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Chris Grayling: It is clear from the Minister's last remarks that she does not understand the importance of this part of the Bill to many outside groups, small businesses, GPs and organisations that provide insurance to GPs. If this part were implemented wrongly, it could have a significant effect on the welfare and possibly even the survival of a number of smaller businesses. I shall therefore challenge what the Minister said about the negative and affirmative approach to future statutory instruments, and attempt to convince her that she is wrong about that aspect of the measure.

It is true that we have received from the Government some clarification of their intentions in the Bill. In Committee we debated a number of provisions that were vague and confusing, and the Minister has gone some way to clarifying the Government's intentions, but in doing so, she has created additional confusion. I shall deal with some elements of the confusion that arises from the changes that she has made.

It was clear from the comments of the Minister of State, the right hon. Member for Barrow and Furness (Mr. Hutton), in Committee that the measure was intended to apply solely to injury. As the hon. Lady rightly said, we raised the issue of long-term chronic

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conditions and the fact that it was impossible for the insurance industry to plan for those, as such conditions sometimes emerge years after the event. The Government's focus on injury specifically was welcome and helped to clarify their intentions.

However, I remain uncertain, as do my hon. Friends, about some aspects of what is proposed in the Government's amendments. The Minister spoke about psychological injury. It is appropriate that we should recognise that injury is not always physical and that it is sometimes psychological. The hon. Lady set out a good example in which this aspect of the Bill might be applied—the case of a substantial and distressing public event, following which a large number of people were treated for shock, post-traumatic stress disorder and other psychological conditions that resulted from experiencing or being an eye-witness to the incident.

In the case of a major sporting event, the impact on the organisers could be substantial. We need only think back to some of the more terrible incidents that we have experienced in this country in recent years, such as the Bradford City fire and the Hillsborough disaster, in which large numbers of people were affected by direct experience of an appalling situation. Sports clubs that must insure against the risks to them could face huge problems. [Interruption.]

Mr. Deputy Speaker: Order. I am being distracted by conversations while the hon. Member for Epsom and Ewell (Chris Grayling) is addressing the Chamber.

Chris Grayling: In assessing the risk associated with large-scale sporting events or public events of any variety, including rock concerts or open-air classical concerts, the insurance industry will have to take into account the possibility of reimbursing to the national health service the cost of treating people who have suffered shock and other psychological aftermaths as a result of a major incident of the sort that we hope will not occur too often. That will be factored into insurance premiums in future.

What discussions has the Minister had with the insurance industry about that issue? Has she made any assessment of how the Government could limit the measures? In Committee, the Minister of State, the right hon. Member for Barrow and Furness, said that he would cap the payout that an insurance company could have to make in an individual case. Of course, as a large number of payouts could be made in relation to an individual incident, insurance organisations and event organisers could face substantial payouts, as a single incident might affect not only one person but a range of people. Will the Minister clarify that point?

I should also like clarification in respect of disease acquired from injury. The Minister cited the example of septicaemia. We can all understand how that would feature in a case for personal injury. She will be aware, however, of the very widespread incidence of MRSA, a hospital-acquired infection. She and her colleagues have indicated that health care providers will not be exempt from the provisions. What is the position in respect of infection acquired as a consequence of having an injury, rather than as a direct result of the injury itself? Where will she draw the dividing line, especially in respect of claims against the national health service? Treatment for

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an injury and an adverse incident of the sort that many people experience when they pick up MRSA in a hospital might be indistinguishable in that context. What about somebody who falls out of a bed in a hospital because they have not been properly protected with barriers at the side of the bed? That happened to an elderly gentleman in my constituency a few weeks ago and he contracted a hospital-acquired infection. How will the distinction be made in law?

Our amendments need to be seen in the light of the substantial number of unanswered questions in the Bill. We received a number of assurances from the Minister of State, the right hon. Member for Barrow and Furness, that various limitations would be put in place. For example, he said that a maximum amount would be retrievable by the national health service under the Bill. Of course, the Bill does not specify that maximum amount, which will be subject to regulations. Various provisions in clauses 144 and 141 give the Government the freedom to modify the scheme, whether to withdraw eligible circumstances in which payments can be made to the NHS or to add to them. Frankly, I do not accept what the Minister said about the road traffic measure and the negative procedure. I suspect that the argument that we are having tonight about the affirmative and negative procedures also occurred when that measure was debated.

As was amply demonstrated by the very good piece of work done by the Department for Work and Pensions on the problems that employers are facing because of the rising cost of compulsory employers liability insurance, if the Government get this measure wrong, it will have a significant adverse effect on smaller businesses in particular. Therefore, it is not good enough to send the Government forth from this place with a free hand and the ability to make regulations and push them through with the negative procedure. I know that business groups are less than satisfied with what the Government are doing and do not feel that they understand the consequences of even a limited scheme for the cost of liability insurance in respect of smaller employers who already face a substantial increase in costs as a result of circumstances in recent years. They will pay more at a time when they can ill afford to do so.

I am grateful to the Minister and her colleague, the Minister of State, the right hon. Member for Barrow and Furness, for saying that the Government would wait at least until the Department for Work and Pensions review is completed before implementing the measure. I find it surprising that it was drafted in separation from that process, but it is welcome that they have agreed to delay it. None the less, when the Government come to frame the regulations off the back of that DWP work and the measures set out in the Bill, they should come back to the House and seek its consent. They should not hope that hon. Members will spot the regulations when they have been tabled and pray against them. The issue is too significant for the small businesses of this country. There is no reason why the regulations should not be made a matter of mandatory debate in this House. The issue is important and it is a shame that the Government do not feel it appropriate to tell the House that it will automatically have a chance to debate this issue and to challenge them

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over it. That is to be regretted. I hope that, even at this stage, the Government may change their mind and that the Minister will accept that the affirmative rather than the negative route is the right one.

Dr. Evan Harris: I have two brief questions for the Minister. First, does the provision that she has made to distinguish between injury and illness and to provide for illness directly resulting from injury mirror the equivalent road traffic measure? Does she intend it to do so for consistency?

Secondly, I mentioned that the only problem that I envisaged was working out what illnesses were attributable to an injury, but I have a further question about that issue, which was prompted by the remarks of the hon. Member for Epsom and Ewell (Chris Grayling). The Minister argues that injury may be "physical or psychological". The amendment does not refer to physical and/or psychological injuries or to physical and psychological injuries, but allows for psychological injuries alone. I imagine that she may have in mind post-traumatic stress disorder, but it is hard to argue that that is not an illness rather than an injury. As an illness, it would not be countered by virtue of Government amendment No. 237, which seeks to introduce into clause 141 a new subsection (4A):

One might argue that post-traumatic stress disorder is more like a disease or condition than an injury. In the absence of any physical trauma—I think that that is the distinction on which she and her draftsmen are relying, which is logical—it is hard to see how post-traumatic distress disorder and other purely psychological injuries might be considered injuries, as they are more likely to be considered illnesses when push comes to shove, such as in the event of an appeal, as the trauma causing the condition will not exist in that instance. I should be grateful for clarification.

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