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

Good morning, and welcome to the One Health Group Plc Investor Presentation. [Operator Instructions] Before we begin, I'd like to submit the following poll. I'd now like to hand you to the management team, Derek, good morning, sir.

Hi. Good morning. Hi. Well, welcome, everyone, and thank you for attending for our 2026 full year results. My name is Derek Bickerstaff. I'm the Founder and Chairman of One Health. I'm an orthopedic surgeon by trade. And so I have about 40 years of experience in the health service. And Adam?

Yes. My name is Adam Binns, I'm the Chief Executive of One Health Group. Gave our formal introduction in a minute, but we'll start the presentation.

Okay. So what is One Health? Well, One Health is an organization that provides medical services to the NHS. Specifically, we provide medical services in the form of elective surgery covering orthopedics, spinal surgery, gynecology and general surgery. And these 4 specialties constitute about 80% of those people waiting on a waiting list for surgery excluding ophthalmology. We provide this service through a contract which we first obtained in 2012 called Any Qualified Provider and that allows us to accept referrals directly from the general practitioner. And so this is extremely important for One Health because this allows us to get -- to own the complete pathway. So we don't subcontract to trust hospitals or anyone else. We own the patient from first referral through to final discharge. And we provide our services in a novel way, different to any other independent sector provider because we've moved from a hospital-centric model to a community-centric model, which is 1 of the 3 pillars of the 10-year health plan. So we see our patients in around 40-plus community clinics where our subspecialist surgeons leave the hospital, sees the patients locally. If they need surgery, then we contract with our present 14 independent sector hospitals, and they have their operation within there. The patient is then back out into the community where they see our consultant surgeons again for the rehabilitation and eventual discharge. So we will demonstrate to you how we've been growing organically, certainly since COVID, but even from before COVID. So we constantly increase our footprint where we see patients. However, what we have noticed is that there are certain areas where our patients have to travel too far for surgery because there's poor NHS provision, and there's no independent sector provision. And these companies tend to be -- there's certainly high demand for NHS care, but they tend to be more under-privileged than certainly under-resourced areas. So in those areas, we're going to build our surgical hubs, and we will build a network of surgical hubs, which will further enhance our revenue and profit. And we'll explain what a surgical hub is and our plans on how we're going to operate them. The first surgical hub is actually in construction already. But we'll discuss this later.

Okay. So in terms of how the patient arrives at One Health, there's something called patient choice, which is up since 2009 under Blair's government. And in theory, what this means when a patient is in the GP and needs a secondary consultation, they've given a range of choices of provider secondary care. Very similar to google search, so the GP has a system called ERS, Electronic Referral System. So when you put in what you need to be seeing for and where you are, One Health will always feature quite highly on that search, if you like, in terms of where we, predominantly because we operate all our first point of contact with patients in outreach clinics, of which they were 40 by the end of the year, 40 at the end of the year. And that's the first time a patient a One Health consultant, and they will appear on the GP's search statistical ERS. We're also very quick and try consultations in very quick time and we've obviously got a very good reputation. So patients choose One Health group at the GP surgery for their provider of secondary care. It's really important to know there's no cost to the patient. We are paid by the NHS, and we provide our care free to that patient. This works through a system called the NHS tariff. So in very simple terms, every single thing we do for a consultation to physiotherapy to a procedure at a price on this tariff, that's a big price list. We then pay the consultant per item of service as well. So clearly, it's attraction to them as well in terms of attracting consultants to the group. Just in terms of waiting lists, there's been also focus in the press since the pandemic on the number of people waiting for procedures in NHS. It's around 7.1 million at the end of March. So the patient choice agenda upon which we receive patients isn't really touching that waiting list. All the patients that One Health has seen over the past 5 years, bar a few, has been brand new patients, bypassing the waiting list and straight to One Health Group. But longer term, clearly, there has been a need to get that waiting list down, and that's really where we'll see a significant amount of growth beyond the organic growth we'll demonstrate today, but certainly, the initial point of source of a patient is through a GP referral through patient choice. On the right-hand side of that slide you can see on the screen there, we've shown you how we allocate the -- this is inpatient activity, so a procedure, a typical hip replacement of which we will get paid GBP 7,500. Today, we pay a good amount of that independent hospitals that we use. We book capacity in independent hospitals across England. We then pay the consultant underneath directly. We take diagnostics and physio and the balance is our 20% gross margin as in 2026. So the independent hospital charges is the bulk of the cost today and that will change slightly where we open surgical hubs, whereby we'll internalize some of that margin, which will demonstrate.

So this is a depiction of the pathway that One Health runs. As I mentioned, we own the patient from referral right away through to discharge. So referral, patients referred into us from the GP usually through a system called ERS, which is the E-Referral System. And it's basically like a Google search. So in the GP surgery or independently at home, the patient can log on to this and then they will look to see where the nearest provider is for what they're looking for, let's say, a hip replacement or a knee replacement. And because One Health run lots of community clinics, we will inevitably be quite close to where they live. They'll then look at the waiting times. And again, we're able to offer waiting times, which are far shorter than the NHS. So for those two reasons, that's the real reason why patients choose us. We also get patients referred to us by trust hospitals who are trying to manage their own internal waiting list. And if they're struggling, we provide access to our pathway and so they will refer patients to us. So fundamentally, the patients coming at the referral area, and that's the point at which they're picked up by our patient liaison team. They then perform a logistical task whereby they match the patient with the subspecialty problem with the surgeon with the subspecialty interest into a clinic near to the patient. The patient is then seen in the clinic near to their home by our subspecialist surgeon. And the surgeon arrives there -- with an electronic patient record. So on the laptop or desktop, the patient will have access to all the patient's records and all the patient's diagnostics, such as x-rays and scans, et cetera. So the surgeon sees the patient there. The patient might need further investigations, which again, we organize out in the community. But then the patient -- well then surgeon will come to a decision as to how to manage the patient. 60% of our referrals don't need surgery and so they would be referred back to the GP with advice on further conservative management. The 40% that do need surgery, our patient liaison team again, matched that surgeon with the subspecialty interest of the patients in a operating facility near to their home, and we will work from 14 independent sector operating facilities at present. The patient then gets discharged and the patient is again seen by the same subspecialty surgeon and also undergoes all their rehabilitation. So our patient liaison team perform a logistical task matching the patient throughout the whole of the pathway. And you won't be surprised to learn that we're already investigating various AI models that can help increase our proficiency and productivity throughout this whole pathway. So why do people choose One Health? Well, the first two, I've already mentioned, is we're able to offer the NHS short waiting times and we offer clinic local to the patient, so they don't have to travel. With regards to continuity of care, the patients are seen by the same subspecialty surgeons through every step of their management. In an NHS hospital, they might be seen by a resident doctor, by a nurse specialist, by staff grade specialists as well as the consultant. So we offer a complete continuity of care. The inpatient facilities we use are all in independent sector hospitals and that is valued by our patients. There's plenty of parking. They like the setup of the hospital, the private rooms, et cetera. I've mentioned our patient liaison team and an additional factor I didn't mention is that patients are given a named person when they first book on to that care pathway. Throughout the pathway, if there's any problems, they can contact that patient in the patient -- that work in the patient liaison team who will be able to manage that problem for them. So it's like providing a private practice service, but this is all for NHS patients. So when we measure our quality of care and we use the measurements that the NHS wants us to, which is call friends and family. We have this huge -- usually high number of 99.5% of patients will recommend or likely or extremely likely to recommend further treatment with us. So this is a huge number. And in comparison to the NHS, they report figures of around about 25%. So clearly, the pathway that we offer is valued by our patients.

Okay. So a update on the business with a bit more details to follow in terms of our numbers, our position. So this is really a story of 5 years perpetual growth. Very pleased to announce that's continued as of this morning, released our results. So revenue of GBP 31.6 million, a growth of 11%, 5th year of double-digit growth. EBITDA particularly strong at GBP 2.6 million versus GBP 2 million last year, a growth of 28%, as you can see. An important measure on that slide is the cash position. So admittedly, GBP 11.1 million at year-end includes the IPO raise last March. But over that same period, we spent GBP 2.8 million on a combination of surgical development, dividends and developing our head office, and we still got GBP 11.1 million left after GBP 11.4 million last year, which demonstrates how much cash we generate organically just through ongoing activity. I think an important message in terms of longevity of contracts, over 80% of our work of the GBP 30 million roughly is now contracts or long-term contracts. Historically, we used to renew every contract every year. So we started a conversation over 2 years ago now to get longer contracts, which is well received. So the perception that everything is on a rolling 12 months at risk of loss is not really the reality. All our contracts are now longer term, and we've never lost a contract. We keep on growing contract activity predominantly by opening new areas and doing noncontract activity, getting on radar and then formalizing that to a longer-term agreement. So we see a perpetual organic growth. I'll explain how that's going to work before we move to strategic growth. And there's a slide coming from in terms of geography and where we are, but in very loose terms, we took 70% of England's ICBs last year, which is a significant number of the total opportunity in addition to work with local trusts, of which the 6 worked with in the previous year gave us more work again this year, and we'll explain what that means shortly. That resulted in increase in surgical procedures, obviously, and obviously new patient consultations, more subtle point on that slide. But in terms of the contract, the shareholder base for One Health Group, we have 22 of our subcontracted consultants, of which they are now just over 80 that own shares in One Health Group. They bought in the Aquis IPO back in November '22 and have all held shares since both dividends and capital growth over that time. So in terms of some detail within the business, we have a number of operational and financial KPIs, which we track. So the first one there is operational KPIs, as we've talked about already, new patients, consultations and surgical procedures, all growing significantly over the past 5 years, no drop-backs. Consultants, key to growth, which Derek will touch on shortly, but 88 at the end of 2026, and that continues to grow. And indeed, there are more on-boarded since March and into this new financial year. Outreach fleet, the same story, 40 at the end of the year. There are more now than there were at the end of the year. So continually growing that geographic footprint through the development of outreach facilities and then inpatient facilities in private hospitals primarily. And again, the final bit on that slide, the trust we've supported. And this is the real waiting list activity, the GBP 7.1 million at end of March. We see some of that through trust transfers traditionally end of the year. But the important message is that 95% of our work over the last 12 months has been from GP referrals and those patients totally bypass the waiting list coming to One Health Group by choosing One Health Group patient choice. So there's a huge opportunity within the 7.1 million people waiting at the end of March. In terms of headline financials, again, a story of growth. The only one that's slightly down is cash, which I explained already, growth despite spend of over GBP 2.8 million on dividends and hub investment. But again, strong growth in EBITDA to nearly GBP 2.6 million. Earnings per share are up, as you'd expect, earnings per share continue that journey. We've always paid dividends, both pre and post listing. No plans to change that. And to put it in perspective, people say, why do you pay dividends when you're trying to grow a hub network. Dividend cost to the business this year is about GBP 800,000, hubs cost between GBP 8 million and GBP 9 million. So it's a small price to pay. But obviously, we've got people who invest for dividends as well as capital growth. So we look to maintain that. And in terms of headline EBITDA, we talk about adjusted EBITDA to adjust for the cost of listing on AIM in 2025. So add back that GBP 400,000 year ending March '25, we've grown by nearly GBP 600,000 or 28% between '25 and '26. I'm very pleased to keep confirming growth past 5 years perpetual.

So what are our 3 drivers for growth? These we look upon -- we look at constantly. Have we got enough patients? Have we got enough surgeons to operate on these patients? Have we got enough operating capacity to do the operations? So patient demand. As Adam said, there are still 7.1 million patients on the waiting list, which is a huge number. It has decreased recently, but nonetheless, 7.1 million is a huge number. The government's goal is to bring the waiting list down to 92% of patients waiting not more than 18 weeks. And that equates to around about 3 million to 4 million people on the waiting list. So we've got about 4 million people that need to come off the waiting list over the next 3 years, which is a huge task. The NHS has been not reliant upon, but the NHS has looked to the independent sector to help them this over the last 25 or 30 years. And at present, the NHS provides about 11% of that cover. So there are a vast amount of patients out there. As we said, most of our patients come from patient choice, but we also get referrals from 6 local trust hospitals. So we don't consider there being a shortage of patients. We have a full order book, if you like, for patients. Do we have enough surgeons? Well, again, we're good at attracting surgeons. We contracted with another 8 clinicians over the last year. So we don't have difficulty. We often find patients apply to join us, but we're very strict on who we bring on board. We have a very strict onboarding process and the surgeons have to fit into the ethos, the vision of what One Health is providing with its community-based model. The reason surgeons like us is we generally work in more underprivileged areas. So you won't really find a One Health clinic in, say, Wilmslow or Virginia Waters where there's a huge amount of private practice, we tend to operate in areas where there's low private practice. So there isn't enough private medical insurance or self-pay work for the surgeons. Clearly, a surgeon could be paid more per case than they would take that. But in the areas we work, they don't have that option. So they like One Health because we provide them with full clinics and full operating theaters. The other reason that surgeons like us is we have a very, very robust clinical management system where we measure -- clinical audit system where we measure everything that the surgeons do. So we're able to tell them what their complication rates are, et cetera, et cetera. And this is very important because over a lifetime as a surgeon, mistakes will be made and claims may be made against that surgeon. And because we have all the data, we're able to support the surgeon with any investigations that may occur. And the surgeons like that. It's like a comfort blanket around them rather than working in isolation in a private hospital. The other reason the surgeons like us is that we pay a fixed fee per item. So every consultation, every operation attracts a fee, so they know exactly what they're going to get. So we don't have any problem finding surgeons. With regards to operating capacity, again, we're good at finding new hospitals. We've increased the number of hospitals we work in this year, and there's another 3 or 4 hospitals that we know are going to come on in the next year. So we're constantly growing the number of independent sector facilities that we use for our operations. But also when we work with an independent sector partner, we increase the number of operations that we do with them year-on-year. So we're very good at doing more surgeries in the hospitals we have and also finding more hospitals. However, what we have noticed is that there are certain areas, and these tend to be in more under-resourced areas where there's high NHS demand, and they tend to be more underprivileged areas where the NHS isn't providing a good service. And the independent sector won't open a hospital there because it can't attract any self-pay or private medical insurance. So we're finding that we're having to transfer patients too far for their operations. So our intention is to build surgical hubs in these areas. We'll explain this later, but we've already started our first surgical hub, and we plan to open a network of surgical hubs operating in these under-resourced, high demand but more underprivileged areas.

Okay. So let's talk about our operating footprint today, and this is very much about where we are pre-surgical hubs, but I'll explain that in more detail. So the dark blue area on the right-hand side is where we are today, and that's our operating footprint across a couple of ICBs. But where we grow, we grow in the periphery, the orange section, which should be in the next 3 years and the yellow's in the next 5 years. And it's a very simple hub-and-spoke model. We open our each clinics on the periphery of where we are today, which lets us test demand for NHS patients. If they're successful, we widen that capacity. If they're not, we find a different one. So it's a very easy, flexible way to test growth. Should we targeting peripheral clinics, we then find another independent hospital within that footprint to then take the patient to surgery should that be required. And just a reminder, only 40% of all new patients require surgery. So it's not all the patients we speak to or have consultations with. So again, we target regions with a heavy reliance on NHS, not enough cash to self-bear to have medical insurance. But more importantly, where there are regions where there's insufficient supply, be that independent hospitals or NHS facilities, we'll build a surgical hub. So in terms of the Xs on the map, the light blue one is the existing site, I'll come on to explain more detail about. The green Xs are other locations identified that meet the criteria for development of surgical hubs. So I'll talk about the light blue one first.

Okay. 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 all our consultations, our diagnostics, our rehabilitation are done out in the community. So a surgical hub for us is very simple. It's an operating theater, a recovery area and sufficient beds around that to be able to maintain the throughput we wish to. Surgical hubs are not a new concept. They've been around for decades. When I first started One Health 22 years ago, I did a tour of physician-owned ambulatory centers in America, which are effectively surgical hubs. Surgical hubs are used throughout Europe. The government is supporting this. They want us to own surgical hubs. They are trying to open surgical hubs within the NHS, but they haven't really got the capital to be able to do true completely geographically distant surgical hubs. So they are looking towards the independent sector to help with this. And the concept of surgical hubs is fully supported by the Royal College of Surgeons. So we're pushing against an open door regarding this. Now the type of cases that we do these surgical -- in these surgical hubs are the high-demand work, hip replacements, knee replacements and spinal surgery. We don't need a surgical hub to do -- mainly the rest of the work we do is day case surgery. We've got plenty of other capacity to be able to do that. And the advantage of the surgical hub, primarily the advantage to the patients is they get their operations in a center near to their home. But for us as an organization, it increases our revenue and increases our profitability. So we intend to open a network of surgical hubs, and we'll explain later how we're doing that.

Okay. So hub #1. This is very much in construction. You can see the photo bottom right-hand side there. That was taken this weekend and shows very much coming out of the ground now, which is really great news. So in terms of what the surgical hub is One Health world, it's a single operating theater and 12 bedrooms. The logic behind that is that the sort of stuff we'll do, hip replacements, knee replacements and spinal surgery, 99% of those patients will be one-night stays. So although the initial modeling to generate GBP 6 million of revenue is based on only 4 patients a day to give you some very round numbers, there's physical capacity built-in to get it to 6 patients a day and therefore, 6 overnight beds, 6 new patients following day, hence, 12 bedrooms. Again this is not a hospital. Again, if you look at the geographic footprint there on the top, the first bullet point, it only covers a site of 1.8 acres, of which 0.4 acres is the hub itself. So very small, very compact, very efficient, only used for doing surgeries. And because of that, it's relatively cheap to run, only 20 staff covering 24 hours. So a fairly small workforce, single level and fairly low capital cost in terms of development. This site will be complete early full year '28 [indiscernible] for bringing in patients from the area. And in terms of where this is in North Lincolnshire, in Scunthorpe, we have a fairly significant One Health demand in that area and all patients requiring surgery travel back towards Sheffield. So this is absolutely a sweet spot of high demand where patients traveling too far for surgery. And one of the benefits of the One Health model, because of the nature of our receiving patients from ERS referrals or GPs, we can drive our own demand. We can have more capacity when the hub is nearing completion to ensure we've got a full order book when we're ready to go. So we can effectively start prebooking patients into the hub when it's complete months in advance. And in terms of targeting for key individuals, we recruited our surgical hub manager a couple of weeks ago, now working within the business, doing some really good work. And once we get closer to opening, we'll be recruiting staff in the local area tapping into our network, bearing in mind that the existing model of taking a consultant and the subcontractor hospital will be the same at the outset. So all we're looking for is hospital and ward staff. So we made some really good progress on that front. Moving on from that, we've got 2 more sites identified. I was out there last week looking at both South Derbyshire and West Yorkshire, 2 other good sites identified, and we'll start the process quite soon to acquire land at one of those 2 sites. And in terms of lessons learned on the first one, we'll be starting planning very, very early in the process to ensure there's no delays around a step-by-step approach. We've got a model. That model you can see top right-hand side will effectively be a copy-and-paste blueprint. We'll drop into the footprint, get planning and start as soon as we can, but we'll acquire the land first.

So we're confident with regard to the outlook for One Health. We've already demonstrated strong organic growth, and that's continued post COVID. Indeed, we were providing that growth pre-COVID. The independent sector is helping support the NHS in achieving its targeted decrease in its waiting list. And this has been supported by the current Prime Minister, who's due not to be current and also the previous Health Secretary. But again, the present Health Secretary is part of it. And the use of the independent sector to help with waiting list is part of the 10-year plan. Now we don't know which [indiscernible] we're going to get coming in soon, but we're confident that they will continue to use the independent sector in helping deliver the NHS care. So activity has remained strong. All our key performance indicators are positive. We're moving forward. We have lots of patients. We have lots of surgeons who want to work with us. And as you'll see, you can also see how we now have a second arm to our growth with this strategic growth with the surgical hubs. So we're confident. Just to explain again about the significant market opportunity, the government within the 4 specialties that we operate in, orthopedics, spine, general and gynecology, the government spends GBP 13.4 billion per year on providing that service. The independent center only provides 11%, and that is increasing. One Health only provides 0.2%. So there's a huge opportunity for growth within this sector. So we have very strong ambitions for One Health. This isn't a forecast at all. But based on our organic growth and our strategic growth of opening a hub a year, we're looking in the medium term to be an GBP 80 million turnover company and in the longer term to be a GBP 200 million turnover company. So we think we've demonstrated the growth. We're confident and we're confident for the future for One Health. Okay. Thank you for listening. That ends the formal presentation. So we will turn to questions now.

[Operator Instructions] I'd like to remind you that recording of this presentation along with a copy of slides and the published Q&A can be accessed by our investor dashboard. As you can see, we have received a number of questions throughout today's presentation. And Alice, if I could just hand back to you just to read out the questions to share with the team, and I'll pick up from you at the end.

Fantastic. Thanks, Lilly. And the first question was actually on One Health strategy in regards to potential changes with government policy, but we've kind of already discussed that. Second question is, in terms of the surgical hub strategy, how does the company plan to fund future surgical hubs. Will the rollout of other hubs be implemented after the first hub is fully operational?

It can be all of that. Yes. So I think we've demonstrated in the slide pack we've just run through now that we do generate a lot of cash. I think we showed that there was growth -- free cash within 2026, around GBP 2.5 million. The other key point in terms of future growth is our change of banks quite recently. We moved to Barclays. Barclays are the biggest fund of health care in the U.K. and are very keen to support One Health Group. So cash generation internally is a strong feed of future growth. Bank debt through a combination of funding of the existing site we're building at the moment, they're keen to put some debt against that. We've also got a head office in Sheffield worth around GBP 2.7 million. So GBP 1 million loan against that. There's another GBP 1.2 million there. So if we effectively fund the -- or get debt against the land already bought at Scunthorpe and part of that hub plus the head office in Sheffield plus cash generation, we're very quickly at GBP 7 million to GBP 8 million. Surgical hubs cost between GBP 8 million and GBP 9 million. So we're very comfortable we probably self-fund the first one without the need for more equity. Now clearly, once we prove the concept, we'd like to accelerate growth, there's no reason we can't do 1 or 2 at the same time. And certainly, in line with our strategy to build 1 a year, we may come back for equity, but that's not the intention at this stage. We'd like to prove the concept, use cash generated and bank debt to get into #2 quite quickly. And as I mentioned previously, we've already looked at 2 of the sites in South Derbyshire and West Yorkshire, which will probably be the next piece of land we acquire for building on.

Excellent. Thank you, Adam. The next question is, "how dependent is the company's growth on NHS waiting list pressures?"

Again, if you go back to the presentation, I think it's worth highlighting a strong point that 95% of our activity last year to 2026 was GP referrals. I stress these are brand-new patients go to the GP, refer to One Health Group, treat them and discharged. So there's that waiting list, the 7.1 million at the end of March, we talked about, we're not really touching that just yet. The only time we see that is generally towards the end of the year around quarter 4. We get calls from local trust asking for support with reducing the internal waiting list, which is where the waiting list sits across England. It's inside NHS Trust. So 5% of our revenue last year in patient numbers was transfers in quarter 4 from NHS Trust, which is a tiny, tiny fraction of that GBP 7.1 million that needs to come down to meet the government's targets. You may have seen in the press the desperation from the government is to achieve the old target of 95% of patients treated with 18 weeks by March 29. Now in real terms, that means reducing that 7.1 million waiting list to around 3 million in the next 3 years, which is a monumental task. And certainly, it's been demonstrated already that the independent sector's contribution to supporting NHS has grown significantly. Pre-pandemic around 6% or 7% of outsourced activity. It peaked at 13% last year. So I think it demonstrates clearly that without support, that waiting doesn't come down of any significance. And we do it at the same price, bear in mind. We get paid the same with NHS Trust. There's no premium to that. So it makes a lot of sense to outsource the more straightforward activity, hips and knees and the likes out to the independent sector and focus on the complicated stuff and really drive down that waiting list. So we are confident that waiting list will be a future part of our business. But to stress the organic growth we've demonstrated is not touching that waiting list yet.

If I could just make a further observation. I mean, One Health was born in 2004 in the last labor government where they really wanted to get waiting list down. And so at one point in One Health's history, waiting list were down to about 1.8 million. And we had a strong and growing business at that time. Waiting list are ridiculously high now. The independent sector has been embedded in getting waiting list down now for about the last 30 years. So we will -- so the use of the independent sector will be fundamental in getting these waiting list down, but they will still be needed to maintain the waiting list of those areas. So it's not so much waiting list pressures once they're down to the desired target, the independent sector also involved. To get to that desired target, the independent sector has to do more and more and more of a percentage of that work. And so they will need the independent sector to maintain it there. So we're very, very confident that the model that we have built in will be built into the NHS provision for elective operating.

And following on from that question, "How secure are your contracts with the NHS?"

That's the easy one to answer. We've never ever lost a contract in 22 years. So I mentioned on the geographic coverage slide, the way we grow organically is through building on the periphery through outreach clinics and then finding independent hospitals to support the surgical work required. And the way that works is we become more and more prevalent in areas where we haven't been before through noncontract activity growth. And then the ICBs get to say, can we contract with you formally? So it moves noncontract to contract. The difference is academic in real terms because noncontract is effectively contracted work. We still get paid. So the contracts keep on growing, and we've never lost one yet. And I mentioned previously, we've got more now on long-term contracts. We secured two 5-year contracts 2 years ago. We've added 2 more this year on to the balance of those 5 years. So 80% of our work is now on long-term contracts, which is a fundamental shift from 5 years ago.

Next question. "I've heard people describe you as a mini supplier. Could you explain how you get from them?"

Yes. That's pretty straightforward really. I mean the basic business model is completely different. Spire is a very successful independent sector company that runs a hospital-centric model for private medical insurance and self-pay work principally. It will do some NHS work, but the core model is to do -- NHS to do the private work. And as I say, it does it through a hospital-centric model, not a community-centric model. So our business model is completely different. We provide a community-centric model for NHS patients. And as we've described earlier, we think we will always be required to help the NHS maintain their low waiting lists. So the only similarity between us and One Health, I mean, I wish we were a GBP 1 billion revenue company, apart from that, maybe one day. But whilst it's fundamentally different, and we think ours is a more robust business model to be able to provide a service to the NHS in the future moving forward. And in addition, we're also buffered again to say there were any changes in how elective care is managed. And our view really is that in the future, elective care will probably go more towards European system where the social insurance. But to be able to provide that, you really need a low-cost solution to do that. And we provide a low-cost solution with community care, not a hospital-centric model, which is a very hungry beast, needing more and more patients to do more and more diagnostics, rehabilitation, consultations, operating, whereas we've evolved that into the community. So ours is a distinctly different model to that offered by Spire or indeed any of the other big independent sector hospital groups such as Circle, Nuffield or Ramsay.