There are risks, too, associated with more conventional hospital surgery. The British Medical Association is concerned about the lack of regulation among some overseas healthcare providers at a time when UK clinicians are more tightly regulated than ever. “We’d prefer to see people treated at home, where there’s continuity of care and the GP has access to the full medical records,” a spokeswoman says.

Mavis Childs, now walking three or four miles with little effort, accepts that if her surgery had proved disastrous, she would have turned to the NHS to put things right: “But my GP didn’t object to my going to India and the NHS has saved the cost by not having to operate on me, giving someone else a chance to step up the ladder. I’m all in favour of the NHS — but they simply can’t cope.”

Childs’s surgery was brokered by the Warwickshire-based Taj Medical Group, one of a growing number of UK agencies acting as intermediaries between patient and foreign hospital. Dipa Jethwa, the “customer support manager”, has no medical qualification beyond a biomedical sciences degree; her co-founder husband, who signs himself Dr Jagdish Jethwa, earned his doctorate in mechanical engineering. That did not prevent them sending “40 or 50” patients to India in November and December for major operations, including cardiac, spinal and orthopaedic surgery. “We’re just the brokerage, and don’t give medical advice,” Jethwa says. “Let’s say you are looking for spinal surgery. We’d need to see your MRI scans and any reports from the UK, and can give you prices once the neurosurgeon in India has had a look at them. Taking into account the flight and the recuperation time in a hotel, prices are generally a third of the cost of private surgery in the UK.”

The three-year-old company works only with hospitals meeting standards set by the Joint Commission on Accreditation of Healthcare Organisations, an independent US body. It aims to ensure that all clinicians are UK or US-trained and qualified, claiming to benefit from a growing tendency among NHS-trained Anglo-Indian doctors to move to the subcontinent. Yet if something goes wrong, Jethwa says, the burden falls on the patient to seek redress: “The patient’s contract is with the hospital, so it’s the patient’s risk. We’re only putting them in touch, though these are reputable hospitals.”

Should a problem occur during or after surgery, liability specialists advise that patients may find themselves fighting expensive legal battles to establish responsibility. “If a seriously ill patient travels from country A to country B, and coming back at 35,000ft they collapse and become a vegetable, which jurisdiction will determine responsibility?” asks Leslie Smith, who runs Medibroker, a health-insurance brokerage. Smith has good cause to be concerned. Two years ago, he established his own medical-tourism agency, Treatment Choices. He estimates that it sent more than 1,000 British patients for treatment in Europe, Asia and South Africa, ranging from hip replacements to heart bypasses. But last October, he suspended the service “after my lawyers frightened me to death”.

An NHS trust had approached Treatment Choices the previous month to organise what Smith recalls was its 50th sex-change operation in Phuket, Thailand. “The trust’s lawyers wanted me to carry the risk as they did not have £30 million cover in case this chap came off the trolley and the NHS had to take care of him for years. I thought, that’s a good point.”

Until he can arrange suitable risk insurance — which he hopes to have in place for a relaunch this year — Treatment Choices will remain shuttered. Not that this will diminish the rising demand for such services, Smith suggests. “We were getting 300 inquiries a month and demand was growing. The NHS is in its death throes, and all my research shows that, over the next five to ten years, it cannot possibly deliver on orthopaedics, on obesity, on heart bypass. There will be a

60 per cent increase in hipreplacement demand alone over the next five years. The waiting lists are going to get painfully longer. There’s a desperate need for these arrangements (with foreign hospitals), but the NHS trusts and the Government are adamantly against them and want to kill off this sector.”

The Government’s position is certainly ambivalent. Since 2001, the Department of Health has advised health trusts that they can send patients elsewhere in the European Economic Area — mainly France, Belgium and Germany — if overseas surgery would cut “unduly” long waiting lists in specific circumstances. This has typically involved group tours to hospitals no more than three hours’ travel away, typically for orthopaedic and minor cardiac procedures. But the policy does not extend to giving patients experiencing long waits the choice of arranging treatment abroad at NHS expense.

This could be about to change. The European Court of Justice decided last month that failing to provide this choice breaches our rights to free movement as EU citizens, supporting the case of Yvonne Watts, 74, who had argued that Bedford Primary Care Trust should reimburse her a hip-replacement operation in France. The court has ruled in her favour. This could, in theory, radically expand NHS patients’ rights to be treated abroad. But the ruling is not specific about how serious a condition has to be before the NHS would have to pay for treatment abroad, and there is plenty of room for legal wrangling.

Meanwhile, the Department of Health urges caution to those tempted to jump the queues by paying for their own treatment abroad, suggesting that overseas hospitals may not always deliver NHS-quality treatments. “It is important when considering surgery abroad to think about the standard of the facility, the qualifications and experience of the doctor, and what you can do if something goes wrong,” a Department of Health spokeswoman told The Times.

In other words, buyer beware.

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