The case of: General Healthcare Group Limited (GHG)
Those that have read my articles in the past will recognise the topic of composite or separate supplies rears its ugly head on many occasions. It is a matter that has occupied businesses, advisers and HMRC since VAT’s inception, and shows no signs of disappearing any time soon. To put it into the Tribunal chairman’s words: This is another appeal on the subject of whether a transaction which comprises several different elements should be regarded as a single supply or several distinct and independent supplies.
In the latest episode, a ruling was handed down by the Upper Tribunal (UTT) in the case of GHG.
Background
GHG challenged the decision in the First tier Tribunal (FTT) that it made a single supply of prostheses and operating services via its consultants. Consultants fit prostheses in certain procedures, eg; hip replacements when they operate in GHG hospitals. The prostheses are supplied by GHG which also provide the hospital facilities to enable the independent, self-employed consultants to supply healthcare which includes the fitting of prostheses, to its patients. The FTT (in the lead case of Nuffield Hospital with GHG) decided that there was a single supply of exempt healthcare to the patient in these circumstances. GHG appealed against this decision, contending that there is one supply of exempt healthcare, and a separate zero rated supply of the prosthetics prescribed and fitted by the consultants who performed the operations.
VAT Impact
Treating the prosthetics as zero rated rather than exempt would have no impact on output tax (no VAT would be due in either analysis) but zero rating would enable GHG to recover input tax on the prosthetics in question and an increased amount of VAT incurred on general overheads. It is likely that such a claim, across the board would run into many multi-millions.
Decision
The UT dismissed GHG’s appeal, stating that “… from the point of view of the typical patient who requires a prosthesis, GHG makes a single supply of hospital and medical care which includes providing the prosthesis to be fitted by the consultant …”.
Commentary
The decision appears logical and in line with both EC and UK legislation and past case law and was not really a surprise. In these type of cases it is important to consider what the recipient of the supply thinks (s)he is receiving. In this case, and having been on the receiving end of a similar procedure (although I hope that I am a few years off a hip replacement) I think it is absolutely accurate to say that the patient would consider that (s)he is receiving a single supply of medical care. However, I have no doubt that the patient who has just received a new hip would be very unlikely to be thinking of the VAT treatment of their….errr treatment in the slightest…..
The UTT chairman stated that it declined to make any reference to the CJEU.
As always, this is a tricky area, if you have received any questionable rulings from HMRC on single/multiple supplies, or wonder whether there is a different way of analysing your supplies, please contact us as explained above, the matter continues to throw up interesting results.