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HMRC internal manual

VAT Government and Public Bodies

Government departments and health authorities: Contracted Out Services (COS) Headings: COS Heading 41 - Nursing services

This Heading is intended to allow recovery on nursing services in its widest sense and there is no stipulation that the nursing staff have to be providing medical care.  The Royal College of Nursing define nursing as “the use of clinical judgement in the provision of care to enable people to improve, maintain, or recover health, to cope with health problems, and to achieve the best possible quality of life, whatever their disease or disability, until death”.



  • Situations where you are charged VAT on the provision of nursing services or agency nursing staff, this would include:


All grades of registered bank nurses, working on wards across the NHS

Healthcare Assistants

Midwives and midwifery assistants


Theatre Scrub nurses

Nurses employed by the 111 service

Operating Departmental Practitioners (ODPs) where due to the changes in the nature of their role they now provide a nursing services. Previously ODPs were excluded from Heading 41 as they were not providing a nursing service.




  • Other types of medical professionals such as doctors, locums
  • Other healthcare professionals such as ambulance paramedics


Additional information

You should not assume that there is a VAT element included in the charge made to you for nursing services, as the supply may be exempt from VAT.  You should check the suppliers invoice to check whether VAT has been charged.