VAT exemption for services that are directly supervised by a registered health professional

Hi all, I'm wondering about VAT exemption for services that are directly supervised by a registered health professional. VAT Notice 701/57 paragraph 5.3 lays out the conditions for VAT exemption in this situation. Point two under this paragraph states the requirement that: "the service requires supervision by a registered health professional, and is provided predominantly to meet the medical needs of a client". I'm wondering what the word 'requires' means in this context. For example does it mean there is a legal requirements for supervision? I'm trying to think of healthcare examples in which this would apply. For example, a care assistant that helps a nurse with personal care - would their services be VAT exempt? Clearly the act of helping with personal care itself does not legally require a registered professional's supervision, but i would have thought this service would be VAT exempt? My particular interest is in psychotherapists, who are not included as medical professionals (as per paragraph 2.2), but do 'require' supervision. This is not a legal requirement but is a requirement to obtain insurance and maintain their professional registration. Oftentimes this supervision is performed by other psychotherapists and so the supervision does not necessarily need to be a registered health professional in some contexts. However, in the context of deputised work from say a clinical psychologist then this would require supervision from a registered professional. So it would seem the condition is somewhat context specific, and i would have thought in this situation their services would become VAT exempt? Is there any service provided by HMRC that can advise about this on a case-by-case basis to help with interpretation in the context of a specific situation? https://www.gov.uk/guidance/health-professionals-pharmaceutical-products-and-vat-notice-70157

Hi Matt,
Paragraph 5.3 refers directly to care services that may be VAT exempt when all listed conditions are met. 
The first condition being-
the services are supervised by one of the registered health professionals listed in paragraph 2.1 and the supervisor is professionally qualified to perform and supervise the service.
Services provided by Psychotherapists are not listed in paragraph 2.1 ‘Meaning of a health professional’ therefore the services can not be exempt.
Thank you.
 

Hi and thanks for your reply. Sorry for not being clear in my message. In this case the supervising health professional is a psychologist, who is a registered professional as listed in paragraph 2.1, and is professionally qualified to perform and supervise the service. The person being supervised is a psychotherapist, who does require supervision for purposes of registration and insurance, but this is not a legal requirement. My question is whether psychotherapy services would be exempt in this case (Ie acting under appropriate supervision, and where supervision is required, but not legally required). Thanks in advance for your reply, Matt

Hi Matt,
We woud recommended the best way to seek a definitive answer would be to request a VAT Clearance from our Wriitten Team.
Please see below for instructions on how to request this from us:
Where you should send your application
Thank you.