Spire Healthcare Group H1 2025 Earnings Report

Spire Healthcare Group EPS Results

• Actual EPS: GBX 4.10
• Consensus EPS: N/A
• Beat/Miss: N/A
• One Year Ago EPS: N/A

Spire Healthcare Group Revenue Results

• Actual Revenue: N/A
• Expected Revenue: N/A
• Beat/Miss: N/A
• YoY Revenue Growth: N/A

Spire Healthcare Group Announcement Details

• Quarter: H1 2025
• Date: 7/31/2025
• Time: Before Market Opens
• Conference Call Date: Thursday, July 31, 2025
• Conference Call Time: 4:00AM ET

Spire Healthcare Group (LON:SPI), together with its subsidiaries, owns and operates private hospitals and clinics. It offers various treatments in the areas of allergy and infectious diseases, blood tests, bones and joints, bowel treatments, breast screening and surgery, cancer investigations and treatments, cosmetic surgery, cyst removal, and dental surgery, as well as ear, nose, and throat treatments. The company also provides eye surgery and treatments, family planning, gastroenterology, general medicine, general surgery, haematology, hand surgery, hip and knee treatment, and heart and kidney treatments. In addition, it offers treatments in the areas of men's health, neurosurgery and neurology, paediatrics, pain management, rehabilitation, sports, physiotherapy, podiatry, respiratory medicine, and rheumatology; and scans and investigations, skin treatments, spinal care, sports science, urology, vascular surgery, weight loss, and women's health. Further, the company offers various tests and scans, which include cardiac CT, CT, MRI, ultrasound, and X-ray scans. It offers in-patient, daycase, and out-patient care services through hospitals and clinics across England, Wales, and Scotland. Spire Healthcare Group plc was founded in 2007 and is headquartered in London, the United Kingdom.

Spire Healthcare Group H1 2025 Earnings Call Transcript

Key Takeaways

• Positive Sentiment: In the first half, the group delivered revenue growth of 4.9% to £1,250 million and adjusted EBITDA growth of 2.8% to £133 million, in line with guidance.
• Positive Sentiment: Cost transformation is on track, with over £10 million of savings delivered in H1 and a further £20 million planned for H2, targeting more than £30 million for the full year.
• Neutral Sentiment: The transformation program includes the launch of three regional patient support centres and a reduction of around 400 permanent roles, with one-off restructuring charges of £9.6 million in H1.
• Positive Sentiment: Primary care revenue rose 6.5% to £64.4 million, with core EBITDA up over 6% when excluding start-up clinics that are expected to breakeven in year two.
• Negative Sentiment: Adjusted profit before tax declined 11.2% to £23.8 million and adjusted free cash flow fell to £15.3 million, driven by the phasing of savings, capex timing and one-off items.

Presentation

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

So good morning, everybody. How are we? Not too wet, I hope. Good to see you here this morning. And thank you for coming, and welcome both to people in the room and people online for coming to our half year results presentation for the period ended 06/30/2025.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

Thank you for joining us. So I'm going to start by giving an overview of our H1 performance. Then I'm going to hand over to Harvand Samra, our Group CFO for a financial update before giving a more detailed review of our strategic progress. So, I'm pleased to say that we have delivered in line with guidance in the first half. EBITDA growth is on track and we've managed to do this while driving a remarkable amount of change through the business.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

So put simply, our strategy is on course and we're delivering today, whilst accelerating our transformation as an integrated healthcare business. So we are effectively managing our payout mix with discipline through a diversified three payer strategy. Our transformation program is helping us deliver with greater efficiency. We've added further scale to our primary care business. And of course, we've maintained our focus on quality and innovation through our well invested estate.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

So in short, the business we think is in the best position it has ever been in to navigate a very dynamic environment. Our strategy is delivering, transformation is on track and the actions we've taken in the first half mean we expect our full year outlook to be in line with market expectations. We've got a well invested business and we continue to evaluate options to drive long term shareholder value. Now we couldn't have done any of this without the amazing commitment, professionalism and support of our consultants and colleagues across the business. That includes colleagues who've left the business as a result of changes we've made in the last six months.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

And I'd like to take this opportunity to thank them all for their contribution. Even as we have been in the midst of transformation, our colleagues have continued to go above and beyond in the care they give to patients. And it's been inspiring to hear stories of their impact through our Iris and DAISY awards that we've made in the first half. And you can see here colleagues proudly receiving those awards and also colleagues at Spire St. Antony's when I went along to visit their new surgical robot.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

More of that later. So now I'll hand over to Harbent to walk through the numbers.

[Harbant Samra, CFO & Director at Spire Healthcare Group]

Thank you, Justin. Let me start by confirming that the group has performed in line with expectations delivering a solid set of results during a period of significant change. Revenue has grown in line with our guidance up 4.9% with hospitals up 4.7% and adjusted EBITDA was up 2.8% year on year to £133,000,000 You'll remember that we've accelerated our savings program this year to mitigate national insurance and national minimum wage rises, payer mix changes and the roll off of our energy hedge. And I'm pleased to say that cost savings are on track delivering more than £10,000,000 in the first half with a further £20,000,000 planned for H2, taking the full year benefit to over £30,000,000 Group adjusted profit before tax declined 11.2% to £23,800,000 largely due to the phasing of savings, the depreciation and finance costs broadly evenly spread across the two halves. Whilst adjusted free cash flow declined, this was again due to the same phasing impacts, which I'll cover later.

[Harbant Samra, CFO & Director at Spire Healthcare Group]

And finally, return on capital employed expanded by 50 basis points to 8.1%, reflecting our continued focus on driving returns. Now turning to the hospitals, the largest segment within our business. Total revenue grew 4.7% to £732,300,000 and we continue to expect greater than 5% revenue growth for hospitals on average over the medium term. This is driven by both volume and average revenue per case up 1.94.2% respectively. Adjusted EBITDA rose 3.3% to £130,000,000 representing a margin of 17.8%.

[Harbant Samra, CFO & Director at Spire Healthcare Group]

These figures are stated after the uplift in National Insurance and National Minimum Wage, which came into effect from April. Excluding these items, EBITDA grew by more than 5% year on year, delivering margin expansion of more than 20 basis points. The result includes efficiency savings of more than £10,000,000 during the first half, with greater EBITDA growth expected in H2 as we deliver the rest of our savings target. And adjusted EBIT was in line with expectations increasing to £74,500,000 with a margin of 10.2% compared to 10.4% in H1 twenty twenty four. In terms of performance by payer, I will start with our private business in our hospitals, which includes self pay and insured patients.

[Harbant Samra, CFO & Director at Spire Healthcare Group]

Overall, revenue grew just shy of 1% with average revenue per case more than offsetting the reduction in volume. Now let me dig into the dynamics we are seeing and the actions we are taking. On the positives, PMI and Self Pay saw steady growth in average revenue per case, up 5.44.2%, respectively. In PMI, pricing is linked to a range of inflation measures, and we have driven revenue by optimizing the mix of higher margin procedures. In self pay, this reflects our close management of price, where we frequently adjust levels in relation to local markets as well as margin management.

[Harbant Samra, CFO & Director at Spire Healthcare Group]

In the more recent months, we've seen some improvement in volume trends in self pay, which we believe reflects both the broader market as well as our investment in marketing. Now the challenges. We've seen a small decline in PMI volume. This has been impacted by some insurers managing their claims process more tightly across all insurers across all health care providers, sorry. And stronger growth in younger lives covered, which we believe has also some impact on volumes, given they typically need less complex care.

[Harbant Samra, CFO & Director at Spire Healthcare Group]

Proactive tendering by insurers continues. But that said, we are responding with a clear set of actions. One, we continue to manage pricing and high acuity mix well. Two, we are expanding into primary and community care services, where the market is seeing higher growth. Three, we are continuing to roll out strategic initiatives such as specialist cancer and musculoskeletal centers that concentrate volume while meeting high clinical quality and outcome targets.

[Harbant Samra, CFO & Director at Spire Healthcare Group]

I'll now move on to the NHS where we saw very strong revenue growth of over 16% building on trend from last year. And we increased our proportion of high acuity procedures, achieving a 4.2% uplift in average revenue per case, which compares favorably against the NHS tariff uplift around 3.4% in the same period. This growth has been achieved against a dynamic backdrop. The government is committed to reducing waiting lists, which have declined marginally but remain elevated, and has again confirmed that the independent sector will be a key partner to achieve this. But at the same time, the NHS is dealing with large scale change, and there is friction within the system.

[Harbant Samra, CFO & Director at Spire Healthcare Group]

ICBs are adapting to the changes and are looking at options to manage budgetary pressures through commissioning. Our focus therefore remains on building high acuity work and working closely with both government and commissioners where we already have strong relationships. I've mentioned I've just mentioned that we are confident that the declining PMI volumes we are seeing reflect a broader market trend. I say this because if you look at the data for the areas in which Spire operates, it shows consistent gains in the private patient market over several years. This reflects our focus across a combination of factors, including the quality of our facilities, our marketing, price and mix optimization and of course, high clinical standards.

[Harbant Samra, CFO & Director at Spire Healthcare Group]

Continuing in market share data, the most recent national joint registry data through to April 2025 shows that Spire continues to lead in its addressable markets, conducting the largest number of hip and knee procedures across all patient groups. Moving on to Primary Care, which is a central plank of our growth strategy. In the first half, revenue reached £64,400,000 a 6.5% increase on a comparable basis with strong growth in Vita led by its talking therapy business. And taking the benefit of bolt on M and A, growth was even higher. Adjusted EBITDA was £3,800,000 which did decline year on year, but reflects the economics of rolling out new clinics.

[Harbant Samra, CFO & Director at Spire Healthcare Group]

As we said before, these clinics have start up and fixed costs in their early months of operation, but typically breakeven during year two. Excluding those start up clinics, primary care EBITDA would have grown by more than 6%. Importantly, these clinics are also sending referrals to our hospitals and following the startup phase deliver positive EBITDA to the business as a whole. EBIT was in line with our expectations coming in at £1,500,000 with a margin of 2.3%. As we've highlighted before, another attractive feature of Primary Care is it operates in a lighter CapEx model compared with our hospital business.

[Harbant Samra, CFO & Director at Spire Healthcare Group]

Now turning to the important topic of our transformation program. We've had a successful start to the year delivering as planned. The sheer scale of change under the transformation program is very significant and it should not be taken for granted that it's being delivered with relatively low levels of disruption. In the last six months, we launched two major initiatives. Firstly, we have moved to a more flexible, clinically led hospital resourcing model.

[Harbant Samra, CFO & Director at Spire Healthcare Group]

As we announced in late May, we reduced the number of permanent colleagues by around 400, with staff leaving the business in July and August. And as a result, the associated savings benefits will be weighted towards H2. Secondly, we've consolidated hospital admin and booking functions into three regional hubs, known as patient support centers. This is an exciting step in our transformation journey, and Justin will share more detail later. These changes have led to one off restructuring costs amounting to £9,600,000 which we recognized in our P and L as adjusting items.

[Harbant Samra, CFO & Director at Spire Healthcare Group]

We expect the second half charge to be materially lower. Turning to CapEx, we've maintained our focus on deploying capital into projects aimed at growth and improving efficiency. In the first half, we invested a total of £51,000,000 which is over half of the total CapEx we expect to invest this year. We've allocated £27,000,000 to growing returns, including the establishment of our patient support centers, improving our patient and consultant facing systems. We purchased several new MRIs and robotic surgery platforms, and we rolled out our solar panel installations across our estate.

[Harbant Samra, CFO & Director at Spire Healthcare Group]

These investments are already delivering a healthy return above our hurdle rate. The remaining GBP 23,000,000 of CapEx was directed towards maintenance of our estate equipment and facilities and GBP 1,000,000 was for investing organically within primary care. Bringing together what I presented around growth, savings and targeted capital deployment, I can report that our return on capital employed is up 50 basis points year on year. On a like for like basis, excluding National Insurance and National Minimum Wage Rises, ROCE would have been 8.3%. And our balance sheet remains in a strong place, supported by a freehold portfolio of 19 hospital properties, which is well invested and was externally valued at more than £1,400,000,000 a valuation that took place before recent ongoing market activity such as Assura and others.

[Harbant Samra, CFO & Director at Spire Healthcare Group]

Turning to cash. Adjusted free cash flow was GBP 15,300,000.0 for the first half, and the year on year movement reflects the phasing of transformation savings and CapEx. In addition to this, we've had a working capital outflow in the first half, owing to the timing differences connected to the growth in NHS activity. To complete the picture on cash, our cash balance closed at £20,800,000 at the period end, which reflects the phasing of savings and CapEx as well as a couple of one off items. These items include the purchases of our own shares to settle employee saving and award schemes, which we brought forward from H2 to H1 to take advantage of the low share price.

[Harbant Samra, CFO & Director at Spire Healthcare Group]

Additionally, we paid for the remaining non controlling interest in one of our hospitals. If we look at cash on a more comparable basis, excluding the one off items, our cash balance would have been £34,700,000 with a bank leverage ratio of 2.1, which is much closer to where we ended 2024. Moving on to the outlook. Financial performance was as expected in the first half. We have delivered growth managing payer mix effectively through our three payer strategy.

[Harbant Samra, CFO & Director at Spire Healthcare Group]

And we've seen good growth in our primary care services business. We have delivered efficiency with more than £10,000,000 of savings in the first half and we're on track to deliver more than £30,000,000 for the full year. This will in turn support full year growth in profit before tax. And whilst we are improving returns, we know there is more to be done. We are focused on growing return on capital employed to more than 10% and we'll continue to have a disciplined approach towards CapEx and M and A activity.

[Harbant Samra, CFO & Director at Spire Healthcare Group]

Bringing that together, our full year outlook is unchanged, and we're currently trading in line with market expectations. With that, I'll hand back to Justin. Thank you.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

Thank you, Harbund. So our numbers are driven by the continued delivery of our strategy. As background, The UK has a growing social and economic need for people to have healthier, happier, longer lives and increased productivity by supporting those who are ill to return safely to work. And bringing down waiting lists remains a top government priority with the support of the independent sector. Smile is building a business that can respond to these challenges, a business that provides fast access to high quality healthcare professionals.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

We're developing a fully integrated primary and secondary care offering in a grubby market that's worth a combined £12,000,000,000 supporting patients through preventative care, diagnostics, mental health support and occupational health, all the way through to elective operative care. And we are exceptionally well equipped to meet the changing health needs of The UK population. There are four ways in which we're building Spire to be an efficient integrated healthcare business. As I mentioned earlier, they are our diversified three payer strategy, transformation, scaling primary care, whilst maintaining focus on quality improvement and innovation. So I'm now going to talk through each of those in a little bit more detail.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

So if we start with our pale mix, we've maintained hospital revenue growth and margin expansion, excluding the impact of National Insurance increases by effectively using the levers shown on this slide to manage our mix and costs with discipline. First, we focused on increasing the proportion of procedures that attract higher margins, where we are seeing growing demand. These now account for approximately 38% of total private admissions across our hospitals. Second, we've expanded our high acuity work. For example, orthopedics now represents over 60% of total NHS submissions, up from 50% just two years ago.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

Third, we continue to optimize hospital pricing to balance volume and value with the average revenue per case up more than 4% year on year. And across the board, we're lowering our cost of delivery. More of that in a moment. Turning to transformation. The transformation program is at the core of our strategy.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

In H1, we focused on three areas. The first was ramping up digitization and centralization in our administrative functions, along with greater consistency across the business in keeping with our one best way approach. Our three patient support centers in Brentwood, Cardiff and Siam are already delivering benefits today while paving the way for future opportunity. And I will expand how in a second. The second transformation was moving to more flexible hospital resourcing.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

So we're better able to respond to changes in demand, building on best practice across our sites. Now our new approach is still clinically led, but teams are now aligned to consistent roles across the company with simpler management structures. And we've rebalanced the way some teams are resourced with a different mix of bank and permanent colleagues. And the third area of focus was investment in robotics and innovation, and I'll also come back to this. So together, this package of changes improves service delivery, enhances patient and consultant experience and it lowers the cost of delivery whilst maintaining the highest quality standards.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

Our patient support centers are now central to the way we are transforming the business. I've recently been to Cardiff and Centimeters and I cannot overstate the change involved and the excitement of this transformation. We have done something really difficult, really well. I'm conscious it's been hard work for colleagues, consultants and medical secretaries moving to a new system. And of course, there's room for further improvement, but we're now set up really well for the future and we're already seeing benefits.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

We are answering 50% more patient calls and we've approved our ability to manage private and NHS bookings more effectively And we've got better digital visibility of consultant diaries. The centers are more efficient. They're operating already with approximately 10% fewer staff. And they're also unlocking additional clinical capacity as we repurpose former administrative space within hospitals for new clinical services. And crucially, this shift will give us far greater oversight of the patient journey, which improves our ability to support consultants and create treatment pathways across Spire.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

And as we bed in our patient support centers, we'll realize bigger benefits in 2026 and beyond. Turning to Primary Care. We have a clear plan to scale our Primary Care business towards our medium term EBITDA target. The growth will be driven primarily by organic expansion with margins expanding as we scale over the medium term. The core business performed well in H1 and we started multiple new long term NHS and corporate contracts worth £8,000,000 in annual revenue, including a contract with John Lewis Partnership to provide their occupational health services.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

We're making good progress with targeted strategic M and A. This year, we acquired Acorn Health, an occupational health specialist in Cheshire, and we announced today the acquisition of Physiolistic, which is a physiotherapy business in the Thames Valley. Together, we expect them to contribute a combined annualized EBITDA of £2,000,000 Both are immediately accretive and were acquired at mid single digit multiples. Finally, our clinics where we're moving forward, we will be focusing on opening smaller clinics at lower cost. Taken together, these initiatives provide a clear and achievable pathway to reaching the £40,000,000 EBITDA goal.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

Finally, in H1, we maintained our relentless focus on quality and innovation. We are really pleased to retain our 98% rating for good outstanding hospitals, having had two good ratings from CQC visits already this year to our hospitals. And patient satisfaction at ninety seven percent and consultants at eighty four percent respectively remain high. I'm particularly proud to the organization that we were recognized in two specific areas. We were highly commended by Thrombosis UK for our work on thrombosis prevention and management.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

And in addition, our pathology management was highlighted as best practice in Dane Penney Dash's patient safety review. Finally, we're investing in technology like clinical robots and AI enhancements to MRI scanning. We also signed MOUs with Oxford Genomics and EDX Medical. Whilst they're not yet contributing to the P and L, they're going to help us build genomics and health tech capability that will drive the next phase of SPIRE for our patients. So in summary, I'd like you to take away three things from today, please.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

Point one, we've implemented significant change and we've managed it well. It set us up to be more flexible, responsive and efficient whilst maintaining and improving quality. Point two, our strategy is on track and puts our business in the best possible position to manage what will continue to be a dynamic market. We're building an integrated, innovative and sustainable health care business for the future. Point three, all this is supported by a well invested estate and freehold property valued at more than £1,400,000,000 We are a successful, valuable business that's well placed for the future.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

Thank you for listening. We're now going to turn to M and A. I'll take questions from the audience. What did I say?

[Harbant Samra, CFO & Director at Spire Healthcare Group]

M and A.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

At least you know I'm focused. We're now going to focus on M and A. We're going to have a Q and A in which you can ask me about M and A. And then we'll all go to the V and A. Okay.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

Can I take questions, please? We're going to take audience first online later. Please state your name and your question.

[Sam England, Director & Head - European Med Tech Equity Research at Berenberg]

Good morning. It's Sam England from Berenberg. Thanks for taking the questions. So firstly, you mentioned budgetary pressures in the presentation at the ICB level. Can you just give us a bit more color around the dynamics there and what mitigation opportunities you have in the second half?

[Sam England, Director & Head - European Med Tech Equity Research at Berenberg]

And then to ask one about M and A. On the Primary Care business, you announced the acquisition of Physiolytic. Can you talk a bit more about the M and A landscape more broadly in And Primary then as you look at that £40,000,000 EBITDA target, I suppose the balance you see of that coming organically versus through M and A?

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

Okay. I'll take both of those. So NHS land is always complicated by the way. So there's sort of no new news, NHS land is complicated other than what is new news. So we have a labor government, which is not only committed to using the independent sector, but the Secretary of State sent out a press release commending the independent sector for having treated 500,000 patients since the start of the administration.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

This is new news. And our general view is the government is totally committed to getting waiting list down and quite focused on it. The head of NHS England has a grip and is very focused on that. And that clearly we play a key part. So imagine what would happen to waiting list if 500,000 people hadn't been treated by the independent sector.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

Secondly, NHS England is also calling for trust to balance their books, which hasn't happened for a decade, okay? And therefore, they're responding in terms of how they think about their budgeting indicative plans. And the reason we raise it is because people will be aware of this. This happens every year. It's a bit clearer this year, partly because there's more clarity from NHS England and what they're trying to achieve.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

Choice is top of the list. Our volumes come from electronic referrals, not from trusts. And we have good visibility of our volumes going into the latter part of this year. So in summary, these things will resolve themselves. But there is a debate going on about how to balance all that.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

The way we mitigate it is one, we're on the ERS system and we really lean into that and we really talk to GPs about how patients have a statutory choice that if there's a long waiting list somewhere else, they can come to us and we make our waiting list visible. Secondly, we're in very close conversation with all local commissioners because we understand the pressures are under, it's tough under the NHS and with the center and we navigate our way through. I'll also emphasize by the way, we are very focused on the right work going into our hospitals. I've always said before, we could open up our books to things, which aren't right for us to do, which could fill our waiting rooms, which would compromise our ability to deliver on orthopedics. And the sales would go up, but it wouldn't deliver for the business and therefore for patients.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

So summary is, we're telling you it's a complex environment. So when you pick up, it's complex, it's complex. We're all over it. So hopefully that gives you a sense of that one. So what's happening with the M and A environment overall?

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

Well, if you look at big M and A, there's just been a deal done for an occupational health business, I think at 15 times, okay? Do write that down. So we are building a business in the bit of the market, which is of extreme interest to government because it deals with the issue of long term sickness. And I think I've mentioned before, that if you have an Employment Assessment Plan with Vita for MSK or mental health issues, our return to work statistic is greater than ninety five percent. We think we've literally got the secret weapon which helps unlock productivity in The UK.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

I'm not exaggerating. We're pushing this very hard. We're clearly working with the Mayfield review on this to emphasize you can solve these problems. So it will be quite easy to lean into that and pay very high multiples, but we're also being disciplined. So we think the way forward both in occupational health and physiotherapy is targeted acquisitions with people who by the way stay with us, which is quite important.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

I was up with Acorn, fantastic team. They're excited to be there. They're full of ideas. We've got all their talent coming into the business. There's plenty of small bolt on acquisitions out there.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

We are quite fussy. They've got to fit. Occupational health is not all one thing, always physiotherapy. But we think there's lots out there, but also we're not running at it and just picking up everything we can, which is why I keep focus on being disciplined and targeted. So the balance will be, I don't know the right proportions.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

Organic growth is the most important part, okay? The John Lewis partnership, we're very proud to work with such a good employer. Contract wins like that. Selective NHS contract expansion, just growing the base dermatology business. But M and A is going to be an important underpin, partly because what it's doing, we keep mentioning the geography.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

We're building geographic picture so that we have coverage across the geography. When they get to having a £40,000,000 EBITDA business, feel free to look at multiples available in M and As and multiply with that to work out how valuable it's going to be. Thank you.

[Sam England, Director & Head - European Med Tech Equity Research at Berenberg]

Thanks.

[Harbant Samra, CFO & Director at Spire Healthcare Group]

Justin, can I just add one sort

[Harbant Samra, CFO & Director at Spire Healthcare Group]

it's of which also worth remembering that we said that that growth will come with a CapEx amount of no more than £50,000,000 So as an overall figure, I mean, that's a fairly modest amount of CapEx for to grow EBITDA from 10,000,000 to 40,000,000 Further questions?

[David Adlington, Managing Director at J.P. Morgan]

David Addington from JPMorgan. Three, please. So firstly, on self pay, I just wondered if you could get your thoughts on potential headwinds and tailwinds from the doctor strikes in the near term. On PMI, you mentioned about PMI tightening claims access. Are they delaying access to procedures or fully restricting?

[David Adlington, Managing Director at J.P. Morgan]

And what areas are they restricting? And then thirdly, you highlighted the value of the property portfolio. I was just wondering if you're thinking about doing anything to crystallize that. Okay.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

Think I'll try cover those, Harvind. Okay. So I understand self pay. So look, nobody wants strikes in the NHS because we've all got relatives and you don't want to see that disruption happening. So what I will say is we continue to deliver throughout strikes.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

Okay, so that's point number one. We have economic econometric models for self pay that look at the economy, marketing, waiting lists and it calculates the effect that has on self pay. If waiting lists go up as a consequence of something, it's supportive to self pay, okay? Whether they will go up because of strikes, don't know. We carried on delivering.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

So I think the backdrop for self pay, we've said we're seeing some improvement. That's without compromising and going to areas where we feel we shouldn't go. There's a number of reasons for that. There's a bit more confidence in the economy, okay? So that's definitely a driver of our economic model.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

And also, although waiting lists have come down for the longest waiters, They're broadly static for the vast proportion of the population. So and by the way, we've been doing some very targeted, very focused and successful marketing. So we think overall, the environment is slightly more supportive for self pay. Let's not get carried away. We're not saying it's suddenly going to fly off again.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

But overall, broadly supportive, I wouldn't think it strikes. I think that would be inadvisable. So PMIs, so first of we're just trying to solve for an equation, which I think people have been asking, which is if PMI say they're signing more books, why isn't the PMI market in healthcare provision going up as fast? Well, the answer is actually it is, but it's outpatients and primary care Because younger patients have been signed up either individually or through expanding corporate books. They are less likely to need a hip replacement that comes later in life.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

They are very keen both with self pay and insurance to have a private GP appointment, to have an outpatient appointment, to have an MRI and not wait. It's one of the reasons we're building a primary care business because the patients of the future are coming through primary care. It's why some insurers are investing in their primary care network because that's where those claims come through and service them in that way. So that's the first thing. So the market overall is growing.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

What's been banked here is to primary care business today and the hospital business of the future. So it's really very supportive in the long term. It just doesn't translate. So that's the first thing we're pointing out. So claims tightening, we see this.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

Actually, we've seen it in the NHS. We've seen it with insurers and we're seeing it again. It will be a feature of a number of things. One will be, they weren't fully on top of claims and they're making sure they fit with policy. Two, diverting that to primary care.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

So go and see a physio, don't see a consultant. And three, just slowing down the process by really checking those claims. So the sustainable bit will be claims that really shouldn't have gone through. Physiotherapy as opposed to consultant tends to delay, but we've literally seen this before. And that was a big thing in the NHS a few years ago.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

And you literally just saw it work its way through in eighteen months later. Eventually, if you've got a treatment condition that needs if you've got a condition that doesn't need the hip replacement, the consultant will say see a physio, right? If you go to a physio, you need a hip replacement, you can delay it, but you need a hip replacement. You can't change the underlying condition, so it will work its way through. So I think all of those things are happening.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

It's a tough economic environment. Insurers have also been hit by National Insurance. So this we think will work its way through. It's about an eighteen month period, if that makes sense. On the property portfolio, what we're pointing out is it's extremely valuable and it underpins our valuation.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

That's not an indication we're going to do something with it. It's also not an indication that we're not because we have sold freeholds before. There are valuable potentials or the cash for things we might want to do. So the answer is we're just putting the statement out there at the moment. Ian, did you want to add anything to that point?

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

Are you happy with that? Okay. Further questions? Thank you.

[Natalia Webster, Equity Research Senior Associate at RBC Capital Markets]

Hi, Natalia Webster from RBC. I have two questions please. The first is just on the sustainability of price increases. You talked about the high margin procedures now making up more than 38% to private hospital admissions and in the NHS, more than 60% of admissions. What sort of proportions are you targeting over the midterm?

[Natalia Webster, Equity Research Senior Associate at RBC Capital Markets]

And what sort of ARPC increases do you see as sustainable over the midterm? And my second question is around cost savings. So you've delivered GBP 10,000,000 cost savings in H1 already and are expecting GBP 20,000,000 in H2. Is this going to come predominantly from those job cuts and consolidation of patient support centers that have already been done in H1? Or are there any other key initiatives to call out for H2? And then similarly for the focus on 2026?

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

Thank you. Hubbard, want to pick up the cost question first, please?

[Harbant Samra, CFO & Director at Spire Healthcare Group]

Yes, happy to. So yes, so GBP 10,000,000 in the first half, 20,000,000 in the second. As I just said a little bit earlier that we obviously undertook a couple of significant initiatives over the summer, which have led to headcount reductions, which obviously will form a significant part of the uplift in the second half. Beyond that, we're also completing other elements of our automation strategy. So for example, one of the exercises I've talked about before is P2P.

[Harbant Samra, CFO & Director at Spire Healthcare Group]

So we've finished a chunk of that in the first half, but we're now rolling out the remaining element in the second half. And there are other activities alongside P2P, which will also be completed in the second half, which will take us to the £30,000,000 The work that we've done in the first half though gives us confidence that that £30,000,000 is some that we will comfortably hit that.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

Thank you. I'll just add just totally. If you walk around the patient support center, you can see the answer to that question. Is so much information, there's so much data, there's so much visibility of the patient pathway. There's so much opportunity for AI, by the way, right.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

So currently, a really excellent call handler, there's a really great cohort have come in, are looking up on what's essentially a posh spreadsheet, the skills and qualifications of our consultants and then checking they've got it right. AI will allow it to pop up with a choice of consultants in eighteen months time looking across all their different modalities. Patients will be on the phone saying I want to hit replacement. AI will know what that means technically. And the future is just really exciting now, right?

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

So there's the things which Parvat says we know we've got in the pipeline. And there's all the things which you just think of when you go around. So that we've got a great platform for that. So overall on pricing and acuity. So first of on pricing, what we're aiming for and achieving is price rises or ARPC increases ahead of inflation, right?

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

That's what you've got to try and achieve. It is not straightforward, okay? There's pressures all over the place. We've to think about self pay, the relationship between price and volume. I've mentioned before, Peter's team, we've a fantastic model, which really does scrape and analyze all of the responses to pricing.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

And to get there, we put prices up and we also put prices down because we have to get this right. And it can change in a particular location. With the NHS, we are broadly price takers. But clearly, we try and affect that by talking about the cost pressures to set to house. But also we're affecting it by focusing on those areas, which have higher ARPC.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

It's almost the reverse It's cherry picking because we're offering more and more complex care actually. It's one of the things we're doing. We're doing heart procedures for the NHS. We'd love to do more. Then with complexity, the real place where complexity kicks in is PMI because heart procedures are quite expensive.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

You don't get many in self pay. There is loads of potential to roll out more complex services. Last year, we rolled out two new cardiac services. Robots play a key piece in this by the way. You can recover more pricing, so that's the self pay point with robotic surgery.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

That's also offset by the fact you get price pressure from insurers. I haven't had an insurer ring up yet and say, would you like a price rise? Okay, it doesn't work that way. They ring up and say the reverse. So we have to balance.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

We've talked about proactive tendering. We have to balance the opportunity associated with price with insurance. If we think they can lean into it, we mentioned one last year, we thought they could versus where it's simply trying to extract value. We're doing a great high quality job in which case we treat it slightly differently. So if you put all that together, more complexity, yes.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

Is it going to go to 100%? No. So but we've just opened, I went and opened a cath lab in Bristol, a new cath lab. So that's CapEx, because it's new and fast and AI supported. Literally two consultants have signed up to bring us their business on that day because of the investments, which goes to the CapEx piece around growth.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

You could call it replacement CapEx, but it's new technology. So there's lots of potential to continue. Well, the trajectory is slow, but theoretically, I don't know if it's next year or the year after. But as we sit here, there are new treatments which are more complex coming online. And pricing overall, that's our day job.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

It's really complicated. It's really detailed. We're really disciplined and we're all over it. Any other questions, please? Are there questions online? Yes.

[Operator]

Thank you, Justin. For those of you joining online, if you would like to ask a question in person, then please click the raise hand function in Zoom, and we will come to each of you in turn. Alternatively, if you would like to submit a written question, then please type it into the q and a button on Zoom, and we will read it out on your behalf. We have a raised hand from Cain Sluskin. Cain, if you would like to unmute and go ahead and ask your question.

[Kane Slutzkin, Director - Healthcare Equity Research at Deutsche Numis]

Thank you. Good morning, guys. Most of it has been asked. But just, Justin, on the if you could just sort of remind me on the self pay, sorry, might have missed a bit of a bit of it. You're saying you're slightly, I guess, more positive. Just the wording in the release talking about the exit rate being similar to '24 but improving in recent months. Could you guys sort of give a little bit of color what that sort of improvement is, maybe quantified, maybe not? And then just I did notice in June, Bupa had acquired an independent private hospital.

[Kane Slutzkin, Director - Healthcare Equity Research at Deutsche Numis]

I'm just wondering, you know, obviously, that's probably the first one they've done in, I don't know, say, fifteen, twenty years. But just wondering if do you think that's part of a broader strategy to return to large scale sort of hospital provision in The UK, was that just kind of more opportunistic? And just last one, just on the capital allocation, you've spoken to sort of the freehold and potential there, but just wondering if buybacks could be back on the cards at some point? Thank you.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

Okay, thanks, Cain. Do you want to handle anything you want to say about improvement? Freeholds and I'll take the Bupa question.

[Harbant Samra, CFO & Director at Spire Healthcare Group]

Yeah, thanks, Cain. So on the improvement point, I'm not going to quantify it. But I will say this, mean, to us, it's important to share that information with yourselves that there has been some improvement since the 2024. And we continue to watch that closely. Like I said earlier, I think that's a testament to the work that we've been doing to continue to tap into that market, particularly in the marketing side.

[Harbant Samra, CFO & Director at Spire Healthcare Group]

But yes, from our perspective, that's a positive and we want to share that with yourselves. On the buyback piece, so we did a small buyback last year. We remain open to the idea of doing buybacks. But equally, are a number of other options that we're looking at when it comes to our available capital and what's the right thing to do in terms of driving long term shareholder growth.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

Thank you, Harvind. So I mean, it's interesting, isn't it? So I think the conclusion to drill from Bupa is they also announced they're going to open 70 mental health clinics. We have the right strategy. And I have mentioned the fact that one of the reasons for our strategy is we need to get ourselves out in front of consumers because others will.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

And that's what Bupa is doing there. So I don't know where they're headed with it. It's London, it's a particular market. So I'm not sure we're drawing any particular conclusions from it. But the one conclusion you can draw is this is going to be an integrated healthcare world, which people have hospital provision and primary care provision and mental health provision.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

And we're right out there with the right strategy. So we're focused on what we're doing. I saw it as a validation of we're in exactly the right place. And we're moving at exactly the right pace. So I think that's the way to think about it.

[Kane Slutzkin, Director - Healthcare Equity Research at Deutsche Numis]

All right. Thanks, Justin. Thank

[Operator]

you very much for your question, Cain. Our next question comes from Seb Jamset. Seb, if you would like to unmute and go ahead and ask your question.

[Seb Jantet, Equity Analyst - Healthcare at Panmure Liberum]

Hi, Hi, good morning, everyone. Hopefully, you can hear me. So just two questions, if I may. First of all, just in terms of the kind of PMI market, you talk about kind of ongoing tender kind of process, and I appreciate that's kind of past the normal business. Just wondering whether you're starting to kind of get opportunities with the PMIs for tendering for some primary care business with them because most of them have actually got their own primary care network.

[Seb Jantet, Equity Analyst - Healthcare at Panmure Liberum]

So just kind of wondering how you're progressing on that one, or do you need to grow your own network a bit more before you can do that? And then the second piece is just to understand kind of, you know, the outlook for NHS work in the second half. I mean, like you, I've been hearing quite a lot of stories about the ICB looking to kind of throttle kind of spending in that area. I'm also understand you can kind of put stuff up on the choice kind of side of it and drive volumes that way. I'm wondering if you could just help us kind of understand what the uptake percentage uptake is on the choice slots you're putting there and and whether you're getting the theater utilization from the NHS that you need to in order to make that kind of nice and profitable for you?

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

Okay. Thanks, Seb. So the answer is we already provide primary care services through Vita to the PMIs. That's one of the backbones of it. And the reason for doing the M and A is to increase our coverage so we can do more so, particularly in physiotherapy.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

And mental health, we've got good coverage. So we're already there. It's already part of it. And And obviously, the other big area we wanted to focus on is direct to corporate support, which is the biggest piece of it. So the answer is yes.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

This whole thing is becoming this integrated eco structure in which we're playing a key part. That's why that acquisition was so key. So on the NHS, so first of we have good visibility, okay? If we see a patient, we get paid for that patient and we are our books are open and they're booked months in advance. So that's partly the answer for H2.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

And then I'll come back to my previous answer. They're going through a budgeting exercise in which they've been forced to try and allocate. I'm sure that NHS England is focused on will that lead to waiting list reduction or not. So I'm pretty certain an answer that says we're not going to focus on waiting list because you've got the balance sheet budget won't work because I've sat in meetings with the Prime Minister saying it's one of their top priorities, right? And this government is really focused on that and really focused on the role of the independent sector.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

So the reason I've raised it, there's a budgetary process going on, not to do with us. We know where things are headed. And we know that NHS England is really focused on getting weighting this down and the numbers say, you've got to use the independent sector to do it. So we just have to see how that whole thing plays out. We're so connected to it and we're confident of the way it will play out overall.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

It doesn't mean that individual hospitals won't see changes by the way. There are some economies, local health economies waiting to sit down a bit. There are many more, but they're massively up and they're not making progress, okay. So it's both a granular game, a central game and the strategic political conviction that it has to be done.

[Seb Jantet, Equity Analyst - Healthcare at Panmure Liberum]

Great. Thanks. Thanks, guys.

[Operator]

Thank you, Seb, for your question. Our next question comes from John Unwin. So, John, if you could unmute, go ahead and ask your question.

[Analyst]

I have three questions, please. And apologies on the first one if I missed it. But have you given your expectations for what you think volume growth in PMI can do in the second half? Do you expect any of the recent improvement to continue? Then my second question is on the interesting chart that you showed on the share gains in the private markets since 2021.

[Analyst]

I was just wondering if that was all organic or any of it came from acquiring new sites or new businesses and whether you can maybe quantify that. And is it just hospital or does it include the benefit from Visa? And then my third question is on, actually, on your ophthalmology business, which we don't necessarily talk about that much. I think it's probably quite a small part, but is this mainly NHS cataract surgery or are you doing private cataract surgery? And I'm just wondering if you've seen any shift from sort of monofocal basic ophthalmology surgery to to premium intraocular lenses and whether that drives a price uplift for Spire in that business?

[Analyst]

And then what your expectations are for that business over the next twelve months? Thanks.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

Okay. Thank you. Do want are you minded to give any more detail on volume growth on PMI in the

[Harbant Samra, CFO & Director at Spire Healthcare Group]

No, but I think the only thing I'd remind people of is the fact that we are in a great place to leverage the patient service centers. So we move forward into the second half with confidence in terms of continuing to build on a great platform that we've got. On the market share point, you want me to tackle Yes. So if you look at the data there, the only add on since 'twenty one would have been Claremont, which we purchased a couple of years ago, which would have had a modest impact. Since then, though, you're looking at that data on a like for like basis, and it covers the hospital room.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

Although there's also Abergelly Clinic, which definitely contributed to self pay growth in that particular geography in North Wales. It's a tiny number, but it just goes to show in that particular area, it's made a real difference to market share. So I'm glad you asked a question about ophthalmology. So we do know NHS ophthalmology, okay. We've always been cautious about that market.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

We feel it's oversupplied. We are entirely focused on what you've just described, which is more complex care, more complex lenses leaning into the areas which are not provided by the high street, largely NHS providers. We took a downturn a couple of years ago when there was a massive expansion, arguably over expansion of high street providers. We didn't follow on price, we didn't follow with NHS ophthalmology for the reasons I've described. What we did was invest in new ophthalmology centers, significant increase in ophthalmology outpatient testing equipment because that's what we really need, really state of the art stuff out there now.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

And we're starting to see modest growth in a much more complex area. I think there are changes coming in. There's currently a consultation out there on tariff reduction on NHS ophthalmology out there. So I'm pleased we're not being affected by that. We've got a small, high quality, high valuable business in ophthalmology.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

And I can see it expanding. And it's one of the examples of being disciplined, focusing on complexity, focusing on excellent quality service and focusing on margin. Thank you.

[Kane Slutzkin, Director - Healthcare Equity Research at Deutsche Numis]

Thank you

[Operator]

very much, John, for your question. Our our next question comes from Miles Dixon, and he asks in relation to NHS revenues and orthopedics in particular. Without asking you about the average margin that you make on NHS tariffs for individual hips and knees, etcetera, do you see any prospects for Tariff Plus in the future? And or do you see ways that your efficiency drive might continue to improve margins on those procedures?

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

Should I take that? Sure. So the first thing to say is if you want to know the relative margins, a couple of years ago, we did actually put them out there. We gave you an indexation, okay? Now one of the benefits we're getting from our efficiency program is we're effectively improving our margins across the piece.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

And it particularly allows us you may remember that at the half year I said, if you have an increase in NHS mix, it's negative versus private until you've adjusted for efficiency. So that's what we've been doing in the first half. We've been doing literally what we said we would do, which is it takes you about six months to adjust. We're now more efficient in delivering NHS work to help to make it supportable from a margin perspective, okay? Tariff plus, we work at tariff, okay?

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

If there's a particular request that requires a particular mobilization, then we might be outside of tariff. But the vast majority of work is at tariff. Just so you know, by the way, that makes it cheaper for the NHS and using a trust because although they are meant to be on tariff, they also have subsidies. They also have CapEx subsidies, whereas we fund our CapEx out of the tariff. Just make that point for the general audience.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

So I would not this is not an environment where we're pushing for tariff plus. It's an environment where we're making ourselves more efficient, but focusing on those areas which are best for us, which are highest acuity and therefore allow us to continue achieve ARPC increases in a sustainable partnership way. Anything to add to that on any of those points?

[Harbant Samra, CFO & Director at Spire Healthcare Group]

No, thanks.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

Thank you.

[Operator]

Thank you very much everybody for your questions. That was our final question. So I will hand back to Justin.

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

Thank you. I don't know why I feel like a game show host. But anyway, thank you very much for this. Thank you very much for the online questions. Are there any more questions in the room?

[Justin Ash, CEO & Executive Director at Spire Healthcare Group]

Okay. So thank you very much. Thank you for coming. Thank you for listening and see you all soon. Thank you.

Participants

Executives

• Justin Ash, CEO & Executive Director
• Harbant Samra, CFO & Director

Analysts

• Sam England, Director & Head - European Med Tech Equity Research at Berenberg
• David Adlington, Managing Director at J.P. Morgan
• Natalia Webster, Equity Research Senior Associate at RBC Capital Markets
• Kane Slutzkin, Director - Healthcare Equity Research at Deutsche Numis
• Seb Jantet, Equity Analyst - Healthcare at Panmure Liberum
• Analyst