Does Aesthetic Treatment of Physical Appearance Amount to 'Medical Care'?

Aesthetic treatments can transform clients' psychological wellbeing, boosting their self-esteem and confidence in their appearance – but do they amount to 'medical care' for VAT purposes? The First-tier Tribunal (FTT) addressed that issue in a guideline case.

The case concerned a private clinic offering a wide range of aesthetic, skincare and wellness treatments. It contended that many of its services consisted of the provision of medical care by a registered medical practitioner and thus qualified for exemption from VAT. HM Revenue and Customs, however, took a contrary view.

Ruling on the matter, the FTT noted that the clinic's sole director is a highly qualified, skilled and ethical medical professional, registered with the General Medical Council. Its clients include vulnerable people who have suffered disfiguring physical consequences of medical conditions, including cancer. Many are depressed or anxious about their physical appearance.

In a VAT context, however, the FTT noted that medical care is defined as diagnosing, treating and, in so far as possible, curing diseases or health disorders. In dismissing the clinic's appeal, it had no hesitation in finding that its relevant services did not fall within that definition and were thus subject to VAT at the standard rate.

The relevant services, whilst delivered with care and professionalism, were distinct from those provided by a GP or other health professional. Their general purpose was to help people feel better about their appearance. Whilst assisting clients to achieve such goals may well improve their confidence and self-esteem, that did not amount to treating their mental health status. It was, the FTT found, a misuse of language to describe the relevant services as healthcare falling within the VAT exemption.

The FTT acknowledged that clients who are discontented with some aspect of their appearance may leave the clinic in a happier state of mind. That, however, did not mean that their treatment was medical or had a therapeutic aim. Clients went to the clinic intending to have a cosmetic procedure and had no expectation that they would be seen by a psychiatrist, counsellor or therapist.