One Health Group Plc (OHGR.L) Earnings Call Transcript & Summary

Good afternoon, and welcome to the One Health presentation. [Operator Instructions] For now, I'll hand over to Adam and Derek.

Thank you. So just a quick introduction. My name is Derek Bickerstaff. I'm the Founder and Chairman of the One Health Group.

I'm Adam Binns, CEO of One Health Group.

So what is One Health? Well, One Health provides medical services to the NHS, specifically we provide elective surgical care to deal with the enormous waiting list, as I'm sure you're aware, is present in the United Kingdom. We do that work through a contract which we gained in 2012, called the Any Qualified Provider contract, and that allows us to take patients referred to us directly from the GP through patient choice. We then take the patients throughout the whole of the pathway of care. The type of specialties we do are orthopaedics, spinal surgery, gynaecology, general surgery and more recently, urology. And if you exclude ophthalmic surgery, that accounts for about 80% of the waiting list. And we provide this service, which we think is from a unique model, which is different to the other independent sector hospital groups. We take the patients out of the hospital into the community, which is one of the aims of the government with regards to returning patients back to care in the community. So we take our subspecialist surgeons out into about 40 community clinics that we have and then if they need surgery, they go back into 12 secondary care facilities for operating and then they're back out into the community again for their rehabilitation and then final discharge. This work is heavily supported by the government, and they've repeatedly said that they will be looking to the independent sector to deal with this enormous waiting list to use as much capacity as is possible. And they have a target. They set themselves the task of getting 92% of patients being treated within 18 weeks by the time of the next election in 2029. Bear in mind that this target has not been achieved 2015. Presently, we have 7.4 million people on the waiting list and to get down to this level of 92%, that means we need that to get down to 3 million people on the waiting list. So we've got to get down 4.4 million people and also treating those people who are adding to the waiting list. So this is a gargantuan task. But we believe and will explain why One Health is ideally placed to be able to help them with this. We'll show you later in the presentation about our organic growth and how that is consistent. And we'll also discuss with you our strategic growth, which fundamentally is owning our own surgical capacity with a growing network of surgical hubs. We floated on aiming March of this year, and we have sufficient funds to be able to fund the beginning of our surgical health. Adam?

Super. Okay. So running through some numbers related to the first half of this year, I shared the interims this morning. So over the first half of the year, we've seen just over 9,000 new patients. Now those 9,000 patients with around 4,000 surgical procedures. That's typical. On around 40% of new patients require surgery, 60% don't. That's a typical ratio of inpatient to outpatient as we call it. To be clear, in terms of the value of the activity, the bulk of the activity is in the inpatient work, surgeries, the outpatient, which is consultations is relatively low but high volumes. As Derek touched already, that work in terms of surgical procedures is carried out in 12 independent hospitals. They're primarily part of large groups like Circle, Spire, and we're working with Ramsay at the moment to develop a good relationship, but into well-established hospitals local to where we operate. In terms of the way we do that work, we have an employee workforce of 50 in One Health Group, but all of the work in terms of consultations of consultants and anaesthetists are subcontracted, around 130 in total. All of these consultants are full-time NHS, and we buy their spare time, which is allowed within the NHS contract since it was established. In terms of the first point of contact for a patient, it in one of our 40 community-based outreach clinics. Now an outreach clinic is typically a GP surgery or a health care center, where we rent space by the half day or the hour or the full day. These are very, very flexible, very quick setup, but equally quite quick to close down if not affected. So it's a very fluid number, although it's been 40% of last year, and we're working to maximize the efficiency of those sites one by one. We'll talk about KPIs later in the presentation, both operational and financial. We've had a very strong year so far and very much reflecting the performance from the back end of last year, H2 flow-through in terms of organic growth. So very quickly turn over GBP 15.6 million in the first half, the last half year was GBP 13.3 million, organic increase of 18%. We expect EBITDA full year to be in line with previous market expectations have been shared. And to be clear, a question we often get around the nature of our contracts, we operate with around 60 different commissioning bodies. They could be ICPs, hospital trusts or noncontracts, quite complex makeup. And in terms of the surgical procedure where the value is, there's been a 17% increase half year to half year. That very much reflects growth of capacity within existing independent hospitals but also the addition of more half year to half year. Cash, as you'd expect, after an IPO in March is GBP 10.9 million, more than enough to fund the first surgical hub and leaves a headroom of around GBP 1.5 million to GBP 2 million post build. And we do generate a lot of cash. We're a very asset-light business at the moment. Most profit converts to cash. We pay dividend, and we are profit making clearly. On the next slide, talking about patient choice. Now patient choice is one of the best kept secrets in NHS. Since 2009 under the Blair's government, NHS patients have been given the right to choose their provider of care. They used to be just NHS trusts and then it widened to NHS on a wider geography, almost was full, but then independent sector provider introduced that list, which includes One Health. This is key in terms of business growth. So we work very hard on promoting patient choice to patients specific GPs, but also the government supporting that campaign more recently through a number of initiatives, particularly as the waiting list has been stubbornly high for a good 3 or 4 years now. To be absolutely clear, there is no cost to the patient. All activities paid for by the NHS we provided for free. That's consultation, surgery, diagnostics, everything. There's no charge to the patient. And the way we are paid is against something called the NHS standard tariff. This is effectively a price list and every single touch point with the patient from consultation to knee replacement, hip replacement, hand surgery, every single thing has a price. And that price is established every year, the financial year from April through to March and is reviewed in line with inflation. A very good example of that will be last year when the junior doctors first went on strike now called resident doctors, there was a pay lift awarded, which has been talked about by West Street. That was directly reflected in the tariff, and we got a half year uplift of around 2% to reflect the impact of that labor increase to the trust. So we don't do private self-pay, it has a key message. We entirely focus on NHS patients and helping reduce the national waiting list. Very importantly, Derek touched already, the government has set out in its agenda at the end of this parliament to get down to 92% waiting less than 18 weeks. That's a huge task and can't be done without support of the independent sector. Now looking to the right-hand side of that slide, what I've tried to show you there is the allocation of our revenue down to cost level, very high level, but give you an indication how it works. So in a typical hip replacement, which that is based on the GBP 7,500, you see a large proportion goes to independent hospitals which then provided fully end-to-end service for the patient admission due to discharge back into One Health. The patient remains a Health patient throughout. We then pay the surgeon a fee for carrying out activity on a piece -- part basis. Diagnostics and Physio are paid for in NHS. And then what's left is our gross margin around 90%. This half year, very pleased to say it's around 20%. We've made some really good improvements on not only cost control, but also the mix has changed towards heavy orthopedic procedures like hips, knees and some spines. They carry a greater percentage margin. So this is a [indiscernible] patient pathway. So we get patients referred in from the GP, and this is done through an e-referral service and that's basically like a Google search. So patients will look -- if they go see their GP and they're told by the GP they need a hip replacement, they will then look on the ERS or Google search to find the nearest clinic that can offer that service. Because we work in 40 clinics, we score very highly on that. So we get lots of patients who choose us. And particularly because on there, we have our waiting times as well, which are also very short. So patients are referred through to On Health. And then the patient is then picked up by our administrative staff and the patient is booked into a clinic, which is near to their home for the special -- the appropriate specialist for that problem. So our subspecialist surgeon goes out to see them in the clinics. We run an electronic patient record and all the imaging are available to the surgeon wherever the location of the clinic. So patient is then seen by the surgeon. They might need more investigations. And if they do, again, these are done out in the community with third-party providers. About 40% of our referrals will need an operation. And if that's the case, then the surgeon indicates what the outcome is and our administrative staff then books that patient into a hospital, which is appropriate for that type of cases being done as near as possible to the patient. So the patient then really only needs to travel outside of their local area for the surgical treatment. And then after discharge, they're back out into the community, they're being seen by that surgeon again, and all the rehabilitation is done back out in the community. So we own the whole of the patient pathway from referral right the way through to discharge. So why do people -- why do patients choose One Health? Well, the most obvious reason is very short waiting times when compared to the -- to what's offered in most of the national health service units and also it's local to patients. And again, this is ticking the box with regards to government directives to moving from a hospital-based service out into a community-based service. With regards to continuity of care, the patients are seen every step of the way by the subspecialist surgeon who saw them at the first occasion. So the patient isn't handed on to registrars, staff grade surgeons, consultant nurses, et cetera. They're seen by one person throughout the whole aspect of their care. We operate in very comfortable inpatient environments, lots of parking that's well liked by our surgeons -- by our patients. We also have a very good patient liaison team who will manage the whole of this pathway. When a patient joins the beginning of the pathway, they're given a named person who will guide them throughout the whole of the pathway going through to the end. And it's not surprising, therefore, that when you look at our quality of care metrics, they always score very high and there we have 98% of postoperative patients are likely or extremely likely to use One Health. So we're very proud of the service that we use. So moving on to the growth drivers. There are 3 main growth drivers for One Health. Have we got enough patients? Have we got enough surgeons? Have we got enough operating capacity? So firstly, patients. Last year, we had a 28% increase in referrals to us, which we're extremely proud of. This year, we're standing at 16%, Again, great result for us. So we're getting patients -- plenty of patients referred to us and increasing number of patients referred to us. Patients generally refer to the patient choice mechanism, which is increasingly being recognized by the public and is being pushed by the NHS and has been pushed by the Department of Health. They're incorporating this into the new revamp of the NHS app. So we have no shortage of patients out there. The waiting list is standing at 7.4 million. We get the second bite of the cherry as well because patients are obviously referred into local trust hospitals. But because of the demand on those services, the local trusts have increasing waiting times. So by the time they come to the end of the year, they start off loading those patients. And we have -- certainly last year, we had a contract with 6 local trust hospitals. So those patients get referred back out to us by the trust and then they just get plugged into our clinical pathway and are seen in that way. We are constantly -- our organic growth is constantly because we're growing the geography. And as we grow the geography, we just come across more and more patients who are referred to us. So next slide is the, have we got enough surgeons? Well, the answer is yes, we do have enough surgeons. We're constantly enrolling surgeons. At the start of One Health, it was more we were chasing the surgeons, but now that we're established and we have such a good product that we have surgeons coming to us. We also have surgeons in the pipeline who are going through our onboarding process, which is a very important process, making sure that they fit into the ethos of One Health of what we're trying to achieve. Surgeons like our platform. I'm a surgeon myself, and we like to see patients. We like to operate on patients. We don't like admin. One Health take all the admin offering. Also, we see -- we operate in areas which are relatively poorer. So there's not a lot of private medical insurance. There's not a lot of self-pay patients. So the consultants don't have access to those patients or if they do, there's a lot of competition from other consultants. So what we provide them, however, is that we can fill the rest of their clinic, we can fill the rest of their list with NHS work. So it makes it worth their while turning up for clinics list. And they're also paid per item of service. So every outpatient appointment, every operation they do, there is a fee that they gain for that. So they like the model. And one of the additional things they like about us is we have a very robust clinical governance program, which is like a warm blanket around them so that they know they're protected by us because we have all the data on their work. They also work with their colleagues. So for instance, we have about 8 or 9 knee surgeons at the minute working for us. So if they have a difficult case or they want a colleague to work with them on a difficult case in the theater, then they have that available. So surgeons are very, very keen on the type of platform that we provide them. So finally, do we have enough surgical capacity? Well, we're constantly growing this. We've got 17% increase in surgical procedures in this first half year. And also, we're constantly adding new hospitals to this network. Recently, we've added a further 2 hospitals. However, because the workover of a very wide geographical area, we do find that there are some areas, particularly in the more underprivileged areas where there's relatively poor NHS provision and there's no private provision. Because they're poor areas, independent sector hospitals won't open a hospital there because there's no private or self-pay work. So it's in these areas that we're going to drop in our surgical hubs, and this is part of our strategic growth. We've got our organic growth, which we will carry on regardless. So this is our strategic growth where we're going to open a surgical hub, which will increase our capacity in that local area. We'll talk later about the hubs and our progress with that. What we're describing today is outsourcing, which is predominantly what we do. There is also some in-sourcing available with the NHS trust. We tend not to work in that, but we are in consultation with a couple of trust with regards to help them out with their own surgical hubs, which they are finding difficult to manage. So that's an ongoing work. It isn't anything that's going to happen imminently, but it's something we are always looking at.

Okay. So let's talk about operating geography and where we are today, where we're going to go next. The map on the right-hand side there shows the dark blue is our current operating footprint. I'll talk about the exits in a second. The orange is aspirations within 3 years. We're making some good plans there already, predominantly driven by finding more independent hospital capacity. We then put our [indiscernible] around that and grow. And then within 5 years, we expect the yellow areas. And again, early conversations taking place with independent hospitals in those regions. Key growth, and Derek touched on it briefly a second ago, is the nature of the demographic in that area. These areas with relatively high population density and a high reliance on NHS support, very low private medical insurance uptake or ability to self-pay, so not affluent areas, model wouldn't work in affluent areas and high local NHS waiting list. Now pre-pandemic, it was possible to isolate parts of the country with high lists and low lists. The cold hard facts are at 7.4 million. There aren't many low lists anymore. So regions with poor ability to self-pay are target areas for One Health Group. [indiscernible] as well, again touched on briefly is making sure there's no -- there's insufficient capacity for surgery by either the NHS through their own trust or small hospitals or other independent hospital groups. There's no quick tick in any activity around there, it's just already taken. So talk about the exits briefly. There are 5, 6 marks on that map. These regions we've highlighted for growth and activity. The light blue one is one we'll talk about in more detail. This is our first surgical hub in Scunthorpe in North Lincolnshire, an area with high demand and low supply. So what do we mean by a surgical hub? Well, what we don't mean is a hospital. We don't need a hospital because most of our care is out in the community. All our consultations, diagnostic and rehabilitation is in the community. So a surgical hub for us is an operating theater, a recovery room and 12 beds, and that's it. We will be putting through that high tariff work like hip and knee replacements. And because we're limiting the type of surgical procedures in this place, we become extremely efficient and far more efficient than in other areas. What we're not doing is taking over an NHS facility. We're not taking over and running an NHS hospital. This is new bespoke capacity. And the surgical hubs aren't a new thing. They're been a revolution internationally, and it's heavily supported by the Royal College of Surgeons. And the governments are also heavily supporting it because it takes the pressure off the local trusts who have their beds taken by winter pressures and the viral illness or whatever. So we believe we've got a following wind behind us. And as I said earlier, the NHS is looking -- the government is looking to the independent sector to be able to provide increased capacity for the management of the patients on the waiting list. And you will have seen recently in the press whereby they're looking again at how the independent sector can bring in capital investment to be able to provide the capacity. As again, these are in the poorer areas, the one where there is high patient demand. And again, just to reiterate the point, this is not -- we're not going to tamper with our organic growth at all. This will carry on regardless. This is additional capacity for additional patients.

Okay. Some detail on what the surgical hub actually is. And this is based on the current plans for [indiscernible]. So on the right-hand side of that slide, a very quick run through. That's the piece of land we've already bought. So the cash position at the end of September reflects around GBP 800,000 already having gone out. So you see there's plenty of cash there. On the bottom of that field, if you like, at the moment, is the surgical hub itself, the construction. It's a single laminar flow theater and 12 rooms. To explain why there are 12 rooms is at its peak, it will see 6 patients in 24 hours. So a patient will come into the hospital in the morning, check into a room and ready for surgery that day. They'll have the surgery during the day, go back to the room for recovery and the following morning, 6 more patients will come in. So at the outset, we're basing the modeling on 4 patients a day, which will generate GBP 6 million of revenue per year. Just to repeat the point, this is on high tariff activity, so hips, knees and simple spinal activity, all high-tariff procedures. So that's the reason of 12 rooms and a single operating theater, single level -- single story level, but very, very efficient. In terms of staffing, because it's a relatively small unit, it's a fairly low headcount. We've got 20 employees staff across 24-hour operating window. Clearly, with patients staying in beds overnight needs to be covered. So we've got cover over that period of time. We've got a very highly experienced builder engaged already, contracts signed, ready to go. Total cost, including land and VAT is around GBP 8 million to GBP 9 million. I can reassure anybody listening that we are within 1% of that based on latest estimates and those are well advanced in terms of final costings. And we expect to be delivering activity within 1 year at the start of construction. Now one of the benefits of the One Health model and the way we can attract patients through the ERS system and GP surgeries, once we get a confirmed start date in terms of availability to use the hub, we can start building patient waiting lists and in fact, booking patients into slots in the hub in advance so we can create the demand at the front end to meet supply at the back end well in advance of opening. So to repeat the point, initial capacity will be a 5-day working week. We cover 1,000 hip and knee, all simple spinal procedures, around GBP 6,000 per procedure, so it varies based on complexity. That's an average. So revenue between GBP 6 million and GBP 9 million based on the operating window. The important benefit as well as the operational growth is the margin benefit. So today, as you saw in the interim accounts, we make around 20% gross margin. That's up from 18% 2 years ago. We can see 30% to 31% by effectively internalizing the margin we pay the independent hospitals today on a comparative basis. To repeat, we're not taking work out of those hospitals. This is all new strategic growth. Organic will continue in the background. And we expect to be earnings enhancing in the first year of operation. This will be a very efficient, very quick to start model. So in terms of what does it look like, there's impression based on the building in Scunthorpe. I would argue quite an attractive building, level single story level in a much needed area. So where are we with our first hub? Well, we had the planning application granted in July. We bought the land in September. Part of the planning, however, had certain provisions that needed to be addressed before we could put a spade in the ground. And they have largely been dealt with. Five have now been discharged. One is about to be discharged. There's one that's still ongoing. But again, we put the information in there, which we are being told will be sufficient. We were expecting to get a phone call on the 26th of November, which unfortunately didn't happen. And then again on the 29th, and again, it didn't happen. Adam and myself were hoping to be here today to say that it started, but we are literally expecting it imminently. So we have the funds available, the planning is approved. We've got all the holdings up and erected. We've not wasted time because before you start construction, you've got to get supplies delivered, things like that. So that's now all in hand. We're also working on how we're going to staff it. And again, because the local NHS Trust Hospital has downsized, there are more staff available. So again, we're already engaging with people. We found -- we've also identified 2 further sites for the second and the third hub, one in West Yorkshire, one in South Derbyshire. And what we've described to you is a blueprint that we will just then be able to drop in with the same -- exactly the same type of facility and drop it into these new pieces of land. So highlights. So highlights, well, Adam will go through the figures with you later, but the operational metrics and the financial metrics are all little green. We've increased our revenue. We've increased our patients and our profitability is in line with expectations. We've got plenty of cash. We're a very cash-generative business, but we raised GBP 5.6 million at the IPO, and all this is going towards our first hub development, which is GBP 89 million, including land. If you look at our cash flow for the period, where we've got plenty available. There's no issue. So we've got all the money in place. Again, we've increased our dividend slightly, and we've already talked about the planning approval and the further slide. So a very positive first half year. And although we can't give you the results for the third quarter, again, they are looking very positive. Okay, some details. So these are the metrics we use internally for measuring performance of the business, both operational and financial. Starting with operation. So clearly, new patient referrals are important. That's the front door of One Health. So just over 9,000 in the first half, 16% up on the same period last year. We've also shown for the record the improvement full year to full year from '24 to '25 on the right-hand side of that slide. So the point I made earlier was this is really a continuation of H2 '25 activity into '26. It's been very pleasing. Now those new patient referrals, obviously result in consultations. That's a number of first consultations and then follows postoperative. So around 2:1 ratio. That's fairly typical. And again, comparable growth on that front. Number of surgical procedures. You may remember earlier in the presentation, we talked about 40% conversion. That's fairly typical and year-on-year between 40 and 45. So 4,000 surgical procedures carried out in those 12 independent hospitals that we use today, really good productivity there. The other point to make there is the outreach clinic, which is the front of One Health, which is these typically GP surgery health care centers where the consultant travels out to community to meet the patient has grown as well by 8%. But what I would say, if you look at the growth in outreach clinics compared to the growth in new patient referrals, we're clearly getting a lot more efficiency out of rather just the total count increase. So that's been really impressive. Registering consultants, many months ago we used to be chasing consultants to grow the business. We're now accepting and holding many. They come to the group and ask to provide their services. Just to repeat the point, these are not employee consultants, they're subcontracted. We buy time from their spare time then scheduled as and when they want. There's no obligation to provide work or vice versa, but we see a really strong interest in providing services to One Health. So operational KPIs across the board strong continue to the end of last year. On to financials. Already talked about revenue in terms of size, but 18% growth so far half year to half year compared to 23% full year to full year last year. So you can see again a continuation of strong organic growth into the first half of this year. I talked briefly before about the growth in gross profit percentage, not shown explicitly on that slide, but the 3.12% versus 15.6% is around 20%. That's up from 17.4% back in 2024. So good, strong growth. A bit of that is mix. We're doing more high-volume orthopedic activity, which carries higher percentage margins, but also good work by the entire One Health team to reduce costs, operational cost of delivery, things like focused on average clinic cost of those, cost of surgeries, looking at different hospitals and different commercial rates, really good margin growth, which has flowed down to EBITDA. As you can see, 23% growth in EBITDA, just short of GBP 1.2 million at the half year. We're very pleased with that. Just to make the point, the reason the earnings per share and dividend cover has gone backwards is because there are now 3 million more shares in existence following the March IPO on AIM. So underlying both have improved the same sort of ratios. We've always paid a dividend. We continue to do so, and that again has increased year-on-year. We've got a fairly progressive view on dividends. And dividend cover by default is also strong. Final point on that slide, cash, nearly GBP 11 million is a combination of the IPO raise, strong cash generation, and that's after buying the land for still just under GBP 800,000. So we think the outlook for One Health is extremely positive, and we have a tailwind with the government who are insisting that they want to use the independent sector to use their capacity. And this has been repeated throughout the year. And so we're very confident with regards to that. We have demonstrated to you that we have strong organic growth, and that is growing at double-digit percentages year-on-year. In addition to that, we're going to have our strategic growth where we'll deliver these surgical hubs, and our ambition is to develop one a year. Again, we have a progressive dividend policy. People often ask us about what the market opportunity is. And forgive me, but these are, frankly, huge figures. But we've worked out that GBP 13.4 billion is spent by the NHS on the 4 main surgical specialties that we deliver on. The independent sector only does 11% and One Health does 0.2%. So given the pressure on the waiting list and the desire by the government to use the independent sector, we can only see an increase in growth with this huge market that's available to us. We can't give you forecast. We can't give you long-term forecast. But as I said, with regards to our ambition for this company, based on our organic growth and our growth of surgical hubs in the medium term, we're looking at an GBP 80 million revenue company and the longer term at GBP 200 million revenue company.

Okay. Thank you very much. Thank you, Derek. Thank you, Adam. We're going to move on to the question-and-answer section of the presentation.

[Operator Instructions] In the meantime, I have some pre-submitted questions here that came through the system. Regarding your first surgical hub, do you expect to have to do further work on meeting the pre-commencement planning condition sign-offs? Or is it just a case of waiting for your paperwork to be reviewed and approved? And ideally, we'd like to see an early Christmas presence, but could you see anything or foresee anything that would prevent this from happening in early 2026 at the latest?

I'll take that, if that's okay. So as we touched on previously, we received planning on the 4th of July. Within that planning pre-commencement planning conditions were put in place as well. It's a big deal. We felt we would address many of those at the outset, but we obviously work through them again. Of the 7, we're comfortable with 5 are now done, 5.5 arguably, given we've had no feedback on one that's been submitted and one more to go. So one is about land contamination. It's our landfill site. We're confident we've proven there's no need to do more work around that. And the second one is called BNG related, which is legislation last year around ecology, unsurprisingly. But I think the game in a good place on that one. As Derek said before, we had indicative dates of the 20th and the 27th of November into potential sign-offs. And I keep saying imminent, I sound like a broken record, I apologize. It is literally, I don't think there's any more work to do. We're just waiting for sign off then.

A question here about your relationship with the NHS. Is there a risk that you are at the mercy of the NHS with only one contract, one customer?

Definitely not. I think that's a perception gap. So the NHS contract is effectively a master agreement upon which all trusts, independent providers work. It's around 300 patients, 300 [indiscernible]. Once you've proved you can work to that contract, you then have to sign subcontracts to that contract. So I talked earlier in the presentation around 60 NHS commissioners, that's a combination of trusts, all CCGs, ICBs today after all the merger activity. So it's just one contract. I think today, if you look at cold hard contracts signed up, I think we've got 11 or 12, including trust work. The rest is noncontract work against that contract. So there isn't one contract. So I'd argue we're not at risk of losing that. Unless something catastrophic happens. We operate in a very important part of work in terms of patient care. It's very important. We are very safe, long-standing provider of the NHS. I would argue certainly locally, we're an important part of that network.

I've got one more question. What are the chances of seeing a big player in the sector coming in and replicating what you're doing with the surgical hubs? Is this the kind of thing that Ramsay, Circle or Spire might do?

Yes. We don't believe that as a particular problem. It's very difficult to get into the -- once you're in the NHS, you're in, it's very difficult to get in to do this type of work. So to get this work, we have to get the -- any qualified provider contract, which now isn't available. And in fact, the NHS is not really encouraging more entrants into the market. But then the other issue is the regulatory control, which is huge. Quite rightly, it is huge if you're going to be treating treating patients. So it took us a lot of time and a lot of treasure to be able to build this infrastructure within our company to deal with all this regulatory control. So it's difficult for another entrant to come into the market and sort of take over what we do. Now the big companies like Spire, Ramsay, they're already on the AQP contract. They always have been. We got asked in 2012. I think they probably got theirs in 2009. But they have a completely different model to us. Their model is for doing the private medical insurance and self-pay work. That's where their focus is. That's how their hospital-centric model is set up. Ours is a completely different model. So we don't think we compete with them. In fact, we think we complement them. And we had a very positive meeting recently with the Board of Circle. So we believe that we work well with them. So we don't envisage any player suddenly arriving on the market to be able to insert the position that we have.

I think it's also important to remember that we usually use the word unique probably too much sometimes, but One Health is unique in what it does. We only do NHS patients. We don't do private self-pay. So not only does that give you handling contract negotiations with NHS because there's nothing to [indiscernible] the waters, but we're not trying to take on private self-pay work. We're focused on NHS work where there's not enough supply to build a home. A long term, who knows, there's talk in NHS about private funding of -- sorry, NHS and private funding developing in units. We're ahead of the curve. We'll have built one by the time that comes across.

Thank you both. Just as a reminder to anybody, if they have any more questions, so we've got no more on the system today. But if you do have any questions, please e-mail Walbrook PR on [email protected]. We'll add you to a mailing list and certainly keep you up to date with the news that the company has. But again, thank you to Adam and Derek for the presentation, and I'll hand over to Derek for his final remarks.

Yes. Well, again, thank you for listening to us. We do truly believe that we have an excellent company. It's hitting the mark just at the right time. A lot of the good things in business is timing, and we believe that we have timed the market in just the right way. As to the future of the NHS, I mean, it's a hugely difficult problem. The NHS have massive things to organize like mental health, primary care, A&E access, cancer therapy, hugely difficult problems. Probably the easiest problem to sort out is elective care because it's very procedural, it's very repetitive, and that's the market we're in. We believe that if we're allowed to get on with it, we will be able to manage this problem and particularly with the growth of our surgical hubs, should the funding of the NHS change in the future, say, 5, 10 years' time with another government, we will already have a very good low-cost product with mainly community care and very highly efficient hub hospitals that will sit very nicely within this type of environment. So whether we continue with the NHS model as now or a blended model, I think One Health is in an ideal position for that. So thank you again your attendance, and we'll be happy to answer any further questions should you wish to ask. Thank you very much.