People are living longer than ever before, and wellness programmes and cosmetic treatments have never been more popular as a result. Those in their 50s, 60s and beyond now have the desire, the means and the time to prolong the taste of youth and are increasingly demanding holidays that provide healthcare as well as relaxation.

A hotel spa may no longer suffice if it fails to offer medical ministration to guests. Many operators are trying to conquer this market, but terminology is tricky and what one property calls a "medical spa" may mean something entirely different to another brand.

Susan Harmsworth, CEO of ESPA International, thinks this lexical mix-up is a big barrier to hoteliers looking to advance their venue’s repertoire.

"I’ve concluded that people are getting very confused with the words ‘spa’, ‘medical’, ‘medical tourism’ and ‘complementary health’ and I think the hospitality industry is getting very confused with figures from these industries," she says.

Harmsworth started working in the sector at 21 and has managed health farms all over the world. ESPA, which runs luxury facilities at venues including Gleneagles and Corinthia London, arose when she saw a market for beauty salons that could also provide health treatments. She now sits on the board of the Global Spa and Wellness Summit.

The Corinthia offers guests lifestyle programmes that include physiotherapy, osteopathy and nutritional advice. Harmsworth believes treatments like these have a place in hotel spas, but worries that operators will misinterpret the appetite for wellness as a demand for surgical procedures.

"My view is that people who are well and interested in enjoying themselves do not mix with people who are unwell or postoperative," she says. "You really don’t want to be lying by a pool covered in bandages with young, healthy people running around."

While the idea of hotels offering invasive treatments concerns her, Harmsworth believes providing non-invasive health therapies alongside conventional relaxation can be a good way of targeting the 50-plus market.

"They’re the ones who are spending the money and deciding they want to go on healthier holidays," she reveals. "I’m ancient and very conscious that I don’t want to be unhealthy. I no longer want to go to the Maldives to put on five pounds and get pissed all the time."

New age travellers

Michael Wallace, spa director at Danubius Hotels, agrees that retreats offering health components are increasingly popular. His brand runs a range of properties across Europe where trained doctors provide guests with personalised treatment plans for ailments such as osteoarthritis. Most of the clients stay for at least two weeks.

He says such offerings have been recession-proof and grow more profitable each year. "I think there are two types of medical spa," he says. "In Western Europe there are more aesthetic procedures, while in Central Europe, which is our product, the focus is on rehabilitation and the treatment of mobility diseases. These spas have been around for 200 years, but are increasingly popular because of the aging population."

A maturing public may not be the only reason for the increasing noise about medical spas in the industry, though. With superbugs on the rise, many potential clients are increasingly wary of hospitals and welcome alternatives for health checks and minor surgery.

Medical spa pioneer Dr Paulo Malo puts the success of his MALO Clinic down to taking treatments such as dentistry and cosmetic surgery out of hospitals and into retreats.

"We all know infections in hospitals are growing at a very dangerous rate," he says. "People are going to them to have full-body check-ups and this is a crazy situation. Hospitals are dangerous places and you should avoid going to them."

Despite his obvious hyperbole, Malo is convinced that offering medical treatments in what he believes to be a safer environment has been fundamental to his enterprise’s success.

After carving out a successful career as a dentist in Lisbon, he combined his medical background with an entrepreneurial flare and set up his first luxury medical spa in 2008. Six years later, his empire stretches to clinics all over the world, including locations such as New Jersey, Sao Paulo and Milan. His flagship venue lies within the Venetian Hotel, Macao.

Believing his sizeable portfolio to consist of the only "true" medical spas currently in existence, he loftily dismisses the competition as mere pedlars of pseudoscience.

"All the top quality hotels have spas, but they need to go further and integrate a different kind of treatment," he says. "Massages, hot stones and miracle oils… you can’t cheat people all the time. Sooner or later, clients will realise that it is all lies and will want hotels to take a scientific approach, which is where we come in."

MALO Clinic Macao offers rehabilitation and cosmetic dentistry, preventative medical care and cosmetic anti-aging, plus a range of relaxation treatments. Inaugurated in 2009, it has since been honoured with numerous awards.

"Here you’re staying inside a spa, being pampered, which is not the same as going to the hospital and waiting in line for six hours on a wooden chair," says Malo. "Until now, illnesses and aesthetics were separate. Whatever was inside you came under hospitals, while your external appearance was resigned to the beauty parlour. We have brought the two together."

Softly, softly

Wallace, too, champions moving away from the cold, sterile ambience of the infirmary towards making the experience more comfortable for guests.

"Twenty years ago, people came to our spas expecting it to be like a hospital," he reveals. "Gradually, as the European borders opened up, we realised that we had to soften the style of how we delivered the treatment. We’ve spent a lot of time and energy in making the experience more appropriate for a hotel."

However, Malo admits that when it comes to his clinic at the Venetian, it’s not that easy for other hotels to follow suit. These types of medical spas are unfamiliar territory for many and success certainly won’t happen overnight. "It’s taken a lot of guts to do this, because it’s new. It’s something that people won’t understand, so it takes time," he cautions.

There are many other challenges to take into account. A major one is the size of the hotel. No matter how luxurious a property is, making a profit will be difficult if it only has 60 rooms.

The Venetian medical spa certainly doesn’t have this problem. It’s located at the largest casino in the world and inside the biggest single-structure hotel building in Asia. The tower provides 2,905 suites and numerous clients.

Size isn’t everything, though. Good connections between the spa operator and hotel management are essential, says Malo. The property must focus its marketing on the medical offerings.

"It’s actually very rare that we spend one week without a major hotel brand asking us to do something," he says. "Unfortunately, these kinds of things cannot be done just anywhere."

Harmsworth is adamant invasive treatments aren’t appropriate for hotels to offer, anyway, and while many hoteliers are attracted by the idea, she’s yet to hear many success stories. Medical procedures require stringent regulations; approvals and licensing are required even for minor treatments at ESPA.

"All the major brands are talking about it. Every client I’m seeing at the moment who is building a spa is looking at medical, but they’re all discarding it for insurance reasons, safety and contraindications," she reveals. "We have to jump through hoops just to supply vitamin infusions to patients: imagine what happens when it gets more complicated."

However a hotel decides to tackle the trend for healthier holidays, every spa development should be undertaken absolutely authentically and not be viewed as a gimmick.

"I think hoteliers do a lot of things mainly for marketing reasons and then don’t fully deliver," Harmsworth warns. "I am sure that complementary medicine and disease-prevention treatments can and will happen in hotel spas, but they cannot just be used as promotional tools."