If your wife will fall into the lower rate tax band next year as a result of unpaid leave and she is paying for private maternity care, why not pay the consultant fees in advance this year so she can claim the tax back this year at the higher rate? The disadvantage is that you end up paying the bill before you actually have to but you'll be able to claim more back. As far as I know there isn't any problem in doing this and I know of cases where it has been done.