Britain has been in high-level discussions with India about the possibility of flying NHS patients there for treatment to cut waiting times, India's minister of health, Anbumani Ramadoss, told a conference of doctors in London last month.
Ramadoss told the conference, organised by the British Association of Physicians of Indian Origin (BAPIO), that he had had informal talks with Hugh Taylor, permanent secretary at the Department of Health, and had discussed the possibility of NHS patients being treated in India.
A source close to the Health Secretary, Alan Johnson, confirmed that the offer had been made by the Indian minister, but said such a proposal was not under consideration by the Department of Health. A spokesman added that the British government's position remained that there was no right for NHS patients to receive treatment outside the European Economic Area (EEA).
But Ramadoss insists that the permanent secretary's "response was positive". He told the conference he was "confident" that the next few months could see the NHS opening out.
Sending patients for treatment outside the UK is not a new idea. Since January 2002, almost 600 patients have been funded by the NHS to travel to France, Belgium and Germany for treatment. This is arranged at the discretion of primary care trusts.
However, the ultimate decision to travel to the EEA rests with the patient. "Patient choice in cases when the NHS cannot provide a service quickly has been seen as one way of bringing waiting lists down, especially where the NHS system has failed to improve despite more resources," said Professor Ewan Ferlie, director of the Centre for Public Services Organisations at Royal Holloway University. So far, those seeking destinations for quicker treatment have been restricted to Europe. "India is going too far - literally," added Ferlie.
Professor John Appleby, chief economist at the King's Fund, the influential health policy think-tank, believes that sending patients to India would not necessarily be cost-effective. Though the cost of treatment may be lower than in Britain, travel, accommodation and other costs could add up to a substantial amount, he thought. "This is a complicated solution to an issue which is somewhat diminishing in intensity," he said.
The idea that India could become a viable destination for NHS patients has its supporters. Dr Ramesh Mehta, president of the BAPIO, said that India could offer the same, if not better, quality of treatment than patients receive in Britain or the EEA on two counts: "First, Indian hospitals are offering to provide for families who accompany the patient, which European hospitals do not do. And the second point is obvious - treatment is so much cheaper."
Last year, some 150,000 foreigners travelled to India and paid for their own treatment. But the health services of some countries do send patients considerable distances for treatment. Tanzania is one. In the past five years, nearly 200 Tanzanians have travelled to India for heart surgery. Canada is another. Patients can be reimbursed for treatment abroad, provided they have approval from the provincial authority.
"I'm pro-choice, and I think patients should be able to choose where they get treatment," said Nick Bosanquet, professor of health policy at Imperial College London. But he expressed reservations about how popular India would be with patients. "It's positive for those who might go to India anyway, like people from the Asian community, for instance, or people who want to go there on holiday. But the distance, travel difficulties and the question of how to organise aftercare may not appeal to everyone." Numbers suggest otherwise. Last year, more than 70,000 British patients went abroad for treatment, India being a favoured destination.
"They spent their own money to do this and that's simply not fair," said Mehta. "Patients deserve quick treatment, and if they can't get that in their own country, they should be paid to get it somewhere else. The fact that so many went to India last year shows that patients are telling the NHS what needs to be done."