Spire Healthcare Group plc (SPI) Earnings Call Transcript & Summary

So, good morning, everybody. How are we? Not too wet, I hope. Good to see you here this morning. And thank you for coming, and welcome both to people in the room and people online to coming to our half year results presentation for the period ended 30th of June, 2025. Thank you for joining us.  So I'm going to start by giving an overview of our H1 performance. Then I'm going to hand over to Harbant Samra, our Group CFO, for a financial update, before giving a more detailed review of our strategic progress. So, I am pleased to say that we have delivered in line with guidance in the first half. EBITDA growth is on track, and we've managed to do this while driving a remarkable amount of change through the business. So put simply, our strategy is on course, and we're delivering today whilst accelerating our transformation as an integrated healthcare business.  So we are effectively managing our payor mix with discipline through a diversified 3-payor strategy. Our transformation program is helping us deliver with greater efficiency. We've added further scale to our Primary Care business. And, of course, we've maintained our focus on quality and innovation through our well-invested estate. So in short, the business, we think, is in the best position it has ever been in to navigate a very dynamic environment. Our strategy is delivering. Transformation is on track. And the actions we've taken in the first half mean we expect our full year outlook to be in line with market expectations. We've got a well-invested business, and we continue to evaluate options to drive long-term shareholder value.  Now, we couldn't have done any of this without the amazing commitment, professionalism and support of our consultants and colleagues across the business. That includes colleagues who've left the business as a result of changes we've made in the last 6 months. And I'd like to take this opportunity to thank them all for their contribution. Even as we have been in the midst of transformation, our colleagues have continued to go above and beyond in the care they give to patients. And it's been inspiring to hear stories of their impact through our IRIS and DAISY awards that we've made in the first half. And you can see here colleagues proudly receiving those awards and also colleagues at Spire's and [ Anthony's ] when I went along to visit their new surgical robot, more of that later.  So now, I'll hand over to Harbant to walk through the numbers.

Thank you, Justin. Let me start by confirming that the group has performed in line with expectations, delivering a solid set of results during a period of significant change. Revenue has grown in line with our guidance, up 4.9%, with hospitals up 4.7% and adjusted EBITDA was up 2.8% year-on-year to GBP 133 million. You'll remember that we have accelerated our savings program this year to mitigate National Insurance and National Minimum Wage rises, payor mix changes and the roll-off of our energy hedge. And I'm pleased to say that cost savings are on track, delivering more than GBP 10 million in the first half, with a further GBP 20 million planned for H2, taking the full year benefit to over GBP 30 million.  Group adjusted profit before tax declined 11.2% to GBP 23.8 million, largely due to the phasing of savings with depreciation and finance costs broadly evenly spread across the 2 halves. Whilst adjusted free cash flow declined, this was again due to the same phasing impacts, which I will cover later. And finally, return on capital employed expanded by 50 basis points to 8.1%, reflecting our continued focus on driving returns.  Now turning to the Hospitals, the largest segment within our business. Total revenue grew 4.7% to GBP 732.3 million, and we continue to expect greater than 5% revenue growth for hospitals on average over the medium term. This was driven by both volume and average revenue per case, up 1.9% and 4.2%, respectively. Adjusted EBITDA rose 3.3% to GBP 130 million, representing a margin of 17.8%. These figures are stated after the uplifts in National Insurance and National Minimum Wage, which came into effect from April. Excluding these items, EBITDA grew by more than 5% year-on-year, delivering margin expansion of more than 20 basis points. The result includes efficiency savings of more than GBP 10 million during the first half with greater EBITDA growth expected in H2 as we deliver the rest of our savings target. And adjusted EBIT was in line with expectations, increasing to GBP 74.5 million with a margin of 10.2% compared to 10.4% in H1 '24.  In terms of performance by payor, I will start with our private business in our hospitals, which includes self-pay and insured patients. Overall, revenue grew just shy of 1% with average revenue per case more than offsetting the reduction in volume. Now let me dig into the dynamics we are seeing and the actions we are taking. On the positives, both PMI and self-pay saw steady growth in average revenue per case, up 5.4% and 4.2%, respectively. In PMI, pricing is linked to a range of inflation measures, and we have driven revenue by optimizing the mix of higher-margin procedures.  In self-pay, this reflects our close management of price where we frequently adjust levels in relation to local markets as well as margin management. In the more recent months, we have seen some improvement in volume trends in self-pay, which we believe reflects both the broader market as well as our investment in marketing. Now the challenges. We've seen a small decline in PMI volume. This has been impacted by some insurers managing their claims process more tightly across all insurers -- across all healthcare providers, sorry, and stronger growth in younger lives covered, which we believe has also some impact on volumes given they typically need less complex care.  Proactive tendering by insurers continues. But that said, we are responding with a clear set of actions. One, we continue to manage pricing and high acuity mix well. Two, we are expanding into primary and community care services where the market is seeing higher growth. Three, we are continuing to roll out strategic initiatives such as specialist cancer and musculoskeletal centers that concentrate volume while meeting high clinical quality and outcome targets.  I'll now move on to the NHS, where we saw very strong revenue growth of over 16%, building on the trend from last year. And we increased our proportion of high acuity procedures, achieving a 4.2% uplift in average revenue per case, which compares favorably against the NHS tariff uplift of around 3.4% in the same period. This growth has been achieved against a dynamic backdrop. The government is committed to reducing waiting lists, which have declined marginally, but remain elevated and has again confirmed that the independent sector will be a key partner to achieve this. But at the same time, the NHS is dealing with large-scale change, and there is friction within the system.  ICBs are adapting to the changes and are looking at options to manage budgetary pressures through commissioning. Our focus, therefore, remains on building high acuity work and working closely with both government and commissioners where we already have strong relationships. I've mentioned -- I just mentioned that we are confident that the declining PMI volumes we're seeing reflect a broader market trend. I say this because if you look at the data for the areas in which Spire operates, it shows consistent gains in the private patient market over several years. This reflects our focus across a combination of factors, including the quality of our facilities, our marketing, price and mix optimization and, of course, high clinical standards. Continuing the market share data, the most recent National Joint Registry data through to April 2025 shows that Spire continues to lead in its addressable markets, conducting the largest number of hip and knee procedures across all patient groups.  Moving on to Primary Care, which is a central plank of our growth strategy. In the first half, revenue reached GBP 64.4 million, a 6.5% increase on a comparable basis, with strong growth in Vita led by its Talking Therapy business. And taking the benefit of bolt-on M&A, growth was even higher. Adjusted EBITDA was GBP 3.8 million, which did decline year-on-year, but reflects the economics of rolling out new clinics. As we said before, these clinics have start-up and fixed costs in their early months of operation, but typically breakeven during year 2.  Excluding those start-up clinics, Primary Care EBITDA would have grown by more than 6%. Importantly, these clinics are also sending referrals to our hospitals and following the start-up phase, deliver positive EBITDA to the business as a whole. EBIT was in line with our expectations, coming in at GBP 1.5 million with a margin of 2.3%. As we've highlighted before, another attractive feature of Primary Care is that it operates in a lighter CapEx model compared with our Hospital business.   Now turning to the important topic of our transformation program. We've had a successful start to the year, delivering as planned. The sheer scale of change under the transformation program is very significant, and it should not be taken for granted that is being delivered with relatively low levels of disruption. In the last 6 months, we launched 2 major initiatives. Firstly, we have moved to a more flexible, clinically led hospital resourcing model. As we announced in late May, we reduced the number of permanent colleagues by around 400 with staff leaving the business in July and August. And as a result, the associated savings benefits will be weighted towards H2. Secondly, we have consolidated hospital admin and booking functions into 3 regional hubs, known as Patient Support Centers. This is an exciting step in our transformation journey, and Justin will share more detail later. These changes have led to one-off restructuring costs amounting to GBP 9.6 million, which have been recognized in our P&L as adjusting items. We expect the second half charge to be materially lower.  Turning to CapEx. We've maintained our focus on deploying capital into projects aimed at growth and improving efficiency. In the first half, we invested a total of GBP 51 million, which is over half of the total CapEx we expect to invest this year. We have allocated GBP 27 million to growing returns, including the establishment of our Patient Support Centers, improving our patient and consultant-facing systems. We purchased several new MRIs and robotic surgery platforms, and we rolled out our solar panel installations across our estate. ,These investments are already delivering a healthy return above our hurdle rate. The remaining GBP 23 million of CapEx was directed towards maintenance of our estate equipment and facilities and GBP 1 million was for investing organically within Primary Care.  Bringing together what I presented around growth, savings and targeted capital deployment, I can report that our return on capital employed is up 50 basis points year-on-year. On a like-for-like basis, excluding National Insurance and National Minimum Wage rises, ROCE would have been 8.3%. And our balance sheet remains in a strong place, supported by a freehold portfolio of 19 hospital properties, which is well-invested and was externally valued at more than GBP 1.4 billion, a valuation that took place before recent ongoing market activity, such as Assura and others.  Turning to cash. Adjusted free cash flow was GBP 15.3 million for the first half and the year-on-year movement reflects the phasing of transformation savings and CapEx. In addition to this, we've had a working capital outflow in the first half, owing to the timing differences connected to the growth in NHS activity. To complete the picture on cash, our cash balance closed at GBP 20.8 million at the period end, which reflects the phasing of savings and CapEx, as well as a couple of one-off items. These items include the purchases of our own shares to settle employee saving and award schemes, which we brought forward from H2 to H1 to take advantage of the low share price. Additionally, we paid for the remaining non-controlling interest in one of our hospitals. If we look at cash on a more comparable basis, excluding the one-off items, our cash balance would have been GBP 34.7 million with a bank leverage ratio of 2.1, which is much closer to where we ended 2024.  Moving on to the outlook. Financial performance was as expected in the first half. We have delivered growth, managing payor mix effectively through our 3-payor strategy, and we've seen good growth in our Primary Care services business. We have delivered efficiency with more than GBP 10 million of savings in the first half, and we're on track to deliver more than GBP 30 million for the full year. This will, in turn, support full year growth in profit before tax. And whilst we are improving returns, we know there is more to be done. We are focused on growing return on capital employed to more than 10%, and we'll continue to have a disciplined approach towards CapEx and M&A activity. Bringing that together, our full year outlook is unchanged, and we're currently trading in line with market expectations.  With that, I'll hand back to Justin. Thank you.

Thank you, Harbant. So, our numbers are driven by the continued delivery of our strategy. As background, the U.K. has a growing social and economic need for people to have healthier, happier, longer lives and increase productivity by supporting those who are ill, to return safely to work. And bringing down waiting list remains a top government priority, with the support of the independent sector.  Spire is building a business that can respond to these challenges, a business that provides fast access to high-quality health care professionals. We're developing a fully integrated primary and secondary care offering in a growing market that's worth a combined GBP 12 billion, supporting patients through preventative care, diagnostics, mental health support and occupational health, all the way through to elective operative care. And we are exceptionally well-equipped to meet the changing health needs of the U.K. population.  There are 4 ways in which we're building Spire to be an efficient, integrated healthcare business. As I mentioned earlier, they are: our diversified 3-payor strategy; transformation; scaling primary care whilst maintaining focus on quality improvement; and innovation. So I'm now going to talk through each of those in a little bit more detail.  So, if we start with our payor mix, we've maintained hospital revenue growth and margin expansion, excluding the impact of National Insurance increases, by effectively using the levers shown on this slide to manage our mix and costs with discipline. First, we're focused on increasing the proportion of procedures that attract higher margins, where we are seeing growing demand. These now account for approximately 38% of total private admissions across our hospitals. Second, we've expanded our high acuity work. For example, orthopedics now represents over 60% of total NHS admissions, up from 50% just 2 years ago. Third, we continue to optimize hospital pricing to balance volume and value with the average revenue per case up more than 4% year-on-year. And across the board we are lowering our cost of delivery. More on that in a moment.  Turning to transformation. The transformation program is at the core of our strategy. In H1, we focused on 3 areas. The first was ramping up digitization and centralization in our administrative functions, along with greater consistency across the business in keeping with our One Best Way approach. Our 3 Patient Support Centers in Brentwood, Cardiff and Seaham, are already delivering benefits today, while paving the way for future opportunity, and I'll expand how in a second. The second transformation was moving towards flexible hospital resourcing. So, we're better able to respond to changes in demand, building on best practice across our sites. Now, our new approach is still clinically-led, but teams are now aligned to consistent roles across the company with simpler management structures, and we've rebalanced the way some teams are resourced with a different mix of bank and permanent colleagues.  And the third area of focus was investment in robotics and innovation, and I'll also come back to this. So together, this package of changes improves service delivery, enhances patient and consultant experience, and it lowers the cost of delivery whilst maintaining the highest quality standards. Our Patient Support Centers are now central to the way we are transforming the business. I've recently been to Cardiff and Seaham, and I cannot overstate the change involved and the excitement of this transformation. We have done something really difficult, really well. I'm conscious it's been hard work for colleagues, consultants and medical secretaries moving to a new system. And of course, there's room for further improvement, but we're now set up really well for the future, and we're already seeing benefits.  We are answering 50% more patient calls, and we've improved our ability to manage private and NHS bookings more effectively, and we've got better digital visibility of consultant diaries. The centers are more efficient. They're operating already with approximately 10% fewer staff, and they are also unlocking additional clinical capacity as we repurpose former administrative space within hospitals for new clinical services. And crucially, this shift will give us far greater oversight of the patient journey, which improves our ability to support consultants and create treatment pathways across Spire. And as we [ bed ] in our Patient Support Centers, we'll realize bigger benefits in 2026 and beyond.  Turning to Primary Care. We have a clear plan to scale our Primary Care business towards our medium-term EBITDA target. The growth will be driven primarily by organic expansion with margins expanding as we scale over the medium term. The core business performed well in H1, and we started multiple new long-term NHS and corporate contracts worth GBP 8 million in annual revenue, including a contract with John Lewis Partnership to provide their occupational health services.  We're making good progress with targeted, strategic M&A. This year, we acquired Acorn Health, an occupational health specialist in Cheshire. And we announced today the acquisition of Physiolistic, which is a physiotherapy business in the Thames Valley. Together, we expect them to contribute a combined annualized EBITDA of GBP 2 million. Both are immediately accretive and were acquired at mid-single-digit multiples. Finally, our clinics where we're moving forward, we will be focusing on opening smaller clinics at lower cost. Taken together, these initiatives provide a clear and achievable pathway to reaching the GBP 40 million EBITDA goal.  Finally, in H1, we maintained our relentless focus on quality and innovation. We are really pleased to retain our 98% rating for Good or Outstanding hospitals, having had 2 good ratings from CQC visits already this year to our hospitals. And patient satisfaction at 97% and consultants at 84%, respectively, remain high. I'm particularly proud to the organization that we were recognized in 2 specific areas. We were highly commended by Thrombosis UK for our work on thrombosis prevention and management. And in addition, our pathology management was highlighted as best practice in [indiscernible] Patient Safety Review. Finally, we're investing in technology like clinical robots and AI enhancements to MRI scanning. We also signed MOUs with Oxford Genomics and EDX Medical. Whilst they're not yet contributing to the P&L, they're going to help us build genomics and health tech capability that will drive the next phase of Spire for our patients.  So in summary, I'd like you to take away 3 things from today, please. Point one, we've implemented significant change, and we've managed it well. It set us up to be more flexible, responsive and efficient whilst maintaining and improving quality. Point two, our strategy is on track and puts our business in the best possible position to manage what will continue to be a dynamic market. We're building an integrated, innovative and sustainable healthcare business for the future. Point three, all this is supported by a well-invested estate and freehold property valued at more than GBP 1.4 billion. We are a successful, valuable business that's well-placed for the future.  Thank you for listening.We're now going to turn to M&A (sic) [ Q&A ]. I'll take questions from the audience. What did I say? At least you know I'm focused. We're now going to focus on M&A. We're going to have a Q&A in which you can ask me about M&A. And then we'll all go to the [ V&A ]. Okay. Can I take questions, please? We're going to take audience first, online later. Please state your name and your question.

It's Sam England from Berenberg. So firstly, you mentioned budgetary pressures in the presentation at the ICB level. Can you just give us a bit more color around the dynamics there and what mitigation opportunities you have in the second half? And then to ask one about M&A. On the Primary Care business, you announced the acquisition of Physiolistic. Can you talk a bit more about the M&A landscape more broadly in Primary Care? And then, as you look at that GBP 40 million EBITDA target, I suppose the balance you see of that coming organically versus through M&A?

Okay. I'll take both of those. So NHS, NHS Land is always complicated, by the way. So there's sort of no new news that NHS Land is complicated, other than what is new news. So we have a Labor government which is not only committed to using the independent sector, but the Secretary of State sent out a press release commending the independent sector having treated 500,000 patients since the start of the administration. This is new news. And our general view is the government is totally committed to getting waiting list down. We're quite focused on it. The Head of NHS England has a grip and is very focused on that. And that clearly we play a key part. So imagine what would happen to waiting list if 500,000 people hadn't been treated by the independent sector.  Secondly, NHS England is also calling for trust to balance their books, which hasn't happened for a decade, okay? And therefore, they're responding in terms of how they think about their budgeting indicative plans. And the reason we raise it is because people will be aware of this. This happens every year. It's a bit clearer this year, partly because there's more clarity from NHS England and what they're trying to achieve. Choice is top of the list. Our volumes come from electronic referrals, not from trusts. And we have good visibility of our volumes going into the latter part of this year.  So in summary, these things will resolve themselves, but there is a debate going on about how to balance all that. The way we mitigate it is, one, we're on the ERS system, and we really lean into that. And we really talked to GPs about how patients have a statutory choice that if there's a long waiting list somewhere else, they can come to us and we make our waiting list visible.  Secondly, we're in very close conversation with all local commissioners because we understand the pressures they're under. It's tough NHS and with the center, and we navigate our way through. I'll also emphasize, by the way, we are very focused on the right work going into our hospitals. I've always said before, we could open up our books of things which aren't right for us to do, which could fill our waiting rooms, which would compromise our ability to deliver on orthopedics and the sales would go up, but it wouldn't deliver for the business and therefore, for patients. So summary is we're telling you it's a complex environment. So when you pick up it's complex, it's complex, we're all over it. So hopefully, that gives you a sense of that one.  So, what's happening with the M&A environment overall? Well, if you look at big M&A, there's just been a deal done from an occupational health business, I think, at 15x, okay? Do write that down. So we are building a business in the bit of the market which is of extreme interest to government because it deals with the issue of long-term sickness. And I think I've mentioned before that if you have an employee assistance plan with Vita for MSK or mental health issues, our return to work statistic is greater than 95%. We think we've literally got the secret weapon which helps unlock productivity in the U.K., and I'm not exaggerating. We're pushing this very hard, but clearly working with the Mayfield review on this. To emphasize, you can solve these problems.  So it will be quite easy to lean into that and pay very high multiples, but we're also being disciplined. So we think the way forward, both in occupational health and physiotherapy, is targeted acquisitions with people who, by the way, stay with us, which is quite important. I was up with Acorn, fantastic team. They're excited to be there. They're full of ideas. We've got all their talent coming into the business. There's plenty of small bolt-on acquisitions out there. We are quite fussy. They've got to fit. Occupational health is not all one thing, always physiotherapy. But we think there's lots out there, but also, we're not running at it and just picking up everything we can, which is why I keep focus on being disciplined and targeted.  So, the balance will be, I don't know the right proportions. Organic growth is the most important part, okay? The John Lewis Partnership, we're very proud to work with such a good employer, contract wins like that, selective NHS contract expansion, just growing the base dermatology business. But M&A is going to be an important underpin part because what it's doing. We keep mentioning the geography. We're building geographic picture so that we have coverage across the geography. When [ they ] get to having a GBP 40 million EBITDA business, feel free to look at multiples available in M&As and multiply that to work out how valuable it's going to be. Thank you.

Justin, can I just add to that once...?

Sure.

Which is, it's also worth remembering that we said that, that growth will come with a CapEx amount of no more than GBP 50 million. So, as an overall figure, I mean, that's a fairly modest amount of CapEx to grow EBITDA from GBP 10 million to GBP 40 million.

Further questions?

David Adlington from JPMorgan. Three, please. So firstly, on self-pay, I just wondered if you get your thoughts on potential headwinds and tailwinds from the doctor strikes in the near-term? On PMI, you mentioned about PMI tightening claims access. Are they delaying access to procedures or fully restricting, and what areas they're restricting?  And then thirdly, you highlighted the value of the property portfolio. I was just wondering if you're thinking about doing anything to crystallize that?

Okay. I think -- shall I cover those, Harbant, or you can answer? Okay. So self-pay. So look, nobody wants strikes in the NHS because we've all got relatives and you don't want to see that disruption happening. So what I will say is we continue to deliver throughout strikes, okay? So that's point number one. We have economic -- econometric models for self-pay that look at the economy, marketing, waiting lists, and it calculates the effect that it has on self-pay. If waiting lists go up as a consequence of something, it's supportive to self-pay, okay? Whether they will go up because of strikes, I don't know. We carried on delivering. So I think the backdrop for self-pay, we said we're seeing some improvement. That's without compromising and going to areas where we feel we shouldn't go.  There's a number of reasons for that. There's a bit more confidence in the economy, okay? And that's definitely a driver of our economic model. And also, although waiting list have come down for the longest waiters, they're broadly static for the vast proportion of the population. So -- And by the way, we've been doing some very targeted, very focused and successful marketing. So we think overall, the environment is slightly more supportive for self-pay. Let's not get carried away. We're not saying it's suddenly going to fly off again. But overall, broadly supportive, I wouldn't think it'd be strikes. I think that would be inadvisable.  So PMIs. So first of all, we're just trying to solve for an equation, which I think people have been asking, which is, if PMIs say they're signing more books, why isn't the PMI market in healthcare provision going up as fast? Well, the answer is, actually, it is, but it's outpatients and primary care because younger patients have been signed up either individually or through expanding corporate books. They are less likely to need a hip replacement, right, that comes later in life. They are very keen, both with self-pay and insurance, to have a private GP appointment, to have an outpatient appointment, to have an MRI and not wait. It's one of the reasons we're building a primary care business because the patients of the future are coming through primary care. It's why some insurers are investing in their primary care network because that's where those claims come through and service them in that way. So that's the first thing.  So the market overall is growing. What's been banked here is the primary care business today and the hospital business of the future. So it's really very supportive in the long-term. It just doesn't translate. So that's the first thing we're pointing out. So claims tightening, we see this. Actually, we've seen it in the NHS. We've seen it with insurers, and we're seeing it again. It will be a feature of a number of things. One will be they weren't fully on top of claims and they're making sure they fit with policy. Two, diverting that to primary care. So, go and see a physio, don't see a consultant. And three, just slowing down the process by really checking those claims.  So, the sustainable bit will be claims that really shouldn't have gone through. Physiotherapy as opposed to consultant tends to delay, but we've literally seen this before, and there was a big thing in the NHS a few years ago, and you literally just saw it work its way through in 18 months later. Eventually, if you've got a treatment condition that needs -- if you've got a condition that doesn't need a hip replacement, a consultant will say, "See a physio", right? If you go to a physio, you need a hip replacement, you can delay, but you need a hip replacement. So you can't change the underlying condition, so it will work its way through. So I think all of those things are happening. It's a tough economic environment. Insurers have also been hit by national insurance. So this, we think, will work its way through. It's about an 18-month period, if that makes sense.  On the property portfolio, what we're pointing out is it's extremely valuable and it underpins our valuation. That's not an indication we're going to do something with it. It's also not an indication that we're not because we have sold freeholds before. There are valuable potential sort of cash for things we might want to do. So the answer is we're just putting the statement out there at the moment.  Ian, did you want to add anything to that point? Or are you happy with that?

Yes.

Okay. Further questions.

Natalia Webster from RBC. I have 2 questions, please. The first is just on the sustainability of price increases. You talked about the high-margin procedures now making up more than 38% of private hospital admissions and in the NHS more than 60% for admissions. What sort of proportions are you targeting over the midterm? And what sort of ARPC increases do you see as sustainable over the midterm?  And my second question is around cost savings. So you've delivered GBP 10 million cost savings in H1 already and are expecting GBP 20 million in H2. Is this going to come predominantly from those job cuts and consolidation of Patient Support Centers that have already been done in H1? Or are there any other key initiatives to call out for H2? And then similarly for the focus on 2026?

Harbant, do you want to pick up the cost question first, please?

Yes, happy to. So yes, so GBP 10 million in the first half, GBP 20 million in the second. As I just said a little bit earlier that we obviously undertook a couple of significant initiatives over the summer, which have led to headcount reductions, which obviously will form a significant part of that uplift in the second half. Beyond that, we're also completing other elements of our automation strategy. So, for example, one of the exercises I talked about before is P2P. So, we've finished a chunk of that in the first half, but we're now rolling out the remaining element in the second half. And there are other activities alongside P2P, which will also be completed in the second half, which will take us to the GBP 30 million. The work that we've done in the first half gives us confidence that, that GBP 30 million is -- that we will comfortably hit that.

I'll just add just totally, if you walk around the Patient Support Center, you can see the answer to that question, right? There is so much information. There's so much data. There's so much visibility of the patient pathway. There's so much opportunity for AI, by the way, right? So, currently, really excellent call handlers, a really great cohort have come in, are looking up on what is essentially a cost spreadsheet, the skills and qualifications of our consultants and then checking they've got it right. AI will allow it to pop up with the choice of consultants in 18 months' time, looking across all the different modalities, patient to be on the phone saying I want a hip replacement. AI will know what that means technically.  And the future is just really exciting now, right? So there's the things which Harbant says we know we've got in the pipeline. And there's all the things which you just think of when you go around. So we've got a great platform for that. So, overall on pricing and acuity. So first of all, on pricing, what we're aiming for and achieving is price rises or ARPC increases ahead of inflation, right? That's what you've got to try and achieve. It is not straightforward, okay? There's pressures all over the place. We've got to think about self-pay, the relationship between price and volume. I've mentioned before, Peter's team have got a fantastic model, which really does scrape and analyze all of the responses to pricing. And to get there, we put prices up and we also put prices down because we have to get this right, and it can change in a particular location.  With the NHS, we are broadly price takers. But clearly, we try and affect that by talking about the cost pressures the sector has, but also we're affecting it by focusing on those areas which have higher ARPC. It's almost the reverse to cherry-picking because we're offering more and more complex care, actually. That's one of the things we're doing. We're doing heart procedures for the NHS. We'd love to do more. Then with complexity, the real place where complexity kicks in is PMI because heart procedures are quite expensive. You don't get many [ of ] self-pay. There is loads of potential to roll out more complex services. Last year we rolled out 2 new cardiac services.  Robots play a key piece in this, by the way. You can recover more pricing, so that's the self-pay point, with robotic surgery. That's also offset by the fact you get price pressure from insurers. I haven't had an insurer ring up yet and say, "Would you like a price rise?" It doesn't work that way. They ring up and say the reverse. So we have to balance. We've talked about proactive tendering. We have to balance the opportunity associated with price with insurers if we think they can lean into it. We mentioned one last year we thought they could versus where it's simply trying to extract value where we're doing a great high-quality job, in which case we treat it slightly differently.  So if you put all that together, more complexity, yes. Is it going to go to 100%? No. So -- But then we just opened -- I went and opened a cath lab in Bristol, a new cath lab. So that's CapEx because it's new and fast and AI supported. Literally, 2 consultants have signed up to bring us their business on that day because of the investments, which goes to the CapEx piece around growth. You could call it replacement CapEx, but it's new technology. So there's lots of potential to continue. Well, the trajectory is slow or theoretically, I don't know if it's next year or the year after. But as we sit here, there are new treatments which are more complex coming online. And pricing overall, that's our day job. It's really complicated. It's really detailed. We're really disciplined and we're all over it.  Any other questions, please? Are there questions online? Yes.

[Operator Instructions] We have a question from Kane Slutzkin.

Most of it has been asked, but just, Justin, on the -- if you could just sort of remind me on the self-pay, sorry, I might have missed a bit of it, you're saying you're slightly, I guess, more positive. Just the wording in the release talking about the exit rate being similar to '24, but improving in recent months? Could you guys sort of give a little bit of color what that, that sort of improvement is maybe quantified, maybe not?  And then just I did notice in June, Bupa had acquired an independent private hospital. I'm just wondering, obviously, that's probably the first one they've done in, I don't know, 15, 20 years. But just wondering if you think that's part of a broader strategy to return to large-scale sort of hospital provision in the U.K.? Or is that just kind of more opportunistic?  And just last one, just on the capital allocation. You've spoken to sort of the freehold and potential there. But just wondering if buybacks could be back on the cards at some point?

Okay. Thanks, Kane. Do you want to handle anything you want to say about improvement and freehold, and I'll take the Bupa question.