The vast majority of medical tourism in the UK is attracted to London where there are 25 private hospitals and clinics and 12 private patient units run by NHS hospital trusts. American organisations including the Cleveland Clinic, the Mayo Clinic and Ambulatory Surgery International have established operations in London. In 2017 there was a 3% decline in the £1.55 billion market because of fewer clients from the Middle East, who perceive London as expensive. Overseas patients coming to London are now more likely to be looking for cancer treatment than orthopaedics. Income for NHS providers rose by 9% in 2018–9, pushing the Royal Marsden nearer the 50% statutory limit.