Arjo AB (publ) (ARJOB) Earnings Call Transcript & Summary

Good morning, everyone, and a warm welcome here to Arjo's Capital Market Day 2022. Thank you, everyone, for being here in Stockholm. And also thank you, everyone, for joining online. I am Sarah, and I will be joined today by the presenters we have. I will be moderating, but presenters will be Joacim Lindoff, our President and CEO; Daniel Fäldt, our CFO; and Christian Stentoft, our Chief Strategy Officer. We have a full agenda for this morning, but we will start off by going through the quarter results from Q3 and we will then follow that with a Q&A focusing solely on the Q3 results. We will then have a short break, some more breakfast, for those of you who missed that this morning and then come back to focus more on our long-term strategy and why that's more relevant than ever before. We will look into the business environment and the challenges we are facing. The key strategic initiatives for growth and profitability. We will talk about our updated financial targets and what potential risks and opportunities we are facing. And then in the end, we will have a long Q&A session, combining all the different topics we've covered during the morning. There will be plenty of time for the Q&A, and we will also have the opportunity to post questions through the online version of this session throughout the morning, and then we will combine them at the very end. We hope to close around lunch time. If needed, throughout the morning, we will take a short leg stretch apart from the break that is planned. And also, if you haven't already seen it, we have the presentation material available online already, if you want to follow that throughout the session. So I think that's all the practicalities for the morning. And by that, I'd like to welcome you Joacim on stage.

Thank you very much, Sarah. And also from my side, a very warm welcome here today. And for those of you online, a very warm welcome as well. The intention, as Sarah was saying was saying is that we're going to go through the Q3 results and helping me there will be Daniel Fäldt and then after that, we'll move into and discuss a little bit more on future things and developments. But let me start by going through the Q3 in isolation. What we're seeing in Q3 is a continued solid demand situation on most of our main markets. We continue to see good growth in our global sales business. We continue to see good growth in our Canadian business but we are seeing a decline in our U.S. business, very much related to the Critical Care rental that, as you know, had a very good run due to the Delta variance of COVID in Q3 of 2021. The decline in that niche product just for the quarter is around USD 11.5 million. And without -- if you would exclude those numbers from the quarterly numbers, we would have seen the underlying growth of volume to be just short of 5%. We see a decline in our gross margin that is reported at 40.6% versus 46% in Q3 of 2021. Very much related to product mix issues in the Critical Care rental which has a heavy effect on the gross margin given that, that product or that niche product in Q3 of 2021 had a gross margin of around 75%. We continue to see high material costs, slightly higher transportation cost than expected, and as discussed before, an increase in inflationary costs around salaries, fuel and energy in general. We report an EBITDA and adjusted EBITDA of SEK 420 million and the cash conversion that is increasing from previous quarters and is now at 67%, very close to 68%. We are revising our outlook for the full year, solely on the based on the current development on the U.S. market, and I will come back to details around that, but we're now estimating that we will be at around 0% organic growth for the full year. And again, only based on the current market developments in the U.S. I will also shortly present the updates to the Arjo's leadership team that has been happening after the close of Q3 and go through how we are set up for future challenges. Let me start off with North America. And again, probably sounding a little bit like a parrot in this case, but North America sees a decline of 8.8% in the quarter, very much driven by the decline of Critical Care rental. Again, USD 11.5 million that has taken down that number. It is around the same number as we expected, and we are seeing the full year decline of Critical Care rental now to be around USD 30 million versus 2021 which is assuming then that Q4 is going to land with a decline of just short of USD 7 million. Canada continues to develop in a positive way in all aspects, capital service and also in rental. And the good thing also from a U.S. perspective is that our core rental and also our service business continues to develop in a good way, both on top line and also on profitability. The volatile market conditions in the U.S. is sometimes obvious in the latter part of Q3 and going into Q4. It is a situation where a lot of the health care providers in the U.S. are signalizing that they have OpEx issue or the significantly increased OpEx, which is lowering their interest around investing currently into capital goods. We also see that we, due to both slightly lower elected surgeries than expected and also slightly different behaviors around stock keeping or inventory levels at our distributors a lower DVT level for the quarter. And what we can unfortunately also see in the quarter is that we have a slightly lower traction on the implementation of already one rental contracts, very much related to the staff shortage problems that we are seeing in U.S. health care today. We continue to see good momentum in the introduction and the implementation and conversion of contracts in the U.S. around our SEM scanner and pressure injury prevention solutions. That is a momentum that we will bring with us into 2023. And where the plan as communicated before, is very much valid and stable. We are initiating a pretty large U.S. rental efficiency program. Where we expect to have savings on a yearly basis of around SEK 50 million starting from the end of 2022. And I'll let you through the -- and I'll go through those details in some more detail later on in the presentation. It is important to say, however, that the North American business, again, if we would have excluded the Critical Care rental side, it's growing with almost 3%. So the underlying business in our North American business is still good. And we need to continue in a positive way to navigate the current market challenges around capital investments. On global sales, a really good performance overall in the quarter. Global sales in total growth was 6.8%, with a better-than-expected development in our West European markets where we are seeing our main markets like the U.K., like France, like Germany, growing with the [indiscernible] and double-digit area and in Germany with 5%. We continue to see a good order intake on capital, and we continue to see our rental business and also our service business continuing to develop well, both on top line and also on profitability. We have and continue to follow our plan around the SEM scanner introduction in Europe. It is, as I said, a delayed plan because of COVID, but slowly and -- slowly but solid. We are getting there and are expecting a good uptick also in 2023 in that area in our Western European markets. Looking into the other part of global sales being rest of the world, we also here see a good growth of 5%, spearheaded by a really good growth in Australia, driven by both capital, rental and service over the quarter. We also see good development in some of our distributor markets where our African business or South African business continues to develop well. We also see that we continue to create traction after the COVID period with our activities in Japan. And overall, the -- I would say the trend line for our rest of the world business is back to where it should have been when we entered into the COVID period. Some markets are still affected by COVID, by COVID regulations, but our exposure to those distributor markets are fairly small. And our exposure, for example, to China from a sales perspective is also fairly small in comparison to the overall group. And therefore, the effects of those continued COVID-related issues is something that we can navigate in a good way. Looking into the more detailed part of the gross profit, where we are, as I said, seeing a decline from 46% down to 40.6% for this quarter. And it is heavily affected by the Critical Care rental side, where that is approximately 2 percentage points of drop from our gross margin. Equaling around SEK 80 million, SEK 85 million on a gross profit level. We can also see a very heavy effect of material in the quarter. Material came out at approximately SEK 47 million worse than the quarter -- the same quarter in 2021, and that is higher than expected for the quarter. And we now expect that material cost will be approximately SEK 150 million above last year. But important to say, and I will try to stress this on a number of occasions that we are starting now to see good traction of our price increases. We are seeing the first visible signs in Q3 where price increases are adding short of a percentage point on the gross margin. And that is the trend. As we have said before that we believe will continue into Q4. And a statement from previous quarters where we have said that we are in a situation to be able to compensate fully for the material cost increases through price increases on a rolling 12 basis as of Q4 still stands. Transportation comes in slightly higher. We had expected a flat development on transportation this year based on previous communication, comes in at around minus 7% versus the quarter before. But we are continuing to see, especially in the back end of the quarter, clear trends that our transportation cost is starting to trend in the right direction. And we are today at around SEK 100 million higher in cost on transportation than we were when we started the year. We -- the expectations for the full year is now that we will be at around SEK 80 million for the full year, so a decline in Q4 is what is expected and what we can also read out from the details that we get from the market. We continue in my view to, in a very solid way, manage the challenges that we are seeing from a continued strain supply chain that we continue to see from a number of suppliers that are [ Swiss ] both financially, but also from their side around the transportation and logistics. And the organization is doing a very, very good job on a 24/7 basis to make sure that we are firefighting our way to the outcomes that we want to have. Currency effects in the gross margin is this quarter at -- from a translation perspective, minus 1.5%, but we are getting help from the transaction effect, so the overall currency effect on our gross margin is around negative 0.3%. If we look at EBIT, obviously, the gross margin side has a great effect on the EBIT development but some additional flavor on that one. Our OpEx, my view continues to be well managed. We are comparing the outcome of OpEx this quarter versus a very low activity quarter in Q3 of 2021. Again, reminding you all that we had a quarter in 2021 that was very affected by the third or fourth wave of COVID, which means that our selling, marketing activities were on a very low level. And where we also, in some markets, had governmental help to cover for that. But compared to that, I must say that we are now on a normal level when it comes to our selling activities and also on our admin activities, with one exception. And that also hits into the gross profit, and that is around inflation. Inflation is negative in gross profit, again, extraordinary inflation that we've been talking about before is negative in the quarter in gross margins of around SEK 17 million and is affecting COGS with just short of SEK 10 million. In terms of slightly higher salary cost than expected, that has not struck fully. Obviously, energy cost and fuel costs, remembering that we have, on a daily basis, around 2,900 vehicles driving around globally. We are, as said, initiating a cost efficiency program in our U.S. Rental business. That program has been initiated and will deliver savings on a rolling 12 basis of around SEK 50 million which will be a direct effect on our COGS starting from the end of 2022. And the program itself is to take down infrastructure that is related mainly to our Critical Care rental side. It is fair to say that we are expecting very, very low sales of Critical Care rental also in Q4 and also throughout 2023, 2024 and 2025. And for that reason is obviously the right decision, we believe, to take down infrastructure related to that and be significantly more reactive with that niche product and making sure that we are spending our money wisely. So around SEK 50 million worth of cost savings starting from the end of 2022 related to that. Daniel, I'll leave it up to you to go through the balance sheet part.

Thank you very much, Joacim. So some comments from my side on the working capital and operating cash flow. Obviously, we've continued to face more or less the same challenges that we faced in the previous couple of quarters in terms of supply chain challenges and interruptions along with the fact that we haven't delivered out a lot of the finished goods that we've had. So we have continued to build on raw material coming into the supply chain and also last part of it that is semi-finished goods and finished goods that remain on a high level for the moment. At the same time, we are continuing a really good job on the receivable side and on the payable side where we have more or less a neutral, if you add them 2 together, development in the quarter. Nevertheless, the working capital base have kept creeping up during the year and also so in Q3 by 4 days, mainly related to the points that I just made. With the hockey stick in terms of sales delivery, expected to be less sharp in Q4. We -- as we've said previously, that we should have a break in the trend, will perhaps be a bit more cautious on where we end up in Q4. In terms of cash flow, we've had the strongest quarter so far this year by far. We're posting SEK 280 million and now almost approaching SEK 0.5 billion for the first 9 months. I should say, though, that we have in the rolling 12 months done SEK 1.1 billion of operating cash flow. So still continuing on the positive trend. But as I said, I think the main point to take away here is that we continue to face the same challenges that we've done in the previous quarters, and that is why we've not been able to break the trend in terms of the working cap days. And -- but it's positive to see that we are accelerating in terms of generating operating cash and also that the cash conversion level is -- keeps creeping up, although we are a little bit -- some distance behind our 80% annual target. Subsequently, a couple of comments on the net debt and leverage development. We kept the net debt at the same level as in the previous quarter. And but very stable and obviously related then to the fact that we are not generating as much cash linked to the working capital development that we've had in the first 9 months. The leverage creeping up also, but from a low level, which, I would say, at 2.7%. And we -- of course, as a subsequent and that we are tying up more capital in the business in order to deliver to the customers and to deliver also into the production chain, which requires us to tie up more capital, more than usual. But nevertheless, we are -- have a very strong cash position, and I see us in a very sound position in terms of, in general, the balance sheet. And that's kind of my comments on the working cap cash flow and debt level. Thank you very much.

Thank you, Daniel. Then moving into the revised outlook for 2022 where we are now saying that Arjo, for the full year, are looking at an organic growth of around 0%. And the revision is solely due to the volatile market situation in the U.S. that has appeared mainly in the very last part of Q4 and into -- sorry, of Q3 and into Q4. And it is important to say that we continue to have a solid pipeline around capital goods in the U.S. We have a good interest from U.S. customers, but given the current situation, it is a very, very slow process to get capital sales through this pipeline. And that is why we take a prudent stance in saying that, that is a situation that will continue throughout Q4 and probably apart into Q3 and therefore, lowering our guidance for the full year to be around 0% organic growth. Again, reminding you that we are taking good measures, my view, in terms of both price increases, making sure that we are compensating step by step to the material and the other cost increases that we are getting but also looking actively at our internal efficiency agenda where the U.S. rental program that we have announced is one of the steps that we're taking to making sure that we also, through internal means can compensate for the higher cost level that we're currently facing. We are also making changes to the Arjo management team. We will, as of the 1st of November have a new Executive Vice President for Supply Chain and Operations and also product development, where Jonas Cederhage, with experience from Permobil, Ericsson and Nilfisk and more than 25 years of experience within supply chain will take over from Mikael Persson, who is moving on to new adventures outside of Arjo. We also have from the 1st of January, a new President of Global Sales, which is Christian Stentoft who is sitting there. Christian is today, our Chief Strategy Officer. And Christian will replace Paul Lyon, who has been with us for almost 40 years and is now going into a very well-deserved retirement. And Christian will, in his new role, bringing not only good focus on the tactical part on the short-term performance, but also through a deep knowledge around our strategy and the new technologies that we're bringing into the market, making sure that we continue our step-by-step transformation towards being a mobility outcome partner truly also in the global sales side. We've also created a new function to put marketing, in general, closer to where things are happening and creating a part of the organization that we call Global Marketing which is including both upstream and downstream marketing. We are looking at medical affairs and very much also around all the categories and that we are driving and the category plans that we have. That will be headed by a gentleman called Tobias Kramer. And Tobias is joining our management team as of the 17th of October. So the management team as of -- sorry, -- here we are. Management team as of the 1st of January will look like this, a good split between age and gender and where we will then have Jonas as a new member, Tobias as a new member and Christian in a new position. And I strongly believe that this is a very solid team that will help bring Arjo to good levels over the coming years. So with that, some takeaways from Q3. Again, continued good demand on many of our main markets. We are seeing an organic growth of 0.3%, being held back by the fact that there is a USD 11.5 million difference in the Critical Care rental. If we would exclude that number, we would be growing the group with just short of 5%. We do see a lower gross margin, well-identified reasons why product mix with Critical Care rental, material, transportation and inflation. And we are continuing or starting to see the good effects of our price increase activities in Q3 and where we are confident that, that will continue also into Q4. And as I said before, it is still our forecast that we will be able to compensate for the now SEK 150 million in higher material costs on a rolling 12 basis with the price increases that we are now implementing. And I -- we are revising the outlook for the full year to 0% for the full year, solely due to the volatile market in the U.S. Again, we are continuing to see a good pipeline but there is a slowdown in the decision process around capital equipment in the U.S. that we need to look into and need to take the active measures of saying we have a risk here and therefore, lowering the estimates down to 0%. I personally very much together with my management team, the new one, that will be in place, are looking forward to continue to develop Arjo, which we will talk about after the break but also looking forward more short term to Q4, where I strongly believe that we will see continued positive momentum from our price increases and where we will start to lift our profitability of Arjo back to the levels where we should be. With that, I believe we can open up for questions.

[Operator Instructions] We have one over here.

Thank you. [indiscernible] So I guess, minus 2% organic for Q4 is what you're saying, now for 2022, what is the main drivers for being down that much of [indiscernible] so flat development in Q2, Q3? And when do you expect this [indiscernible] to come [indiscernible], I mean and use flavor also on what material issue that you're seeing right now. And when we can expect this to improve [indiscernible].

If we are around 0%, we are -- where Q4 especially will end up, that's something that we will address after Q4. But we believe that around 0% is indicating that, that is probably where Q4 will end up as well, somewhere in that range. The -- I would like to emphasize that the current volatility that we are seeing is focused on the U.S. market. The U.S. market and the development really from end of Q3 and into Q4 is, again, we do see a solid pipeline around capital projects, around our outcome projects that you -- for some of you know that we call diligent programs. Those projects are where we are having the main problems to get orders through because of the focus that U.S. Healthcare today has or currently has on a very strained cost position. The staff shortages, the cost for staff in general in the U.S. business is causing volatility and therefore, delaying discussions with customers around especially the diligence side. So the continued buildup that Daniel was talking about around inventory is very much related and almost only related to the U.S. business and to some extent, also that we have more goods in transit because we have longer transportation times today than what we had before. We are for -- from a U.S. perspective, saying that we expect to have a volatile market in the U.S. going into 2023 as well. I can't give you a date when things will start to go back. But it is obviously something that we are monitoring very, very closely and adapting our own actions to that. We are looking at taking down our inventory level over time over 2023, 2024. And again, I would like to emphasize on the fact that it is standard components, we do not have problems in terms of write-down risks or anything like that. This is standard equipment that we are going to sell to our customers over the coming periods. So I don't see a risk on the inventory side. But I can't give you an exact date when things will turn around in the U.S., but it's obviously something that we are following here. I would like to add just 2 things on the U.S. Our service business continues to develop well. Our core rental business continues to develop well with an increase in Q3 isolated of around 10%. Now we would have hoped that, that would have been bigger or higher given the slowdown of the implementation of our won rental contracts, but the underlying business that we are looking at in the U.S. is interesting. And obviously, from a North American perspective, helped by the very good development in Canada.

Perfect. And now the mic is working as well. And comment on how the backlog, the order backlog have developed in Q3, I guess, totally and from a mix perspective as well. That would also be interesting to understand.

Yes. Given that we are compensating, I would say, for an SEK 11.5 million drop of a COVID induced niche product around the Critical Care rental. Obviously, we have been successful in invoicing out on our backlog. And our backlog now for the group of capital equipment is around 10% higher than it was in previous years. But we have done a good job in clearing out and getting a possibility to invoice capital goods, mainly in Western Europe, to some extent, also in rest of the world and Canada over this period.

And then maybe one short one. If you look on the U.S. Critical Care rental business now, how would you say it is 9 months '22 versus 9 months 2019? Just to understand where we are versus prior to the pandemic.

Yes. We are -- let me give it from a full year perspective. We estimate that we will be at around SEK 10 million for the full year this year, invoicing around USD 1.5 million in Q2, in Q3 and also anticipated USD 1.5 million in Critical Care rental for Q4. So in total, our Critical Care rental business will end up somewhere between USD 10 million to USD 11 million for the full year. That is a level that is lower than what we saw in 2018 and 2019. We should also maybe underline that we are not expecting any significant impact from a flu season in the U.S. on the Critical Care side. And that is very much based on the fact that it is a very expensive therapy and we believe that under the current cost constraints that the U.S. health care has, they will try to avoid, even though it saves patients' live, they will try to find other ways of doing it. And we also do not -- even if there is a lot of talk about a very severe and others that are saying that this could be a potential for other med tech companies, we are downplaying the flu effects of -- for Arjo in this year, just to make sure that we're not making any unrealistic assumptions on what will happen. So the Critical Care rental will be slightly lower than 2018, '19 average. And when we look into what we will be discussing after the break, you will see that we are taking down those assumptions around Critical Care rental even further in the years of 2023 and 2025.

Perfect. The last one for me, if we look on the depreciation level in the company, been increasing, of course, due to investments in the rental fleet and so forth. Can you just try to explain to us how we should expect that to develop going forward because it's been increasing quite a lot throughout the year, sequentially.

Yes. And that is, as you say, based on renewal of fleet but also on the new business that we are currently seeing coming our way in terms of Critical Care rental, not ideally mixed right now because of the fact that we are slower in implementation in our core rental in the U.S. than expected but still following a very, very tight process. And I believe what you should be expecting in -- I would say, in comparable currencies is to have the depreciation more or less on the same level in the coming years as we will be having in 2022.

We have one in the back.

Kristofer from Carnegie. Question on the gross margin, given what you're saying of -- or you will have a less impact -- less negative impact year-over-year from the ICU rental. You're talking about lower transportation cost year-over-year and that you will be able to offset material cost. Does this mean we should expect gross margin to be more flat year-over-year in Q4?

No, I think you will still have to -- I mean, we are saying we are at SEK 115 million in additional material cost, approximately, year-to-date. It will be ending up at around SEK 150 million. So it's another SEK 35 million. And there is continued inflationary costs that will hurt us in Q4, which will be to the same tune as we've been discussing before. We are now estimating that -- and I'll come back to that in the presentation later on that we will have around EUR 75 million worth of extra inflationary -- additional inflationary cost on salaries, fuel and energy for the full year. But what you will see in Q4 is the impact of the price increases that are coming our way. So I am expecting, based on that, that we will see price increases to play a much bigger role in Q4 than what we have done before or what we have done for a something in Q2 and Q3. And that obviously has good effects going into 2023. We -- I don't foresee that we will be reaching or coming up to the same levels as we had last year. But I do foresee that we are going to see a good increase of the gross margin going into Q4, if you compare, for example, to Q3 and also if you compare to where we are trending on a year-to-date basis for the group.

Just to make sure I understand. But didn't you say that the high material costs will be fully offset by price increases in...

Exactly. And that's an indication that if we are compensating -- we estimate that material will probably be somewhere around SEK 35-ish million in extra costs. And that's something where we believe that our price increases will hit in also in Q4.

Okay. And then 2 questions on the rental business. Why do you expect ICU rental volumes to be low for several years. You talked about up until 2025 and also, why are you having this higher CapEx for rental business continued in this quarter when volumes are declining?

Volumes in core rental is not declining. Volumes in rental is increasing quite nicely and will continue to increase also in Q4. And as you will see from the presentation later on, also have a good traction in front of it for the years '23 to '25. And we are supporting that growth with the investments in the rental fleet in U.S., in Canada and also in the main markets in Western Europe. So I think that we are on a good level when it comes to those capital investments, supporting a good and well growing core rental business. In our critical care rental business, where we are obviously not making any capital investment because that is an existing fleet that we have been carrying for several years where we are not anticipating any capital investments into that part of the fleet. We have taken the decision, both from a U.S. rental deficiency perspective and also looking at the market that, that type of therapy will be used more and more seldomly in the years to come. And we will carry it to make sure that we can respond to customer needs in the U.S. but we do expect to stay on a realistic level that the amount of net sales in that niche category will be on a lower level in the years to come from today or in 2023 and onwards. And that has to do with a few things. It is a life-saving therapy but for a hospital under financial constraints, an expensive therapy. And we have also seen that we are being able to offer our customers other ways to automate -- automatically prone patients through our pressure injury mattresses, through our patient handling equipment, et cetera. So through COVID, hospitals have found other more cost-efficient way, something that we very much embrace and we help our customers with through the different product categories we have to find other ways of doing more or less the same work as our Critical Care rental is doing, and that is specifically the niche product, RotoProne.

I think we have a question over here.

Thank you, Victor from Nordea. I think given the cost reductions you see now in Critical Care rental, SEK 50 million seems like a very high figure given where your current net sales are. Could you just explain those dynamics a little bit because it seems that you're letting this unit or this business basically die out by itself in the coming years. So could you just put that figure into perspective?

Yes. We -- it is a big number, and it is a big number in terms of infrastructure, both in terms of sites, both in terms of how we are carrying and transporting our RotoProne equipment and obviously, staff connected to that, both when it comes to the cleaning part or the reprocessing part, but obviously also the logistics side that we carry with it. And when looking into this, we believe that it is -- we know that it is feasible to take down the cost with that amount with a fairly small chunk of restructuring costs, as we mentioned in the report with around SEK 15 million, 1-5 million, over Q4 and Q1. We could obviously always discuss why we haven't acted quicker on taking down the infrastructure around Critical Care rental. When we have seen the decline coming, we have known about the decline but we have also been driving in a very, very active way to try to go through clinical sales and normal sales processes to get the volumes back up to try to articulate, in an even better way, the clinical outcomes around the RotoProne. But we must now just conclude that, that will not happen. And therefore, we need to take a decision to bring down the infrastructure costs related to that. And that is a big sum, but the money is there, and we feel very comfortable that we will be able to execute and get costs down with around SEK 50 million starting at the end of 2022.

And regarding the price activities that you have ongoing, what makes you confident in that balancing out the cost inflation on certain parts in Q4? And if you could provide us with the magnitude of those price increases would be interesting.

Yes. As I said, we are expecting around SEK 150 million worth of material cost increases in 2022. And we are on a rolling 12 basis, importantly to say, going to compensate for that full amount based on the activities that we put in place this year. And those effects will start to be truly visible in Q4. Some of it is already visible in Q3, but we will see more visibility on that one in Q4. The reason for being confident around it is that I see the traction based on our very, very detailed follow-up. I see that those price increases is actually ending up in the P&L for Q3. I have good confidence about the plans and how we've introduced them also for Q4. And if we look further ahead, that is, I would say, the main priority within our sales and service organization is to address the need to further compensate for material, transportation and extra inflationary costs also going into 2023 and onwards. And again, as I've been explaining before, this is not us increasing one product group with 20% and then be off it. This is grinding. This is a number of small activities that we are driving locally when it comes to the tactical side. And from a more strategic perspective, when we are launching new products and in cooperation with local, making sure that we have a full understanding where we can bring value add to our customers. So I feel confident around the details of the plan and also the traction that we have seen so far. And that is something that you will see also in the presentation later on, where we will put a lot of emphasis on further price increases going forward in 2023 and onwards.

And just finally, I think you kept your stance on the scanner sales for this year. Has those sales started at this point in time? Or are they even more back-end loaded?

No, we have started conversions in the U.S. with good and fairly large hospitals, where the interesting part of that is that they have started with 1 or 2 hospitals within a chain and step-by-step expanded. So I feel very positive around our overall pressure injury prevention setup where the SEM scanner obviously play an active role. And you will see that again jumping into the presentation that we'll talk about later on, is that we stay firm to the targets that we have mentioned before around how we see the SEM scanner development. And in that area and a few others also with the potential upside.

Rickard Anderkrans from Handelsbanken. So 2 for me, please. Have you seen any order cancellations going -- ending Q3 into Q4?

No. The reason for downgrading on our yearly net sales outlook is purely because of the outlook that we are seeing from orders coming in, mainly on the diligence side in the U.S. And that is, again, us having a healthy pipeline, us working with that healthy pipeline, but there is a considerable slowness and uncertainty in terms of when those orders will come in. So no order cancellation or the postponement in the overall process.

Right. And finally, have you seen any progress on GPO side in the U.S. in the quarter and heading into Q4? More specifically, for example, the health trust agreement announced previously this year, but also perhaps traction on getting new accounts with existing ones.

In general, we do -- just to give you a little bit of a flavor, when we started this journey back in 2017, we had 2 people working on corporate accounts in Arjo. Today, that department is just short of 20 people working with -- and addressing GPOs and large purchasing organizations in the U.S., including government. So our traction in that area is today significantly better and also organized in a much, much better way. So we are getting a lot of business from that area. And that will continue also into the years of 2023 and 2024 and '25, where the add-on to the current setup is that we're going to focus significantly more also on the long-term care side around purchasing organizations and assisting them there because that is an area that we, during COVID had seen a very, very low development because of the situation during COVID. When it comes to the health trust agreement and other agreements that we are on, on the core rental side, the traction of implementation is slower than what we expected. And for us, that is very much related to the current volatility of the market, the staff shortages that we are seeing that the customer has other priorities right now than to short-term changeover. But that sales will come our way, I feel very comfortable about. And as we said, when we announced the health trust program is that the full year effects will not be in our books until mid-next year. So we stated 3 to 12 months when we spoke about the health trust. And that is how long it will take until we know, and I feel pretty confident around the full year effects of the health trust contract. But core rental in U.S. and global is growing in a very nice way.

Any other questions in the room? No. We have no questions online, and we apologize for the mishap with sound just initially. By that, we will take a short break. There will be some coffee and sandwiches. We say 15 minutes, a bit more, but back here, 9:35 sharp to respect our viewers online. So thank you and see you innovate. [Break]

Thank you very much, and welcome back. It is now my intention with the help of Christian Stentoft and Daniel Fäldt to run you through a little bit why we strongly believe that our long-term strategy is more relevant than ever. And obviously, then leading us into a discussion on how we see the financial targets for 2023 to 2025. If we look at Arjo as we sit today. We are a company that in 2021 had a turnover of above SEK 9 billion. We were selling our equipment continuously in around 100 countries. And we have a split where still North America is around 40% of our sales, where global sales, the way we are now defining it is just short of 50% and rest of that comes from rest of the world. Now with all those circles, many of you that have been following us since the spin-off in 2017, you would have said, is that a copy paste slide from the one that you showed us in 2017 where you told us that, for example, your focus on long-term care would be substantially bigger from the 66% that you showed us at that time. Well, there was a thing called COVID in between. And COVID pushed our sales very much into the acute care side of things in 2020 and 2021, where we had big difficulties of entering into the long-term care side. But that is, in my view, obviously not good for the years 2020 and 2021. But serves as a very good example that there is a substantial potential in moving into that side also in the future. But today, we are selling around 70% of our top line into acute care and around 30% into long-term care. And the split is around 40% capital 1/4 going into rental and then the rest is divided between consumables and service, where service, especially in 2022 is continuing to grow in a very good pace. We continue to lead our organization, develop our organization aligned with our vision to be the most trusted partner in driving healthier outcomes for people facing mobility challenges. And embracing that vision is really to understand our strategy full out. And I will spend a little bit of time to understand where we are active and how we intend to fulfill that vision over time. We continue to be active in a market that has positive growth fundamentals. We are getting older. The lifestyle diseases or the age-related problems that we are seeing, for example, around dementia, is increasing. And we're also seeing that the basic demand for health care is increasing globally. All those things are step by step, moving our market and developing the growth of the market where Arjo is currently present. We are seeing a market growth of 3% to 4%, with variations in different regions globally. We are continuing to see a long-term -- institutionalized long-term care market that is growing quicker than acute care. And again, adding to the possibility that we have by being more active in that market. So all in all, an attractive marketplace to be in and a marketplace that is, over time, to be considered as less volatile as other markets because the constant need for health care per capita will continue to be there. We continue to see the trend of health care providers trying to move treatment of patients out to low-cost environment, not low quality, but low-cost environment, where acute care still serves as a very important part but where we are step-by-step seeing an increasing institutionalized, long-term care side and also in home care, where we are focusing our actions on the acute care side and on the institutionalized long-term care side. And where we can and where we can make profitable business, we are in selected countries also active in smaller parts of the home care market, but only in areas where we know that we can drive profitable top line. This graph is also the same as we showed. And this is just to symbolize or give you an indication of what is currently happening when it comes to GDP growth versus the spend per capita on health care. The spend per capita on health care was in 2016 around 10%. It is now end of 2020 up to almost 1.5 percentage points higher. And at the same time, GDP in the world has not increased to that level. This puts absolute additional pressure on health care to do more for less. And it puts a lot of pressure on health care to use the resources and competencies in a better and in a more effective way to be able to handle that increased cost pressure. And as I will come into later on, that is where I strongly believe that Arjo is well positioned within our niche. A number of major trends apart from the market fundamentals that is affecting our business. Comorbidities, the fact that more and more people are entering into health care with multiple different illnesses that makes caring for those patients very challenging for health care staff in general, where we have and must support them to make sure that they can, at all times, provide a qualitative care with the highest possible efficiency. We also see that obesity worldwide is something that is putting a lot of demand on health care and obviously putting additional strain on health care providers. I could give you a number of statistical numbers around what is happening with obesity in the U.S., U.K., Germany and across many markets in the world. But we are going to play a very active role in making sure that also health care providers can provide also for these patients, high-quality care but also [indiscernible] pay for themselves. Digital solutions more and more is coming into play. We strongly believe that, that is an area where Arjo needs to navigate and support our customers going forward, but we need to do so on a step-by-step basis. I don't -- still do not think that introduction of huge digital solutions that looks good on paper is what health care is prepared for today. We need to take it step by step and make sure that the digital solutions that we are implementing and that we're helping our customers with have a direct effect here and now, improving the nurses' everyday life here and now, and that's the way to get traction on digital solutions and actually also get the cost benefit out of that for health care providers. There is a significant workforce shortage and increased cost of workforce globally. That is something that we need to in help health care or med tech, in general, has to help health care to make sure that we can address and help them to use their competence and capacities in the right areas and as efficient as possible, eliminating waste out of the system. And the waste part is multi facial in this one when it comes to sustainability. Because I believe that sustainability is something here that will embrace all of those things and something that is required for more and more customers and customers are working very much more actively in that area and where we need to be a very active part. Sustainability for us is defined very clearly in a number of different processes that we have within the company. And for us, it's important to say that we are from the beginning, a green company. If we look at the Scope 1 and the Scope 2 part of our business, there is very, very low emissions going out from Arjo. So we are, in my view, already as a starting point, a green company. And the other part is that we can create substantial benefits to health care when it comes to developing a sustainable health care over time. But we can help with our solutions, health care -- to provide health care more for less, making sure that they're eliminating waste. Might it be material or waste in -- when it comes to how they're using their competence and capacity and we can play a major role in making that one happen. But obviously, our sustainability framework 2030 is addressing also the climate part of our own activity, something that is requested more and more from our customers. And we are currently looking into driving oil towards science-based targets. We're going to submit and hopefully get accepted on those by 2023. We've already scoped out Scope 1 and 2 and are currently addressing the Scope 3. We're actively looking at life cycle analysis on all our categories to understand where we have the biggest pain points around our categories so that we can address those pain points from an environmental perspective in future product developments or updates of our products. We're actively looking into waste management, not only for our customers but also in our own activities. And importantly to say as well that we are running all our production site on fossil-free energy. Doing investments also, for example, in solar, as an alternative to electricity or to gas as an example. So a very, very tight agenda around sustainability based on a sustainability framework 2030. And we drive that, so it makes a difference to us, and it makes a difference to our customers, and it doesn't become a paper product that somebody puts in a bookshelf. We're also very focused, obviously, on our employees, making sure that we continue to drive an organization where you want to be an employee, making sure that we're driving an organization that speaks about diversity, equality and inclusion. And again, not making it a paper target, but something that we work with on an everyday basis. We're putting a lot of emphasis around business compliance and business ethics, which is an absolute must for any company, but especially for Arjo where we are constantly training our employees to make sure that we have a good understanding of what we mean on that based on our defined guiding principles. And as I said, and I believe as a summary, very important to understand that what we are doing and the activities that we are having is there, obviously, for Arjo to develop both top line-wise and profitability-wise, but also to make sure that we take part and create a more sustainable health care going forward. Sorry. This all leads down to the strategy, and many of you have seen this slide before, and it is the same as we spoke about in the end of 2020 when we had the last Capital Markets Day, a 2-tier strategy where the first part of the strategy speaks about continuing to drive what we are already driving within Arjo, making sure that we send what we have, making sure that we are driving both rental and our service business as efficiently as we possibly can, continue to have a tight OpEx management within the company, making sure that we continuously find ways of improving our efficiency internally to make sure that we can increase, over time, profitability within our company based on the activities that we're currently doing. We're also very much focused on step by step developing the second leg of a -- leg of the strategy where we speak about the return on investment side, making sure that health care can do more for less through the solutions, and Christian will go through a number of those solutions later on where we are clearly stating that invest money with us, and you will have a very positive return on investment and a better quality of care for your patients. That includes new product launches, that includes launches of all the new solutions and includes a step-by-step approach in the digital arena. With that strategy, we are confident that we are going to be a part of the solution instead of being a part of the problem -- of the cost problem. And I think that, that is key. If you want to survive in a profitable way as a MedTech company, that is what you need to address, and that is what you need to do. We are with the new strategy, as you know from before, not only addressing the actual equipment side, which is the normal traditional way of looking on MedTech, but addressing a vastly bigger scope of course, for health care. Helping health care to do more for less with their very big chunk of labor cost, but also adding and helping them around the miscellaneous side, which in, for example, from a U.S. perspective, could be around the litigation side. So addressing a significantly bigger area of cost within health care is everything that the new strategy aims at. The rollout of the new strategy is going step by step. We would be -- we would -- or rather we should state that we are delayed in the rollout of the new strategy because of the focus that COVID had -- has pushed us in. We are now back in full force when it comes to strategy implementation where the U.S. is the first country out given that, that is the -- and has been the engine around mobility outcomes solutions, especially in the patient handling part that is now also addressing our Pressure Injury Prevention side. So the U.S. is the first country out where we, through a very dedicated work clear and detailed commercial excellence analysis or setting up over time, a new organization that is better addressed or better equipped and to address the challenges to take us to becoming a mobility outcome partner. We also believe that, that commercial excellence work that we are going to roll through U.S. first, as you can see on the picture, Germany, U.K. and a number of other countries will also generate interesting benefits when it comes to our own efficiency within our sales force. So we are anticipating that the rollout of the new strategy will also, over time, lead to in percentage perspective, lower selling expenses -- because we believe that we can address the market is slightly different. The implementation of the strategy is a journey. It is a journey that will take us at least to 2030, where we need to have a very clear short and midterm focus in obviously navigating a volatile short-term market situation that we are currently seeing. We need to continue to work around our operational efficiencies, work very hard on the tactical and strategic pricing and making sure that we take the product launches, as we've been talking about a lot before Christian will touch on it later on as well that we make sure that those are as successful as we want them to be and adding and helping customers to find that value add around our transactional sales as well. But we're also going to step-by-step develop our outcome program support to our customers and where we believe that we, step-by-step, we'll start seeing good outcomes, starting with the U.S., but then rolled over the more mature markets that we have in the rest of the world. And obviously, adding to that, but not included in our future financial targets is a focused inorganic agenda well aligned with our strategy. So really, as a summary, the strategy that we presented in 2020 is more valid today than it was when we presented it in the end of 2020. We have a number of very strong underlying growth fundamentals and major trends that is affecting our market in a positive way. We know that there is a great need for health care to reduce the cost per patient and making sure that they can do more for less, and we can play a very, very active part in that one. There is a significant lack of staff across the world, and we are very well addressed as a company and with the strategy we put in place to address that and making sure that we can continue to grow Arjo on that marketplace in a positive way in the coming years. What I would like to do now is just to set the scene a little bit, so we have a joint understanding of the marketplace and how we are seeing that going into evaluating the coming 3 years. We continue to see and we expect to see a healthy demand across most markets. Short term, we do have a volatile U.S. market that we have to navigate. And we need to make sure that we continue to be on top of that and that we've put targets in place that is also under, I would say, more volatile market conditions possible to attain. Our pipeline in the U.S. or in other companies continues to be very solid based on what I just described around market fundamentals. It is -- for example, now in the U.S., a question of making sure that, that good pipeline is converted under the uncertainty that we are currently seeing short term into orders. But overall, a healthy demand on the market that we expect that will continue over time. Now I did something wrong here. Sorry about that. As we've been discussing before, since Q3 of 2021, up until today and also into Q4, there has been significant headwinds into our P&L, mainly based on transportation, on material cost and also especially during 2022 on extra inflationary cost. So if we compare to the situation we had going into Q3 or in Q3 of 2021 versus where we will be when we're exiting out of Q4 of 2022. We have added around SEK 400 million worth of costs into the P&L versus where we were standing when we spoke in the -- on the last Capital Markets Day in the end of 2020. Now a lot of work has gone in to make sure that, that number stayed at SEK 400 million. It's not that we've been sitting around and waiting for that cost to come. It's a 24/7 work with a lot of people involved within Arjo to make sure that we're trying to mitigate as much as we can from this. These numbers are known for you. So if you're adding them together, you would get the SEK 150 million of extra material costs, you will get transportation debt in 2021, in the end of 2021 and together in 2022, rose -- will have risen with just short of SEK 200 million. And on top of that, you have then the inflationary costs that we are currently accounting for, you get to the number of SEK 400 million. And that is obviously a substantial cost part. But that -- I'm telling you this not because it's -- telling you how sorry we are for this, but the fact that we are doing a lot of things to mitigate and we continue to drive a number of things around price increases, around internal efficiencies to make sure that we, over time, compensate for this cost and develop Arjo's profitability over time. To give you some more flavor, for example, around transportation. We believe that we have reached the peak as of Q3 of 2022. We now believe that transportation costs will start to decline and that we will see a significant decline in absolute money also in 2023 and that, that decline step-by-step will continue over '24 and '25. Now we do not believe that we will go the full way back to the situation we had in the beginning of 2021, but we will be on a significantly lower level than where we were -- than where we are right now. When it comes to material, this year has been a dramatic increase in material. Main reason for that in the beginning was around the increases in commodities that started to increase prices. What is now driving price increases is mainly inflationary pressure on sub suppliers. So in the same way, that we are facing inflationary pressure on salaries, on energy, they are seeing the same things. And that is what is currently despite the fact that commodities are starting to go down, we can see that our sub suppliers are -- have a need to increase their prices continuously because of the inflationary pressure that they see. We are exposed to the -- an East Europe network of suppliers, which is obviously, given the situation in those countries is making the inflationary pressure on our sub suppliers even higher. It is absolutely the right strategy -- has been the right strategy to have our factories where we have them to have the purchasing network where we have them but we now constantly need to evolve and make sure that we find even best cost -- even more best cost countries, probably further east and at all time keeping very, very close view on the quality of the suppliers that we are using. But there is a need for us to also strategically move over the coming years to make sure that we, over time, can get our material cost back to where it should be and start declining trend of material as we now expect will happen from 2024 and onwards. Inflationary effects in 2022 has, as we have been communicating before, been there, and we are expecting the full impact of the inflationary cost to be around SEK 75 million for the full year. Most of that as in Q3, where we spoke about around SEK 25 million in inflationary extra cost where SEK 17 million ended up in COGS and SEK 8 million ended up in OpEx. That same type of split is something that we are foreseeing for also for the full SEK 75 million for the full year. Now Q1 was not that affected. So the rolling 12 effect -- all of this inflationary pressure for 2022 is around SEK 100 million, where Q1 is then going to be effective as well. If we are looking at where we believe that the trends -- or how we are anticipating this right now. From an inflation on salary perspective, and now I speak about the salary above the normal 2.5% to 3% or the average increases that we have seen over time. We believe that, that is a significant part of cost increases that will come our way during 2023. Just read the newspapers and see how the discussions are going, if it is in Eastern Europe or if it's in the U.K. or if it's in Germany, there will be a significant increase of salaries in blue collars and white collars in 2023. We do expect that, that pressure will be reduced back to normal levels starting 2024 and 2025. But there is a need for us to, through additional price increases and additional internal efficiencies, to compensate for a fairly large chunk of inflation on salaries in 2023. Energy, we expect to stay on high levels from a market price perspective also in 2023. What will be slightly negative for us in 2023 is that we have not been exposed in fully to the energy cost increases in 2022, because of a number of fixed contracts that we have had within our business, especially within our sales and service units. Where we, from 2023 and onwards will be exposed to higher rates and that will affect especially our absolute OpEx side going forward. Fuel is an area where we believe that prices will stay on a high level throughout 2023. There will be a slight negative effect, if you look on a year-over-year basis in Q1 -- because we didn't see the full -- we're still on the same level as we have seen during 2022 when it comes to fuel or be around 2,900 vehicles that we're having in our [indiscernible] After I've listed all the negative parts. It is very important to emphasize on the fact that we are doing, in my view, a very, very active approach to mitigate. And by those mitigations get Arjo to a different profitability level than what we are right now. I am fully aware that price increases in health care, after I've spent most of my life in this business, it is cumbersome to get through, but we have a very, very diligent work ongoing. We have a detailed work ongoing that is followed up closely by the organization to make sure that we step-by-step compensate for the additional price increases that we have seen. It is both in terms of tactical prices, meaning that we're increasing prices on an everyday basis in the country where we're in, whether that is spare parts, service hours or capital equipment but also a main chunk of strategic pricing around the new product launches that we're introducing, that where we are offering our customers a clear value add and where we are able to charge more. It is difficult, as I said, to get those price increases through. We are in a positive way, very much feeding out of long-term contracts, both on the capital side, but especially on service and rental which in good times is something really, really positive. It is positive, but it takes time to change pricing in those contracts. And that is where you see a lag in our activities versus the material and transportation increases that we have seen. We believe that we will have a significant contribution already in 2023. And as I said, starting in Q4, and that, that level will be maintained in '24 and '25, hopefully increase somewhat. But at least maintain, meaning that when prices for material and transportation are starting to go down, we create a further bigger positive delta in terms of profitability for Arjo. Apart from the part around price increases that I've been talking about. We're also going to continue to work on internal efficiencies both when it comes to our COGS side, where one side is obviously around the efficiency program that we're now rolling out in the U.S. that will generate the around SEK 15 million worth of savings as of end of Q2 -- sorry, as of end of 2022. But we also have a number of activities within the supply chain based on a subsegment of our strategy called the Supply Chain 2027 that will continue to generate operational leverage within our supply chain. That, together with decreased material and transportation costs. We continue to look into and further expand our shared service approach. We believe that we, over the time period 2023 to 2025 can drive process to make our -- mainly our order to cash process more efficient than it is today based on the IT investments that we have been doing and are doing in that area. And that is something that most will have effects on admin in 2024 and 2025. As a part of the strategy rollout, we are driving a very tight commercial excellent review of every market, meaning that we are addressing how we're going to set ourselves up to be as efficient as possible to generate top line growth that we would like to have. And we do see a potential with new ways of working, with addressing different markets in a different way and by working more around clinical support and less with transactional sales. We believe that there is a potential of also from a cost and efficiency perspective, streamlining our sales organizations going forward. But that is a continuous improvement work that we will report back on over the coming years. When it comes to OpEx and how we see that both short term and long term, we believe that our OpEx level for 2022 as we've been discussing before, is probably as a percentage of [indiscernible] is going to end up in and around the same percentage point as we had for 2021. That is a little bit higher than what we said in the beginning of the year, but still good, my view, considering the additional cost that has been flowing into the OpEx side over the last couple of quarters and also taking into consideration that our top line is not where it was expected to be when we started the year. Based on the activities and based on also the slight short-term headwinds that we are seeing around inflation, we do believe that net sales -- sorry, that OpEx as a percentage of net debt will increase slightly in 2023. But that we -- after that, depending on how well we managed to work with our top line, where I strongly believe that we have a good potential on the top line side. We'll start seeing a good decline of OpEx as a percentage of net sales in the years of 2024 and 2025. And I tried to list a number of the headwinds, but I would like, again, to emphasize on the fact that there are a number of activities, especially around the commercial excellence side, around the shared service side and our ability to make sure that we are driving our top line in a profitable way that will help us to see this percentage to go down over time and which will be one of the factors that will take us to the financial target that we will be discussing in a few minutes. So in summary, from a market condition or from a market perspective, still healthy demand, difficult currently to navigate the volatile U.S. market, especially on the capital side. It's not that the pipeline is not there. It's just that it takes significantly longer time to get the orders in, but there is a healthy demand there, approximately SEK 400 million worth of extra cost that has entered into the system over the last 15 months, and we're now actively working on mitigating through price increases and internal efficiencies. And we do have clear plans in place to take us both from a top line perspective but also from a profitability perspective to the targets that we will be discussing in a few minutes. With that, I would like to hand over to Christian. And just to run you through a few of the initiatives that we have around growth and profitability. And I will also add a little bit of flavor to that one later on the presentation. Christian?

Thank you very much, Joacim. I hope you hear me all right. So as Joacim mentioned, I will now like to provide some detail on shall we say, the new or recently added elements that are, you could say, a consequence of our strategic direction, first shared at our Capital Markets Day roughly 2 years ago. So in addition to continuing our efficiency journey where Joacim just laid out some of the key elements of that and also our continued efforts to establishing with more infrastructure, more white space in developing markets. We have 2 -- essentially 2 parts of our strategy that we call new technologies and new business models. And they essentially make up this transition toward becoming a mobility outcome partner. Alongside our inorganic agenda, which Joacim will touch upon a little bit later. They are, you can say, the main difference as opposed to the old Arjo and what we are looking at in the future and what are, you could say, new financial targets are based on. But it's not only the new financial target is also, you could say, how we compete, how we are perceived and the mobility outcome partner part of our strategy, how that will change them. So before going into the activities and providing you an update on those, it's worthwhile to establish the meaning of the applied terms here, so mobility outcome partner and a new business model. So you could say are relatively broad terms and what we actually mean with that, what is the intent of those phrases? Essentially, our strategy implies changing the relationship we have with our customers today, which is very much 1 of 2 parties complicit to a transaction to that of 2 parties being, you would say, mutually involved in a collaboration, that seeks to improve the clinical operational financial outcomes for the customer. So basically moving up this ladder of involvement with our customers. And today, you say our in the marketplace, we are active in is pretty much -- you defined by what your competitive positioning is defined by the list of features that you can provide divided by the price you intend to charge. And given the outlook that Joacim just described for health care overall in relation to you say, world GDP, growth and the lack of filter, the diminishing difference between the 2 lines there that is becoming an ever more challenging cause of upselling features that aren't [ demonstratable ] able to reduce cost in the end. And -- and for that reason, it is very important, we believe, certainly for a company of Arjo's stature to be first movers and move up this line. And really, that implies engaging in a different business model. And at the center of this business model, we have you can say the customer, of course, we have our understanding of the actual clinical operational financial challenges faced by the customer. We obviously still have a great product. We need to have great products that serve the current and unmet needs of our customers. But in addition to that, we are adding the, you could say, ability to change culture. And that is, you could say, an on-site presence, a high-intensity involvement in training and making sure that practices actually changed in terms of making sure that our equipment is actually used to the full potential. And then finally, it is the ability to demonstrate that, that is actually making a difference, there are actually some savings coming out of that. And that is what we call a program and which Joacim refer to as Diligent in the past, that is the legacy name. We've now rebranded that recently to Arjo MOVE, which is, you could say, the commercial marketable brand positioning for that element. And then where are we going to apply this and that's why we call it the mobility outcome partner. So mobility or the consequences of limited mobility is the realm of which Arjo can be effective and competitive in partnering with health care providers around their outcomes. While this is a novel idea in the industry and none of our competitors are currently are trying to have the breadth or ability to engage on the -- say, apply this value proposition. Like Joacim said, this is actually something we have been doing for more than a decade, but in a very small pocket and focusing on one particular outcome here being caregiver injuries, where we 10 years ago, devised something we call a Diligent program that took you say the breadth of our mainly patient handling portfolio, but also parts of our hygiene portfolio and bundle that with the training, the protocol to ensure that caregivers didn't need to get back injuries and health care facilities then need to have millions of cost in workers' compensation. And we gave them a guarantee that they were able to reduce their costs related to caregiver injuries. And this is essentially the same approach we are going to now apply to other mobility related issues and first in line our pressure injuries and venous leg ulcers that are the new additions to servicing our outcomes offering. And looking at just the numbers here, even larger problems in terms of cost, in terms of suffering, in terms of, say, loss of quality of life. And then after that, that's not the end of the road. We are looking at further outcomes that we can have a significant impact on, for instance, incontinence or falls. But we're going to spend to date diving a bit into these 2 outcomes that are in nature a bit different. So take pressure injuries a very complicated issue in its nature. So it cuts across multiple care processes, both in long-term care and in acute care. There are lots of pieces of equipment that are involved in, you could say, interventions and there are lots of different stakeholders. And then you have venous leg ulcers which in itself is -- it's a symptom of a chronic condition that cannot be healed, but this symptom can certainly be alleviated in a much better way and is much more seen for us as you could say, a technology or innovation play. So for pressure increase where we consider our efforts both in terms of, say, stand-alone selling the SEM scanner, but also very much as part of Arjo MOVE program focused on, you say, limiting pressure injuries. This was -- this -- these efforts were launched in 2020, right in the face of the pandemic which caused other priorities to supersede implementations of the SEM scanner and any MOVE programs given some of the obvious challenges operationally that Joacim went through. We are now largely out of that environment and which is making things a lot easier. But as Joacim also mentioned a number of, you can say, operational derivatives or second order effects from COVID, namely in terms of staff shortages are proving to be very persistent. Throughout this period, over the past 2 years, we've had a great interest from customers on how to deal better with this major problem of theirs and they've done several hundred evaluations globally. And we have done together with our customers and really with very good results if you just measure that in terms of reductions in prevalence rates. However, with too few in our sense and relative to previous guidance, too few large-scale conversions into commercial contracts, very much linked to the fact that -- that once you had that conversation, they saw the great results they had, they knew and they had learned from being part of the valuation process that it was a major change to their -- to their protocol, their processes, which requires an allocation of staff in order to -- or you have to invest in that transition. And that's also why we've now brought -- and we are seeing in our pipeline that in the beginning, most of the pipeline opportunity, what you could say, SEM alone -- now I think we're at a point where it's above 75% of the customers who actually understand that this needs to come with a more program like approach for them to be able to have confidence that they can make the transition. Like Joacim mentioned, and I believe that there was a specific question on that. We have had quite good traction on SEM and in conjunction with our program business here in the last 2 quarters. And I guess when we are looking at that, we are starting to believe that our customers, given the amount of strain they are under, you could say financially and operationally are starting to see that they really actually do need to make this investment in order to bring down the waste that will ultimately free up the time for the nurses. It is a -- it's a quite difficult position they're in and they realize they aren't any easy ways out, but certainly removing some of the waste or some of the many, many thousands of millions of hours that nurses spend on attending to fixing or dealing with the verification of pressure injuries would be a good place to start. So we have this issue of staff shortage actually as a -- we -- you can look at that as a headwind. At some point, we believe that it will flip and it becomes a tailwind becomes something needs to be done about this problem. And when breaking down the costs associated with pressure injuries, one can see that the amount spent on preventing this and it's termed a never event for the reason that it shouldn't ever happen and if something shouldn't ever happen, you'd suppose that you go through great lengths in order to prevent it from happening. But -- but the fact of the matter is that, that a miniscule amount of the total cost associated with the problem is spent on prevention, the vast majority is spent on say, the treatment after the fact and an equally large component is spent on some of the quite significant, you can say, collateral elements, not least litigation. And -- and this is actually not so strange considering the clinical practice for determining who's at risk, which really doesn't work in the sense that it does not give an accurate prediction of who's at risk or who should be where do you apply the prevention. And this is exactly why -- or this is exactly what the SEM scanner offers. An objective and clinically proven assessment of risk that on average, gives the ability to intervene 3 to 5 days before the pressure injury would otherwise have been detected. So also why -- to us, this is a very key component of, how you say, our Pressure Injury Prevention solution and our program is the implementation of an accurate assessment of risk, which is absolutely necessary in order to deal with this problem. While it's necessary, it's of course, the ability to probably assess risk in itself does not eliminate any pressure injuries. Something has to be done. A preventative intervention has to be put in place in order to reverse degradation of the skin. And this is where Arjo's broad portfolio of advanced therapeutic services, microclimate management comes into play alongside our patient handling -- broad patient handling portfolio in terms of repositioning the patient, including sliding sheet. The recent acquisition of AirPal is all a great supplement or individual component in order to deal with this. But even customers that have all of this equipment, success is elusive because pressure injuries are really complicated problems. As I mentioned, they cut across multiple care processes and many, many stakeholders has to align, you can say, their individual routines. And that's why our clinical implementation programs, what we call the MOVE with continuous training, follow-up, follow-up on clinical practices in order to anchor new protocol induced behaviors around when to apply, what intervention is ultimately the, you can say, the success criteria that will reduce pressure injuries. And while we have been, you say, held back certainly you can say, on the ground commercially for doing COVID, it was hard to make progress on closing deals under, you could say, ambiguous -- in an ambiguous environment for health care providers. We've been very active in terms of making sure that we build the market going forward for SEM technology and pressure injury -- holistic pressure injury solutions at large. Already prior to -- you would say, our acquisition and inclusion of the SEM scanner in our portfolio, a number of achievements have been made -- like quite a few from 2019 in terms of clinical guidelines. You could say inclusions, not strict recommendations. And we've seen a number of additional ones come through in the past couple of years in Poland and New Zealand to mention a few. We've spent considerable time working with these, you can say, academic guideline bodies in terms of strengthening their wording. And we will have new guidelines coming out at the end of 2023, which we are very much looking forward to. And while achieving consensus around the efficacy of the SEM technology and holistic approaches to dealing with pressure injuries, is important. It does not drive adoption directly, unfortunately. It's more of a pre-requisite. The most important barrier really is how the funding -- the funding for these conditions to work today. And that's typically guided by the national health care policy, insurance policies or the like. And on this front, we have seen some quite positive changes concerning pressure injury specifically and more generally in terms of the overall alignment towards outcomes over the very recent past. To mention a few, what I think very interestingly, in the U.K., the NHS has significantly changed how they do their funding. So previously, under the main NHS Board you had overall funding for acute care hospital systems over here, that's one budget pool. You have another budget pool for long-term care, community care and another for district nursing. All you could say, at the top level, different funding buckets. That's now been changed so that you directly under NHS have something we call an ICS, an Integrated Care System. And their role is really to analyze care pathways across multiple care environments, look at how waste is -- how waste enters the system. And I guess a good example of that is -- that you -- we've in the past and I believe many other health care MedTech companies have been in situations where you have a conversation with someone around a problem and they don't really care because the actual cost of the problem that arises sits within another budget. And so we're very much applauding the significant change to the funding structure in the U.K. in terms of looking at these care pathways across multiple care systems. Then we have in several European countries, you've seen policy being passed in terms of, you say, by law demanding an increase in digitalization of record keeping with the objectives of improving the objectiveness of decision-making, but also improving reporting efficiency. And in relation to the [indiscernible] this is quite a key measure because today, the way you can say, records are being kept, well, this is, first of all, it's a subjective assessment that has been -- has to be entered into a system, whereas with the SEM scanner, you can scan and directly have the information flow into EMR systems. So also a positive push. And then finally, we have both in the U.S. and in the EU as have lately started to see interest from major insurance players in terms of basing premiums on care practices also something that will align outcomes with funding over time. So based on the current development, especially in the U.S. where we've now seen hospital-wide implementations, and a considerable growth in the pipeline and a considerable change in the pace at which we move forward into contracting, we believe that we will end up 2022 with a net sales amount somewhere around SEK 40 million to SEK 50 million, and we forecast to quadruple that to EUR 200 million by 2023, and then as Joacim also mentioned, this is obviously -- this is obviously an explosive growth. It's quite difficult to make very accurate projections further out into the future, especially when you have a number of -- at the end of 2023, we have the significance of new guidelines coming into play, but we are quite positive about the future here. So with that onwards to the other in focus outcome that we also discussed 2 years ago, and I will give you an update on here, leg ulcers use our technology to address that WoundExpress, which, as I said, is much more of a -- it's simple because you have a device that does something differently than anything did in the past. Now leg ulcers are a common disorder experienced by 1% of the Western population along their lifetime. And as mentioned, it's a symptom of a chronic condition called venous insufficiency, which in turn is highly correlated with age and lifestyle conditions. So on the rise, you could say. Leg ulcers have a high negative impact on quality of life. It's painful and further limits mobility and thus turns into a quite negative spiral for the patient. And further, which was mentioned in detail last time and here, just on the headline, it's a very costly problem where interestingly, 80% of this cost, well, there's not much litigation going on here, but 80% of this cost is nursing time. Yes, and this is where we've devised -- or we brought to the market WoundExpress, which is revolutionary as it's very importantly, far more effective in healing wounds or healing wounds much quicker than what would otherwise been the case. It reduces pain and very importantly also, it is administered by the patient and thus really impacting the large cost driver in the equation here. Then we've been talking quite a bit on the RCT and just here re-emphasizing what it is we are doing. And obviously, whenever new and groundbreaking technologies introduced into a field with an established practice, quite significant arguments are required to sway any purchasing or clinical decision-making. And that is the case for the current practice around leg ulcers, which is a combination of steady compression and application of dressings to absorb any wound exudate. This practice really hasn't changed in 30 or more years and the results that come along with it also hasn't changed. So in order to, you can say, break that or you could say, disrupt this market, we've needed to do an RCT to demonstrate with statistically significance that our technology is superior and we set out to do this right in the face of COVID when leg ulcer patients due to the -- on the previous typical characteristics of them being relatively old, frail, typically falling into a high-risk group where they were told to not have their usual visits to these wound clinics where we would be recruiting patients to our RCT. So despite attempts to incentivize enrollment, we have seen very, very slow progress on the intake of patients into RCT. We've now done 2 things to mitigate or accelerate. We've added more sites in more geographies. So we're now at 8 sites and then which -- which in the end will have the benefit of making the RCT more relevant in more markets. So as you're probably well aware, even though you do an RCT in one market in the next -- the neighboring market, they somehow tend to question how those results can be applicable to their markets. But so we have a lot better coverage and importantly, the latest -- the last site we added was in the U.S. that is a bit more complicated. We went through that in the U.S. The other action we've taken here is to, based on say, positive results from some smaller scale evaluations we've done is to say change the inclusion criteria for the RCT in the sense that we are also now recruiting patients that not only have, say, or strictly not only have venous leg ulcers, but also have mixed arteriology ulcers. They looks the same. The reason why you have them is slightly different. And with these changes, we now expect to have the RCT or finalized published by the end of Q2 next year. And as it has been laid out earlier, we have a journey in front of us with WoundExpress in terms of building the market and the technologies application first targeting various treatment scopes and then ultimately going into prevention. And the implication of the alteration of the RCT to include these mixed arteriology leg ulcers was always on our road map and now means that we have the -- upon completion and a positive result, of course, will have the necessary evidence to address a broader patient group post the RCT. So in summary, for WoundExpress, we're now focusing heavily on really making sure that we complete this RCT and we have made the -- what we believe are the necessary changes to accelerate the enrollment pace and expanded the clinical scope and thereby hope or plan to have it completed by Q2 of 2023. We have also obtained the FDA 510(k) clearance. We've also secured, you can say, the funding or the reimbursement coding in the U.S. and are right now building, you could say, or planning the commercial infrastructure so that we can be aggressive once we have the necessary argumentation for appropriate clinical claims with the finalized RCT. And as I said, we will still have more development areas for how to apply for what problems we will -- we will try to solve with this technology and that work continues. And with this, we are optimistic about the future for WoundExpress commercially, and of course, for the patients whose life will greatly benefit from this. We are, however, if you compare, you can say, this effort to that of the SEM scanner and you could say, our overall PIP solution, we are on earlier, you could say, commercial stage. And I'm not -- we are not including what we believe is the actual full potential into any forecast, given the uncertainty. But we very much still believe that in 5 years' time, this should be a separate high-margin business area generating no less than the SEK 400 million annually. So zooming out to and more to the entirety of Arjo again, and as we're certainly also planning on bringing new products and new technology to the market within our core portfolios and have invested heavily in doing so. Our aim is to maintain what we call category leadership within our core, meaning that we will still be able to compete and effectively on the features and the value that we provide on a more, you can say, traditional sense and the transactional relationships with our customers as we have done well for the last decades. And beyond continuing to listen very carefully to our customers, really understand how these needs evolve and they do evolve, I believe, quite a lot more quickly now. And with some of these things, the staff induced operational challenges that you find in -- with our customers, their requirements are changing quite drastically. We are aware and we are spending quite a lot of effort to understand how we can assist in terms of how we develop our products. In addition to that we are applying -- we have 3 distinct in the value creation lenses to our R&D work. And when we put together our pipeline, we look at it through a couple of lenses. So one is in terms of digitalization of the product or the ecosystem, both focusing on what we could say, internal efficiencies for us or the customer or focusing on where additional value can be created. We're also looking at -- you could say a little bit more outside in technology -- advancement of technologies, how that can better be applied to our context and have a couple of quite exciting launches coming out where we will have an entirely new features based on technology that wasn't available in the past. And finally, we are looking at [ you would say], through a sustainability lens exploring alternatives, both in terms of materials that we can exchange and thus, drive a competitive advantage as legislation and procurement characteristics change. And we're also looking at circular business models and how they can be enabled from [indiscernible] design or how our product is put together, how a disposable consumable is able to be reprocessed by -- we acquired this renewable processing plant some years back, and we have some opportunities in terms of both generating a higher-margin business for ourselves and using less say, overall raw material altogether. So looking forward, we -- from an R&D perspective and a launch perspective, we have a couple of exciting years ahead of us where we, for the past 2 years, have had a little bit of a period where significant amount of R&D resources have been occupied with say, keeping the wheel spinning on the existing portfolio, frequent redesigns in order to accommodate changes in possible supplies, mostly around electronics. We now again have people working on what we really know creates additional value for our customers. And we have next year a significant launch for high-end [indiscernible]. Also starting next year and actually going on for a 3-year period, we have a number of large launches within Arjo, usually our largest core portfolio, Patient Handling. And then we have a -- from 2024 and for also a number of additional say, launches within Pressure Injury Prevention. We already had, beginning of this year and in the last year, 2 significant launches in within Pressure Injury Prevention. So when we get to mid-2025, we will have a complete Pressure Injury Prevention portfolio that has an average age of 3 years, which is something that we haven't had for many, many years. It's, of course, and as Joacim mentioned, quite crucial whenever we do these significant launches where we try to replace a number of products with one platform that will enable some benefits for our supply chain and our ability to source better, very much on our radar that these price increases that we now need to be doing are thought carefully into area of these launches. And we have all the markets heavily involved in already now, you can say, positioning us for future contracts as is nature of our business, oftentimes is that, that contract run for many years. You need to know quite a bit ahead of time for major launches that you need to prepare the market for certain price points and features. It remains kind of our ambition to have an R&D spend of approximately 2.5% to 3% of net sales, so that will remain relatively flat. Obviously, whenever if ever there is a significant opportunity to invest, we will be discussing that, and we might deviate from that. But as everything looks right now, that is the plan. What should be said is that we are obviously doing quite a lot of, you could say, investments into our portfolio that is in, you would say, traditional R&D spend. So we're investing quite significantly in developing these programs. And these programs consist of were quite significant training material applications in order to track -- track implementations, track progress with our customers and those investments are not here, and they have been growing significantly, and we believe will continue to be a quite significant part of how we invest in our offering. So with that, I'll hand it back to Joacim to provide some additional points here.

Thanks, Christian. And let me then go to some more hands on things, and that is around our core rental business in the years of 2023 to 2025, where we very much believe that core rental will be one of the growth engines going forward. We are already now seeing core rental growing. We are already now seeing us being entered into a number of larger frame agreements, keeping our positions on existing ones. And we believe that the trend for hospitals to be more flexible and tying up less capital is something that will help core rental to develop in the U.S., but also globally in the years to come. And with that net sales development, we also know that there is operational leverage coming from that. We're also expecting a top line growth of core rental to help us to drive operational leverage and efficiency throughout the value chain in rental in the years to come. Service is, as said already now very much on the growth part. We've been speaking about service for quite some time. We haven't really come about to get that net sales going until really in 2022. And we very much look upon the service as a good opportunity for us to drive top line and to drive profitability going forward. What we can see that has changed in the organization is where we much more consider service to be a part of our business approach. We combined our capital sales to much larger extent with the service offering and we are better at offering our customers preventive maintenance, opportunities and speak to our customers about the value add of uptime, et cetera, mainly on the mature markets. But we're also there to provide service when it comes to ours and parts as any service organization, obviously, keeping a good equilibrium between the 2. Here also in service is probably the area where we are already now seeing good traction on price increases and something that will drive both ours and part upwards to compensate for the extra cost that we have received into the system. So that is also going to be one of the drivers of the service revenue and profitability in the years to come. Two more slides -- on this one. And the first one here is around the European Medical Device Regulation that will come into full force latest in the middle 2024, changing from the Medical Device Directive into the Medical Device Regulation. And a number of MedTech equipment will fall out of their MDD certificate earlier than mid-2024. And therefore, they need to be certified according to the Medical Device Regulation to be able to be sold on the European market. The situation is for a number of companies quite dramatic. Around 85% of all MedTech equipment under MDD is still not certified under the Medical Device Regulation. It's an enormous amount of regulatory work left to be done for a number of our competitors. We are very well positioned. We will have all our products, all our relevant products under MDR when our MDD certificate expires and we have that well planned since many years with our notified body BSI. The huge bottleneck here for MedTech companies is apart from the significant cost that it takes to build up the quality system around this is the interaction with notified bodies. And notified bodies right now, if you get a whole of one requires anything from 13 up to 18 months from start to finish to make -- to certify your products and make it ready to sell under the MDR. We have started this work intensely really since we spun off from getting and also before that. And as I said, are well prepared and will be fully aligned with the MDR when our MDD certificate expires. And we believe that this is as it sits right now, an interesting sales opportunity for Arjo because there will be competitors that will not be compliant to MDR. We also believe that there is an interesting discussion to be held around the classification of a number of programs where we luckily have taken the safe route on more or less all aspects -- when it comes to the defined classification of our products, where we know that there are customers -- sorry, competitors that have taken a different route and see how authorities will handle that. So we believe that there is a sales opportunity around the MDR for us. We believe that there is also a profitability aspect to it because it will drive significant cost in many competitors' P&Ls, which will hopefully stop them from being as price competitive as they currently are because there will be a cost to be compliant to the MDR. And long term, we do believe that it might open up interesting possibilities for M&As for us, depending on how different companies will handle the current situation. Speaking about M&A, and the discussion so far has been a lot around the organic journey, and that is also what our financial targets are based on. But I would really like to emphasize on the fact that we are putting a high focus on the inorganic agenda. We are continuing to look upon our inorganic agenda in 3 buckets where we are looking at infrastructure around service and rental and market expansion in local countries. Second bucket, where we are looking at product companies to expand our category leadership to fill holes in our product categories that we decide proactively not to develop ourselves and to find ways and acquisitions where we can generally find positive sales synergies by finding companies that are plugging a hole in our category where we can add the sales contracts and the call points already from day 1. AirPal, as I said, is one of the good examples around that. And then the third bucket, more opportunistic where we get the possibility to analyze and look into bigger plays on the market. That is, as I said, significantly more opportunistic, and we are focusing our daily M&A activity very much on the 2 first buckets. We are a significantly more stable organization today than in 2017, we have a better balance sheet than what we had back then, and we have the power and own muscles to drive a lot, especially in bucket 1 and bucket 2. And we will continue to keep a high focus on the inorganic agenda, well aligned with our strategy, and we continue to say we will not acquire net sales for the sake of net sales. We will acquire things that is very well aligned with our strategic agenda. With that, I would like to spend a few minutes together with Daniel around the updated financial targets that we have set for 2023 to 2025. And they look from a distance exactly the same as the ones that we presented in the back end of 2020 -- in November 2020, 3% to 5% annual organic growth, 23% adjusted EBITDA by 2025 and an annual cash conversion of above 80%. And we also keep the dividend policy to 30% to 60%. And let me walk you through a little bit around the details of these 3. When it comes to the organic sales growth, I would like to say that we have put a balanced target in front of you, a target that is taking into account the current turbulence that we are seeing on the U.S. market with the uncertainty that, that brings with it. But we're also very much look into the healthy overall customer demand that we are seeing. Again, I would like to emphasize on the fact that we have a good pipeline in the U.S. It's not that the pipeline has disappeared. It's just that significant slowness in the process to convert that from orders into -- or sorry, from pipeline into orders, especially around our Arjo Move projects or at the previous call diligent area. We will see a continued good effect of our price increases on top line and obviously on our gross margin also in 2023. And as I said, those price increases will then continue to be maintained over '24 and '25, starting to create a positive delta on our gross margin when we start to see the effect, the positive effect in our supply chain operations. Continued solid development of our core rental business and our service business, as I've been talking to, which will support the growth going forward. We do have our pressure injury prevention solution as a key driver. Christian was talking about that one earlier on, where SEM scanner obviously plays an important role, but also includes a number of other activities, but that will be one of the main growth areas in the coming 3 years. Together with that, the launches of new products, which will help us both on top line but also as we've been discussing before, around the efficiency in our supply chain and in our procurement. And step by step, the introduction of new technologies like WoundExpress. So we feel, again, as a summary here, that this is a balanced target that starts with 2023, where we, first of all, expect an additional decline of core and I just want to mention as we bring it with us into 2023 in Q1, where we in Q1 of 2021 still had an okay sales of Critical Care Rental. Core Rental will continue to drive an upward trend, both in the U.S. based on the one contract and the implementation of those and also in other parts, for example, in the more established markets in Western Europe. We believe that, as I said, service price, the Pressure Injury Prevention solutions, which -- where Christian was saying that we feel confident around having around SEK 200 million worth of additional sales in SEM scanner in 2023 and starting to see in the U.S., but also outside of the U.S., an increase of our outcome programs. For 2024, 2025 kind of the same type of message, we believe that we will have based on the growth fundamentals that we've been talking about, based on the trends that our market is facing that we will continue to see a good demand for our products, but that we also would start to see an even higher interest for solutions that is reducing waste that is preventing things from happening and really, really taking the steps towards becoming that mobility outcome partner. Core rental and service will, as we see it now, continue to grow, and we should add around both core rental and also on service that if we see a decline in capital investments, there is quite often a trend that we then see an uptick, especially in the service side to maintain the fleet that you already have existing -- so we believe that we will continue to see whatever happens a continued positive trend on our core rental and also on our service side. Again, on the product launches that Christian was talking about that will generate top line but will also generate positive effects on the operational leverage in our supply chain. And very much in 2024 and 2025, expecting our pressure injury solutions to continue to develop in a good pace. On the adjusted EBITDA, I would like to put it like this that we are keeping the target. We are, however, moving the target 2 years because of the inflow of the around SEK 400 million of extra costs that both through price increases, internal efficiency gain and obviously, external factors will start to tail off the effects of that over time. But it will take time for us to compensate for that and the continued inflationary pressure that we believe that we will see in 2023. And therefore, we believe that we have a very realistic approach to having an adjusted EBITDA of 23% in 2025 and continuing the journey after that. The improvements in EBITDA will, in our view, start already next year from a percentage perspective, despite the increases that I've been talking to, because of the effects that we are seeing around our price increases and also the fact that we are starting to see the transportation costs go down, plus the internal efficiencies that we are working with. So the gradual improvement will start in 2023 with more acceleration in '24 and '25. Daniel, a few words on the cash conversion?

Thank you very much, Joacim. So on the annual cash conversion target, we stick with the 80% that we had previously. And -- but please remember also that we increased the target in 2020 by 10 percentage points. But we think that going forward, we will maintain the same target level. And also, I think this year is a bit different where we will probably not reach the target, but we look forward to coming back to a good level in the next period. As I mentioned previously, recovery of inventory efficiency levels, combined with further planned improvements that we have in this area that we have kind of been postponed during this difficult time during the pandemic and now also with the turbulence in the supply chain for different reasons. We also continue to have work streams related to the accounts receivable part that we continue to -- where we have taken -- made big strides in the previous years and we see further incremental improvements also on this side. Along with continued solid payables management, we think it's realistic to stick with the 80% target that we posted in 2020 Capital Markets Day. So what are we doing then? Working capital and cash conversion, the outlook from 2022 to 2025. And I've taken here -- we've taken here the offset in -- at the end of last year. And I've specifically pointed out the SEK 400 million, which we believe now is the additional capital that we're tying up in inventory, mainly due to macroeconomic factors that I spoke about a little bit earlier. This means this bucket of the SEK 400 million is made up mainly with semi-finished and finished goods due to material and product shortages that we have experienced during these previous quarters. Logistics delays and material shortages that we mentioned before and also an extraordinary buildup that we expect over time in the next 3 years to gradually go down. For example, through consuming, obviously, the finished goods that we have, completing the semi-finished goods and delivering that out to our customer where it belongs. And this obviously will mean that we will recover the cash conversion level that we had previously to this situation. So some -- just to highlight some key activities that we're working on to improve our working capital and the cash conversion. I'll split that into 3 buckets: the operating working capital. So as I mentioned, we will consume the excess stock. As Joacim mentioned, the stock increase is all -- there's not an increase in any obsolete stock or stock dropping into older buckets that seem in the aging analysis that would be worrisome. So we fully expect all of that extra stock to be used, consumed and delivered to the end customer. We will continue also to optimize shipment flows, which means more direct delivery directly from the factory to our customer without landing in a warehouse in between. And I think that will be a key part also in improving the inventory management. Also, over time, obviously, we are expecting a stabilization of the external flows that have been -- there have been a lot of interruptions, as you know, in the previous quarters and years. On the receivables side, maybe that is the part where we have made the most progress in the last 3 years, and we are keeping -- we're maintaining that good level that we've established in -- you could look -- go back to the end of 2020, also the end of 2021, and we are at a good level, and we've even continued to improve slightly on that even this year. So how do we do that? We have a higher level of digitalization in terms of credit collection tools. We have a higher, I think, level of focus in the organization throughout the organization, working with this in a more frequent way. And also aligned with that is obviously a close collaboration with the customers around credit term compliance and credit term negotiation. On the payable side, we continue also close collaboration with suppliers around credit term compliance. And obviously, that's been key also now during this more turbulent period. But I think we have a very good working relationship with our suppliers, meaning that they know what to expect from us. And most of the time, we know what to expect from them. And I expect that to continue, and we work to further improve that collaboration. So those are the key activities. We have many more activities behind this, but these are the ones that I thought fit in this forum and to put forward. And yes, so those are the things that I think will generate the 80% cash conversion over time going forward. Thank you very much.

Then to -- if this would work, it would be easier. As always, there are potential risks and possibilities that we need to weigh in. I think we've touched upon on most of them. I would like to state again that I believe that the targets we have on organic growth is a well-balanced target based on how we are looking upon the market as of today. And if we can get stabilization into that back to a more normal market situation in the U.S. for our products that we are convinced that we will get, then I believe that we are -- yes, have good possibilities of achieving and do good. There are a number of risks that I believe that we have good mitigation plans for, and that is if we continue to see a shortage of staff within health care that they do not solve that problem. I believe that over time, the interest for our products around caregiver injury prevention and pressure injury prevention, eliminating waste for the system is something that is going to be very vital for health care to implement and make sure that they, by that, start to solve the problem around the staff shortages. And obviously, that as a part of our outcome programs on the overall Arjo Move approach. The lower capital goods investments that we are currently seeing in the U.S. is, again, something that we believe that we can mitigate through driving something that we have started to work on much more actively around financing option, making sure that we also further include ourselves in to risk-sharing discussions with our customers, given that we know the outcome of the programs that we are launching and obviously, also a continued development of our core rental business and also our service business. The continued inflationary pressure that we are seeing, we are trying to assess that on an everyday basis, trying to understand what type of effects it will have. We will continue with high focus to drive price increases through the organization through tactical price increases, strategic price increases to make sure that we continue to work to mitigate those additional cost increases and make sure that those price increases are there to stay so that we generate that positive momentum of our gross profit when external factors is starting to decline. We continue to work with efficiency projects, both within our cost of goods side and also within our OpEx. I spoke about the U.S. rental efficiency, the supply chain 2027 approach that we're having, but also around the commercial excellence rollout throughout the larger sales and service companies over the coming 3 years. And obviously, very important step-by-step development of our outcome program sales, where we know that our gross profit is higher than when we are doing transactional sales because of the focus on the return on investment and where the focus on the price or price per product is less than if you look upon the full outcome of the program. Opportunities that we currently see, apart from possibly seeing a more stabilized market, which I do believe is an upside into this one is the MDR, as I spoke about earlier on, I believe that there is -- it's difficult to quantify, but it will be very interesting to follow a number of our competitors on the European market and how they act based on this. We know that our new approach in pressure injury prevention, as Christian described earlier on with the important part -- with one of the important parts being the SEM scanner has further potential. And I believe it is very interest not only from the more daily work with the different hospitals, but also to monitor how the work will be ongoing around the insurance part, which we know from history was something that kick started our outcome discussions around patient handling a number of years ago. And obviously, as a general term, the quicker health care fully realizes and starts moving in the direction that they are saying is the right one. Around outcome programs, around preventing instead of treating something that they could have avoided, I believe that the sooner that traction starts the better it is for Arjo. With that, I believe we are ready to open up for questions, and then I'll make a short summary afterwards.

Absolutely. By that also welcoming Christian and Daniel back on stage. As before, we have microphones in the room and also welcoming questions from online viewers. And we have a question -- well, multiple questions in the room. Please state your name and who you represent or which outlet you're coming from.

Peter Östling from Pareto Securities. A couple of questions. First, the waterfall diagrams that you showed about the sales development in '23, '24, '25. Does that mean that you are ending up at the midpoint of the 3% to 5% annual growth?

I believe it should be seen as an indicative way to get us to the sales targets that we're having. And as I said, I believe that the 3% to 5% is a well-balanced target. But obviously, let me put it like this. It feels good to be able to present a target under these circumstances where we have a really good understanding on how to get there based on the current market assessment. So whether it ends up in beginning, in the middle or in the upper part, but it's the pipeline that you saw of activities that is taking us well within the interval.

Okay. Great. And then on the EBITDA target for '25, how important is a success within the pressure ulcer initiative. We saw that it's a large part for reaching the sales goals, but I guess there is a lot of costs initially related to that also. So how important is it to succeed according to the hockey stick development that Christian showed in order to reach the EBITDA margin?

Possibly just to say if we reach the hockey stick development that Christian was referring to, then yes, we would probably need to have another Capital Markets Day. But the way I look upon it is that the pressure injury prevention solutions, where the SEM scanner is a part is one of the building stones for Arjo going forward. It is equally important for us to drive our service business is equally important for us to drive our core rental. But what -- the pressure injury prevention side is doing is that it's alleviating leveraging our approach that we currently have around outcome programs. And I think that, that is very much in line with our strategy and something that we would like to drive. But it is an important factor, but it's one of a number of things that it will take us both from a top line perspective and from a profitability perspective. The pressure injury prevention solutions, including the SEM scanner, is a profitable business. for us from a gross margin perspective. You're right, Peter. And I said that when I went to the OpEx side, that there are investments on OpEx that needs to go in to support the buildup of the SEM scanner in 2023 and also to some extent in 2024. The '23 is more a buildup, '24 is more to support the sales that will be there. So I think that 2023 will not be as profitable on that side as '24 and '25 would be, if that helps you.

Okay, a little. Then just remind us, when you signed the agreement with Bruin in 2019, it's plus 2 years, I guess it was. Can you just remind me or us what's happening beyond those 6 years? Is [indiscernible] every year or...

If we fulfill our sales targeted automatically [indiscernible] with that. But it's obviously something that we are discussing very much in detail on a running basis. We have a very close cooperation with BBI. In theory, they have the right to cancel the contract after the 6 years if we don't meet our sales targets. But as the plans are right now and the discussions we are having with BBI, we are addressing it, but we don't see it as a major risk.

Those sales targets or those very aggressive in line with Christian's hockey stick.

They are not in the line of reassemble like a Capital Markets Day again, that you are going to like this.

Just 2 quick ones on M&A before I hand over. The MDR opportunity and M&A, I think you have talked about that for a number of years. Why hasn't anything materialized yet?

First of all, the European Union moved it one year where I don't think that many companies have realized what it actually means. That we are now in a situation where we are 18 months away from the deadline, deadline and for many companies earlier when their MDD certificate expires, has, for some reason, come as a great shock for the industry. There are industry organizations that are kind of now waking up and saying [indiscernible] and now company starting to -- I don't get a hold of a notified body as I used to do because there are only 6, 7 of them that has been certified to audit for an MDR. The normal length of certification is all of a sudden very obvious that it is 13 to 18 months if you get a hold of a notified body. So there is a number of things that is currently being extreme to the industry. And why that is why people haven't realized it before, I actually don't know. We have put it with full focus on our agenda from 2017 and onwards. And as I said, probably before that, he first got a hold of what this means. And we are well prepared -- and as I said, I do expect that this will mean severe implications for a number of med tech providers in our field over the coming years.

And then finally, what's stopping you from doing the one of the major acquisition, you said that, that is more opportunistic. Why is that? Is it still that you see that prices is too high? Or is it something else that stopped you?

Three factors. It should be aligned with our strategy, and I'm not too sure that buying something that is 110% carbon copy of what we are doing ourselves in the category is the best way that would only be a cost-cutting exercise and trying to achieve cost synergies that is quite difficult to get a handle on, while keeping a top line. It needs to be with our strategy. And it needs to be something that we believe and deem is positive from a positive sales synergy perspective. The target must obviously be for sale before we can say it -- and the product has to be, yes, reasonable. And I think that I speak for -- I speak for my management team and I hope that I speak for the Board is that we would rather go for high-quality companies that we know that has a good momentum and a good trend something that we buy -- rolling something that is on a positive development that could add to and where we believe that we can get -- we aren't stopping because we don't have money or anything like that because we believe the companies were this and this, or it's not in line with those strategic intention?

I believe Mattias had your hand up then Victor maybe.

Mattias Vadsten from SEB. I guess if we look on your growth target, I guess you see are you [indiscernible] contribute some 1.5%, give or take. And then especially, I guess, in volume terms, as you would see some sort of higher-than-normal price increases as well going forward? So just some elaboration for Arjo SEM scanner in volume terms?

Yes. I don't think that I have much more to elaborate around when it comes to the SEM scanner volume as such or the pressure injury group prevention as such. But the targets that we had set on the 3% to 5% organic growth is obviously something that is, I would say, Arjo combined and how we see it. And it is also including a view on -- it's a balanced view on a turbulent market in terms of pure volumes in capital sales. So all those things weighed in gives us that we believe that is a balanced view to say 3% to 5% over the coming years. We are also stating that we do believe that if markets are stabilizing, there is potential to do more. We believe that we have pockets in our approach where we can have a more positive trend than what we have produced here, but we're also very realistic around the volatility that we are [indiscernible] on the market. And therefore, we believe that the 3% to 5% is a balanced way of describing how we see the next coming 3 years.

And the next one on top line on the SEM scanner. If you see any immediate competition arising within that field -- and what you believe is a key commercialization risks to [indiscernible]

Christian?

Terms of the competition, I don't see anything. I mean, there's one competing technology called wound vision but that doesn't have any of the [indiscernible] and the major risk to our efforts, I guess, it's the old or the same that I've talked about in terms of to what extent hospitals. And I think this would be different for each individual customer, whether they are able to commit to the change knowing that they will have to set aside time for nurses in order to get this going. But I think also, also to previous questions here, what we've seen is that the SEM scanner isn't any longer to any significant extent sold as a product. It's sold as part of a you can say either technology deployment program where we have on-site presence. And we have -- and even more sophisticated where we also really take part in seeing the outcome. So it's hard to separate the SEM scanner. And relating to the question about the festivity. I think had we just sold it as a box, we would have been more vulnerable in that discussion, but it really comes with the program suite around it. And I do think that it's this staff operational constraints that that's probably going to be -- can either be a significant headwind, but we've seen in recent quarters, actually a couple of large systems doing full implementation. So we are probably -- and with this projection and it came where we're going to think that quite a few customers are not going to be able to commit, but on the other hand, quite a few customers who are doing COVID couldn't commit are now going to say, well, this is actually a way for us to alleviate some of that stress and reduce stress for our staff.

Maybe I want to add on as well. And we've been present together with BBI at the European Conference for pressure injury in Prague and it was held -- and if you would like to understand a little bit more the impact and KOL discussions around subepidermal moisture scanning, I believe it's very worthwhile to look into the posters that was there. It was kind of a -- in Swedish, we would say [Foreign Language], but it turns like it's very bad into English, but it was really a conference where they spend 85%, 90% speaking about the need to scan the subepidermal moisture.

It is really at a point now where the academic debate is over. And we are yet to see that being reflected in latest guidelines. But I mean at that conference, I think there were 18 publications of posters just on this topic. I think there was one on wound vision, just to...

Perfect. And the last one on margins. I mean I appreciate the comments on OpEx as a percentage of sales for next year, but I would assume that you have some inflationary pressure in COGS as well. Of course, you have price against that and I guess, freight rates falling off as well, but you said the adjusted EBITDA margin should come up as a percentage next year already. So I'm guessing we're looking at quite a substantial improvement to the gross margin. So just some explanatory factors here, how would you think about it, how that should be achieved more than what you've said in the presentation.

I hope that I didn't say a firm number on the EBITDA.

You did not.

But I said that the trend was going to go upwards. And I think that there are a number of factors. There is a growth aspect of it in the right product categories. That is going to generate a top line and a slightly better product mix. We have the price increases that will go -- continue to be full throttled during 2023. There are internal efficiency gains, for example, the SEK 50 million in the U.S. rental business that is compensating to some extent or is compensating for the inflationary pressure that we continue to see. And we will need to work very, very diligent in those areas to continue to mitigate. And what we are -- have introduced now in terms of price increases is something that is being worked on as we speak to make sure that we see that, which I did mention in my presentation, the above 1.5% of price increase effects on the top line growth next year. And then working with a number of activities to make sure that we are mitigating where we can on the OpEx side. I think that the OpEx as a percentage of net sales will probably go up next year, but it will be a slight increase that I believe we can mitigate on the full profitability side.

Perfect. And then the last one, I don't know if you can comment on this, but I will try. At what share of operations can you change prices already into 2023? And at what share do you have to wait, let's say, 2 to 3 years just to get a sense on it?

It is a very time-consuming process to increase prices, especially when you are stuck in frame agreements and we have long-term contracts with GPOs, et cetera. But -- what -- and to give you a flavor, if you want to increase usually -- NHS in the U.K., they never allow you to increase prices, but this -- or in 2022, we have been [indiscernible] in to discuss prices. And that is an activity that we started with full focus already back in Q1. We agreed [indiscernible] agreement on the, I believe last day of July. And then they start putting orders that is then delivered. So that is kind of the sequence of events when it comes to price increases into frame agreements. So -- that is why I believe that we will have a significant rolling 12 effect of the current activities that we put in. But on top of that, we are driving additional price increases. And areas where that is easier is, for example, around service, where it is a -- and has been so for years that as long as you can sort of say, motivate through showing what inflation is all about and why you're coming to a certain price increase, you can get prices up for parts and also for ours in service in a quicker way. Then you can within frame agreements, for example, in rental or in capital equipment. But we're also putting in a number of internal processes. It is around price leakage. It is around making sure that we are limiting the, so to say, the decision margins that we are allowing the organization to have. So challenging the organization to make sure that we are closing deals on less rebates or less or on higher margins. So there is one component, which is the external side, and it's one component, which is the internal price leakage side.

Victor, please go ahead.

Victor Forssell with Nordea. I appreciate the insights on the inflationary pressures here today. My first question comes a little bit on the back of the recent discussions here. I'm guessing what's new in terms of these material prices for you increasing or your expectations of them increasing given, let's say, the last 2 months or so back in time. Isn't the risk that -- I know that you have a lot of pricing efforts in place and are adding that as well. But isn't the risk here that we will see a lag at least in the first 2 months of next year that perhaps will delay sort of any gross margin recovery from current levels? And also, if you could just explain your expectations around transportation costs remain so much higher than 2020 levels.

Yes. If we start with what is currently driving material cost, as I tried to explain in the presentation, the first part of the material cost was very much driven around the commodity side where you saw [indiscernible] go up that drove prices up in the first place. [indiscernible] taking on -- while seeing that commodities is starting to come down and you're quite often exposed to looking down with this, and this has happened there is that due to well, see high levels of material. We also see the material price continue to go up, and it's driven by the inflationary pressure on our sub suppliers, mainly the salary aspect and also the energy aspect. That is making their equations very, very difficult to getting us to increase the prices. I mean I believe you've read, I think it was bigger -- significantly bigger companies than us like AB Volvo that spoke about the fact that they're [indiscernible] sub suppliers to even survive under these [indiscernible] that is countering the , I would say, step-by-step decline of commodities. And I believe -- we believe that, that is an environment that we need to live with throughout 2023, that we need to continue to compensate for with additional price increases going forward. When it comes to the gross margin side, one thing that should be said on Q1 and Q2 and that I would like you to reflect upon when analyzing is the product mix effect that we will have. In Q1 due to that is the last quarter -- forever. I tried to make the formal speak about critical care rental. Again, there is where you will have the final drop of that one, which will have a product mix effect in Q1. But apart from that, what we are seeing, given that we are now [indiscernible] first quarter, we're seeing the -- not the full effect, but the effects of the price increase is now made, compensating for the SEK 150 million of material cost from Q4. That is obviously [indiscernible] that is carried through, not only that carried through into Q1 plus the additional little bit we are caring. So I am -- and on top of that and the fact that we are -- and that goes into your third question around transportation, why transportation, why we don't feel the transportation will go all the way down to where it was in end of 2020. Transportation will start to decline. And we can't give you a specific number here and now we'll try to be more specific around these things when we are releasing the Q4 report, and we look into next year. But that transportation costs will go down despite the fact that fuel costs are high and where there is a shortage of truck drivers and there is an inflationary part of that. But overall, transportation will go down. The reason for saying that in -- also in the beginning of 2023, the reason for us saying it will not go back to 2020 levels is more a -- we always hope for that, but I think it's a cautious view to say that, that was extraordinary low prices that we had back then. We had a global system that was in brackets working significantly better than it is right now. And I believe that we will have -- we believe that we will continue to have geopolitical disturbances, a continued awful war in Russia -- sorry in Ukraine that will affect these things. That is not in short term, pushing the whole transportation levels to where we were in 2020. So it's more a realistic view from our side.

Just final one for me. What type of capital sales expectations do you think is feasible to have at this stage for what you're currently seeing? You talked about the dividend programs as a main issue here in Q4. But isn't the risk on the transactional side as well, starting perhaps in the U.S. following into European region in early parts of next year. So how much of that is sort of embedded into your own expectations for the coming quarters?

Maybe not specifically on the capital equipment side, which we do believe from a global perspective, we will continue to grow also in 2023, however, not on the highest levels. But if you exclude the price increases, just on the volumes. I think we will be -- what we are expecting is a more moderate volume development on the transactional side going into 2023, but obviously, with the price component and making the value of capital sales on an interesting positive side, which I have tried to underline what we have done when looking into the financial targets and the 3% to 5% of organic growth is to give it a balanced view of how we are based on today's information, how we are seeing the development in the U.S. over the last 3, 4 weeks and trendlining into what could be expected into 2023 looking into based on the experience that we have, what could be the next steps in Europe and then trying to find a good equilibrium that gets us to the 3% to 5%, right? Yes, I'm not in any way stating that we have covered all the risks into that one. We haven't covered all upsides either, but this is an analysis that we have done based on the information we have today and the experience that we can add to those events that we've seen, for example, in the U.S. now in the last 3 to 4 weeks.

Kristofer, please, in the back?

Three questions. One is if you could comment how this previous AirPal acquisition is doing and if you have reached your target. On WoundExpress, you're changing the criteria in the studies. So I'm wondering if you see that as a -- if that impacts the risk related to outcome and what you could be able to claim? And then on the SEM scanner, the sales for this year. Could you maybe explain a little bit how -- from how many customers that are coming from? And the sales in the Q4, is that customers that were signed earlier that are just buying more? And also it seems that the target of selling for SEK 200 million next year doesn't assume so many new customers, if that's true or if I'm missing something.

Christian, if you prepare the answer on AirPal and on WoundExpress, I'll give a very political answer on the SEM scanner side. When it comes to the SEM scanner sales, it is -- I can't give you the exact number of customers. But as Christian was saying, it's mainly larger hospitals in the U.S. where we have started with a part of those hospital chains and where we believe that we have a good potential of growing SEM scanner sales in those facilities or in those networks. The total sales of the SEM scanner Pressure Injury Prevention Solutions that is added to the around SEK 200 million that you have here. That is, again, a balanced view based on what we see today. If we talk about a carryover effect of, let's say, the SEK 50 million or the SEK 40 million to SEK 50 million that we're talking about, we are ending up in a fairly interesting number in 2023. So also here, I would probably like to say that it is a balanced target going into 2023. And if you can comment on the AirPal and also a little bit around the WoundExpress side?

Yes. If we start with AirPal, I think we certainly consider that as a successful transaction we completed. And I mean, I don't know what -- what measure you would like that answer, but I think in terms of net sales within that category, remind you, we had a -- we did have one product in that portfolio in the past. There was a suboptimal or did meet all the needs in the market. I believe now we are turning over roughly 3.5x what we did prior to the acquisition. So we have grown that substantially and it's really been a one of those gaps in the portfolio, if you look at patient handling more holistically that you are talking about an ideal type of transaction for us to do. We've still -- and we are working on and the majority of all this comes from North America, and we are now in a phase where we are broadening the access with getting through the necessary registrations for the product to other geographies. So I think on all accounts, we consider that as a quite successful transaction.

Sorry, just the 3.5x higher sales, is that before what you had before or what this company had before?

Before what we had, if you combine what we had, but with what they had when we acquired them, I think we would probably be up a little bit more than 2x, maybe 2.5x, we have very little. And for WoundExpress and the question was in relation to is there a risk in terms of the outcome or expected outcome of the RCT. We don't believe so. We've obviously been very careful in this decision given that the RCT in itself is a major investment. So these 2 types of wounds, so where we initially, we're just looking at one -- at the strictly venous leg ulcers were now also including the mix arterial leg ulcers. We've done, as I said, like sample evaluations and achieved incredibly similar healing results and thus do not see that as a significant risk.

Thank you. I think I see no more hand -- yes, one more. Sorry. Rickard?

Rickard Anderkrans from Handelsbanken. So looking at the core rental business in the U.S., can you quantify the market share and a little bit of how the market share dynamic has been moving since the spin out?

Wouldn't be able to give you a market share figure, unfortunately. When it comes to the market share development, we know that we are currently taking contracts away from main players. And what -- without speaking, it is Hill-Rom accounts to an extent that we and others are eating our way into. If we take the HealthTrust contract, for example, was a contract that was solely owned by Hill-Rom up until the decision was made and the go live now on the first of October. So Hill-Rom if I were to deem them how the market share development is, it's Hill-Rom losing and us and maybe 1 or 2 others are gaining market shares based on that.

And how are Hill-Rom sort of counteracting on those moves?

Now that is the difficult thing to understand given the new leadership of Hill-Rom being a part of Baxter. And that we are still trying to fully understand why Baxter did the acquisition of Hill-Rom. We are hearing signs that they are adding on to their cost-saving program and speeding that one up. And we know from experience that seldom is a good sign when it comes to the part that has been acquired. But again, it is their business, and I shouldn't analyze their business. What I do know is that we are taking every opportunity we have to based on a good traction that we have created in the U.S. around and really partnership that we created during COVID times to try to get as much of that cake as we possibly can. And we are significantly better equipped from an organizational perspective from how we are set up when it comes to our rental depots, the way that we are using our rental fleet and building up our rental fleet in the U.S., we are prepared to continue to eat our way into the market share side of things in the U.S.

And just a final one. On Home Care, it's been an area which has been seeing a large proportion of investment in recent years. Can you talk a little bit about the strategy, how you're thinking about that category overall, particularly in the U.S.

Would you like to take it?

Yes, sure. Sure, Well, I mean, Joacim had this page of showing the different patient population. And while it is true that you are seeing or a need to have a significant higher volume of individuals to -- in that care setting. it doesn't mean that the volume in either acute care or long-term care is going down. So just to make that clear, it's not like we are not being exposed to, you could say, fundamental growth in the segments where we are focusing. What we are doing for Home Care is, as we've stated a number of times before, it's a tricky business for us to be profitable. And typically, if equipment placed in Home Care, the nature of the equipment given it's only used with one patient doesn't need to be very -- of very high quality to perform well in that environment. So generally, there -- we would be, you could say, just simply too high quality, too high price. There are, however, a number of -- especially when you can find, you could say, some kind of an aggregator so that you aren't dealing directly with an individual. There are opportunities but we tend to deal with these more locally, so in Canada. They are doing this with communities where the community owns a pool of equipment and they use that in individuals homes. So that is a possibility, but we don't see it being an interesting segment for us to develop specific products that we would have to, have to have margins that are way lower than the ones that we have today.

And just a final quick one. If you could elaborate a little bit more about Japan. Obviously, there's been a lot of talk since the spin out that Japan is going to be a big potential market, but things have been quite sluggish for several reasons. Could you elaborate a little bit on the sort of midterm outlook there and particular drivers for that market would be interesting.

Our overall view of the Japanese market remains and the potential that the Japanese market brings. It is a market where we put a plan in place in 2018 and 2019, committed to a growth and investment plan that was looking at truly driving both market presence, product registrations, et cetera, in Japan over '19 and '20. And thereby starting to see the sales growth being there on a good way. COVID came and for quite obvious reasons, we got a fairly abrupt halt to that expansion plan given that we were just entering into the market. We didn't have an established place on the market. We saw a very, very, not a very, very, but we saw a lower -- significantly lower-than-expected levels throughout the COVID. What we are saying -- what we are seeing now in 2022, which we have been talking about also in the Q1 report and the Q2 report is that we are back on track from a percentage top line growth. Also in this quarter, Japan grows well. And it grows on the back end of the existing product registration in pressure injury group prevention in DVT around our medical beds and where we're also starting to address both ceiling and floor around our patient handling side. We're also building our Japanese organization proactively. So if -- it's not that we are earning a significant amount of money in our Japanese operations, but we are convinced that the investments that we are doing now and we will continue to do over the next coming years will make Japan that important market for us that we spoke about back in 2018, 2019. But I can't give you an exact number, but the belief and that the market is there, absolutely.

All right. We have one more question. Peter?

Sorry, a quick one, Peter Östling, Pareto. Maybe I misunderstood you or misheard you, but when you talked about the manufacturing and maybe the potential to move manufacturing to more low-cost countries outside Eastern Europe. Could you -- if it was -- if it wasn't a misunderstanding or I have misheard you. Can you talk a little bit about what you -- elaborate a little bit about that and the timeline? I guess it's post '25 since you didn't have it on as one of the measures for reaching the '25 goal.

I need to stop you there because it is a little bit of a misunderstanding. We do not have the intention of moving our production from Eastern Europe, it is the supplier base. So being very, so to say, West Eastern Europe in terms of a supplier base. I believe that we have a good potential of seeking supplies further east and further south. But it's not about moving our own manufacturing.

I think that's it from questions in the room, and we do not have any questions from the online audience. So thank you, Christian and Daniel. And with that, I'm going to hand this back to you then Joacim for some final remarks and the summary.

Yes. Very good. And I promise to keep this one short. For all of you in the room, I can just repeat that, you know where we live and for those of you online, you know where we live. Please contact us if you want to have follow-up discussions around what we have presented here. And do that through [indiscernible] and the team. Just some summary or a summary slide. On the Q3 2022 performance, there is a solid underlying growth. We are in the quarter, heavily affected by the SEK 11.5 million critical care rental drop that is affecting us both on top line and on profitability. The underlying growth of the group, excluding that, is around 5%. We continue to see a healthy demand on most major markets but we do see a volatile U.S. market that we absolutely have to take into consideration both when looking at the full year of 2022 and also when looking at the target set for 2023 and onwards. We have a significant cost pressure that has been hitting us over the last 15 months. We are fully focused and committed to -- with price increases, both tactical and strategical through internal efficiencies and through progressing around our mobility outcome journey. We will make sure that we, over time, mitigate that and that we make sure that we meet our financial target of the around 23% of adjusted EBITDA. Our long-term strategy as I try to articulate, is more valued today than ever. It is our view the solutions to many of health care's current problems, and it is a strategy that we will continue to drive with full force over the years to come. And I feel with the -- in my view, based on the information we have today, well balanced new or updated financial targets, I feel that we have a very realistic approach to reaching those financial targets and making that with a highly committed new management team and also a highly committed organization throughout Arjo. With that, a big thank you. And well, have a very nice weekend when it starts. Thank you.