Editorials from David Williams (Editor)

Editorials from BL#1 and BL#2
Editorials from BL#4 and BL#6
Editorials from BL#7 and BL#9
Editorials from BL#11 and BL#12
Editorials from BL#13 and BL#17
Editorials from BL#18 and BL#20
Editorials from BL#21 and BL#22
Editorials from BL#23 and BL#24
Editorials from BL#25 and BL#26

VAT change
The recent change to VAT laws that affect aesthetic medicine practitioners might foreshadow darker times. The legislation as interepreted from a European Court of Justice ruling is woolly and widely open to misinterpretation.
Limitations on damage may come from an unlikely source—HM Revenue & Customs, which says: “Primary health care and treatment are not affected by the decision and will continue to be free of VAT.” Apparently, the lack of enthusiasm to collect the tax arises from the UK government’s reluctance to tax medical services.
Where the confusion lies is in what triggers VAT. A specialist medical accountancy firm says VAT does not arise unless taxable “supplies” reach the minimum statutory turnover for registration. If you sell more than £64,000 of injectables in any   tax year, you have to pay and charge VAT, but if you sell less, you don’t have to. Non-VATable services, such as surgical   procedures, are not included in the turnover.
Douglas McGeorge, president of the British Association of Aesthetic Plastic Surgery, focuses on where the services were performed. If carried out in a hospital or authorised private care establishment, then they are not VATable, he says. If, however, the practitioner went to a non-medical club and started injecting patients on a special Botox night, then that service would become VATable.The BMA says the rules are unclear. ”The legislation needs to be tested in court.”
Experts and practitioners may disagree on how VAT should be charged in medical aesthetics, but, thankfully, it is not a big issue… yet. If an additional 17.5% is ever levied across the board, of course there will be an impact.

Aesthetic medicine in need of statutory regulation
The government’s view that the safety of patients in aesthetic medicine is best served by self-regulation is woefully inadequate. Aesthetic medicine is served by disparate associations that protect their own members’ interests rather than a collective that works together to formulate a code of best practice for all practitioners. Not to say that this is particularly damning of medical associations. They are no different from associations in other sectors: their main objective is to protect their members’ interests. Generally, they perform their function well by producing professional codes of conduct, acting on behalf of their members to voice their concerns, and by bringing strengths of numbers to the negotiating table to secure the best deals they can for goods and services that will benefit their members.What distinguishes medical practices, however, is that the decisions made directly affect lives. If you take your car to a garage and a mechanic fits the wrong spark plug, the engine might not fire, but the mistake isn’t fatal. On the other hand, patients taking their bodies for a tune-up to medical practitioners displaying a similar degree of negligence are unlikely to have to worry about driving home. Thankfully, such fatalities are rare. The standards set by individual medical associations are high. What needs work is the creation of a common goal—a transparent framework in which procedures are seen to be performed by a professional certified competent in aesthetic medicine and the modus operandi of each procedure.Surely, a self-regulatory body could oversee this. As Dr Andrew Vallance-Owen, chairman of the Independent Healthcare Advisory Services working group on cosmetic surgery, says: “If things go wrong, some patients could be left scarred physically or psychologically for life. If we, the industry, don’t step in these procedures will be less-regulated than ear-piercing.”
     Perhaps a tad hyperbolic but a point strongly made. Jon Billings, the commission’s head of independent healthcare, says it is important that patients have reassurance. “We believe that a system of industry regulation can work and we shall be working with the Independent Healthcare Advisory Services to support the successful creation of an effective self-regulatory scheme.” Despite the best intentions of self-policing, a regulatory body with teeth can enforce a medical aesthetics standard for uniform application across the associations. As Jenny Driscoll, a health campaigner at the consumer advocacy group Which?, said: “The government needs to step in now because, left to regulate itself, it would be all too easy for the industry to focus on introducing multiple codes that will just end up confusing people.”Possibly the government has an ulterior motive for self-regulation of medical aesthetics: not to get involved with time-consuming statutory intervention.
     The government may have been caught offguard by the growth in popularity of aesthetic procedures and is leaving associations to do its work on the basis that regulating aesthetic medicine is low in its pecking order. It could be that the government would rather allocate its time framing a bill on education, crime or healthcare in general than devote its resources to something that, by comparison, it considers frivolous. In a governmental report in April, Lord Hunt, the then health minister, dressed this up, saying the sector has shown “real commitment” to improving quality and safety. “And so I have decided to ask the industry to take the lead in further improving standards. I am very pleased that it has accepted this challenge.” Lord Hunt said a review would be undertaken once the self-regulatory scheme had been established and in place for a reasonable period—in around three years.
     Commenting on behalf of the British Association of Aesthetic Plastic Surgeons, its president, Mr Douglas McGeorge, said: “Self-regulation is a total nonsense and a way of passing the buck. Botox can be carried out anywhere by anyone with training in giving injections, and there is no way you can self-regulate because of the diverse groups currently offering treatment.”Certainly there are only so many hours of parliamentary time to pass legislation and priorities do have to be set. But with the diverse approaches to administering procedures in aesthetic medicine, the spiralling growth of consumers, and the grave consequences that can arise, the time is ripe to take action. Not in three years.