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You are here: BAILII >> Databases >> First-tier Tribunal (Tax) >> Rapid Sequence Ltd v Revenue & Customs [2013] UKFTT 432 (TC) (14 August 2013) URL: http://www.bailii.org/uk/cases/UKFTT/TC/2013/TC02826.html Cite as: [2013] UKFTT 432 (TC) |
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[2013] UKFTT 432 (TC)
TC02826
Appeal number: TC/2011/07214
VAT – exemption for medical care – whether applies to services provided by company acting as a principal in providing medical doctors on a locum basis to hospitals – no – Article 132(1)(c) Principal VAT Directive – Schedule 9 Group 7 Item 5 Value Added Tax Act 1994 – appeal dismissed
FIRST-TIER TRIBUNAL
TAX CHAMBER
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Appellant |
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- and - |
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THE COMMISSIONERS FOR HER MAJESTY’S |
Respondents |
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REVENUE & CUSTOMS |
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TRIBUNAL: |
JUDGE TIMOTHY HERRINGTON SONIA GABLE
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Sitting in public at 45 Bedford Square, London WC1 on 5 July 2013
Ian Hayes, Chartered Tax Adviser, for the Appellant
George Peretz, Counsel, instructed by the General Counsel and Solicitor to HM Revenue and Customs, for the Respondents
© CROWN COPYRIGHT 2013
DECISION
1.
The Appellant (“Rapid Sequence”)
appeals against a decision of the
Respondents (“HMRC”) contained in a letter dated 19 January 2012 and
subsequently upheld on review in a letter dated 15 June 2012. HMRC decided
that
Rapid Sequence’s
business involved the making of standard rated supplies
of employment agency services and not exempt supplies of medical care,
specifically the provision of deputies for registered medical practitioners.
2.
Rapid Sequence,
as a principal, provides the services of overseas based
anaesthetists to hospitals in the National Health Service (NHS) as locums and
receives fees for the services of the anaesthetists it procures based on the
number of hours worked. As a principal, it pays the anaesthetists concerned a
separately agreed hourly rate, the difference between the two rates
representing the gross profit of its business.
3.
Rapid Sequence
contends that the services it provides are exempt from
VAT under Item 5 of Group 7 of Schedule 9 to the Value Added Tax Act 1994,
which provides an exemption for the provision of a deputy for a person
registered in the register of medical practitioners. HMRC contend that in
order to obtain the benefit of this exemption
Rapid Sequence
needs to be making
supplies of medical care and in this case the supplies at issue are supplies of
staff by
Rapid Sequence
to NHS bodies, not supplies by
Rapid Sequence
of
medical care.
4.
We consider below the relevant law and guidance in relation to the
exemption for medical care in the context of the supplies made by Rapid
Sequence.
We then make findings of fact based on the evidence before us as to
the manner in which
Rapid Sequence’s
business operates. We then set out our
decision on how
Rapid Sequence’s
business is to be characterised for VAT
purposes in the light of our findings of fact, the relevant legal principles
and the submissions of the parties.
“The exemptions provided for in Chapters 2 to 9 shall apply without prejudice to other Community provisions and in accordance with conditions which the Member States shall lay down for the purposes of ensuring the correct and straightforward application of those exemptions and of preventing any possible evasion, avoidance or abuse.”
“the provision of medical care in the exercise of the medical and paramedical professions as defined by the Member State concerned”.
“1. The supply of services [consisting in the provision of medical care] by a person registered or enrolled in …
(a) the register of medical practitioners
4. The provision of care or medical or surgical treatment and, in connection with it, the supply of any goods, in any hospital or state regulated institution.
5. The provision of a deputy for a person registered in the register of medical practitioners.”
The words in square brackets in Item 1(b) were added by amendments which came into force on 1 May 2007.
8.
When Rapid Sequence
first sought clarification of its VAT position from
HMRC in 2005 VAT Notice 701/57, issued in March 2002, provided non-statutory
guidance on the application of VAT to health professionals. Paragraphs 3.4 and
3.5 of that Notice provided guidance on the VAT treatment of the services of
health professionals as follows:
“3.4 Can a business that employs or engages health professionals or unregistered care staff exempt their supplies?
Yes, provided that the business:
· acts as a principal (rather than an agent) in the supply of care; and
· …
3.5 Can an agent arranging the supply of services by a health professional or an unregistered carer exempt their agency or arrangement fees?
No, if you are an agent, your commission, fee or any other charge that you make for arranging and administering the supply is standard-rated.”
“6.1 Are the services of deputising doctors exempt?
Yes. If you are a deputy medical practitioner, your services are exempt in the same way as those provided by a normal practice GP…
6.2 Is VAT due on other charges made in connection with the supply of a deputising doctor?
No. The exemption also applies to:
· agency registration and administration fees;
· charges for transport;
· telephone and stationery costs; and
· any other charges integral to the supply of a deputy medical practitioner’s services;
when these charges are made in connection with the provision of services by the deputising doctor.”
“6.4 Supplies of self-employed locum GPs
When self-employed locum GPs supply their services to an employment business which makes an onward supply to a third party who is legally responsible for providing health care to the final patient, both the supplies to and from the employment business are taxable. The fact that the locum GPs may be supplied to a prison or other institution where they may not be supervised by any medical staff does not mean that the employment business supplying the locum doctor to the third party is legally responsible for providing healthcare to the final patient.”
This reflects the terms of Revenue & Customs Brief 12/10 issued in April 2009 which aimed to clarify HMRC’s policy on the VAT treatment of supplies of health professionals by employment businesses and which stated:
“Supplies of locum GPs
Where an employment business supplies a locum GP to a practice, the employment business’ only responsibility is to make a taxable supply of staff to the practice, not exempt healthcare to the final patient.”
“While it follows from [the] case law that the ‘provision of medical care’ must have a therapeutic aim [although] it does not necessarily follow therefrom that the therapeutic purpose of a service must be confined within an especially narrow compass … medical services effected from prophylactic purposes may benefit from the exemption under Article 13A(1)(c). Even in cases where it is clear that the persons who are the subject of examinations or other medical interventions of a prophylactic nature and not suffering from any disease or health disorder, the inclusion of those services within the meaning of ‘provision of medical care’ is consistent with the objective of reducing the cost of healthcare …
On the other hand, medical services effected for a purpose other than that of protecting, including maintaining or restoring, human health may not, according to the Court’s case law, benefit from the exemption under Article 13A(1)(c) of the Sixth Directive. Having regard to their purpose, to make those services subject to VAT is not contrary to the objective of reducing the cost of healthcare and of making it more accessible to the individuals.
… it is the purpose of a medical service which determines whether it should be exempt from VAT. Therefore, if the context in which a medical service is effected enables it to be established that its principal purpose is not the protection, including the maintenance or restoration, of health … the exemption under Article 13A (1) (c) does not apply to the service.”
Thus it can be seen that in order to qualify for the exemption the service must have a “therapeutic aim”.
“… it is difficult to see how one could rationally conclude that the appellant was making supplies of medical care, once it is accepted that the nurses and auxiliaries were under the control of the dentist to whom they were assigned. This is so even if (assuming, in the appellant’s favour) that the nurses were to be regarded as employees of the appellant. The appellant did not control – or even know- whether, and if so, the extent to which, the dentist directed a nurse or auxiliary to carry out other duties which themselves were not exempt supplies, such as acting as receptionist or assisting with cosmetic dentistry. Even in relation to dental services which are exempt, the appellant did not dictate the treatment offered to the patients, or play any part at all in determining what treatment was offered or how it was provided, nor did she supervise the nurses and auxiliaries. She had no relationship, contractual or otherwise, with the patients to whom the medical care was provided. It is our view beyond argument that her supply was of staff to dentists, who (as the tribunal found) assumed all the responsibility for directing the nurses as to what they should do, and for determining the treatment to be offered to the patients and the manner of its delivery. That the staff (and, indeed, the appellant herself) had a medical qualification cannot affect the nature of the supply. The tribunal correctly concluded that the appellant could not benefit from the exemption, and that the respondents were right to refuse the repayment.”
“40. The provisions in question here are unconditional and sufficiently precise to enable individuals to rely on them directly before the national courts either where the Member State has failed to transpose the Directive into national law within the prescribed period or where it has not done so correctly.
41. In the present case, the Directive was transposed into German law by a Law of 20 July 1995. Between the date by which it should have been transposed and 20 July 1995, individuals were entitled to rely on the relevant provisions of the Directive directly before the national courts in order to enforce, as a minimum level of guarantee, the rights which the Directive attaches to one or other of the categories of information to be notified to the employee by virtue of Article 2(2) (c).
42. Since the date on which it was transposed, individuals can no longer rely on those provisions unless the national implementing measures are incorrect or inadequate in the light of the Directive.”
17. Mr Peretz referred us to Revenue and Customs Commissioners v IDT Card Services Ireland Limited [2006] EWCA Civ 29 where the Court of Appeal considered the extent to which the domestic courts must interpret the provisions of VATA in the light of the Principal Directive so as to be consistent with EU law.
“The approach described above makes it clear that, while under European Union law the member states are bound to interpret national legislation so far as possible in conformity with the wording and purpose of a directive, it is for domestic law to determine how far the domestic court can change other provisions of purely domestic law to fulfil this obligation. Thus in this situation the national court is not concerned to ask what interpretative approach is adopted by the courts of the other member states of the European Union. The question how far it can go under the guise of interpretation, and whether it can for instance adopt what would otherwise be regarded as a strained construction, is a matter for domestic law.”
21. Arden LJ held that the approach taken by the UK courts in adopting an interpretation of legislation that would make the legislation concerned compatible with rights under the European Convention could be applied. She relied on the speech of Lord Nicholls in Ghaidan v Godin-Mendoza [2004] 2 AC 557, a case under Section 3 of the Human Rights Act 1998, in paragraphs 89 and 90 of her judgment as follows:
“89. The critical point made by the House of Lords in the Ghaidan case can be found in the passage from the speech of Lord Nicholls which I have set out above. Lord Nicholls accepts that the effect of interpretation in accordance with s3 of the 1998 Act may be to change the meaning of the legislation but, as he explains, the meaning adopted by the court must not conflict with a fundamental feature of the legislation. He adopts the words of Lord Rodger that the interpretation chosen by the court must ‘go with the grain of the legislation’. Lord Nicholls, Lord Steyn and Lord Rodger all accepted that there would be occasions when the courts could not adopt an interpretation that would make the legislation compatible with Convention rights because that would involve making policy choices which the court was not equipped to make (see paras.33-35 per Lord Nicholls, para.49 per Lord Steyn and para.115 per Lord Rodger). It is also clear from the Ghaidan case that the interpretation of legislation under s3 or the Marleasing principle may involve a substantial departure from the language used though it will not involve a departure from the fundamental or cardinal features of the legislation. It is possible to read the legislation up (expansively) or down (restrictively) or to read words into the legislation. The question of whether s3 can be applied does not depend on whether it is possible to solve the problem by a simple linguistic device.
90. Lord Nicholls also makes it clear that there is no need to find that the statutory language should be ambiguous before interpreting the legislation so as to be compatible with Convention rights. He does not deal expressly with the possibility of Parliament making express provision in contravention of Convention rights. Mr Lasok refers to such a possibility in the context of legislation designed to implement Community legislation in his argument before us (para.60, above). So he submits that Parliament might use language which made it clear that it did not intend VAT to be imposed in a situation in which it was chargeable under the Sixth Directive. The situation which he postulates is not one in which Parliament has specifically stated that it is legislating in a manner which departs form the Sixth Directive. In the situation postulated, as it seems to me, the court’s interpretative duty, whether arising under Community law or arising under s3, is not excluded. In determining whether the solution is one of interpretation or impermissible law-making, the relevant test remains whether the interpretation that would be required to make the statute in question Convention-compliant or in this case, EU law-compliant, would involve a departure from the fundamental feature of the legislation. As I see it, the latter cannot be the case where the effect of the interpretation would be to bring the statute into conformity with the objectives of the Sixth Directive in the absence of clear statutory language to the effect that Parliament intended that there should not be such conformity.”
“I accept that under the principle of legal certainty the person affected by legislation must be able to foresee the manner in which it is to be applied and I would also accept that must particularly be so where the legislation has financial consequences for him such as flow from the imposition of the requirement of account for VAT. A taxpayer has a legitimate expectation that this principle will be observed. Moreover, a taxpayer is entitled to structure his business so as to limit his liability to tax and to take advantage of any loopholes that he can find. These principles can be found in the judgment of the Court of Justice in Gemeente Leusden and Holin Groep BV v Staatssecretaris van Financien [2004] ECR I-5337. However, in the present case, it is well-known that the provisions of VATA 1994 have to be interpreted in conformity with the Sixth Directive and that the supply of telecommunications services constitutes a taxable supply for the purposes of the Sixth Directive. I therefore agree with the judge that the principle of legal certainty is not infringed in this case.”
24. Consequently she concludes in paragraphs 112 and 113 of the judgment as follows:
“112. It follows that the fact that if ICSIL is correct in its interpretation of para.3(3) of Sch 10A, the VAT treatment of the distribution of the phonecards for Interdirect’s services infringes the principles of the Sixth Directive. It further follows that the United Kingdom is acting in a way which is incompatible with its Community obligations if the effect of para.3 of Sch 10A is to relieve any supplier from VAT under the guise of granting relief to a supplier from the double taxation on telecommunications services. Therefore the court is under an obligation to interpret para.3 as far as possible in the light of the wording and purpose of the Sixth Directive and specifically to prevent the non-taxation of the supplies to the UK distributors of ICSIL’s phonecards, or other taxpayers in the same position.
113. This is not beyond the bounds of permissible interpretation because there is no indication that Parliament specifically intended to depart from the Sixth Directive in this respect. The provisions of Sch 10A are equally consistent with Parliament not having foreseen the particular problem that has arisen in this case. It follows from the Ghaidan case that the court’s duty arises even if Mr Lasok is correct in submitting that the correct interpretation of Sch 10A is that VAT is not imposed on the United Kingdom distributors of ICSL’s phonecards in the circumstances of this case. It also arises even if Parliament did not intend to limit relief in the way for which Customs & Excise now contend. The provisions of Sch 10A do not contain any fundamental feature inconsistent with reading into para.3(3) a further disapplication of the disregard in para.3(2) to make para.3 conform to the objectives of the sixth Directive: it is simply a case of widening the existing provision in para.3(3). Indeed the existing provision is directed to a not dissimilar situation, that is where VAT which is due is not accounted for. Moreover, this is not a case, in my judgment, where it is not possible for the court to interpret para.3(3) of Sch 10A ‘so far as possible’ in conformity with European Union law because the provision, as so interpreted, would raise policy issues as to its effect which the court cannot, in performance of its role, resolve. Such issues might arise for instance (to take a very different case) if the interpretation of a statute in conformity with a European Union directive the court to limit a provision of domestic law which had been inserted to protect third parties, such as creditors or consumers, and some equivalent protection would have to be provided. In those circumstances, the task of interpretation might go beyond the judicial role of interpretation … However, the interpretation in the present case does not raise any such consequential issues. Any consequential issues which it raises are inherent in the provision as it stands.”
25. Finally, Mr Peretz referred us to Case C-363/05 J P Morgan Claverhouse v HMRC [2008] STC 1180 as authority for the proposition that the power for Member States to define the scope of the exemption may be exercised only in accordance with the principle of fiscal neutrality: see paragraph 43 of the ECJ’s judgment. Paragraph 46 of the judgment states that principle in the following terms:
“… the principle of fiscal neutrality, on which the common system of VAT established by the Sixth Directive is based, precludes economic operators carrying out the same transactions from being treated differently in relation to the levying of VAT. That principle does not require the transactions to be identical. According to settled case law that principle precludes, in particular, treating similar goods and supplies of services, which are thus in competition with each other, differently for VAT purposes …”.
(1) Group 7 of Schedule 9 to VATA implements the obligation of the UK under Article 132(1) (c) of the Principal Directive to provide exemptions for the provision of medical care in the exercise of the medical and paramedical professions. Consequently, we must interpret its provisions so far as possible so as to be consistent with the provisions of the Directive;
(2) Article 132(1)(c) only permits exemptions for the provision of medical care which only includes services which have a therapeutic aim (d’Ambrumenil);
(3) Items 1(a) and 4 of Group 7 of Schedule 9 VATA confine the exemptions there provided to the direct supply of services which consist of the provision of medical care whereas Item 5 exempts the provision of a deputy rather than the direct provision of the deputy’s services;
(4) The provision of paramedical professionals who are under the control of the medical professionals to whom they were assigned does not amount to the supply of medical care and therefore cannot benefit from the exemption (Moher v HMRC);
(5) An individual cannot rely on the provisions of the Directive once it has been transposed into national law unless the national implementing measures are incorrect or inadequate (Kampelmann);
(6) If a provision of national law is inconsistent with the principles of a Directive it must, so far as possible, be interpreted in the light of the Directive and so as to be consistent with EU law, unless it is clear that Parliament specifically intended to depart from the Directive. This may involve a substantial departure from the language used although not from the fundamental or cardinal features of the legislation. It is possible to read the legislation up (expansively) or down (restrictively) or to read words into the legislation (IDT) and;
(7) The exercise of the power to define exemptions must be exercised in accordance with the principle of fiscal neutrality (J P Morgan Claverhouse).
27. We therefore approach our findings of fact in this case in the light of this analysis.
28.
We heard no oral evidence. We were provided with various documents as
well as correspondence between Rapid Sequence
and HMRC which contained brief
descriptions of
Rapid Sequence’s
business from which we find the following
facts.
29.
Rapid Sequence
was incorporated in December 2000 and commenced trading
in England in 2001. Its majority shareholder is Dr Simon Krige, a consultant
anaesthetist, whose practice is in South Africa and who acts as clinical
director for the company. Mr Krige also provides his services as a deputy in
the manner described later. Mrs Jenny Paterson is responsible for all
administrative tasks.
30.
Rapid Sequence’s
report and accounts for the year ended 31 December 2012
describe its principal activity as that of a brokerage for the placement of medical
personnel in various NHS Trusts.
31.
Rapid Sequence,
primarily through Mr Krige, identifies overseas based
consultant anaesthetists, through meeting them at medical conventions, who may
be interested in providing their services as locums or deputising doctors to
NHS Trusts who have a need for such locums to cover gaps in the services that
their permanent staff can provide.
32.
Before engaging doctors Rapid Sequence
performs checks to ensure they
meet the standards required in the UK and specifically that they are registered
with the General Medical Council and have their own medical insurance.
Rapid
Sequence
then makes these doctors available as required to the engaging NHS
Trust.
33.
The doctors concerned either operate as self-employed individuals or
through an offshore company which the relevant doctor controls. The doctor or
company, as the case may be, contracts to provide his services to Rapid
Sequence
as a principal and an hourly rate is agreed for his services.
Rapid
Sequence
then, again as a principal, makes the doctor’s services available to
the relevant NHS Trust on terms agreed between
Rapid Sequence
and that Trust.
Again these services are charged at an agreed hourly rate, the rate charged to
the trust being higher than that paid by
Rapid Sequence
to the doctor the
difference between the two effectively being in the nature of a commission
retained by
Rapid Sequence.
34.
The details of a doctor who has been accepted by Rapid Sequence
are sent
to the hospital which is looking for a deputising doctor. If the doctor is
accepted by the relevant NHS Trust
Rapid Sequence
emails the doctor setting out
the services he is contracted for, for example by reference to a number of
sessions paid at a rate per session. Accommodation and travel within the UK to the hospital is paid by the NHS Trust. It appears that there are no other written
terms of engagement between the doctor and
Rapid Sequence
and no written terms
of engagement between the NHS Trust and
Rapid Sequence.
35.
At the end of each week, the doctor provides a weekly log of the work he
has performed from which Rapid Sequence
prepares a timesheet which is emailed
to the hospital for a counter signature. Once the timesheet has been
countersigned and returned to
Rapid Sequence
an invoice for the doctor’s
services is generated and sent to the hospital. This will disclose the number
of sessions worked and the session rate which will be multiplied to produce the
total invoice value. VAT is not added to the invoice amount, although those
invoices produced after the time when HMRC and
Rapid Sequence
became in dispute
as to whether VAT was payable on the provision of the doctor’s services bore
the legend “might be subject to VAT”.
36.
The deputising doctor then invoices Rapid Sequence
for his work at the
rates agreed between them and he is paid.
37.
Although Rapid Sequence
provides the services of the deputising doctor
as a principal it carries no insurance of its own in respect of any liabilities
that might arise as a result of the doctor performing his duties for the NHS Trust
concerned.
38.
It is clear that when the doctor carries out his work he is not under
the direction or supervision of Rapid Sequence.
The doctor, who as mentioned
above is self-employed or employed by a company which provides his services,
will exercise his own professional judgment when performing his duties, his
medical services being of course provided directly to the patients concerned.
It will be for the NHS Trust to deal with all administrative matters relating
to the provision of the services in the hospital, such as informing the doctor
where he will be working and which patients to attend. Insofar as there is any
to day control over the doctor’s activities, such control will therefore be
exercised through the medical or administrative staff of the hospital
concerned.
39.
Nevertheless, on occasion Rapid Sequence
does get involved in issues
concerning the performance by the doctors it provides of the services
contracted.
Rapid Sequence
set out some examples in a letter it wrote to HMRC
on 5 June 2013 which can be summarised as follows:
(1)
investigating concerns expressed by NHS Trusts about the competence and
performance of staff supplied by Rapid Sequence;
(2) making representations to NHS Trusts about matters capable of affecting the performance of such staff;
(3) organising the replacement of such staff in response to performance or other issues; and
(4) checking the suitability, competence and professional qualifications of such staff.
40.
Very responsibly, Rapid Sequence
sought guidance from HMRC from time to
time on whether the services it provided were exempt from VAT. The initial
response given by HMRC shortly after
Rapid Sequence
commenced business was not
helpful in addressing the issue and, based on advice it received,
Rapid
Sequence
took the view that the services it provided fell within Item 5.
42.
Rapid Sequence
then wrote again in 2011, having noticed that HMRC’s
published guidance had changed and this correspondence led to HMRC’s decision
which is the subject of this appeal. We note the following paragraphs in HMRC’s
letter of 19 January 2012, notifying
Rapid Sequence
of its decision:
“It is appreciated that the wording of Item 5 of Group 7, Schedule 9 can be problematic. It is HMRC’s view is that the provision of a deputy doctor is not exempt but rather a standard rated supply of employment agency services. It is the medical care provided by the doctor that is treated as exempt.
This is in keeping with the scope of the exemption in Article 132(1) (c) of the Principal VAT Directive. The wording of Item 5 is unfortunate, and it is not entirely clear why it is necessary as deputising services would seem to be covered by Item 1 of Group 7”.
(1)
Whether the services provided by Rapid Sequence
came within the plain
meaning of the provisions of Item 5;
(2)
If the answer to question (1) is positive, bearing in mind the
requirement of Article 132(1)(c) of the Principal Directive to confine the
exemption to the provision of medical care, whether Rapid Sequence’s
services
amount to the provision of medical care; and
(3) If the answer to question (2) is in the negative, as a result of which the UK would have made provision for an exemption that went beyond the powers given in the Principal Directive, whether it is necessary to give Item 5 a construction so as to restrict its application to services which amount to the provision of medical care or whether there is a clear intention on Parliament’s part to legislate for a provision that goes beyond the permitted scope of the exemption.
44.
With regard to the first question, we have no doubt that the business of
Rapid Sequence,
in the manner in which we have found it operates, consists of
the provision of deputies for registered medical practitioners, whether that
provision amounts to the provision of medical care or the provision of staff in
the manner of an employment agency. The activity of arranging, as a principal,
the placement of doctors seeking locum positions with NHS Trusts who
Rapid
Sequence
have engaged themselves as principal, in the manner described in
paragraphs 32 to 38 above, clearly falls within the plain meaning of Item 5.
45.
Were Item 5 purely domestic legislation not enacted in order to meet one
of the UK’s obligations under an EU Directive we would have no hesitation in
determining the appeal in favour of Rapid Sequence.
As Mr Hayes submits, Item
5 is written in plain English and lends itself to no other interpretation when
construed in isolation. It is in clear contrast to the wording of Items 1(a)
and 4 which refer to the direct supply of services of medical care; it is clear
that those items relate to the direct supplies of medical services, such as by
an NHS Trust who employs the doctor concerned, either under an employment
contract or a contract for services, whereas on its face Item 5 goes further
and extends the exemption to the provision of the person who supplies the
medical services.
47.
We therefore turn to the second question. Mr Hayes submits that the
services provided by Rapid Sequence
do amount to medical care. He submits that
there is a therapeutic aim in the provision of a locum anaesthetist which is a
direct action necessary for the smooth continuance of the programme of
operations central to the protection of and health of individuals, which is
consistent with the objectives of the exemption for medical care contained in
Article 132(1) (c). He distinguishes Moher v HMRC on the basis that the
doctors provided do not work under supervision in the hospitals where they
perform their services as they exercise their own professional judgment. As
shown by the examples referred to in paragraph 39 above,
Rapid Sequence
takes
responsibility for the actions of the doctors it provides; the doctors are
merely providing their services in facilities provided by the relevant NHS Trusts.
48.
We reject these submissions. We do not believe the factual scenario is
any different in substance to that in Moher v HMRC; in both cases the
medical care in question was provided by the medical professional concerned,
not by the person who made the arrangements for those services to be provided
by a locum. Rapid Sequence
provides its services to the relevant NHS Trust. The
doctor provided by
Rapid Sequence,
whilst exercising his own judgment as to how
to perform his services does so in the hospital under the direction and control
of the relevant NHS administrators or medical staff. As far as the patient is
concerned, he is receiving services from a doctor working under the supervision
of the NHS Trust, not
Rapid Sequence.
Rapid Sequence
plays no part in deciding
how the doctor concerned provides his services. The matters referred to in
paragraph 39 above are, as submitted by Mr Peretz, no more and no less than one
would expect of a business providing temporary staff and do not indicate any
measure of control by
Rapid Sequence
over how the doctors provided perform
their services. Our conclusion on the second question is therefore that the
services provided by
Rapid Sequence
do not amount to medical care within the
meaning of Article 132(1) (c).
52.
It is clear that to achieve such a conforming construction it will be
necessary to read words into the legislation. Paragraph 89 of Arden Ely’s
judgment referred to in paragraph 21 above makes it clear that we may do so.
It is also clear from paragraph 111 of her judgment that we can do so even
though the effect will be to put Rapid Sequence
under a civil liability that it
did not previously have.
“the provision of [medical care services provided by] a deputy for a person registered in the register of medical practitioners”
The added words are shown in brackets. In our view such an addition would achieve a conforming construction; it leaves it open as to whether there is any specific need for Item 5 as well as Item 1(a) but that is a matter for Parliament.
55.
For completeness, although not necessary for our decision, we accept Mr
Peretz’s submission that as the power to define the exemptions must be
exercised in accordance with the principle of fiscal neutrality, there would be
a breach of this principle if Item 5 had the effect that supply by Rapid
Sequence
of deputising doctors were exempt but supplies of other medical
practitioners were not, with the result that there would be a different VAT
treatment of supplies which from a customer’s point of view were similar.
56.
As we have concluded that Item 5 must be interpreted in the way set out
in paragraph 54 above it follows that Rapid Sequence
is not providing medical
care services but supplying staff and its appeal must fail.
57.
We would understand if Rapid Sequence
finds this outcome highly
unsatisfactory. It is clear that Item 5 could have been reviewed when the
other changes were made to Group 7 in May 2007 but it was not. It appears simply
to have been overlooked.
Rapid Sequence
responsibly sought guidance from time
to time as to the VAT position and HMRC’s position on the issue has changed.
HMRC has accepted that the wording of Item 5 is “unfortunate” and
“problematic”: see paragraph 42 above. As Mr Peretz recognises, HMRC’s stance
has created legitimate expectation issues that HMRC needs to consider when
examining the consequences of this decision, namely that
Rapid Sequence
will
now have to register for VAT and may be subject to assessments in respect of
its past supplies. Those are not matters that fall within the scope of this
Tribunal’s jurisdiction but we hope that HMRC will view
Rapid Sequence’s
position sympathetically.