Healthcare - Exemption Flashcards
What is the significance of Skinrich ltd [2019]?
FTT held that botox and dermal filler treatments and fungal nail treatments in this case were not exempt. They were not providing medical care but treatment primarily for cosmetics purposes.
Procedures are exempt if they have a therapeutic purpose, there needs to be a medically assessed need which included psychological need.
The exemption is limited to those services intended principally to protect (maintain and restore) the health of individuals.
Describe the case of Mainpay Ltd [2020]
Concerned whether consultants that were placed with NHS Trusts were a taxable supply of staff or exempt supplies of medical care.
The FTT held that they were taxable supplies of staff and the UT agreed.
The key issue was whether the consultants came under the direction, control and supervision of NHS trusts. If they did, then a taxable supply of staff had been made.
The UT said that the NHS Trusts had the same degree of control over the consultants and specialist GPs as it did over the consultants which it employed.
Describe the case of Spectrum Community Health [2022]
Tried to separate out its supplies so that it could recover input tax in relation to some of its supplies.
The supplies were of healthcare services to prisons. Most of the services were exempt as medical care but the company tried to argue that prescription drugs and sexual health products were taxable supplies (at 0% and 5%).
HMRC stated that they regarded it as a single composite supply of medical care with which the tribunal agreed.
The prison service was buying a complete package of medical care rather than a collection of discrete services.
What is the significance of the case of Northumbria Healthcare NHS Trust Foundation [2021]
The FTT held that car parking services provided by the NHS Trust were an economic activity and standard rated.
They were not closely related or essential to hospital and medical care within item 4.
What is the significance of the case of Illuminate Skin Clinics Ltd [2023]?
A lack of evidence that treatment had been carried out in response to an appropriate medical diagnosis indicated that the treatment did not consist in the provision of medical care.
Making people feel better about their appearance where that in itself was not a health condition or threatening to their health did not make it medical.
Supplies of aesthetic, skincare and wellness treatments were standard rated.
What is the significance of Dr d’Ambrumenil?
The CJEU defined the term ‘medical care’ as services having a therapeutic nature and examinations or other medical interventions of a preventative nature for persons not suffering from any disease or health disorder.
The effect of this is that exemption is limited to those services intended principally to protect (including maintain and restore) the health of individuals.
What is the significance of Frenetikexito case?
The CJEU held that a person supplying nutrition, fitness and physical well-being services did make separate supplies and it was a question for the national court to decide if the nutrition services pursued a therapeutic aim and were therefore exempt.
What is the significance of the Medacy Ltd [2019] case?
The FTT held that a company supplying services to GP practices was supplying medical services and not taxable supplies of staff.
It contrasted the decision in Mainpay.
What is the significance of the Epem [2023] case?
In this case the clinic treated skin conditions and removed skin lesions. The taxpayer argued that they were improving the quality of people’s lives in a similar way to doctors or dermatologists in a hospital.
The tribunal did not accept this. The tribunal said that patients attending because their skin condition affected their mental health was not ‘medical care.’
In this case the tribunal accepted that some of the supplies might have qualified for the exemption but as there was no evidence on which to make an apportionment, the assessments made by HMRC were upheld in full.
