Call for halt on plastic surgery tax

Bo-Tax is fine, argue surgeons, but ‘subjective’ VAT on surgery is an ethical minefield

17 October 2011 (Last updated: 26 Mar 2019 14:27)

London – 17 October, 2011 – Over 90% of procedures deemed ‘cosmetic’ are non-surgical treatments such as injectables and lasers, and the British Association of Aesthetic Plastic Surgeons (www.baaps.org.uk) agrees with the Government’s decision due out this month that in the current climate they should be taxed with VAT. However, they warn that bundling surgery such as breast reductions, tummy tucks and children’s bat-ear ops under this umbrella term will present an ethical minefield. They call for a debate with the relevant bodies and a halt on this initiative which endangers patient confidentiality, leaves the public vulnerable to arbitrary postcode lotteries and will encourage risky ‘surgery holiday deals’ abroad.

HMRC guidance to health professions states that services are only exempt of VAT if the purpose is to ‘protect, maintain or restore the health of the person concerned’. The BAAPS argues this subjective approach places a value judgment on treatment, fails to recognize the extensive scope and purpose of most plastic surgery procedures and does not provide enough clarification in terms of medical, psychological and social welfare of the patient. It will also require general finance/accounting and audit staff – unqualified to determine what could be ‘medical’ need – to have access to patient records in order to validate criteria.

According to consultant plastic surgeon and former BAAPS President Douglas McGeorge;
“Less than one in ten patients in the ‘cosmetic’ market is actually having real surgery. Non-surgicals represent, in fact, over three-quarters (75%) of the monies spent in this area. A whole array of individuals including plastic surgeons offer non-surgical treatments - from dermatologists and GPs, through dentists and beauty therapists. Apart from a few techniques used for medical purposes, no one could argue that these are not performed purely for beautification reasons, particularly since the treatments are totally unregulated. Surgery, however, is very different. It is performed in regulated hospitals and done to help maintain or restore the health of the patient and their quality of life. Any justification to HMRC of our decisions to impose or not impose VAT will be impossible unless patient confidentiality is breached.”

According to consultant plastic surgeon and BAAPS President Fazel Fatah;
“At the start of the recession, well over a quarter of BAAPS surgeons had already noticed an alarming increase in patients presenting with problems from cut-price surgery deals abroad. At our Annual Meeting this year, one London hospital revealed they were having to perform corrective treatment every month on such cases – each patient on average staying in hospital over two days – and warned the trend was on the rise posing an ever increasing burden on the NHS. Taxing private plastic surgery in the UK will only aggravate this situation. Moreover, using blanket terminology such as ‘free choice rather than medical necessity’ and ‘purely for aesthetic purposes’ without engaging in any kind of public debate or formal consultations as to specific definitions of what is therapeutic, places a value judgment on treatment and compromises the doctor-patient relationship.”

Douglas McGeorge adds;
“Many of these operations have been excluded or rationed in the NHS – the postcode lottery denies treatment in certain parts of the country whilst allowing surgery in others. For example, a recent study revealed that only 62% of PCTs carry out tummy tucks, and rules governing who is eligible are arbitrary and sometimes contradictory. Some exclude women who’ve had problems after pregnancy, and others exclude those who’ve undergone stomach stapling. Many of these procedures have major functional as well as psychological benefit and they must have at some point been deemed medical or the state wouldn't have offered them. The option of having all our patients ‘rubber-stamped’ by a clinical psychologist on a daily basis is simply unrealistic. Are all children who have their teeth straightened to be taxed? There is certainly no functional need for the vast majority. Should prominent ear correction be taxed; an operation performed on young children to prevent them being bullied and developing psychological problems? What level of asymmetry or abnormality is required to justify breast surgery? When do large breasts create enough of a physical problem to allow treatment? Large noses will kill no one on their own but can create major problems in life that prevent individuals contributing to society and, indeed, have been known to result in self harming. At what level is treatment acceptable with drooping eyelids that impair vision and should their treatment be extended to allow harmony in facial features or be restricted to just the immediate problem, perhaps leaving the patient looking odd? Our role is to make sure patient needs justify treatment, not VAT exemption.”

Fazel Fatah says;
“Treatments carried out by plastic surgeons do improve the psychological as well as the physical wellbeing of patients. For many it is impossible to ascertain which aspect is the most important, but, as enshrined in the World Health Authority, psychological wellbeing is just as important as the physical. The subjective proposals being put forward by HMRC will potentially harm large numbers of patients. They imply that, by definition, any procedure that corrects appearance rather than function is not a medical need. There has been no meaningful discussion with the professional bodies involved. We can only hope that common ground can be found that protects the wellbeing of patients whilst balancing the obvious need to increase tax revenues. With surgery, we are quite literally, dealing with human lives."

Fazel Fatah concludes;
“The reasons for undertaking aesthetic plastic surgery vary widely and from patient to patient – the same condition can affect each person in a different way. Some may experience side effects, others it can affect their ability to work, or they could suffer serious psychological impact. It is simply not possible to generalise about the reasons for treatment.”

HIGHLIGHTS
• HMRC states that services by health professionals are only exempt when the primary purpose is to ‘protect, maintain or restore the health of the person concerned’
• In 2009 Ultralase won a case to reclaim tax as their treatment was not medical but for ‘beautification’ purposes
• The World Health Organisation (WHO) defines health as ‘a state of complete physical, mental and social wellbeing’
• Many aesthetic procedures were performed on the NHS for psychological reasons, although they are no longer offered. So clearly there were considered medical before
• Providing an audit trail for HMRC to verify if a procedure is exempt or not breaches doctor patient confidentiality and the Data Protection Act
• HMRC state that cosmetic services ‘performed mainly for beautification or rejuvenation purposes’ and ‘done out of free choice (elective) rather than medical necessity’ are liable to VAT
• For services to be exempt, HMRC expects ‘an appropriately qualified health professional to supervise…such as a psychologist or psychiatrist qualified to deal with the underlying condition.’ However psychiatric assessment on a daily basis is likely to be problematic due to availability, and these are inadequately policed services as not part of the CQC
• ‘Bo-Tax’ as it was known, was halted in the US in 2010 when it became clear that the majority of people receiving plastic surgery were women with families and in employment (in the UK, women account for 92% of cosmetic surgery procedures). Similar attempts to introduce such a tax were also halted in Australia due to reasons such as those outlined in this release


The BAAPS (www.baaps.org.uk), based at the Royal College of Surgeons, is a not-for-profit organisation, established for the advancement of education and practice of Aesthetic Plastic Surgery for public benefit. Members undergo thorough background screening before they can join. Information about specific procedures and surgeons’ contact details can be found on the website, or by contacting their office at 020 7430 1840. Further materials can be posted to members of the public seeking specialised information. BAAPS is also on Twitter: www.twitter.com/BAAPSMedia   and Facebook: www.facebook.com/BritishAssociationofAestheticPlasticSurgeons

For all media enquiries, please contact pr@baaps.org.uk

 

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