Sandison Lang Client Newsletter - Autumn 2022

Sandison Lang news Issue 26

Autumn 2022

BIGGEST TAX CUTS FOR 50 YEARS The Chancellor Kwasi Kwarteng used his first major fiscal moment to make grand and unexpected announcements as he pledged to "turn the vicious cycle of stagnation into a virtuous cycle of growth”.

It was billed as a ‘mini’ Budget but was, in fact, quite the opposite. He announced a £45billion package of tax cuts, the largest in a single fiscal event since 1972. Adding the word ‘mini’ meant the chancellor did not need to wait for a forecast from the Office for Budget Responsibility to check the implications of borrowing an additional £411billion over five years.

The result was that within hours of the statement, the pound plunged to a near 40-year low against the dollar and economists predicted

the Bank of England would trigger an emergency rate rise to stabilise Sterling.

Unperturbed, Mr Kwarteng signalled that further tax cuts could be under consideration stating “We have only been here for 19 days. I want to see, over the next year, people retain more of their money.”

His headline move was to scrap the 45 per cent additional rate of income tax from next April but the backlash which followed forced a U-turn, although it took more than a week to get there.

However, the chancellor was also reported to be considering a tax-free allowance for workers paid more than £100,000 a year and lifting the lifetime allowance for pensions.

He also decreased the basic rate of income tax

from 20 per cent to 19 per cent on income between £12,571 and £50,270. His predecessor chancellor Rishi Sunak had previously announced in the Spring Statement that he would take the same action but not until 2024.

The planned rise in corporation tax will no longer take place – pushing some £19bn back into the economy. The tax was due to rise next year for companies with high profits to 25 per cent but will now remain at 19 per cent. Mr Kwarteng said: “We believe that high taxes reduce incentive to work, deter investment, and hinder enterprise.”

These two substantial moves will force many to consider whether their medical trading structure remains the most tax efficient. Your accountant will be pleased to discuss this issue with you in the coming months.

The Treasury has delayed the Budget until Spring 2023 but will reveal the government's 'fiscal plan' by 23 November.

Sandison Lang News Issue 26 Autumn 2022

Accountants to the medical profession

Dr Mark Martin: NHS round up She said she will be a “champion” for patients and have “a relentless focus on measures that affect most people’s experience of the NHS and social care”, especially long waits. We are used to politicians saying all the right things but surely only major initiatives would help turn things around for the health service before the winter deluge makes things untenable.

While Ms Coffey’s speech showed the government may now realise the severity of the workforce issues it faces, it seems the measures announced do not go far enough to prevent senior doctors continuing to retire early or reduce workloads.

The new health and social care secretary (and deputy prime minister) Thérèse Coffey has announced “Our Plan for Patients” – a package of government measures designed to strengthen the crisis-stricken NHS.

There was still no tactical plan to address the punitive Annual Allowance in full, despite acknowledging that ‘pension rules were a disincentive for clinicians who want to stay in the profession’. The issue was finally due to be debated in the House of Lords in September but

was postponed because of the official period of National Mourning.

Ms Coffey instead announced that NHS trusts would be mandated to offer pension recycling by 2023. This could be useful for senior doctors who have already reached maximum pension levels as it allows employees who have opted out of the NHS Pension Scheme to be able to take any unused employer contributions as extra salary.

Other proposals addressed ‘fixing’ the rules which link the NHS pension to inflation by changing the pension revaluation date in the NHS Scheme and a series of measures to increase retirement flexibilities for NHS staff.

We are moving in the right direction but undoubtedly the issues facing those nearing retirement are unbelievably, getting ever more complex.

Q&A Q: Are doctors being ‘targeted’ by HMRC for tax investigations?

Michelle Trivett writes: While it is true that HMRC occasionally announces an industry-wide focus, we have not been made aware that medics are more likely than others to receive undue attention. However, the taxman generated an extra £30billion during tax investigations last year. In the first quarter of 2022, there was a 36% increase in the number of tax ‘compliance’ checks made by the taxman.

For this reason, we provide a tax investigation fee protection service which reimburses the accountancy fees incurred should we need to

defend you in the event of a tax enquiry.

Sadly, even minor audits can span months of investigation. Our role is to work on your behalf to respond to lengthy queries, negotiate directly with HMRC and attend meetings or formal tribunals. We will work diligently to do whatever is necessary to defend the tax return.

Our protection service starts at just £50 per year and the policy may pay out up to £125,000 to cover costs. Policyholders also have access to a 24/7 tax helpline and a legal advice hub.

Please do speak to your accountant if you would like to know more.

Company update: New team members We are delighted to welcome two new trainee accountants to our team, Harry Sears and Ellie Miller.

Sandison Lang News Issue 26 Autumn 2022

Thanking you for thinking of us Congratulations to Dr Miraj Patel who wins £1,000 in our latest refer-a-friend prize draw.

also receive an entry into the draw if a friend or colleague mentions your name when they first enquire to Sandison Lang.

Do you have a friend or colleague who could benefit from our specialist services? Simply email their contact details to us to be entered into our bi-annual draw. (Please do mention that we might be in touch.) You will

You may refer as many people as you wish – for every person that you suggest, you will receive another entry into the competition which will be drawn in April 2023. Many thanks for supporting our business.

Accountants to the medical profession

Sandison Lang interview with Professor Tan Arulampalam So, I was a convert to laparoscopic surgery and in those days there was no structure to the training programme in surgery, but I knew I wanted to be on this particular train. I found my way to the best people in the country and in the world. I went to Whipps Cross and Chase Farm Hospitals and then to Colchester where I worked for my mentors and friends Roger Motson and Don Menzies.

We were doing things that very few people were doing around the world. It was great at the age of 30-something to be doing surgery that no one else was doing and to be getting great results.

Professor Tan Arulampalam is a Laparoscopic and General Surgeon based at the Ramsay Oaks Hospital, Harley Street and Lyca Health Canary Wharf.

Why did you choose medicine?

I come from a long line of doctors in Sri Lanka and my ancestors were some of the first apothecaries and then doctors in the north of the island.

In 1847 an American missionary named Dr Samuel Fisk Green built the first medical school in South East Asia in north Sri Lanka. Their work focussed on moving the population away from traditional medicines to more conventional western medical treatments. My grandfather became the lead TB doctor and one of my inspirations, as was my father who was an eye surgeon.

I did fight the medical path for a while in my teens when I wanted to be a pilot but chose the easier option around 16/17. My mother and grandfather went to King’s College and the only rebellious thing I did was choose to go to Barts in London instead.

That was 30 years ago this year and we have a big reunion planned for September with doctors flying in from Australia and New Zealand to join us.

How did you choose your specialty?

I believe if you can’t be curious or find a place for yourself in medicine you’ll struggle anywhere.

There is so much variety. Succeeding is a combination of being given a break, a bit of luck, and being in the right place at right time.

I worked with a surgeon called James Wellwood in 1995 and he was working on keyhole operations, some three years after the very first keyhole bowel resection and 10 years after the first reported keyhole operation. I thought this is how we must do surgery from now on.

Sandison Lang News Issue 26 Autumn 2022

It’s not been easy though – on reflection it’s been a long and gruelling career. If I hadn’t had those amazing highs it would have been difficult to stay the course.

And you teach as well?

I feel for the junior surgeons today who have so many punishing targets and a real lack of training. I had 22,000 plus hours but the trainees now have just 6-7,000 hours. They are not poorer surgeons but the structure and the way we train them has to be so much improved.

That’s why I love teaching. I found that when somebody taught me to do things, I was able to think and to perform. So I have spent my whole career teaching as well as practising medicine.

I’ve learnt over 30 years that once you have your technical skills, it’s actually making the decisions that is much more important. My mantra to my trainees is ‘decisions not incisions’. It’s saying ‘think before you act’ and you can apply that to all things in life. We also need to convey that idea to the people who we’re looking after. The more experience I’ve got, the more listening I do. I should have done more at the start of my career.

By listening, you realise what people’s anxieties are and what they really want.

situation was appalling and we knew it would run for many months.

I like to innovate and got fed up with webinars as a way of training people so we moved to producing a series of short movies explaining certain conditions.

I then got involved in two commercial ventures.

Firstly, I created a start-up with colleague Dr Ram Senasi (who was one of my trainees about 15 years ago) and Ahsanul Haq, a Consultant Urologist.

Together we created Imperial Medical Solutions ltd to help digital transformation in healthcare.

We realised virtual consultations were here to stay and that remote training was being done poorly. It was also difficult for the device industry and for med-tech to get into hospitals to train people. So we became a b2b, helping hospitals, mainly abroad, to choose the right solutions to help them.

Our first big successful project was to teach a group of surgeons in Trinidad how to use a robotic surgical camera holder for their keyhole surgery. In normal times, I would have been on a flight to Trinidad which would have been amazing. We organised training with a company called Digital Resilience UK (DRUK). The founder of DRUK is Hamish Mackenzie and together with Freehand Robotics, we put together a package of low-cost consumer tech with digital assets for training.

We trained the surgeons and then through Imperial Medical Solutions, we used our network to involve the British High Commission, the health ministers and the health system in Trinidad. We had a big launch on 20 September last year and I was sat in my kitchen on my laptop, watching four operations being performed where I’d not even physically met the surgeons.

It can sound trite, but the art of medicine is not what you do or say, it’s how you make someone feel. Everyone expects me as a doctor to be able to be good at operations but the doctors of today also need to understand the value of human connection. If not, you’ll miss things and then double your workload.

Is this the future of surgery?

We need to focus on how we move into the world of blended learning – to change the learning ecosystem. I have five children, the eldest is 22 and in the military. When he talks to me about military training and their discipline, how they are taught, as an officer, to look after his men and women it’s really interesting so I’m taking note of some of those skills.

You used the lockdown to create new ventures?

People forget how scary 2020 was. My first patient had HIV and Covid so an operation which should have taken one hour, took 7 hours. The

My youngest is ten and is on the computer game Roblox. She lives in a digital world. It reminds me of the saying ‘the visible world is no longer a reality and the unseen world is no longer a dream’. Those two worlds are coming together in Accountants to the medical profession

Interview continued the metaverse. I want to explore this world as I think for medicine both clinical therapeutics and for training, the virtual world with entities such as avatars is going to be more and more the norm.

I do a lot of reading of non-medical books. I read Sapiens by Yuval Noah Harari and his two subsequent books which talk about the power of the mind and how we as individuals will interact with the world. It’s not helpful to tell our youngsters not to get on their devices or go on the internet as the devices are and will be their world. IT saved our children in lockdown because they were able to play and chat to their friends.

In the future, hospitals will be training people with avatars and be immersed in the virtual world.

And the second lockdown project?

I worked with a company called IQ Endoscopes to design a disposable endoscope. We’ve raised a few million pounds in development and we are on the beta prototype now. We hope to have FDA authorisation and credentialling in 2023.

We are particularly excited because the global

market is substantial. Since around 2019 and up to 2025 we have and will see a dramatic increase in the volume of flexible endoscopies from around 70 million procedures a year to 130 million. This rate of growth will create great challenges from a global healthcare point of view.

The demand is coming from people getting older and surviving longer, increased early screening and detection of illnesses and a wide acceptance for minimally invasive surgery. And it’s not just in one region but across the world.

I believe we have to look at our roles in medicine and find new routes that we are passionate about as we cannot keep operating forever. it’s an exciting time. The actuaries tell us that our healthy life span is up to around 63 so I have no intention of working until that time. I want to enjoy transforming what I do now so I can stay healthy and enjoy life.

You have also worked with the media?

I was medical adviser to the TV programme Holby City for around 13 years. I started when I was hard up for money. We had two children and I was doing unfunded research with no salary. My professor was going on holiday and asked if I

would cover his adviser role to the programme.

I developed a good rapport with the team and got the drama fitting in with the medicine. I told them they should get the X-rays up the right way for a start. I would travel to Borehamwood to the set and started when it was just 8 episodes per series. By the time I left, it was 50 episodes a series.

I can’t claim the BAFTA which I’d like to, but I did make sure the script worked for the winning episode. Whenever new characters started, they would come to Colchester to shadow my work which was fun – particularly with popular actors.

I’ve also worked on the shows Harley Street, Law & Order UK, Dalziel and Pascoe, and Messiah.

How do you fit so much in?

I have an amazing wife who is very tolerant. We both do our things, and we have a lot of fun along the way. Your family will often take second place to medicine but they won’t take third or fourth place so I don’t push it. Whenever I threaten to spend more time with the family they all say no!

Viewpoint: William Myatt, partner She just managed to launch a crowd-pleasing energy package before having to lead a nation in mourning. Ms Truss has her own links to the energy industry, having previously worked for Shell which she joined as a graduate trainee. Her role involved managing the shipping of liquid natural gas around the world. It is hard to imagine how such work experience prompted her former PM David Cameron back in 2014 to make her his environment secretary looking after Britain’s countryside.

In the space of a few weeks, we said goodbye to Her Majesty Queen Elizabeth II, welcomed King Charles III and have been presented with a new prime minister. Liz Truss must have had a solid plan for her first week in the top job when she finally got there but she was soon scuppered by fate.

Once safely at No 10, Ms Truss soon had to grapple with a UN general assembly and an emergency Budget. Before their meeting, US president Joe Biden announced he was ‘sick and tired of trickle-down economics’ and then her new chancellor delivered their first fiscal performance focussing largely on corporate tax, bankers’ bonuses and high earners.

Was it a brave or foolish move to upset our closest ally? It has already been reported that our new PM dislikes the term ‘special relationship’ causing White House aides to quip that they will suspend the label ‘for now’. Are they suggesting Whitehall is a merry-go-round of people in power? Certainly sceptical MPs have suggested that Truss had already decided to ‘go big or go home’ with major announcements to turn around current fortunes.

Interesting that Liz Truss and Kwasi Kwarteng have been working on their policies for over ten years since writing their book Britannia Unchained: Global Lessons for Growth and Prosperity (along with fellow authors Priti Patel and Dominic Raab).

As ever, we will be here to help you decipher any new ‘initiatives’.

SANDISON LANG Specialist accountants to the medical profession 2 St Mary's Rd Tonbridge TN9 2LB Sandison Lang News Issue 26 Autumn 2022

01732 365351 office@sandisonlang.com

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