Health and Spa Tourism in the UK – the Potential

By Nancy Cockerell and Jill Trew
May 2003
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Summary

Tourism centred around the concept of health and/or 'wellness' is a relatively new phenomenon in the UK market. Appreciation and understanding of the curative properties of natural mineral springs and seawater are much less deeply ingrained in contemporary British culture than in many European, Asian and Arab societies – although this has not always been the case. But, partly in reaction to the health club craze, which was first fuelled by achievement-oriented baby boomers determined to use their bodies as efficient machines to help them get ahead in the worId, people are now looking for less energetic ways to cope with their stress-filled lives.

The use of spas – including spa holidays and short breaks, which highlight the importance of integrating the body, mind and spirit – fill that need. Spa tourism used to be the preserve of older, well-heeled women who went for beauty treatments or to lose weight. Spas still attract this type of client but they are now also appealing to a younger, less affluent clientele, a significant share of whom are men.

The UK will have to work hard to catch up and compete with its European neighbours, where spa tourism is already a way of life. But it increasingly has the right products to attract both domestic business and – if it can successfully promote the image of the UK as a spa destination – international business. The potential is undisputed. What still seems to be lacking is a sound marketing and distribution strategy, carefully co-ordinated between all industry stakeholders.

  • Statistical data on the health/wellness tourism sector is very sparse – something that needs to be urgently addressed by VisitBritain, so that trends in the UK domestic market can be closely monitored. The planned new European Spa Federation intends to undertake a survey of the European market as soon as it is up and running.
  • Despite the lack of meaningful data, anecdotal evidence strongly suggests that domestic demand for spa tourism in the UK is growing, particularly for weekend and short breaks.
  • An increasingly broad range of age groups from very varied socio-economic backgrounds is becoming interested in and knowledgeable about spa treatments – some spas report a ratio of 50:50 in terms of male to female guests.
  • Innovative new facilities at UK hotels and health resorts are raising the quality of the UK's spa product, but this could be undermined by unregulated second-rate facilities and services exploiting the current demand trend.
  • Thermae Bath Spa is an important first step in reviving the UK's traditional spas, but large-scale public-private sector investment, high-level support and strong marketing are needed to expand the scheme further.
  • More specialist health/wellness tour operators will emerge, but mainly for outbound business. Domestic spa tourism will largely be sold direct, although there is considered to be huge potential for online sales through specialist websites – in line with trends in other parts of Europe.
  • As a spa destination, the UK faces formidable competition from Europe. Although the UK's spa sector is expanding and upgrading, Europe's health/wellness resorts are also adapting to changing demand.
  • The more savvy international markets will be interested in the UK product as long as it offers something different and of a high quality. International business is important as it is of higher yield than foreign tourism generally, it can extend length of stay and reduce seasonality, and it does not depend on the weather.
  • The greatest potential in this area is short breaks, add-ons for business travellers and conference delegates, and spa treatment as part of an incentive or combined with other cultural and activity programmes.

This report is intended to provide a broad analysis of the health/wellness or spa market, largely from the demand side, and to assess the potential for the UK in this sector. It focuses primarily on Europe, both as a source market and a competitive destination for the UK. But it also looks briefly at trends in the USA and prospects from the US and other key non-European market sources for the UK.

Given the size and importance of the purely medical side of the health/wellness market, this sector is discussed briefly in the report. However, the main focus is on what can be termed 'preventative' or 'soft' medicine and 'wellness' – the use of spas to improve general well-being and for relaxation and enjoyment. Since the scope of this sector is so vast, encompassing fitness and sports as well as all types of beauty treatments, the coverage is nonetheless limited to water-based therapy. This is, in fact, the traditional meaning of 'spa', which comes from the Latin sanus per aqua.

Treatments range from the more traditional 'thermalism', based on natural mineral springs – and which is now also known in France as 'aquatherapy' when the treatment is more for wellness than medical reasons – to 'thalassotherapy', or seawater treatment, and all other forms of water-based therapies. Termed 'balneotherapy' or 'hydrotherapy', these use tap water with the addition of different minerals, seaweed, etc.

It should be pointed out, however, that the term 'spa' in the USA and Asia does not necessarily involve water-based treatment. Any centre offering services geared to refreshing the guest physically or mentally can brand itself as a spa.

Statistical data on the demand side of the health/wellness or spa market is scarce and most of the statistical sources available are not directly comparable from one market or country to another. The only exception is the European Travel Monitor (ETM), which quantifies the size of the European international health holiday market by country, as well as indicating the volume of non-holiday trips taken abroad for health reasons.

A wide range of different sources was used for the compilation of this report, all of which are quoted where relevant. The main statistical sources were the national spa and health resort federations, such as the Deutscher Heilbäderverband in Germany and Federterme in Italy, and national tourism organisations (NTOs) in the respective countries, like VisitBritain and Maison de la France.

The European Spas Association (ESPA) and the USA-based International SPA Association (ISPA) were also consulted. However, ISPA has just closed its European and Asia Pacific chapters and was unable to provide any information on statistical trends outside the USA. ESPA, on the other hand, has an abundance of statistics from its members – the national spa and health resort federations – but they are not very meaningful as far as the wellness sector is concerned. Most of their data covers visits to spa towns – many of which do not involve any spa treatment whatsoever – and, of those that do, the majority are for purely medical reasons.

Specific care should, therefore, be taken in interpreting statistical data related to health/wellness and spa tourism – not least as far as the UK market is concerned. The UK Tourism Survey (UKTS), which monitors domestic travel, has some broad figures on 'health' activities. However, these refer to holiday trips only, and do not cover demand from business travel, meetings and incentives – all acknowledged by suppliers and the travel trade to be an important source of business. In addition, it is impossible to identify five-year trends from the UKTS data, since a change in methodology for 2000 means that comparisons with earlier years are not valid.

Most importantly, the 'health' category identified by the UKTS is rather broad – it includes health and fitness activities as well as beauty therapies and treatments. It seems likely that a respondent who visited a hotel beauty salon for a hair-do and manicure while on holiday, or spent half an hour on a hotel running machine, may well be included in the health/fitness/beauty category. The number of domestic tourists who actually participated in 'spa tourism' as defined in this report must be smaller than the UKTS figures suggest.

As for international visitors to the UK, there is no indication in the International Passenger Survey (IPS) – the best source of statistics on international travel to the UK – on whether the trip included a visit to a spa, or indeed if health was the main purpose of a trip.

It is probably fair to say that, while a number of consultants have produced readable – and even interesting – reports on this sector in the UK, there is very little hard data on the demand side of the market. Some consultants are now embarking on producing listings of facilities at hotel and destination spas, as well as on the type and number of clients/guests they attract, but their results are not yet available.

VisitBritain's Health Benefits Fact File, published by the English Tourism Council in 2002, was a one-off piece of research designed to alert the travel industry to the potential of health tourism in the UK and to establish a framework for the sector.

While the report was well received by the industry – and it does, admittedly, include some interesting information in terms of supply – it is important to point out that it also contains a lot of data on demand that can at best be termed 'unreliable'. As an example, it suggests that in 2000 – before many of the spas open today even existed – the UK generated a 5% share of the total European spa market (equal to Italy's share, well above France, and second only to Germany and Austria). This is clearly an absurd assumption, as this report hopes to demonstrate.

Because of the lack of meaningful statistical data, this report draws heavily on interviews with NTOs, national spa federations and other industry bodies, together with a range of tour operators, incentive travel organisers, operators of spa facilities, spa tourism specialists and hotel management groups in several countries.

The following definitions, adapted from ISPA's own classification of spas, are used in this report:

  • Destination spa – a spa, the sole purpose of which is to provide guests with lifestyle improvement and health enhancement – including healthy eating if required – through professionally-administered spa services, physical fitness and training courses on a full-board, live-in basis;
  • Resort/hotel spa – a spa located within a resort or hotel, providing professionally-administered spa services, fitness and wellness programmes, and spa cuisine menu choices;
  • Day spa – a spa offering a variety of professionally-administered spa services to clients on a daily-use basis;
  • Club spa – a facility whose primary purpose is fitness and which offers a variety of professionally-administered spa services on a daily-use basis;
  • Cruise ship spa – a spa aboard a cruise ship providing professionallyadministered spa services and spa cuisine (healthy eating) menu choices.

The term 'health tourism' is in many ways paradoxical. This helps to explain why the market for spas and health resorts has had such a blurred image in the past, and why it has been such a difficult market to evaluate and quantify.

Where does the medical side of the business end and tourism begin? At one extreme, there are the purists who jealously guard the medical image of the spa and health resort business – as a distinct type of health facility that should be supported by the state and taxpayers' money. This attitude is to some extent understandable, since the medical label lends a certain credibility to the industry.

Nevertheless, the traditional European health resorts, which used to depend almost exclusively on clientele taking three-week state-subsidised 'cures', have all been forced to diversify to ensure their continued commercial success or, in some cases, their survival. This is due to the tightening of eligibility rules for subsidised treatment over the last decade or more – particularly in Germany and Italy.

Insurance companies in France – the only other major market in the Western world where the state has traditionally recognised spa treatment as a justifiable medical expense – have followed their example. However, a significant share of guests and overnights in France's thermal/mineral springs' resorts are still paid for by state medical insurance, even though it is impossible to get state insurance coverage for treatment at a thalassotherapy centre.

Some private health insurance companies do allow treatment to be covered, but this again varies from one country to another.

The diversification of traditional spas and health resorts in Europe has both responded to and, at the same time, stimulated, increased demand for health and fitness and alternative/complementary therapies. People's working lives are more and more stressful and this, combined with the growing threat of later retirement, has made people more aware of the need to lead healthier lives. This is reflected in the huge growth in health clubs and fitness centres around Europe – and, indeed, all over the world.

Nevertheless, while sporting and fitness activities continue to be very popular, a growing number of people are opting instead for more relaxing ways of staying healthy, including passive treatments with lots of pampering and cosseting.

The three major markets for wellness in Europe – Germany, Italy and France – are also those where 'taking the waters' is a national tradition. The growth of the industry in these countries – and, particularly, the linking of health/wellness with tourism rather than just for day use on a local basis – has also been due to acceptance of the value of treatment by the medical profession. This is also true to a greater or lesser extent in Austria, Switzerland and most parts of Eastern Europe, the Nordic countries and the Baltic states.

While a few days a week in a spa can make one feel refreshed and relaxed, the real benefits of spa treatment – particularly treatment based on natural mineral springs or seawater – can only be felt after some days. In most parts of continental Europe, day use of spas has been secondary to the desire for a once- or twice-a-year 'cure'. And it is probably true to say that short breaks have developed in popularity because they provide the regular top-up treatment required to continue enjoying the benefits.

Tourism centred around the concepts of wellness, pampering, de-stressing and holistic treatments and therapies is a relatively new phenomenon in the UK. Appreciation and understanding of the curative properties of natural mineral spas and seawater are much less deeply ingrained in contemporary British culture than in many European, Arab and Asian societies. But this has not always been the case.

In the 17th and 18th centuries, spas based on natural mineral springs were popular centres both for convalescence and for pleasure. Spa towns and cities such as Bath, Buxton, Harrogate and Cheltenham were the most sought-after destinations for fashionable society in the early 18th century. By the 19th century, however, seaside resorts (Brighton, Margate, etc) had taken over as the most fashionable spots to visit, although inland spas maintained a role as places for convalescence, such as for First World War casualties.

The number of operating spas in the UK dwindled through the 20th century, declining from as many as 200 at the turn of the century to around 60 in 1920 and just ten in 1946. Although a few were absorbed into the National Health Service when it was established in 1948, there was little or no investment in spas throughout the century, and almost all fell into disuse. Waters from the hot springs at the best known of England's spa cities, Bath, were banned from public use in 1978.

Meanwhile, the private sector began to set up health clubs and farms – Champneys opened in 1925, for example – but their appeal was strictly limited, not least because of the high cost involved. Sports and exercise were more popularly seen as the route to health and fitness, and beauty treatments developed along separate lines.

Interest in wellness and the interlinking of health and holidays has only taken off in the UK in the past decade. Underlying trends to this surge of interest are well documented. The population is ageing, working hours are longer, jobs and lifestyles are more stressful, obesity is a growing problem, complementary medicine is more acceptable, and long-haul travel has exposed more British people to different cultures and alternative forms of well-being. The growth of the health-food sector, gyms, fitness clubs and day spas are clear indicators of a growing interest in a healthier lifestyle. A decade ago there were almost no magazines on health – now there are over 30.

In terms of supply, the competition facing the UK as it looks to develop its own health/wellness tourism business is formidable – not just from Europe, but also from other parts of the world. The number of countries that boast health resorts and spas seems to be growing by the month. And the range of treatments they offer is mindboggling.

There is a wide choice of spas for every medical problem imaginable – from asthma and gout to arthritis and skin diseases. All forms of hydrotherapy – and especially thalassotherapy – are also recommended for functional rehabilitation, or occupational therapy, after accidents and operations. Iodine – present in seawater, sea air and seaweed – is also increasingly recognised as an aid to relaxation and an antidote to stress.

While all forms of hydrotherapy are supposed to be beneficial, some swear more by one method than another. And this depends to some degree on what is fashionable. Thalassotherapy is currently very much in vogue and is often associated with algotherapy, or seaweed treatment. There are even health centres located a long way from the sea which claim to offer thalassotherapy. But this is, of course, not the real thing, since, in order for all the minerals and oligo-elements in the seawater to maintain their properties, it is essential for it to be freshly pumped from the sea before being heated to around 34-36°C.

Thalassotherapy, like all other types of hydrotherapy, has a long history. Both the Greeks and Romans were believers in the therapeutic powers of seawater. Twenty-five centuries ago, in 350 BC, Hippocrates wrote: "The sea cures all men's ailments." And Egyptian priests are reputed to have cured Plato with hot sea baths at around the same time.

The tradition died out and – what few people today realise – was revived many centuries later, in 1753, thanks to the publication of a report by a British doctor, Charles Russell, extolling the curative properties of seawater. And, in 1791, the first ever marine hospital was opened in Margate in the UK.

There is a certain faded glory about many of Europe's famous spa towns. True, some have played on this, and following extensive renovations and the addition of attractions – such as casinos, cultural and conference centres – have become well-known tourist resorts, while still continuing to cater for longer-stay guests enjoying state-subsidised treatments. Baden-Baden in Germany is one example, as are Aix-les-Bains in France and Montecatini in Italy.

But many of continental Europe's traditional spas are actually located in rather bleak environments and hotel facilities are frequently spartan. Moreover, spas are very much associated with an ageing market, so this adds to its tired image. In contrast, thalassotherapy attracts a younger clientele, so its image is much more dynamic. Nevertheless, since a number of thalassotherapy centres have been built around deluxe landmark hotels – La Baule and St Malo are two examples – thalassotherapy has had difficulty in shedding its upmarket image.

The renewed popularity of spas has encouraged a boom in construction of new facilities and the upgrading and modernisation of older resorts. In Spain, for example, there has been major investment in the renovation and restoration of the old Arab baths developed by the Moors 500 years ago. Hungary has earmarked health tourism as one of its markets with the best growth potential and has also embarked on a massive upgrading of the country's spas and supporting facilities. Budapest's Gellert Hotel and Spa is a very popular short-break destination for Europeans.

Two famous spa towns in the Czech Republic, Karlovy Vary (Carlsbad) and Mariánské Lazné (Marienbad), are also undergoing major renovations, and Estonia has revived its spa tradition and is promoting wellness holidays – mainly to Scandinavians. Following the modernisation and improvement of their facilities, Italy's different spa regions have developed exciting new programmes offering wellness holidays combined with cookery classes, wine-tasting, or cultural, historical or archaeological study tours.

Many of Europe's national tourism organisations (NTOs) now have dedicated health and wellness brochures, and NTOs outside Europe are increasingly trying to tap the European market as well. Asian countries, such as Thailand and Sri Lanka, have been most successful, thanks to their own particular brands of Asian wellness including, for example, Thai and Ayurveda massage.

All the leading hotel groups are also coming out with dedicated spa brochures, either developing their own unique brands – as is the case, for example, with Mandarin Oriental and Raffles – or promoting spa/wellness packages in combination with other activities such as golf, or as add-ons for business and conference guests. Hotel spas are becoming increasingly important in terms of providing a competitive edge – in the same way as health clubs and swimming pools were some years ago – even if, as a US survey shows, most guests do not use the hotel spas.

One of the latest trends, which started in the USA, is the development of spas in timeshare resorts and on cruise ships. Leading cruise lines say that the concept is working well. Marriott Vacation Club International already has spas at, or in the vicinity of, nearly half its timeshare properties, and the group sees them as essential to the success of any new timeshare developments.

Almost 20 countries in Europe have health/wellness resorts offering water-based treatments and, if additional spa facilities in hotels and clubs are taken into account, the total number of facilities probably exceeds 6,000. According to the European Spas Association (ESPA), there are more than 1,200 resorts that are medically respected centres – mostly members of ESPA through their national associations and other umbrella organisations associated with ESPA. These include the Royal Spas of Europe and the Baltic Seas Spas Co-operation (BSSC).

As already indicated, it is extremely difficult to determine the size of the market in Europe for health/wellness holidays. While there is reasonable documentation on trips taken for medical reasons, the whole wellness sector is difficult to capture, especially if short breaks and day use of spas are included in the count. Because of the difficulty in defining the market, much of the data available seems contradictory and cross-market comparisons are almost impossible.

Certain key trends are important to note, however.

The health/wellness market is predominantly a domestic one. Foreign travel for health/wellness holidays is largely confined to neighbouring countries or – in the case of curative treatments – to destinations specialising in particular ailments. While there does appear to be a growing market for destinations further afield – such as Thailand or Sri Lanka for Asian wellness – the wellness element, in most cases, is only one part of a bigger holiday programme/itinerary.

According to the European Travel Monitor (ETM), health/wellness tourism accounted for a mere 1% of total outbound trip volume in 2002, although this share only refers to trips of four nights and longer abroad. This puts the number of foreign trips made for health or wellness at little more than four million. The respective share was highest for Germans, however, at 3%, which means that Germans generate around 50% of Europe's total count. No comparative data is available for short breaks.

Women still outnumber men in the market, and the age group most likely to opt for a health/wellness holiday is the 45-64-year-old group. However, the faster than average increase in demand for short breaks has resulted in more younger people and more men entering the market. In addition, the average cost of health/wellness packages has declined somewhat and this is helping to popularise the product, bringing it within the reach of a larger socio-economic group.

Clearly, these general trends mask fairly wide fluctuations from one country to another. But the main differences in trends in various countries would seem to stem from whether or not there is a clear spa culture in different markets.

Although things are changing – in line with changing lifestyles and increased health consciousness – Germans, Italians and French are probably more likely to appreciate the benefits of spa treatment than the British. And it is even more of an established culture in Asia and the Middle East. But even in the USA, where the medical establishment has traditionally viewed the spa industry with suspicion, there is now increasing demand for alternative health treatments at spas, performed by licensed practitioners.

The results of a recent study commissioned by the Hungarian Tourist Board from KPMG would seem to confirm that the highest level of spa usage in Europe – for health or wellness – is among Germans. Nevertheless, according to research by The Travel Business Partnership, the penetration level among Germans is still well below that in Japan, where the number of spa, visits per year is equivalent to more than 1.2 visits per capita.

TABLE 1: ESTIMATED USE OF SPAS IN DIFFERENT MARKETS
MarketPopulation (mn)Spa visits ('000)Penetration (%)
Japan123.6150,000121.5
Germany79.816,00020.1
Italy57.13,0005.2
Switzerland7.12503.5
France57.51,3002.3
USA250.03,5001.4
Spain39.94001.0
Source: Estimates by The Travel Business Partnership based on research carried out using different sources, including The Strategy Group (USA) and KPMG (Hungary)

Caution must be taken in interpreting the data in the above table, however, since the methodology on which the estimates are based may not be the same in each country. In principle, the number of visits does not include visits of less than 24 hours, although, if this is the case, the German share would seem to be too high.

In the next few sections of the report we will look more closely at individual source markets – some of which hold reasonable potential for the UK – as well as providing a brief overview of trends in inbound health/wellness tourism in the respective countries.

At the end of 2002, Germany had 330 officially-recognised spa towns and resorts with a capacity of more than 55,000 accommodation establishments between them, and a total bed capacity of 2.6 million. There are four basic types of resorts: spas, whose mineral springs or mud form the basis of treatment; coastal resorts, some of which can claim to be thalassotherapy centres; 'Kneipp' resorts, with treatment based on a specific form of hydrotherapy using cold water; and resorts where a particular climate is the main factor in treatment.

Baden-Württemberg has the largest number of resorts – mainly located in the Black Forest region – followed by Bavaria and Hessen. These are the only three regions with 50 or more resorts. It is interesting to note that Bavarian resorts attract the highest share of domestic tourists on health/wellness holidays (see Table 4).

The number of visitors to German spas and health resorts – for medical or health/wellness reasons – has increased steadily over the past 15-20 years, reaching 16.9 million in 2002. Overnight volume declined during the second half of the 1990s – in line with the trend towards much shorter stays, as the German resorts opened up to a broader, less medically-oriented clientele. It has since started to increase again, although the longer-term trend is expected to be towards even shorter stays.

Foreign clients for Germany's spas come primarily from the Netherlands, Austria and Belgium – in order of importance. However, the German National Tourism Organisation (DZT by its German initials) says that a number of East European sources have been growing, and that the USA was starting to show good potential before the events of 11 September 2001.

TABLE 2: VISITORS TO GERMAN SPAS AND HEALTH RESORTS, 1985-2002
YearVisitors ('000)Nights* ('000)Average length of stay (%)
19856,98594,39213.5
19908,409105,39711.8
19959,345111,47411.9
200016,669103,8276.2
200116,884105,6426.3
2002 **7,69445,4985.9
Source: Deutscher Heilbäderverband
* 1985 and 1990 figures are days
** First six months

A survey conducted in the late-1990s suggests that some 3% of German adults aged 14 years and over are regular clients of spas and health resorts. An additional 24% go occasionally. (Note that these percentages cannot be strictly compared with the data in Table 1, since the latter covers the whole population.)

As might be expected, women slightly outnumber men – in line with the ratio of women to men in the population – and there is a sharp increase in propensity to take the waters as Germans grow older. Income is not, however, an important determining factor – partly because of the availability of health insurance to cover treatment (fully or partially) and, in some cases, hotel accommodation and transport as well.

The annual Reiseanalyse, conducted by the research institute Forschungsgemeinschaft Urlaub und Reisen (FUR) in Hamburg (which excludes all non-holiday health travel), shows that there is a sharp increase in propensity to take health holidays with increasing age. Interest in wellness holidays, on the other hand, is spread much more evenly across all age groups.

TABLE 3: GERMAN HEALTH AND WELLNESS HOLIDAYS OVER THREE YEARS, 1999-2001*
 % taking holidays for:
 Total (mn)HealthMedical treatmentWellnessFitness/sports
Population (14+ years)64.107.64.12.73.6
Western Germany50.997.73.82.93.5
Eastern Germany13.117.45.11.93.9
      
Age     
14-29 years13.111.80.82.64.3
30-39 years11.973.30.92.83.6
40-59 years20.567.83.33.34.1
60+ years18.4714.49.42.22.5
      
Monthly household income (DM** net)     
Under 3,00018.708.44.71.82.3
3,000-4,99927.657.64.12.43.7
5,000+17.756.93.54.24.7
      
Education     
Basic33.959.04.62.12.5
Secondary school20.316.43.33.44.4
Further education9.835.54.13.65.6
Source: Reiseanalyse 2002
* % of population taking at least one holiday of 4+ nights for the above reasons (main or secondary reason) over the three years
** DM1.95583 = €1
TABLE 4: MAIN DESTINATIONS VISITED BY GERMANS ON LONG* HEALTH/WELLNESS** HOLIDAYS, 2001
DestinationHealth/Wellness holidaysAll holidays
Germany (%)55.229.2
Including:  
Bavaria24.76.9
   
Abroad (%)44.870.8
Including:  
Hungary7.72.1
Italy6.79.4
Czech Republic/Slovakia6.71.7
Austria6.27.6
Spain4.113.6
   
Total trips (mn)2.163.4
Average length of trip (days)16.213.8
Spend per trip (€)838793
Ratio of main to secondary holidays76:2477:23
   
Total holidays (mn)2.163.4
Source: Reiseanalyse 2002
* Holidays of 4+ nights** Excludes fitness/sports holidays

Although domestic destinations are still more important for Germans on health/wellness holidays (again, excluding purely medical trips), the foreign share seems to be growing. In 2001, close to 45% of all holidays of four nights and longer – some 940,000 – were to destinations abroad, with Hungary, Italy, the Czech Republic/Slovakia, Austria and Spain generating 31% between them. The UK does not even feature in the top ten destinations, although some German tour operators believe there is potential for upmarket spa weekends combined with shopping or culture.

Of the total trips, 76% were main holidays and 24% secondary trips. Average trip length was 16.2 days and average spend per trip €838 – as against €793 for holidays overall.

Interestingly, as many as 34% of health/wellness holidays were booked through the travel trade. Again, this reflects a sharp increase over the past five years or so, and goes a long way to explaining why so many of the German generalist operators have entered this sector of the market. Both TUI and Thomas Cook recorded strong growth from sales of wellness packages in 2002 (Thomas Cook's Neckermann wellness brand was up 68%), and have expanded their respective programmes, both for foreign and domestic travel.

TABLE 5: ORGANISATION OF GERMAN HEALTH/WELLNESS HOLIDAYS, 2001 (% OF TRIPS)
OrganisationAll holidaysHealth/wellness holidays
Travel trade booking*4534
Booking direct with hotel/other supplier2948
Neither of the above2818
Source: Reiseanalyse 2002
* Through a travel agency and/or tour operator

The German market for health/wellness is a particularly interesting one for the UK as price is not likely to be a major deterrent. This sector of the market has continued to show growth, albeit from a small base, at a time when outbound travel in general has stagnated and even shown a decline. Also important is the fact that over 70% of Germans on health/wellness holidays opt for hotel accommodation.

TABLE 6: ACCOMMODATION USED ON GERMAN HEALTH/WELLNESS HOLIDAYS, 2001 (% OF TRIPS)
AccommodationAll holidaysHealth/wellness holidays
Hotel/guesthouse5571
Holiday home2419
Other2110
Source: Reiseanalyse 2002

Short health/wellness breaks of 1-3 nights accounted for some 3.8% of the short-break sector overall in Germany, or some 920,000 trips, in 2001. There were an additional 823,000 fitness breaks. In contrast to trends in the fitness sector, propensity to take health/wellness short breaks increases with age, although the difference in share between 30- and 60-year-olds is not that significant. Neither is there much difference from one socio-economic group to another.

According to a spokesman for the TUI-Vital brand, most Germans taking short wellness breaks prefer not to travel further than 250 kilometres to reach their destinations. So the only foreign destination that features significantly is Austria.

TABLE 7: GERMAN SHORT BREAKS FOR HEALTH/WELLNESS AND FITNESS, 2001
 Total short-break travellers (mn)% taking short breaks for:
 Health/wellnessFitness
Total market24.223.83.4
Western Germany19.364.03.4
Eastern Germany4.862.93.1
    
Age   
14-29 years5.191.93.1
30-39 years4.313.04.6
40-59 years8.354.53.7
60+ years6.364.72.3
    
Monthly household income (DM* net)   
Under 3,0005.563.91.6
3,000-4,99910.343.13.5
5,000+8.314.54.4
    
Education   
Basic10.824.03.3
Secondary school8.513.83.5
Further education4.903.13.3
Source: Reiseanalyse 2002
* DM1.95583 = €1

Interest in health/wellness holidays among Germans has grown rapidly over the past few years, according to the Reiseanalyse. For wellness alone, the share of Germans planning a holiday over the next three years rose from 6% in 1999 to 13% in 2002. Data for this year's survey is not yet available.

TABLE 8: GERMAN INTEREST IN HEALTH/WELLNESS HOLIDAYS OF ALL TYPES*, 1999-2002 (%)
 1999200020012002
Health holidays generally14201920
Medical treatment (cure)14151416
Wellness6101013
Fitness7111011
Source: Reiseanalyse 2002
* % of Germans who said they were interested in taking a heath/wellness holiday at some point over the following three years.

Spas have existed in Italy since Roman times and they still have an important place in Italian life. Most Italians believe in the therapeutic effects of the 'terme', and around 22% of all Italians over the age of 14 have stayed in one of the country's spa towns at some time or another in their lives. Of these, almost 50% were there for spa-related treatment.

Nevertheless, pressures to cut the national health budget and social reforms have made it increasingly difficult to be eligible for reimbursement of costs. Fifteen years ago, more or less every civil service worker was entitled to 12 days a year spa treatment – as separate from his or her holiday entitlement. The eligibility rules were tightened in 1990, and they have become even tougher since then.

Italy has a total of some 450 spas and there are over 2,500 hotels in spa towns. Nevertheless, dedicated spa business still generates a fairly modest share of total Italian arrivals and overnights – estimated at 4% and 5% respectively.

The average age of Italian spa clients is similar to that in Germany, at 50-plus years. This compares with around age 42 for tourists generally. But expenditure by spa clients is about 15-20% higher than the average.

There has been big investment by Italian spas over the past few years to attract more accompanying visitors to spas, as well as simply holidaymakers, and to promote weekend and short breaks. Some of them have shown a lot of imagination and initiative in terms of the type of programmes developed and marketed abroad. The number and type of attractions available for visitors in spa towns has increased significantly and some of these have reportedly been added with the aid of European Union funds.

Although no recent data is available, foreigners are still reported to account for more than one-quarter of spa clients and overnights in Italy's spa towns. The foreign share comprises mainly Germans and Austrians – a few of whom are covered by health insurance schemes – who undergo longer treatment than Italians generally. Medical stays do not, of course, feature in tourism guest and overnight counts.

A number of other source markets are growing, although these – including the British – tend to combine a spa experience with a cultural or gastronomic holiday in the country.

Health tourism has been established for many years in France, as in Italy and Germany, but, until recently, the French did not really make much effort to attract international business. The situation changed for a number of reasons.

  • First, France's resorts also found themselves struggling to make profits and so decided to diversify their products and markets to compensate for their declining state-subsidised clientele. Resorts like Vichy, Vittel and Contrexéville – well know because of their mineral waters – were among the first to focus on wellness and fitness programmes as well as on traditional health treatments, and to promote preventative medicine or alternative therapies.
  • Second, in response to demand from its membership, Maison de la France created a Club Forme (health and fitness), to jointly market and promote France's health/wellness resorts to foreign markets. A study has also just been commissioned to try to identify the prime sources of business for each type of resort.
    • Finally, thanks to its strong presence in all the different areas of the health/wellness sector in France and other countries – thalassotherapy, thermalism, aquatherapy and 'beauty and spa' – the Accor Group has contributed significantly to the product and market diversification and helped to popularise health/wellness tourism in France. Aquatherapy is Accor's own brand name for health/wellness at mineral springs-based spas – as opposed to the statesubsidised 'thermalism'.

Despite this progress and the high quality of its health/wellness product, France's potential is still underdeveloped – even in terms of domestic business. If the propensity of the French to visit spas and health resorts were at the same level as that of the Germans, or even Italians, the market would be very much bigger. As it is, the total volume of clients taking this kind of holiday is estimated at little more than 1.3 million a year – 930,000 for mineral springs-based resorts, 332,000 for thalassotherapy centres and around 50,000 for other centres, including hotel spas, offering other forms of hydrotherapy.

TABLE 9: HEALTH/WELLNESS IN FRANCE, 2001 ('000)
 No. of clients
Centres with thermal/mineral springs 
Foreign10
Domestic: 
State-subsidised600
Private*200
Local clientele120
Sub-total930
Thalassotherapy centres 
Foreign42
Domestic: 
Private*250
Local clientele40
Sub-total332
Total**1,262
Source: Estimates by The Travel Business Partnership – see text for further details based on a Maison de la France study, Le Marché du Bien-Etre et de la Remise en Forme avec l'Eau, dans les Domaines du Tourisme et des Loisirs, carried out by MKG Consulting
* Includes both clients opting for health/wellness treatments as the main purpose of their trips and those on holiday in the region taking advantage of the existence of the health/wellness facilities 
** Excludes hydrotherapy/balneotherapy at spas not using natural mineral springs or sea water 

These statistics are derived from a study conducted for Maison de la France in 2002 by MKG Consulting, entitled Le Marché du Bien-Etre et de la Remise en Forme avec l'Eau dans les Domaines du Tourisme et des Loisirs (loosely translated as the health/wellness sector using water-based treatments for tourism and leisure). While the findings of the study show that the market has shown only modest growth in recent years, it highlights significant potential for future growth from the domestic market which, it believes, could reach some 900,000 visits a year for thalassotherapy and 565,000 for aquatherapy. In addition, MKG estimates that several million visits a year could be generated from people living in the vicinity of health/wellness resorts.

As far as inbound tourism is concerned, the growth potential is even more impressive, albeit from a lower base. MKG believes that France could attract 0.6% of German adults (347,000), 2% of Swiss (140,000) and 1% of Belgians (102,000) to French health/wellness resorts. This would mean a total of some 1.4 million visits a year. The British market is not seen as having good growth potential in this sector – MKG puts its ceiling for France at 0.1%, or a maximum of 58,000 guests.

The Accor Group would probably disagree with these projections as it already enjoys quite good business out of the UK. In terms of its thalassotherapy resorts, foreign business accounted for 20% of its 150,000 guests and one million treatment days last year. And after Belgium, the UK was the second most important source, ahead of Italy and Germany. More importantly, 60% of its guests at its thalassotherapy resorts are repeat visitors.

There are currently some 45 thalassotherapy centres in France, excluding functional rehabilitation and occupational therapy centres. The first of the so-called modern thalassotherapy centres, which helped to revive the tradition for seawater treatment, was opened in 1964 at Quiberon – one of ten centres operated by Accor.

There were two main reasons for thalassotherapy centre development in France. The first was economic diversification for French fishing ports as a replacement for their ailing fishing industry. The second was to provide an added attraction – and a yearround one – in some of the north coast's former famous beach resorts, such as La Baule, St Malo, etc. This explains why in these resorts the centre has been built around existing deluxe hotels – thus reinforcing the upmarket image of the product.

TABLE 10: ACCOR'S THALASSOTHERAPY OPERATIONS, 1998-2002 ('000)
YearGuestsTreatment days
199890.0430.0
199994.6426.0
200098.4442.0
2001133.8919.8
2002*150.01,000.0
Source: Groupe Accor
* Estimated

The top 11 mineral springs' resorts in France – Dax, Aix-les-Bains, Balaruc-les-Bains, Amélie-les-Bains, Gréoux-les-Bains, Barbotan-les-Thermes, Bagnoles-de-l'Orne, Luchon, La Bourboule, Vichy and Bourbonnes-les-Bains – account, between them, for about 45% of the total days of treatment. Dax, located in south-western France, heads the list with close to 56,500 clients enjoying state-subsidised treatment in 2001, as well as some 20,000 private treatment days. No data is available for the wellness sector alone, but most leading resorts claim to have enjoyed good growth in the last few years.

In fact, since 11 September 2001, there has reportedly been strong demand for this type of holiday and short break – attributed to the fact that people are nervous of travelling abroad and are looking for new holiday options in France. This has led to several new tour operators entering the market – in addition to established operators, such as Accor Vacances – including some of the generalists like Nouvelles Frontières.

Although the French market will remain predominantly a domestic one, Accor is one operator that believes it has some potential for the UK – one of the reasons the French hotel group plans to develop new spa facilities in its UK hotels.

Other European source markets for health/wellness that may hold potential for the UK – primarily for short breaks or add-ons for business travellers – include Austria, Switzerland, the different Nordic markets and Eastern Europe. Younger Russian and Polish travellers interested in health/wellness, for example, are seen by Germany and France as potential target markets.

Interestingly, the most important age group in terms of demand for health/wellness tourism among Austrians, for example, is from 25-44 years. And while most other age groups in Austria choose domestic destinations, almost 67% of those aged 18-24-years -old prefer to go abroad for health/wellness.

Switzerland is also an interesting market, as the country has a wide range of spas based on natural springs of its own and its spa culture is, therefore, well established. In addition, it was perhaps one of the earliest markets in Europe in which tour operators played a role. Specialist operators such as TPT (formerly Tourisme pour Tous) claim that the past 12 months have been excellent ones as far as sales of wellness holidays are concerned. And veteran operator Destinations Santé, established in the early 1990s by the leading pharmaceutical company in French-speaking Switzerland, now generates 50% more sales per annum as the UK's leading wellness operator, Thermalia.

Destinations Santé's slogan – interesting for a pharmaceutical company that would have been expected to focus more on selling medicine and pills than getting involved in the travel business – is: "If you take the time to relax and de-stress, you will need far less medication during the course of the coming year." Perhaps Boots will follow suit in the UK!

Best-selling health/wellness destination for Destinations Santé is Tunisia – attributed to the fact that it offers the best value for money. But health/wellness resorts in a number of different countries feature in its brochure, including the Lodge and Spa at Ireland's Inchydoney Island.

Although little data on Asian and Middle East health/wellness markets is available, anecdotal evidence from hotel groups and other suppliers suggests that both markets hold potential for Europe, and not least the UK. Nations in both regions already have a strong spa culture and are frequent users of spas at home and when travelling abroad.

There is fairly strong demand from both these regions for specific health treatment in European spas – usually the traditional health resorts well-known for particular ailments and medical conditions, or for rejuvenation and other similar treatments. But some visitors also enjoy spa treatments as a quick lift to combat jet-lag or to relax after a hard day's work in the frenzied environment of Europe's capital cities.

Interest in health/wellness tourism from both markets is reflected in the number of new spas being developed in these regions – from Dubai to Lebanon, and from Japan to Indonesia.

In both the USA and Canada, health/wellness and spa tourism (and specifically the combination of holiday-taking and spa usage) is still in its infancy. However, while there are reported to be fewer than 300,000 regular spa users in the USA – less than 1.5% of the population compared with 5% in Italy, 21% in Germany and over 120% in Japan – the North American market has been growing rapidly. Between 1999 and 2001 spa revenues more than doubled, to US$10.7 billion, after doubling in the previous two years.

There are important changes taking place in the market as well. Whereas traditionally it has been women who have primarily used spas for beauty treatments, rapidly increasing numbers of men are now seeking spas as fitness and stress-relief centres – up from 9% of total spa guests in 1987 to 27% in 1997, and to more than 35% today. The corporate market is being wooed by spa owners and is responding, viewing spa resorts as an interesting and potentially beneficial alternative to more traditional types of incentive location.

The health club craze in the USA was fuelled by achievement-oriented baby boomers, determined to use their bodies and minds as efficient machines to help them get ahead in the world. A decade later, those boomers are older and wiser, but they are still looking for healthy ways to cope with their stress-filled lives. Spa holidays, which highlight the importance of integrating the body, mind and spirit, fill that need. In 2001, according to research carried out by PricewaterhouseCoopers (PWC) for the International SPA Association (ISPA), there were 9,632 spas in the USA, up 69% over 1999's level. Some 75% of these are located in day spas, with hotel/resort spas accounting for 12%. The number of spa visits, including day usage, was 156 million, up 64%, with day spas accounting for a 68% share.

Day usage has shown faster than average growth, attributed to the fact that time is a major constraint to most spa users – hence the interest in combining spa usage with holidays. Interestingly, while they often used to scoff at the idea of gaining real medical benefits from spas, more and more Americans are coming around to the traditional European and Asian way of thinking.

TABLE 11: THE US SPA MARKET*, 1999 AND 2001
 19992001% change
Revenue (US$ bn)5.010.7114.0
No. of locations5,6899,63269.3
% of day spas7775
% of hotel/resort spas812
No. of visits (mn)9515664.2
% day visits (mn)na61.8
No. of employees ('000)15528281.9
Source: ISPA, from the ISPA 2002 Spa Industry Study conducted by PricewaterhouseCoopers
* Locations included in survey: day spas, hotel/resort spas, club spas, destination spas, medical spas, mineral springs' spas and cruise ship spas

There is considerable anecdotal evidence of a booming demand for spa tourism in the domestic market but, as already explained, little objective data exists to prove the case, or to help assess the size of the market.

The number of domestic holiday trips with health, fitness, or beauty as the main purpose of the trip is small when compared with the rest of Europe. In 2001, there were approximately 300,000 trips within the UK made by UK residents specifically for health and fitness, or for beauty treatments or therapies, according to the UK Tourism Survey (UKTS). These represented just 0.3% of all holiday trips. The volume in 2000 – a better year for tourism in the UK – was around 400,000, or 0.38%. As a point of comparison, 4% of respondents gave walking as the main purpose of their trips in 2001, while golf, cycling, sailing and swimming each accounted for 1%.

Spending in the UK as a whole totalled £110.6 million for these trips in 2000, declining slightly to £107.8 million in 2001. However, spending in England grew from £91.7 million in 2000 to £96.8 million in 2001 – an increase of 5.6%. Importantly, health, fitness and beauty trips took a 0.7% share of spending in 2001, but only a 0.3% share of volume, confirming that this is a high-value sector of the market.

The picture changes when looking at numbers of domestic holiday trips that include health, fitness or beauty treatments or therapies – whether or not this was the main purpose of the trip (Table 14). In 2001, this category totalled 5.6 million, or 5.5% of all domestic holidays. This is an improvement on 2000, when 5.1 million holiday trips (4.8%) included health, fitness, or beauty activities.

TABLE 12: DOMESTIC UK TRIPS, THE MAIN PURPOSE OF WHICH IS HEALTH/FITNESS/BEAUTY THERAPY OR TREATMENT, 2000-01 (mn)
 20002001
 All holiday tripsHealth, fitness, beauty% shareAll holiday tripsHeralth, fitness, beauty& share
England8.270.30.3680.10.30.37
Scotland12.3*11.5*
Wales9.4*8.3*
Total UK1060.40.38101.20.30.3
Source: UK Tourism Survey (UKTS)
* = less than 100,000    

Among other activities pursued during domestic holidays in 2001, walking was undertaken by 65%, golf by 5%, cycling by 7%, sailing by 5%, fishing by 4%, tennis by 3%, mountaineering by 2%, swimming by 23% and other sports by 6%.

The health, fitness and beauty sector convincingly out-performed domestic holiday trips as a whole in 2001, which declined 4.5% from 106.0 million in 2000. As already explained, the UKTS's 'health' category is broader than the 'spa' definition used in this report but, nevertheless, the growth in both volume and share in 2001 is very encouraging for the sector. Although full results from the UKTS were not available for 2002 at the time of writing of this report, it is likely that the growth in health, fitness and beauty trips continued. First results show an increase in domestic trips of 2.6%.

TABLE 13: SPENDING ON UK DOMESTIC HOLIDAY TRIPS, THE MAIN PURPOSE OF WHICH IS HEALTH/FITNESS/BEAUTY, 2000-01 (£ mn)
 20002001
 All holiday tripsHealth, fitness, beauty% shareAll holiday tripsHealth, fitness, beauty% share
England12,413.091.70.712,988.096.80.7
Cumbria770.090.1.2738.06.00.8
Northumbria738.01.40.2628.0*-
North West1,975.03.80.22,093.08.60.4
Yorkshire1,691.01.5-1,452.03.00.2
Heart of England2,793.019.10.72,832.012.90.5
East of England1,537.07.20.51,799.06.90.4
London3,070.00.3-2,995.020.30.7
South East1,490.015.01.01,843.01.6-
Southern2,052.022.41.11,929.025.71.3
South West3,122.04.90.23,291.04.90.1
Scotland2,317.017.70.82,298.05.80.3
Wales1,196.00.9-1,243.05.00.4
Total UK16,494.0110.60.717,016.0107.80.6
Source: UKTS
* = less than £100,000; – = less than 0.1%

Spending by all UK holidaymakers on health, beauty and fitness grew by some 11%, from just under £1.3 billion in 2000 to almost £1.4 billion in 2001 (Table 15). Overall, spending on holiday trips was only up by 3% in 2001. In England, expenditure was up by 17% and in Wales – where new spa facilities at Celtic Manor and St David's made a strong impact – by 47.8%.

TABLE 14: DOMESTIC HOLIDAY TRIPS IN WHICH HEALTH/FITNESS/BEAUTY ACTIVITIES WERE UNDERTAKEN DURING THE TRIPS, 2000-01 (whether or not they were the main purpose of the trips) (mn)
 20002001
 All holiday tripsHealth, fitness, beauty activities during trip% shareAll holiday tripsHealth, fitness, beauty activities during trip% share
England82.73.94.780.14.55.6
Cumbria4.10.24.93.50.38.6
Northumbria3.20.26.32.50.14
North West8.80.44.57.80.56.4
Yorkshire7.70.45.26.70.23
Heart of England12.50.56.3130.86.2
East of England6.80.45.97.80.79
London90.44.48.20.56.1
South East7.60.45.380.45
Southern8.90.55.67.70.56.5
South West13.10.64.614.30.74.9
Scotland12.30.75.711.50.54.3
Wales9.40.44.38.30.44.8
Total UK1065.14.8101.25.65.5
Source: UKTS
TABLE 15: SPENDING ON UK DOMESTIC HOLIDAY TRIPS IN WHICH HEALTH/FITNESS/BEAUTY ACTIVITIES WERE UNDERTAKEN DURING TRIPS, 2000-01 (whether or not they were the main purpose of the trips) (£ mn)
 20002001
 All holiday tripsHealth, fitness, beauty activities% shareAll holiday tripsHealth, fitness, beauty activities% share
England12,413.0980.37.912,988.01,1508.9
Cumbria770.075.29.8738.075.510.2
Northumbria738.037.05.0628.019.83.1
North West1,975.076.73.92,093.0123.95.9
Yorkshire1,691.065.73.91,452.041.72.9
Heart of England2,793.0104.73.72,832.0162.35.7
East of England1,537.083.75.41,799.0106.35.9
London3,070.0104.33.42,995.0158.15.3
South East1,490.089.36.01,843.090.04.9
Southern2,052.0122.05.91,929.0122.86.3
South West3,122.0203.26.53,291.0189.45.8
Scotland2,317.0182.57.92,298.0123.45.4
Wales1,196.056.34.71,243.083.26.7
TotlalUK16,494.01,257.37.617,016.01,396.18.2
Source: UKTS
* = less than £100,000; – = less than 0.1%

The number of international visitors coming specifically for spa tourism is tiny, the travel trade believes. Of course, many more international leisure visitors use spa facilities during their stay. Delegates at corporate meetings, regular international business travellers, people on incentive trips or on golf tours, staying at the Old Course at St Andrews, Westin Turnbury, Skibo Castle, etc tend to be enthusiastic users of hotel spas.

Health resort group Champneys – which comprises five health resorts since 2002, when the Purdew Group bought the Champneys' operation – says 5% of its guests are from overseas. Internationally-known hotel Chewton Glen, with a health and country club, also attracts a small percentage of overseas visitors to its spa, particularly from Switzerland, Scandinavia and Germany, but it cautions that some of its international clients are, in fact, expatriates based in London or the South East of England.

Hotels with strong spa products generally agree that the spa is very unlikely to be the main reason that the international guest has visited the UK, but it could well be the reason that one hotel has been selected over another. In London, Mandarin Oriental says that many of its business clients, particularly Asians, routinely pre-book spa treatments during their stays.

In the past, the traditional health farms approved by the British Health Farms Federation (BHFF) have identified their main markets as women (80% of clientele, according to the BHFF) aged between 30 and 65, with the average age at 49. The majority of clients are A-C1, although C2s are gradually showing interest. Small groups of women – friends, work colleagues, mothers and daughters – have been particular marketing targets, but couples are increasingly showing interest. Several new spas are incorporating double treatment rooms.

There are no definable seasonal booking patterns for UK spas, and occupancy levels tend to be very high – at around 80%. Even in dedicated health farms, people are tending to book for shorter stays, but are more frequent guests. Repeat business is also high.

The new contemporary spas, which are mostly associated with hotels, are finding a wider audience.

Small groups of women are still one key source of business, but couples are also important. At Sheraton's new One Spa in Edinburgh, for instance, men now make up 40% of users. In London, the male to female ratio at a top quality spa is likely to be 50:50, although the purchase is still more likely to be female-driven.

Bookings from older couples who are retired, or who are gradually phasing out of full-time work, are strong, say hotel spas, but younger couples in their 30s – typically DINKS with stressful but well-paid jobs – are also showing great interest, particularly for weekend breaks. They are prepared to pay for pampering, and believe that de-stressing and relaxation are achievable in a short period of time.

Spas at golf destinations such as Gleneagles, the Westin Turnberry and the Old Course Hotel at St Andrews say that, with the exception of golf massages, their spa facilities are more likely to be used by women.

Within the UK, the bulk of buyers are from London and the South East. But new facilities away from the south, such at St David's Hotel and Spa in Cardiff, or One Spa in Edinburgh, confirm that they are also attracting people from other parts of the country, especially from the urban centres of Manchester and Birmingham, and from a 2-3 hours' drive away for short break visits.

One distinctive trend among spa users, operators say, is their expanding knowledge about the different types of treatments in the marketplace. More British people are experiencing a whole range of spa treatments in the Caribbean and Asia, says specialist operator Thermalia, and are happy to try them again – or something different – in the UK.

The traditional UK health farms, with costly promotion and marketing campaigns, have also helped raise awareness of health tourism over the past decade, and the media attention continues to give spa tourism a high profile. The surge in spa-branded retail products has also helped to raise awareness.

Rapid expansion in the supply of hotel spa facilities over the past few years reflects fast-growing demand, while established health farms are being upgraded to keep pace with international trends in health treatments and therapies. A number of new spa projects are associated with conference and incentive venues.

A recent listing from VisitBritian's Business Tourism Department identified 65 health spas and resorts that also offer meeting, seminar or conference facilities with accommodation. As elsewhere in the world, luxury hotels in the UK are opening spas to satisfy customer expectations and give a competitive edge. In many cases, the high costs of maintaining and staffing a spa facility are met by offering club membership to local residents, and by operating as a day spa to non-members.

Quantifying the current UK spa supply is difficult, and no comprehensive survey has yet been conducted.

One indication comes from the British Spa Federation (BSF), which says it has listed some 200 establishments that could be potential members.

Another indication comes from the English Tourism Council which, in 2000, listed 527 establishments with serviced accommodation (ie B&Bs, hotels, guesthouses, country houses, castles, townhouses) claiming to have comprehensive health and fitness facilities, but the quality and scope of these facilities is not clear. In the same year, almost 3,000 establishments with serviced accommodation said they offered some health facilities.

These figures clearly hide a wide range of differences in quality.

At one end of the spectrum are health farms and destination resorts like Champneys, and spectacularly-designed hotel spas of the calibre of Mandarin Oriental, One Spa and St David's. These typically use the latest technology, offering treatments which could range from Ayurveda to Reiki, Shiatsu and mud treatments, and classes that might include Tai Chi or Pilates, and featuring brand products from companies such as E'SPA, Clarins, Decleor and Thalgo.

At the other end of the scale are converted hotel fitness rooms where a hot tub and a couple of treatment rooms have replaced the exercise machines and become the hotel 'spa'.

Numerous new spa projects are in the pipeline, among them major facilities at The Grove hotel, country club and conference centre in Hertfordshire, opening in the summer of 2003. The new Spa at Pennyhill is due to come on line this spring/summer at the Pennyhill Park hotel, Surrey. And particularly interesting for the UK health sector is the move by Accor, the world's largest thalassotherapy operator, to develop spa projects in the UK.

The number of health farms – or health resorts as some are now renamed – where the treatment is the clear priority, are much more limited. Just 11 are listed as members of the BHFF, affiliated to the BSF, although Internet booking company, www.healthyvenues.com lists 14 'bona fide' health farms in the UK.

A total of some £70 million has recently been invested by BHFF members in the upgrading and modernisation of their facilities, and many more millions of pounds of investments are planned. Members of the BHFF, who are proud of their 'medical' label, must conform to stringent minimum requirements which necessarily exclude many facilities that call themselves spas.

One major development for the UK spa sector is the attempt to revive the UK's traditional spa culture. Leading the way is Thermae Bath Spa, due to open in mid-2003, in a spectacular new building designed by Nicholas Grimshaw, just 100 metres from the Roman Baths and 18th-century Pump Room, and using the city's natural mineral-rich hot springs.

The spa is technologically innovative – a special feature will be a year-round open-air pool on the roof, fed by the hot springs which deliver over one million litres of water daily at a temperature of 45ºC. There will be a full range of orthodox and complementary spa treatments, and the bulk of treatments – at least 80% – will be for leisure, with the remainder dedicated to medical treatment. There is no specific accommodation attached – following the model of some European spas, users will stay at any of the city's existing hotels.

Funding for the project is also innovative – it was part-funded by a £7.7 million Millennium Commission Fund grant, with the balance of some £20 million from the city and from private sector partners, these include the Dutch company, Thermae Development Company, which will operate the venue. Although not without its problems – costs have over-run and the project is currently nine months late – the project is being carefully watched by other traditional British spa towns that would also like to revive their spa capabilities.

Plans are at various stages of development in several spa towns, including Droitwich, where Thermae Development Company currently has six months to assess the commercial and technical viability of reviving the city's spa that finally fell out of use two years ago. Like Bath, Droitwich's scheme would predominantly focus on leisure.

Summary of key minimum requirements for membership of the BHFF

  • Paramedical staff available on request and some form of medical screening
  • Treatments available throughout the day (six days a week)
  • A guests to treatment staff ratio of 3:1
  • Fitness classes with fully-qualified instructors available all day and outdoor activities available
  • Facilities must include pool and well-equipped gym with fully-qualified instructors
  • Restaurant promoting healthy eating, with special diets and dietician available
  • Accommodation (at least 20 rooms) open every day of the week, offering a range of health packages and options for various treatments

Sources: English Tourism Council; British Health Farms Federation

An important feature of Bath's project is its integration into the city's tourism sector as a whole. Spa management stresses it will draw on an existing visitor market, not create an entirely new one. Bath attracts almost a million overnight visitors, a third of them from abroad. All the key markets – the USA, Germany, France, Scandinavia and Japan – are thought to be sympathetic to the concepts of spa tourism.

Overseas visitors will not come to the city specifically for the spa, says management, but the facility should enhance the Bath experience, and help convert day-visitors into overnight visitors, or extend one-night stays to two nights. The spa should help boost the city's overseas visitor count which has declined in recent years, in line with a general UK-wide decline in overseas leisure visitors.

If domestic and international visitors to nearby Bristol and the surrounding countryside are also included as potential spa users, the market for Thermae Bath Spa could be as high as 2.5 million. Since the spa is not attached to any particular hotel, it should attract users from broader socio-economic groups. A two-hour stint is modestly priced at £17. Day visitors to Bath (an estimated 2.7 million a year) and local residents are also expected to use the facilities quite extensively. Up to 250 people a day can be accommodated at the spa, and 175,000 a year are forecast to use the spa, generating £3.8 million for the city and 260 new jobs.

In the Peak District, meanwhile, the Buxton Crescent and Spa Project has already secured support in principle from the Heritage Lottery Fund, and hopes to finalise selection of a developer by August this year, start work by mid-2004, and open by the end of 2006. The project will provide a working spa in the former baths building in the Georgian Crescent, with an adjoining hotel. Visitors will again be able to 'take the waters' in the former pump room, and a visitor attraction centred on the town's spa heritage is also planned.

The scheme is integral both to Buxton's tourism development and to the need to maintain its important architectural heritage. Project managers believe that, initially, the market source for the spa will be drawn from existing visitors to the Peak District – the UK's most visited national park – but in the longer term Buxton would become a destination spa in its own right. The spa may well be developed along similar lines to those of Thermae Bath Spa, but there is also the potential to reintroduce some of the unique treatments for which Buxton was famous in the 18th century – including a 'moor' or 'peat' bath.

There are only a handful of specialist operators for spa tourism in the UK, with Erna Low and Thermalia the best known. Erna Low has been advising clients on treatments and the right locations for them for 21 years, and Thermalia was established 12 years ago to sell health packages specifically using true mineral waters for drinking, or bathing, or for thalassotherapy treatments. Both companies now note a growing demand for shorter holidays which, at best, can give a psychological boost. Both also offer short as well as longer stays in which the treatments could provide more benefits.

Although both operators report strong repeat business and growth in sales – Thermalia's are up by an average of 25% a year – their respective client volume is relatively small. Thermalia handled around 6,500 clients last year. Both operators include UK spas in their programmes, but the bulk of their sales are for overseas spa destinations. People tend to book direct with the spa if it is in the UK, they say. Italy is very much the favourite with Thermalia's clients, followed by Portugal, Hungary and Jordan, while Erna Low says that its clients tend to follow the general fashions in destinations.

A greater volume of spa sales seems to be made through generalist tour operators, which sell holidays in resorts at which spas are one of a range of attractions. But increasingly, the generalists are singling out spa packages as one of a number of specialist offers. Superbreak, for instance, offers 'timeout for body and soul' and 'spa celebration packages', which are sold alongside theatre breaks, event and entertainment breaks, and golf breaks. At the top end of the market, operators like Abercrombie & Kent and Elegant Hotels and Resorts focus on spa facilities as an important element in the luxury packages that are on offer.

Another distribution development is the emergence of spa specialist web-only booking agencies. Spabreak is an independent website which acts as an agency for both UK health farms and hotel spas. Its owners say they created Spabreak from their more general sports and activity website, Sportbreak, some 18 months ago – after they realised that by far the largest demand from their website users was for spas. Internet sales of gift vouchers for spa breaks in the UK are also booming through sites such as thanksdarling.com and lastminute.com, say operators, and media coverage in the general press currently generates an immediate flurry of bookings.

The development of central websites stocking a range of spa products and last-minute promotions is considered to be an important step in attracting foreign business to UK health/wellness resorts. France's experience in online sales – through central booking sites such as Thalatel – confirms that the Internet is a good distribution channel. It could also help develop and raise awareness of the UK as a spa destination, and could provide information on the history and traditions of UK spa towns. Between 30-40% of all Scandinavians who take spa breaks book online, and the respective share for Austrians is 25%.

Spas presented as weekend packages – whether by hotels/resorts or the travel trade – seem to be the source of major growth at present. Currently, some UK destination spas say that weekends are fully booked for 6-9 months ahead. The Celtic Manor Resort in Wales, which has a range of leisure and meetings facilities including its large Forum Health Club and Spa, says it typically has a waiting list of around 50-60 people each weekend. At the Sheraton Grand in Edinburgh, weekend occupancy has increased by 20% since introducing a weekend spa break at adjoining One Spa.

Spa combination programmes are a growing feature of UK packages, although the offers are less varied than for overseas programmes, which might combine spas with a gourmet cooking course or art history course in Italy, a safari in Africa, or a meditation course in Asia. Combined golf and spa packages are the most common pairing in the UK marketplace – the UK clearly has particular strength in this area, with a number of worldclass golf/spa venues. Wentworth Travel's Finest Golf and Spa Resorts in the World brochure, for example, features nine golf and spa packages at different UK venues.

By far the greatest demand for UK spas will be from the British market. The UK's spa tourism is likely to develop more along the lines of the USA's product than on traditional European lines – at least for the foreseeable future. The emphasis will be more on 'feelgood' retreats and on a holistic approach to relaxation and rejuvenation, and will draw on elements from treatments from other parts of the world. Short stays, which give a psychological boost and a chance to relax and restore well-being, will be favoured over the more traditional minimum six-day treatment programmes.

This is not to say that the curative properties of traditional spas will be ignored. Some industry specialists believe that, within a decade, true medical spas will be operating in the UK. Already, specialist operator Thermalia sees its clients moving away from manmade spas, understanding more about the curative properties of natural spas and wanting to experience them.

Another possible boost to the UK's spa tourism development could come from the revival of traditional spas in inland spa towns – 12 spa towns and cities are currently members of the British Spa Federation. Much depends of the success of Bath Thermae Spa and its efforts to provide a leisure-oriented contemporary spa that meets current demand. As Bath has already experienced, funding and technical problems are key issues to resolve, and it could take many years before enough spas have re-opened to make an impact at national level.

For those prepared to pay for the luxury end of the spa market, the range and quality of treatments in the UK will continue to expand as more top-end hotel groups develop spas to maintain their competitive edge. Already, groups like Fairmont, Mandarin Oriental and Shangri-La are developing their own unique spa brands, and more hotel groups will follow suit. But there are also signs that, as more people in the UK become interested in the benefits of spa tourism, there will be a growing supply of less expensive facilities developing in the UK – including spas at some of the Accor Group's existing and planned two- to three-star properties.

Although no British destination or hotel spa would compete with the cachet of the more exotic and luxurious spa resorts of Asia and the Caribbean – nor indeed with many of the famous spas of Europe – the UK's spa sector should benefit from the growing British trend of taking several shorter holidays a year.

The current political climate, with terrorist threats and SARS dampening demand for overseas travel to some countries, could also be an additional boon this year for UK spas.

On the other hand, low-cost airlines are opening the way to European spa destinations which would have been too expensive for many British visitors in the past. One UK operator is able to offer a full package, including travel, for one week in a natural curative spa in Slovakia or Hungary for the cost of a weekend in some British health farms.

Also encouraging is VisitBritain's growing interest in promoting and marketing the UK's spa sector to both domestic and international markets. VisitBritain has identified an opportunity to develop a campaign for health products – health farms, hotel spas and private medical treatment – to residents of the United Arab Emirates, who are increasingly travelling to Germany and Eastern Europe for treatments.

VisitBritian's focus is the size and range of the UK's spa facilities and the country's good track record in medical treatments. Other VisitBritain offices in the USA, France and Ireland are also interested in developing promotions for their markets. International incentive and business markets are other VisitBritain targets, with spas seen as a means of extending a conference or business trip. However, these are early days for the UK, and a full-scale spa brochure of the quality produced by many of the German and Italian spa regions, or the 'Wellness in Germany' brochure produced by the German national tourism organisation, is some way off.

Another positive sign is the re-opening of discussions between VisitBritain and the British Spa Federation on setting standards for the sector. This would clearly enhance the image of the spa sector in the longer term, and help sort out current problems with definitions of what constitutes a spa, and provide the consumer with some benchmarks of quality of service and facilities.

In terms of international demand, the UK faces huge competition from elsewhere in the world. The exchange rate with European currencies is still not favourable to British spas and, in any case, the UK does not have a strong image as a spa destination.

For the moment, international visitors to the UK's spas will have already made the decision to come to the UK before deciding to spend some of their time here at a spa. However, Europe's spa industry believes the UK does have a future in the international sector. The chairman of the marketing body Royal Spas of Europe, for instance, believes Germans, French and Scandinavians could choose to come to a spa in the UK, but "it must be different and it must be better".

Nancy Cockerell and Jill Trew are respectively Editorial/Research Director and Senior Editor of The Travel Business Partnership (TBP), which provides customised research and consultancy for the travel and tourism and related industries. TBP publishes two monthly newsletters, Travel Markets and City Profiles. For further information, please contact research@t-bp.com