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I genuinely don't know if I'm missing something here, but Q13 of the consultation asks:

"Q13: Should the availability of Periodical Payment Orders affect the discount rate?"

The argument seems to be that PPO's are risk free, hence the first specific issue the question asks is:

"Should refusal to take a PPO be taken as grounds for assuming a higher risk appetite? If so, how big a difference should this make to the discount rate?"

I can just about understand that line of thinking, though I can think of several reasons why refusing a PPO may have nothing to do with appetite for investment risk. However, the next question is:

"Should this assumption apply in cases where a secure PPO is not available?"

Again, unless I'm missing something, this is asking whether it should be assumed that a Claimant who refuses a non-secure PPO has a higher risk appetite. How can turning down something that is non-secure equate to an appetite for risk?

The NHSLA has for many years pushed quite firmly for PPOs in every large claim I've dealt with. It's barely even a discussion now; we know the NHSLA will offer part lump sum, but PPOs for as much as it can. The PPO offered will include all future care and case management unless there is a (overwhelming) reason not to. The only real issue is whether the PPOs include over heads of damage like loss of earnings, equipment, etc... claim. That in turn usually depends on the accommodation, and how much had to be "borrowed" from other heads to make up deficiencies in the Roberts v Johnstone calculation. To be fair, I've not pushed against that stance as PPOs do avoid investment risks and are clearlyfairer for both sides if life expectancy estimates (guesses) turn out to be wrong.

If I were cynical, I'd say PPOs are the NHSLA's/Treasury's preference because it postpones the liability rather than being an up front capital cost, but let's assume they just think it's fairer too.

However, my understanding is that insurers have been quite averse to PPOs, and will usually avoid offering these in settlements and/or will make seemingly generous lump sum offers to persuade Claimants away from PPOs. Maybe this is simply that they want to close their book on the Claim....

Being cynical again though, maybe it's because they're well aware that the discount rate has been far too high for years, making lump sum payments far cheaper than they should have been.