer integration of health and social care is part of the answer to enable that flow through hospitals out into the community?”
“I commend the hon. Gentleman for speaking so clearly about why having an independent HSSIB—independent of those providers—to investigate is so important. Time and again, we hear about devastating failings in the NHS. He alludes to maternity services, but we could add to the list infected blood and pelvic mesh.”
“I thank my hon. Friend and her Committee for the excellent work that they have done in preparation for this Bill. Pensioners who bought retirement flats in Aire Valley Court and Sutton Court in my constituency were hoping for peace of mind; instead, they have had rocketing service charges, poor maintenance and a lack of communication and…”
“I was moved to hear about Jo Cox’s life and the impact of her work on women globally in last week’s debate. She was a strong advocate for women’s rights and overseas development aid.”
The complete record
Every one of 567 lines we hold for Anna Dixon, in date order, each linked to its source. Free to read, in full, without an account. Page 8 of 12.
“I thank the hon. Lady for so eloquently describing some of the variation in the use of drugs in the case of assisted dying. In normal practice we have a yellow card scheme, which allows for any adverse events from ingestion of prescribed medication to be reported. Is it her understanding that, under the current proposals, that would not happen for assisted dying? Is she also aware of a review that shows a great variation in the range and dosages of drugs used?”
“My hon. Friend makes a strong argument for excluding private, for-profit providers. He may know that I tabled an amendment in Committee that would have limited the provision of assisted dying to charities; unfortunately, it was rejected. Will he clarify where and how he thinks assisted dying should be provided, and his understanding of the Bill in that respect, given the lack of clarification we have had from my hon. Friend the Member for Spen Valley (Kim Leadbeater)?”
“I wonder what my hon. Friend’s view is of the opinion of the Royal College of Pathologists—the body responsible for medical examiners—which is that: “deaths following assisted dying should be notified to the coroner, just as other deaths following the administration of drugs, prescribed or not, must be.””
“Does he agree that, in a way, we already have in place some highly skilled individuals who are closely involved in making sure that these decisions are made in the best interests of the patient and the public, but also with clinical input?”
“I think there is some agreement between us, in the sense that obviously a police officer is not necessarily best placed to deal with those who are in mental distress. Having spoken to my local police team, I know that they would much rather there were frontline mental health professionals with the capability to take a person to a place of safety that is not a police station. We will come on to that in relation to later clauses, but does the hon. Gentleman agree that we already have some highly skilled professionals who are closely involved in these decisions in the form of approved mental health professionals? The vast majority of them—95%—are social workers. They play a very strong and excellent role, particularly to counterbalance the narrower clinical health perspective that there may sometimes be.”
“Obviously, the Lords amendment puts the role of the police into law. I think we agree that we do not want to have the police’s role enshrined in legislation. Over the implementation period for this important Bill, the idea is that community health services will be in place, including urgent response for those who find themselves in crisis. We need to remove this provision to make sure that the default position remains for community support.”
“We should allow clinical best practice, treat the person as an individual and apply the updated criteria in the Bill, recognising those individual cases.”
“That suggests a potential lack of a standardised application of the use of CTOs in some cases, which is perhaps slightly more subjective. The use of the clear criteria, therefore, along with the code of practice, will, I hope, certainly help to address the racial disparity as well as the unwarranted interprofessional variation in the use of CTOs that we see in practice. It is important that we consider the fact that people may be on a CTO longer than necessary, from the point of view of therapeutic benefit or, indeed, of the risk criteria. I commend the intent behind the amendment that was made in the other place, but there is a clear challenge in putting statutory limitations on the use of CTOs.”
“Member for Hinckley and Bosworth has discussed, is possible overuse and, in particular, disproportionate use in relation to race and ethnicity. Black people are seven times more likely to be placed on a community treatment order compared with white people. The Committee has received extensive evidence highlighting those racial disparities and the injustice not only in the application of CTOs, as the hon. Member pointed out—we will come to racial disparities in due course—but in the disproportionate use of CTOs to provide supervision in the community. The evidence from the Centre for Mental Health concerned the interprofessional variation among psychiatrists. Practice can vary even within the same area, so it is not just inter-area variation.”
“The provisions in the Bill are still in line with those underlying principles about the restrictions and the person as an individual. The clause will amend the previous legislation, in particular to align the new risk criteria for detention, which we discussed in some detail under clause 5. It is important that there is consistency in the criteria for detention under a community treatment order, or indeed under detention in an in-patient setting. Again, that supports the need to use the orders only where serious harm may be caused to the health and safety of the patients or the person—the negative likelihood of harm, as we discussed with regard to similar amendments to a previous clause. There is wide support for the use of the criteria for detention as an in-patient as well as under the CTOs. One of the concerns, as the hon.”
“It is a pleasure to serve under your chairship, Mr Vickers. I will speak in support of the clause and Government amendment 30, and I may touch on the amendment moved by the Liberal Democrats. As we all know, community treatment orders were introduced in 2007 under previous legislation, with good intent at the time. There was too often a problem with revolving doors into in-patient settings, in particular for patients with psychosis and schizophrenia. The intent behind the introduction of CTOs was to allow patients to be discharged into the community as long as they followed certain conditions, to provide ongoing contact with mental health services, and to provide support and help to prevent relapse. Under certain conditions, patients subject to CTOs could be recalled to a hospital under the Act.”
“Mental health advocacy is clearly critical, particularly for those who lack capacity as well as those who are compulsorily detained in an in-patient setting. I hope and expect that with the use of CTOs as a method of discharge, the relationship with advocacy they may have accessed in the in-patient setting would continue in the community. I acknowledge the spirit behind the amendment and hope to hear the Minister respond on how we will ensure that all those with complex mental health issues—particularly those who lack capacity and are detained in an in-patient setting—will have access to appropriate advocacy.”
“In addition to the ongoing data collection and feedback to clinicians, which it was suggested the Minister might want to take away and consider with the NHS, the Department and NHS England—while perhaps also talking to NIHR about the research and evaluation in this area, as well as the research gaps that could inform future implementation of CTOs and help to underpin best practice—we might consider looking into such matters as what is driving the racial inequalities and interprofessional variation, so that we can ensure that future policymakers and legislators like ourselves are better informed and can make more evidence-based policy decisions. I am close to concluding, but I would like to touch briefly on Liberal Democrat amendment 11.”
“There is clearly quite a disparity in the views that this Committee has heard, with the likes of Mind perhaps at one end in saying that the only solution is to get rid of CTOs. I think the majority of us here see a role for them, but only if used in the right way.”
“In that sense, I will support Government amendment 30 as long as the Minister gives a reassurance that we do not accept either the racial disparities in use or some of the lengthy uses, and that he is confident that the provisions in the code of practice will start moving us away from the current situation with the use of CTOs. The hon. Member for Hinckley and Bosworth made some interesting points about research and evaluation. Having been the chief analyst in the Department of Health and Social Care, I am well versed in this. Obviously we have a generous settlement for all the research and innovation. The National Institute for Health and Care Research is world-renowned for the research that it commissions.”
“Those review points need to be as effective as possible at ensuring that people are not unnecessarily being kept under community supervision when that is no longer necessary. I will be seeking assurances from the Minister about what will be in the code of practice to ensure that any statutory time limit is really just a backstop that maximises the ability of clinicians to have some discretion, while using these other methods to ensure good practice, consistency in decision making and reductions, certainly in racial disparities, and as an urgent matter, but also in some of the intra-professional variation that is not necessarily connected with racial discrimination.”
“There is a big difference, because when we address clinical variation we usually do so through clinical guidelines, clinical best practice, training and many other non-statutory levers, which are much more effective at driving out unwarranted variation. They also include feeding back data; the hon. Gentleman talked about data and encouraging NHS trusts and organisations to ensure transparency about which psychiatrists are overusing CTOs. That feeding back of data can be much more effective at driving out unwarranted variation, although that is not to say that we accept that there are people who are potentially on long CTOs that go through renewal. The other point is that there are other mechanisms, as the hon. Gentleman acknowledged, such as the tribunals.”
“I am grateful to the Minister for outlining so clearly what safeguards will be in place to ensure that there are no unnecessary extensions to CTOs beyond the period during which the patient is benefiting therapeutically or meets the detention criteria, which are being updated by the Bill. The answers that the Minister has given assure me that there will be significant review points. Does he, like me, think that these provisions will, in time, reduce some of the unwarranted variation and some of the excessive lengths? As the Bill is implemented in practice, we will see changes in the pattern of use of CTOs.”
“I commend my hon. Friend for her honest account of her personal experiences and thank her for bringing that experience into our discussion of the Bill. It is absolutely right that the welfare and wellbeing of individuals who are living their lives, at such distressing times as when they need mental health support, should be at the heart of the Bill. I want to acknowledge her contribution to the debate.”
“The constitution states: “NHS services must reflect, and should be co-ordinated around and tailored to, the needs and preferences of patients, their families and their carers.” It goes on to say: “Patients, with their families and carers, where appropriate, will be involved in and consulted on all decisions about their care and treatment.” Even though freedoms have, in a way, been taken from people through detention under the Act, it is so important that such detention should not remove all their choice, autonomy and ability to express preferences, whether that is simply over things in daily life, such as when they wake up, get up or go to bed. It is about making it really clear that patients can continue to express preferences and make choices over things that may give them a better quality of life, even while they are detained.”
“It is an honour to speak again in the Committee’s debates on the Bill. I really welcome clause 21, in that it introduces care and treatment plans, as well as a statutory requirement that all those patients formerly detained under the Act should have such a plan, apart from those who were only on short detention. It also brings England in line with Wales. The clause fits with the fundamental purpose of the NHS. One of the founding principles in the NHS constitution is: “The patient will be at the heart of everything”.”
“If I may, I will briefly read from the review: “We must improve choice and decision making, both prior to and within a setting of compulsion…We believe that improving patients’ and service users’ ability to make decisions about their own care and treatment is essential to upholding dignity.” The report recommended that where a patient has capacity, the care and treatment plan should record their wishes and preferences, whether expressed at the time or in an advance choice document.”
“I agree that it is really important to put it on a statutory footing. Obviously, other provisions such as subsection (5) of proposed new section 130ZA will ensure that it is regularly reviewed. There is no point in having such a plan if it is not regularly updated to ensure that it reflects trigger points, which the hon. Member for Guildford raised. When circumstances change for the patient, that is obviously an important point at which to reconsider their care and treatment. I want to go back to the Wessely review. The clause is such a fundamental part of realising all four of its principles.”
“I thank the Chancellor for listening to the priorities of people in my constituency and across the country and investing in our schools. It was great to see free breakfast clubs in action at Baildon Glen and Beckfoot Priestthorpe schools recently, and I am delighted to hear today that the Labour Government will be putting in some £2.3 billion to fix our crumbling schools, having recently visited Eldwick primary school, where pupils are being taught in a temporary building with half the school out of action due to reinforced autoclaved aerated concrete. Can the Chancellor reassure the pupils at Eldwick that they will finally be able to get back to their classrooms?”
“The shadow Minister is making some useful observations about best practice. One of the real injustices that we are seeing with detention at the moment is the racial disparities in detention rates. One could argue that such a disparity is a potential risk factor, but behind it is something that we should be addressing through dealing with inequalities in the mental health system, particularly the unwarranted variation in practice from clinicians perhaps making discriminatory judgments in these cases. Does the shadow Minister agree that that is another reason why we should not be over-specifying some of these points where we see associations between risk factors and detention rates under the Mental Health Act, and that therefore we should not be including them in the Bill?”
“This discussion of the list of risk factors throws up a concern for me: one of the risk factors that has been facing families and other constituents of mine in Shipley for some years is the inability to get appropriate support for their children from children’s social care, for example, because there are very long waiting times for child and adolescent mental health services. Even when people have EHCPs, they are often not fulfilled. Does the hon. Gentleman recognise that we need to address special educational needs and disabilities and children’s social care and put those things in place, as the Government are doing? Children with autism and learning disabilities will remain at high risk of much more complex mental health needs if they do not get the support they need at an early stage.”
“The hon. Gentleman may want to take these points together. We drew attention to proposed new section 125. Subsection (1) relates to integrated care boards, while subsection (2) relates to local authorities. They do exactly what he wants: strengthen the requirements on ICBs and local authorities to better meet the needs of people with autism or learning disabilities in order to avoid detention. The very essence of the Bill therefore provides the duties that the Minister reassured us on in response to my earlier point. The expectation is that commissioners will meet needs as identified in these dynamic registers.”
“The hon. Gentleman elaborates on the great history of the previous Conservative Government. From where I am sitting, the record is less rose-tinted—but perhaps I am wearing different spectacles. Might he return to the substance of new clause 11, which, it seems to me, is about community provision? I return to the points that I raised earlier about proposed new section 125E. I do not see what new clause 11 adds to the Bill in regard to duties relating to the commissioning of services. I encourage him to address the specifics of the amendment.”
“Yes, briefly. I was trying to get the hon. Gentleman back to the point, which is people with autism and learning disabilities, rather than mental health policy in general. The point of reference I used earlier was the failure to deal with Winterbourne View in 2012. My hon. Friend the Member for Thurrock made the point very well: if we get down to it, we are talking about community provision for people with learning disabilities and autism. Too many people remain institutionalised, too far from their family, friends and community. I was pointing at that failing. I encourage the hon. Member to get back to that point. Would you like to give clarity on what is within scope of the group of amendments that we are currently debating, Ms Furniss?”
“I thank the Minister for setting out so clearly the importance of the annual ministerial statement. Does he envisage that the statement will also give an update on the extent of community provision available and the execution of the transition of people with learning disabilities and autism from institutional settings to community settings closer to home? Is that within scope of the statement?”
“Given that pre-legislative scrutiny was carried out under the previous Government, I am sure that process fully got to the bottom of these issues, and I therefore hope that we can move on.”
“I have a great deal of respect for the hon. Member for Runnymede and Weybridge. I have worked with him on some aspects of the Terminally Ill Adults (End of Life) Bill; he brings great expertise as a psychiatrist, and an understanding of the Mental Capacity Act that is perhaps greater than mine and that of some Members of the Opposition. However, even though I respect the hon. Member for Runnymede and Weybridge, does the hon. Member for Farnham and Bordon recognise that we need to ensure compatibility between the Mental Capacity Act and the Bill before us? I hope the Minister will be able to assure us that the legal checks have been done and that the proposals before us are compatible.”
“I thank the hon. Gentleman for his comments. Does he agree that the Wessely independent review setting out these four principles gets right the balance that even though people may need to be detained, they should not lose their personhood and control, and that embedding these principles in this updated Bill will ensure that those rights are enshrined in law?”
“Does the hon. Gentleman recognise the work of the World Health Organisation in producing the international classification of diseases and ICD-11, which provides a scientific, evidence-based update, including on psychiatric disorders, autism and other neurodevelopmental disorders? Has he considered whether that is an appropriate reference point for the Bill?”
“The hon. Gentleman seems to be overcomplicating the need for additional scrutiny. Will he acknowledge the work of the World Health Organisation to review the evidence on a global basis and update the definitions of psychiatric disorders?”
“It is a pleasure to serve under your chairship, Mr Vickers. I will make a few brief remarks on clause 3. For many of us, the detention and long-term institutionalisation of people with autism and learning disabilities is a shameful part of the NHS’s history. The Bill, and particularly this clause, will finally make it very clear that that is no longer acceptable. It is a further shame that, despite the Winterbourne View report in 2012, so little progress has actually been made on providing for people to be cared for in the community and closer to home.”
“The hon. Member is going into some detail on these amendments. There is a duty where EHCPs are in place. Local authorities have had their funding cut over many years, so they have found it difficult to meet their EHCP obligations for the many children with SEND needs. Is there not a similar risk that the amendments will put duties on local authorities that they will not be able to meet unless they have sufficient resources? There must be some flexibility as well as duty on local authorities and the NHS to balance their duties and responsibilities with resources.”
“Shipley Market Square in my constituency is having a major facelift, but to attract shoppers back into the town centre we know that we need to make it safe. I commend my local officers, Inspector Tany Ditta and his team, for the amazing work they do. Will my hon. Friend join me in recognising that the Labour Government’s commitment to increase neighbourhood policing will allow more patrols on streets in Shipley and in places that she represents?”
“I recognise this issue, because many of my local independent shops in Bingley have been victims of crime, particularly by aggressive scammers demanding money. Does my hon. Friend agree that it is vital that independent shops not only feel confident about reporting the crime, but know that the police will respond and that there will be prosecutions?”
“I really thank the Chief Secretary and the Chancellor for delivering historic investment that will make a reality of the plans of the Mayor of West Yorkshire, Tracy Brabin, for an integrated transport network. I understand that it will be called the Weaver Network, to compete with the Bee Network on the other side of the Pennines. I have been actively campaigning for that along with other West Yorkshire MPs. Will the Chief Secretary confirm that funding is included for a new bus station in Bradford? Does he agree that the investment the Government are making in transport infrastructure in the north will improve connectivity for communities in the Shipley area and beyond, bringing social, environmental and economic benefit?”
“I echo the hon. Lady’s comments about the vital role that family carers and unpaid carers play in enabling people with dementia to live well at home. Does she agree that, in addition to formal respite care, community support from groups in my constituency such as the Wrose Dementia Friendly Community Support Group and Shipley Memories Group is vital to give carers little breaks, when they have an opportunity to get out of the house and meet other carers like them?”
“Much has been made about the decline in bus usage. The pattern is similar in West Yorkshire, where between 2011 and 2022 there was a reduction of some 60 million journeys. There has been lots of mention of Greater Manchester, but West Yorkshire Mayor Tracy Brabin’s bus service improvement plan has already seen a 4% increase in bus usage. Does the hon. Gentleman agree that approaches that devolve responsibility and make it easier for mayors and local authorities to take over public control through franchising are the route to improved usage and, ultimately, the delivery of better buses?”
“Does the Minister agree that schemes such as Helpforce’s Volunteer to Career programme could play a huge role in filling some of the vacancies in NHS roles and that volunteers will play a central role in delivering the 10-year NHS plan?”
“Before I ask my question, I draw attention to my entry in the Register of Members’ Financial Interests: I am an unpaid trustee of Helpforce, a charity that supports volunteering in health and care and works with more than 100 NHS partners to embed volunteering in trusts. As we have heard, volunteers make a huge contribution every day across the country, giving their time and skills to free up doctors and nurses to focus on their clinical tasks. Helpforce runs a scheme called Volunteer to Career, which enables people to try out through volunteering before making the transition into a frontline healthcare career.”
“I support the hon. Lady’s amendment. As the Royal College of Psychiatrists pointed out, pain from unresolved physical symptoms and the fear of physical pain or death can make a person want to die, and depression, which is also associated with a wish to die, is often missed. Does she agree that it is vital that people are supported to be free from pain by having access to good palliative and end-of-life care, and that the Bill’s provisions should be available only to those whom that cannot help?”
“On a point of order, Mr Speaker. I appreciate that you and the team have had a very difficult day, but as someone who tabled an amendment but has not had the opportunity to speak to it, I would like clarification that if a closure motion is moved, my amendment, as well as those tabled by other Members who have been unable to speak to them, will not receive further debate.”
“I note that I am chair of the all-party parliamentary group on carers. A lot of employers are already going further than the statutory requirement, in offering some days of paid leave. Members of Employers for Carers have found it has helped with retention of workers. Does she agree that some leading employers are already showing the benefits of providing paid carer’s leave on a voluntary basis?”
“I thank the Minister for his commitment to review carer’s leave and to consider the opportunity for looking at paid carer’s leave. Does he agree that would particularly benefit low-income workers and women? They make up the bulk of unpaid carers, and they find it particularly difficult to take unpaid carer’s leave because they simply cannot afford it.”
“I apologise for not getting here earlier; I have been listening to carers who have been sharing their stories. I spoke to a woman who is caring for her husband, who has a neurodegenerative disease and currently scores only two points across the board. Their family would be penalised under the tightening restrictions. Does the Minister agree that somebody with a neurological and degenerative disease should be counted as severely disabled and protected from the changes?”
“Thanks to my intervention on her behalf, we got a small victory: the cameras were updated and she got her money back. It should not require the intervention of MPs with these private companies to stop this rip-off Britain. It seems like the companies have a blank cheque and are exploiting law-abiding residents of my constituency and people around the country. I hope the Minister will respond positively to my call and that of colleagues for properly independent regulation and clarity for consumers, and a legally binding code of practice.”