How NHS waiting lists are driving a British health tourism boom
27 February, 2023
Marina Stock, 66, used to work in the NHS as a technician. Working on her feet for years gave her bad knees. Then, she had a fall. The pain became so bad she could hardly walk 100 yards to the bus stop.
In November 2021, a physiotherapist gave her an urgent referral to a surgeon. She needed to get both knees replaced.
“My husband used to say he wouldn’t hold my hand because I rolled so much when I walked that he would get sea sick,” says Stock.
However, it was not until more than a year later, in December 2022, that she finally had her appointment. There, the surgeon told her that the wait time to get just one knee replaced would be 150 weeks – nearly three years.
But by then, Stock had already had one of the operations – at a clinic in Lithuania.
She is part of a surge in British patients who are travelling abroad for orthopaedic treatments. Spiralling NHS waiting lists are driving a British medical tourism boom in Europe.
Clinics across the continent are reporting growing demand for hip and knee replacements, as well as cardiology treatments and cataract surgeries. They are opening London outposts and advertising to attract a new wave of UK customers.
“Historically, the vast bulk of outbound medical tourism from the UK was dental and cosmetic. What we are now seeing is an increased number of people travelling for orthopaedic treatments, driven by NHS waiting lists,” says Keith Pollard, of Laing Buisson, a healthcare business intelligence provider. France Surgery, which arranges medical travel across France, has also seen a surge in British patients looking for cardiology interventions – primarily for coronary angioplasty surgery – as well as orthopaedics.
“Since the pandemic we have had huge demand, huge. Lately we have been getting two or three inquiries a day from English people looking for medical treatment in France. A few years ago, we got one every couple of days, and those would rarely transform into client bookings. Now almost all of them do,” says Iulia Apostu, of France Surgery.
The level of inquiries from British patients is now nearly the same as it was before Brexit, despite the fact that patients now have to pay for the operations themselves, says Apostu.
When Britain was part of the EU, British patients could often get reimbursed by the NHS for medical treatments overseas. Now, this funding has gone. Medical insurance companies also typically refuse to pay for treatment in other countries. The UK’s outbound medical tourism is almost exclusively self-paid – but they are desperate.
In September 2022, the number of patients on waiting lists for consultant-led treatments (otherwise known as “elective care”) in England hit 7.2 million. This was the highest number on record since at least 2007.
This list was swelling before Covid. In the year to April 2019 alone, the number of patients waiting more than a year for hip or knee surgeries jumped by nearly 60pc.
But then the pandemic sent wait times into overdrive. In mid-2019, the number of people waiting for more than 52 weeks for elective treatment was a little over 1,000. By September 2022, this number had multiplied 400 times to just over 400,000. A further 1.5 million people were waiting for diagnostic tests.
The blow dealt to elective surgeries in the UK was unique in scale. Across 2020, the UK saw by far the biggest drops in hip and knee replacements of any country in the OECD. These surgeries fell by 68pc and 46pc year-on-year respectively.
Patients who need treatment must either wait it out or pay to go private. But there is a third, cheaper option – travel overseas.
In September 2022, Stock travelled to Fi Clinica, a hospital in the Lithuanian city of Kaunas, to have her first knee replaced. In March, she will travel back again for her second.
Including flights, the surgery, travel insurance, trains, hotels, and a recuperation period at a spa, each trip will cost her £8,000. “The NHS consultant said that is about half the price it would cost me in the UK just for the surgery, it is a no brainer for me. I can’t wait to get the other one done,” says Stock.
British patients are Fi Clinica’s fastest growing market and account for as much as 80pc of the clinic’s international patients, says Ugnė Perevičiūtė, of the hospital. Their numbers jumped by 25pc in 2022, after a 47pc jump in 2021.
The boom began in the summer of 2020, after lockdown delayed many NHS surgeries, says Perevičiūtė. “People have always been coming for plastic surgery, but the big change in 2020 was that people started looking for bariatric and orthopaedic treatments. Those patient numbers have doubled or more,” she says.
“Especially in orthopaedics, these people who are waiting are in pain. Some of our patients say they can’t even go to church, or play with their grandchildren,” says Perevičiūtė.
Fi Clinica has been paying for Google ads, which show up when people in Britain search for orthopaedic treatments like hip replacements, and has set up Facebook groups where patients can share their experiences. Next, it plans to launch a payment plan system, to further reduce the cost barrier for British patients. In January, it opened a London branch near Harley Street for consultations.
Clinics across Europe are ramping up their marketing to British patients. Acibadem, a Turkish healthcare group, also opened a London office last month to court British clientele.
“I have been following the situation in the UK regarding the difficulties of the NHS to meet demand. We are hoping to become a potential solution for some of them who are waiting for long periods of time on the waitlists,” says Eve Jokel, of Luz Saúde.
The Portuguese hospital started paying for Google adverts in the UK in January. It has an English version of its website and offers video consultations with English-speaking surgeons.
Historically, UK health tourism was inbound. Since the 1980s, overseas governments – originally from the Gulf states – paid for citizens to get treatments in NHS hospitals, says Neil Lunt, a professor at the University of York. Now, the money is going the other way.
There is no cohesive data on medical tourism in and out of the UK. Pollard estimates that around 50,000 patients travel out of the UK each year for medical care, but this number includes those travelling for cosmetic and dental treatments. Overall the average spend is £3,500 per person – but those travelling for orthopaedic treatments are spending several times that amount.
Demand amongst British people for elective medical treatments overseas has jumped by a fifth, says Pollard. The numbers will only go up, he adds.
“If you have an issue, you have to go to your GP and get a referral, then you don’t see a consultant for six to 12 months, then you have to wait two or three months for a scan. I think there will be an increase in people travelling abroad just to get diagnosed,” says Pollard.