Good afternoon, everybody. Welcome to those of you that are able to join us here in Gresham Street and to those of you who are joining us remotely. We're really pleased to be delivering this set of results for the six-month period that ended on the 31st of December, the first half of our financial year, which will end in June. Very pleased after all that's gone on for the last two and a bit years to be delivering once again, what we believe to be is a very, very strong set of results. I know that most of you have been invested in Tristel for quite some time and know us well. For anybody who hasn't been on our journey with us this last several years, let me explain a little bit about Tristel.
We're a global infection prevention company. Everything we do is essentially focused upon the hospital, attempting to eliminate the spread of infections within hospitals from patient to patient, from patient to nursing staff or clinical staff, and from clinical staff to patient. We shouldn't ignore the presence of the public when they visit their loved ones in hospitals as well. We're trying to prevent hospital-acquired infection. We focus upon a proprietary composition that is ours and that is based upon the molecule chlorine dioxide. Chlorine dioxide, the chemical symbol is ClO₂, is a very powerful disinfectant, one of the most powerful disinfectants in common use. It has enabled us to prepare and commercialize two sets or two product ranges, one which we call Tristel, the other which we call Cache.
Tristel product range, the portfolio is used to disinfect medical devices that are used on patients, and Cache, a range of products incorporating chlorine dioxide that is used to disinfect hospital surfaces. We distinguish ourselves in a number of ways from many other companies that are in the infection prevention market. First, we're unique in using chlorine dioxide. Secondly, we harness the power of chlorine dioxide to be able to attain the status granted us by regulators, microbiologists, key opinion leaders, leading scientists. It's a moniker of the product, high-level disinfection. We are within a very elite group of disinfectant products that can claim legitimately high-level disinfection of medical devices.
On surfaces, we're able to kill the most difficult to eliminate organisms, which include bacterial spores, including something that's of great potential harm to patients in hospitals, which is an organism called Clostridioides difficile. The distinguishing feature is chlorine dioxide and the highest level of performance. If we can flip this slide. Our markets are Tristel medical device decontamination, Cache sporicidal surface disinfection in the hospital. Our marketplace geographically is very diverse. We started our business here in early 2000s in the United Kingdom, and it is still our largest single market. Today we have operations in some 45 countries. We have subsidiaries in 14 of them where we sell directly to hospitals and have established our own teams, and we sell through distributors in some 30-odd other countries. We're in two very large marketplaces.
Medical device decontamination involves us in a number of clinical areas within the hospital. We are not targeting one set of instruments and one set of clinicians and one department within the hospital. We have a broad spread within the hospital where medical devices used in ear, nose, and throat, in ultrasound, in neurology, in ophthalmology are deployed requiring high-level disinfection. In surfaces, well, all hospitals all around the world are a potential customer of ourselves as we establish our Cache brand. On the next page, on the next slide rather, you can see our products. We have a small product set. We are very focused on a small number of products, all with the distinguishing marks or hallmarks that I've just described.
They're used and deployed by nursing staff to high-level disinfect medical instruments and to wipe tabletops and medical equipment with our surface products. That brief introduction leads us to the results, which, as I say, mark a bounce back from the disruptions of the last 3 years.
We are delighted with this set of results. We can report that revenue grew by 16% to GBP 17.5 million, which equates to GBP 2.4 million of growth, and that can be split GBP 600,000 with respect to price increases and GBP 1.8 million with respect to volume increase. At an underlying basis, and when I say underlying, I'm talking about before the impact of the Brexit stock unwinding, which took place in the first half of last financial year, and also taking into account the discontinuations that took place last year. On a like for like basis, the growth that we can report is 21%.
I think you can understand our enthusiasm because it really feels like the business is getting back on track. Our overseas sales grew by 12% in the period, and U.K. sales grew by 24%. Our overseas sales make up 64% of the whole now. Our gross margin ticked up very slightly from 80 to 81%. Indeed, we applied a 6% price increase at the beginning of the financial year, or we mandated it at the beginning of the financial year. Not all of our customers could have that or would have that price increase applied because they were either in a contractual arrangement or we had a set timeline by which we could implement a price increase.
In fact, in this period, we have reported a 4% effective price increase, so there's more to come in the second half. Our reported PBT was GBP 2.4 million compared to a loss of GBP 1.2 million last period. The reason for that loss was the impairment of GBP 2.4 million of intangibles in the prior period. Adding that back and making that adjustment, profit before tax actually rose by 41% to GBP 3.1 million, which puts us back in the zone of profitability that we were enjoying before COVID. Our reported EBITDA was up 16-fold to GBP 3.9 million, and adjusted EBITDA up 28% to GBP 4.6 million. Reported EPS was GBP 3.19 .
Adjusted EPS, so again, taking account of that impairment and share-based payments, which is the other adjustment that we make, EPS was 4.65 pence, very slightly down on the pre-prior period, and that's principally because of the significant tax charge that we suffered in this period. The tax charge in current year P&L was GBP 900,000 for the half, and that's split 50/50 between deferred tax and current tax. The reason for such a large deferred tax charge is in relation to our share-based payments. Within the share-based payment, the calculation within deferred tax, we have to take into account the share price volatility, which impacts the likelihood of exercise of our share options.
That fed through the numbers that pushing up the deferred tax asset and as a consequence, the deferred tax charge. Our interim dividend will be maintained this, payable on the 11th of April at GBP 2.62 per share, and we'll maintain that level until we can return to our stated dividend policy of 2 times cover. At that point in time, we will return to 2 times cover so that we can once again, have a progressive dividend.
We will have a review of that dividend policy with an eye to whether or not we shouldn't reduce that cover number, because you may recall that in August this year, we made a special dividend payment, and we'd much rather have a steady and stable standard dividend policy than find ourselves in a position where we're making special dividends. As a reminder, we have no debt on the balance sheet, and we were reporting in this period cash of GBP 8.4 million. Just to give you an idea of what's happened since the 31st of December, today, the cash balance within the business is GBP 9 million.
We've had a very busy 6 months. We could have all sorts of different highlights that we might speak to all around the world, but we're focused upon North America. It's a topic of great interest to us all. During the half, we launched our DUO product in the United States, and we launched it at 3 ultrasound conferences that pretty much all took place at the same time, different cities around the States. The picture is of that product. We call it DUO. It's a foamer. When the user depresses the pump, foam comes out. That foam actually has 2 components. They mix, they create chlorine dioxide is created immediately, and it's applied to the surface of an ultrasound probe or an ultrasound transducer by a dry wipe, which we provide, which has been carefully selected for its purpose.
The product that was launched is approved. It's approved by the Environmental Protection Agency, the EPA. After quite a number of years of data generation, we got the EPA approval something over a year ago, I believe, if my memory serves me right. We embarked upon a state-by-state registrations process, which I can tell you is pretty much complete. All bar 3 states have now approved at state level DUO. The states that are remaining or outstanding are Florida, Hawaii, and Maine, I think. All others, including New York and California, which are notoriously the most difficult states to get approvals from, have granted us their blessing. We launched at 3 conferences. We had our teams out there in conjunction with our business partners' personnel. We shared stand space together.
We jointly promoted, or the stand promoted both our partner's products and our products. Our partner's company name is Parker Laboratories, and they're a specialist ultrasound business. They make the ultrasonic gel that is applied to the transducer or probe head, the bit that comes into contact with the body. In every ultrasound procedure, I'm absolutely certain that at least 99% of us in the room have had an ultrasound scan of some kind or other in our lives. Always the gel is put either onto your body or put onto the transducer head, and then the instrument is swept over your body. There are internal ultrasound procedures carried out as well, rectally and vaginally. A great partnership. They're market leader in the United States. Wherever ultrasound is performed, ultrasonic gel is used, and Parker's the market leader in the sale manufacturing sale of ultrasonic gel.
We felt many years ago, it seems, but it was many years ago, when we embarked upon this project to gain access to the United States market, we identified Parker as the ideal partner for us. We put a relationship together where they perform the role of both manufacturer and distributor for our products when they get approved. We co-hosted many hospital clinicians and sonographers at our stand. Their distributors attended. They have nationwide distribution. They've been in business for a long, long time. We entered the United States market with our EPA-approved product. Take-up has been reasonable. We have the product with three of their main distributors. We're sampling. They're sampling. We've been educating those distributors' sales teams. You can find our product on their websites.
We're in their catalogs as they have been revised. The main event will be getting FDA approval. The FDA has jurisdiction over the invasive probes that go inside the body, and those probes are the probes that require high-level disinfection. We're presenting ourselves to the FDA as a high-level disinfectant. First, approval for a high-level disinfectant in 12 years, as a medical device disinfectant, that is, of course. We will be able to present ourselves to the ultrasound market in North America as being able to disinfect all parts of the ultrasound equipment that are used in many departments in a hospital. I've heard it said, it's been commented by some clinicians that we were talking to the other day, ultrasound is the new stethoscope. It's used.
The ultrasound probe is used, and transducer, they're used all over the hospital for all sorts of purposes that wouldn't have been imagined a decade ago. Ultrasound is a fantastic market for us in all of the countries in which we're represented. It's a growing medical technology. It's being used in many more departments in the hospital than obstetrics and gynec ology, which are its sort of historical places where it's widely used. Now, we have made a submission to the FDA, and we did so in June last year, of an enormous data pack seeking approval under a pathway that they advised us to take, which is called de novo. They reviewed that submission, and after some 100 days or so of questions and answers, some clarifications, they provided us with their formal request for additional data.
This is what happens. It's an entirely normal process. That's called an RAI. We were given, in accordance with their timetables, 180 days to pull that additional data together. It involved retesting, some fresh generation of data. They wanted us to explain a little more in greater detail how chlorine dioxide actually works, how it works on the surface of an instrument, understand the characteristics of the chemistry. The gun had started. We had 180 days to pull all of this together. I'm really pleased to be able to assure you that all of that data has been generated and successfully. We've done new micro tests. We went into another clinic.
We attended a urology clinic where ultrasound probes for rectal examinations were carried out on eight patients. We swapped the instruments after the patient had after the instrument had come out of the patient. All the data's great. Pass, pass. We're busy writing it all up. We need to present solid scientific arguments. We're working with our advisors. Our team is very much, you know, committed to getting it done and in good time. By March the 23rd, we'll respond to the RAI with another substantial data pack delivered to the agency's front door. When that happens, their clock starts again. We've got 75 days left on their clock. If you look at the calendar, 75 days from March the 23rd takes us to June the 8th.
In and on and around June 8th, we'll have a decision from the FDA. We believe we've done everything we can for that decision to be a positive one, but of course, there is no guarantee of it. Whether or not we have FDA approval, we have EPA approval, and there's a good, solid, strong, long-term, profitable business to be built in the United States around what we have. If we have FDA approval, it just expands our opportunity enormously and will be a remarkable inflection point for our business. That's where we are in the States. I will return to it, and we talk a little bit more about it as we go through the presentation.
Okay. Looking at the sales by geography, we're reporting strong growth across all geographic locations with 12% growth overseas and 24% in the U.K., which equates to 16% growth group wide. If we remove from the comparable period sales of the product lines that were discontinued a year ago and add back in the sales that came from NHS Supply Chain Brexit stock holding instead of from us, the underlying sales level is 21%, that can be split 29% in the U.K., and 16% overseas. U.K. underlying sales are growing, that's because of pricing, the price increase that we that we mentioned earlier. It's because of volume.
The use of our products by existing customers has increased, that's partly because of the increased service levels that hospitals are offering in this period we're reporting upon compared to the comparable period, because the comparable period did cover a COVID scale back in outpatients era, and also because we're winning new customers. We are through the pandemic, we didn't just sit still and do nothing. In the U.K., we were able to contact customers, we were able to talk to them and demonstrate and persuade, and we can now see that increased level of custom coming through in the numbers.
Then with respect to the portfolios of the business then, here we're showing our Tristel medical device decontamination, our Cache surface disinfection, the two core product ranges within the company, then other sales than the areas of non-focus. You can see that strong growth was achieved in both of those two key areas of focus. The other range is now principally made up of carriage and complementary third-party technologies and products that just don't fall into the other two categories.
This slide brings us back to North America and, hopefully makes the explanation I provided a few minutes back, easier to see, to visualize. What we're looking at on the two slide or two pictures to the left of the slide is an ultrasound console. Lots of electronics, lots of high tech, a keyboard, a screen, and then connected to the ultrasound console via cord is a probe or transducer. On the left-hand side, but you can see by the shape of it's going inside the body, and that's called a transducer. Sorry, that's called a probe. For that probe to be disinfected, it has to be at the level of high-level disinfection, it has to be approved.
That product has to be approved by the FDA. That's what we're seeking FDA approval for, that device that is described as an ultrasound probe, e-endocavity ultrasound probe. On the right or on the middle picture, there is the same product, but carrying the EPA approval, called DUO, but DUO approved under the EPA. That enables us to disinfect all of the console surfaces. They're all being touched all the time by the sonographer and by other, nursing staff, clinical staff. All of the surfaces need to be disinfected. The disinfectant that is used for those purposes is approved under the jurisdiction of the EPA. We have that opportunity, business opportunity, sales opportunity of disinfecting those surfaces with the product that is approved already and launched.
The picture of the ultrasound transducer in the picture there, that's a skin surface probe. If you're in term as and pregnant, then that's the type of transducer that's looked to use to look at the fetus. If you've got muscle injury, it might be used by a physiotherapist. If you're doing a line insertion and you're trying to get a catheter, either central line or peripheral line into a vein, increasingly ultrasound scanners are used to be able to locate the vein and gain access so you don't keep sticking the patient, which is very painful and uncomfortable for the patient. With increasing levels of obesity, there are a lot of people where finding a vein is a very difficult task for the clinician.
You can see how ultrasound adoption, given an aging population and issues like obesity will be on the rise. On the right-hand side, another iteration of our DUO product here, with a label for which the intended application are ophthalmic devices. Our business has been built around those clinical targets I referenced earlier, ophthalmology, ultrasound, ear, nose and throat, cardiology, and a couple of others. In Canada, we've been approved by Health Canada as a high-level disinfectant for use on ophthalmic instruments that require high-level disinfection. The picture is of a tonometer. That small lens comes into contact with the cornea and is used in glaucoma assessments. There are millions of glaucoma assessments that are undertaken annually across the globe and in North America and in Canada.
We have a product that is suitable for the high-level disinfection of that type of instrument. We've got a broadly based business that can be built in North America. FDA helps, EPA is there. Canada, we have approvals to build upon. On our next slide, we speak to and explain and then both the business relationship that we've cultivated with Parker, but also how we've changed it during the course of the 6 months. As I said earlier, I think Parker is the ideal business commercial partner for us in North America. The 3 events that we were both involved in in the autumn gave us the opportunity as a management team to meet their management team.
There were nights spent post conference day, you know, sitting around a table and having a glass of wine and getting to know each other an awful lot better than we had over the course of the prior 3 or 4 years that we've been working together. It culminated with us sitting down with the proprietor and president of that business and saying, explaining that we've invested more than we had originally thought we would to get to this point, being on the cusp of getting FDA approval. It's going to probably require more resource from us here in the United Kingdom and from our organization around the world to make a great success in the United States.
We felt that the balance of the relationship, the commercial balance wasn't quite as it should be, culminating in a negotiation, a fresh negotiation, and recasting the royalty rates that we will earn from the ultrasound activity in the United States in conjunction with Parker. Previously, we had, from the FDA-approved product, a 17.5% royalty, and it is now 30%. The basis changes slightly, so it's 30% of the gross profit as opposed to 17.5% of revenue. The gross profit level will be about margin will be about 95%. For the EPA-approved product that is in market, rather than a 14.5% royalty on revenue, it goes up to 20%. The business model in Canada is somewhat different.
Parker are not involved. We can elect for them to manufacture the product, but at the moment we're supplying directly from the U.K. We've appointed an ophthalmic specialist as our distributor in Canada, and we sell to them, and they sell on to their customers, the hospital, at a markup. Two different business models, but that's good news and enhanced potential in the United States in terms of profit stream for us. This is a bit of a teaser. We were on a trajectory from 2005 to 2019, I suppose it was, with a compound annual growth rate of revenue of 17%. Consistent growth with only 1 year in which revenues declined.
COVID interrupted that progress and exacerbated for us by stock building by the NHS as a consequence of leaving Europe. As we can see from the numbers, that trajectory has resumed. We extrapolate it forward. We don't have FDA approval. We've barely touched the surface in the United States with respect to the EPA approval we have. All the upside is to come. There is no reason why that trajectory, which is based around our own internal performance target of top of 15% top-line growth, will not be maintained. If we do get an FDA approval, it clearly is an inflection point, and that's what the dotted line is there to illustrate or indicate.
A very sound business, a reasonably fast-growing business, a profitable business, a cash generative business, but an inflection point will be ours to exploit if we get FDA approval.
Here we've got a little slide on our ESG activities during the period. We have engaged with a specialist ESG consultant, and they've helped us finalize our ESG strategy and reporting. Shortly we will be putting up on our website what that ESG strategy is. We will be calculating another year of emissions, carbon emission numbers. By June 2023, June this year, we will set our carbon net zero targets, and we will lay out for all stakeholders the journey on which we will need to travel in order to reach them. As an ongoing piece of work, we are continuing to research alternative and more environmentally friendly packaging options for our products.
In fact, of course, our Cache product range is designed specifically for an environmentally friendly profile, which is to replace the pre-wetted plastic wipes that are used in huge quantities within hospitals. That's the most important ESG activity that we have in terms of the environment. We are also looking at other alternative packaging elements for the rest of our product portfolio. Finally, on these actions, Tom Jenkins, one of our Non-Executive Directors, he is employed by BGF, who has made an investment in Tristel, and as a consequence, he could no longer be considered to be independent. At the moment, he is a non-independent Non-Executive Director.
As of April 2023, he will return to independent NED status, so we readdress that balance of independence on the board. Meanwhile, with respect to gender split, we have got, at the moment, three female members of the board, five male, and so we're not doing too bad in terms of gender split. We'll have an NED vacancy in a couple of years' time when our longest-serving NED steps down, and I'm sure we will try and give a 50/50 balance on gender to the board at that point in time. Leadership roles are, within the organization are already a 50/50 balance. We have achieved a very good gender balance throughout the organization, not just in leadership roles, but also when you look at the salary levels throughout the organization. We have, we've got a very steady and equal balanced business.
Moving on to the summary. Well, here we are back with top-line growth. The business is very high margin, continues to be very high margin generating. We are very highly cash generative, and that has continued. We are increasing our geographical diversity. We can now consider ourselves to be a global business selling into the Americas as well as the rest of the world. Of course, these are consumable products that perform a vital function, that's non-discretionary within a hospital. We, if we circle back to the beginning of the presentation, we use the three words simple, focused, and global to describe the business. This has been a very short presentation, and that's because the business is very simple.
We are totally focused upon chlorine dioxide in the hospital market, we're on the cusp of taking the business truly global.
Thank you, Liz.
Okay.
I think we're ready for questions.
Okay. Just as a reminder, we'll take them from the room first. Kiki is gonna be passing a microphone. If you could just wait until that's in hand and then ask your question. Any questions in the room, just put your hand up.
Will it be a negative, the fact that you're a U.K. company trying to get FDA approval? Is that a big negative? Secondly, if you get FDA approval, will it not invite some bids coming in from America for the company?
Well, I think the answer to the first question is, I would sincerely hope that there would be no bias against us, being a foreign company. If there is, I doubt whether we'll ever know that. I would say that having a partnership with an American company is probably the best place for us to be. The FDA has a very prescriptive process that we have followed meticulously, been well-guided by lawyers, well-guided by consultants, and have engaged on multiple occasions with the agency itself to ask their advice and ask them, "Are we doing the right thing?" As I said, one new novel technology for disinfection has been approved in 12 years. I hope that there won't be a bias.
I wouldn't imagine that there would be a bias against a well-respected company that has got good technology, that is widely used around the world with a great track record. That counts for nothing if we can't meet the data requirements of the FDA, and I do believe we have met them. Whether there's a philosophical issue amongst the team that would be reviewing our submission at the final sort of stage as to our method of application, they've never approved, they've never reviewed chlorine dioxide before. Who knows? It's, it's novel ground, and that's why we're following the de novo pathway. Could you just repeat the other part of the question?
I was,
Oh.
That was a cheeky one, really.
Yeah.
Are you likely to get a bid if you get this FDA approval? Are you?
I didn't answer the first question very clearly. I certainly can't answer the second one. We've got a pretty unique position in the world of decontamination of medical devices. I've described how we do it. We apply by hand a high-level disinfectant uniquely because we're using chlorine dioxide. We do so because chlorine dioxide is very safe. It's very effective, but it's very safe. We own the market of high-level disinfection of medical devices by manual application. There's not another company that does what we do. If the most difficult agency in the world, regulatory body in the world, says yes to our technology, I think it would be the final stamp of approval on something that might be considered to be rather unconventional.
I would say that we've become, you know, we've joined the ranks of convention by that achievement. Who knows? We'll carry on irrespective of what may happen.
It's impressive to see that you've managed to renegotiate those deals with Parker. I mean, it seems that it must have taken a little bit more than a few glasses of wine and a bit of charm. I mean, their position relative to Tristel's quite a large company. I mean, what do you think made them give you those extra extra percentages? Are there any minimums or caps on the numbers?
No, there are no minimums and caps. I, fortunately, the company is owned by a family, and it's run by an individual. We're not dealing with a corporate and dealing with a, you know, manager of a business unit who's got to get approval from the manager of, you know, and on and on and on and on. He took the decision. He's a really sensible, nice fellow. It was done in the spirit of we both need to feel comfortable with the way that we can build the business together. It wasn't as. It was what it was, and we got there without, you know, amicably in a very grown-up way. It, it really was a easy journey, to be perfectly honest.
I'd like to think that he negotiated with us the way that we would negotiate with someone, yeah.
Good evening. Just a question on the North American story. Assuming you get FDA approval, can you just help us how that story scales? Is it, I mean, you've got nice margins there, clearly, but as that scales, how does that impact profitability going forward? Is there a sort of sales and marketing sort of effort you need to really put through post that? Does that sort of eat away at your EBITDA margin? Or is that in, sort of already accounted for in the, in the royalty sort of agreement?
The royalty would show as revenue.
Yeah.
The basis of the business relationship was founded upon us not having to invest in G&A, in overhead, in establishing an operation to support Parker's operation in the United States. That was the original basis of it. Now, what we are contemplating is a bigger prize between us both, and we've committed more in terms of upfront investment in the regulatory process upon which we need to get our return. We are more prepared than we were, say, 2 years ago to invest in resource in the United States to support their effort. It would not be around establishing a sales force because they effectively have a sales force, but it would be more around the educational side of things, helping shape the hospital market's understanding of chlorine dioxide and acceptance of it. [Umm].
Dependent upon how much we invest in overhead, it all flows through to the bottom line. In terms of, having a potentially quite significant impact upon margins, EBITDA profit margins, you know, that's what the model looks like for us.
Thanks.
Hi, Paul. Thank you. Just on the US and Canada progress, have you been happy with how Parker's pushed your product so far? Can you give us an idea of the performance of the products that you've launched up to this point?
Yeah. We're very happy with their capabilities that they've shown us with respect to manufacture. They've got a manufacturing process that's very similar to ours. You've been to our factory, so you know the setup. We're filling small packages with the liquids. They do a very similar thing with their ultrasonic gels. They make those ultrasonic gels in a very similar way to which we make our blend and make our liquid in volume to be then dispensed down and filled into smaller packages. In essence, it's almost an identical manufacturing process. We've been very satisfied with the quality management system that they operate, with their technical capabilities. Now we've, over the course of the last six months, seen them how good they are operationally.
Their admin team has sourced all of the raw materials that we use in our Tristel DUO product, both chemicals, plastics, labels. You know, we've seen at firsthand as we've prepared product for the launch at these 3 conferences, and then manufactured product for inventory, which has been shipped to the 3 distributors that have been identified and appointed, that they're very, very good. There's product in the system with those 3 distributors, so it's in their warehouses, they're sampling, we know how much has been manufactured, and we know if everything was sold and not given away for free trial and sampling, what the sales value that would start to form the basis of the business looks like.
It's not gonna translate to royalties in this level. I'll be very careful in my saying this, but it's about $250,000 worth of product that is likely going to be given away at full value if it were sold at full value. You can see there is some real activity that is in process. Yeah. Early days, it is kind of for real.
Oh, hi. Your presentation was particularly on America, which is what you said at the beginning. Can you give an overview of what's happening around the rest of the world? I mean, are there markets that you're trying to get into or expand?
Yeah.
Can you give an update on all this?
Well, well, let's quickly move around the world. We have subsidiaries and operations in Antwerp, looking after Belgium, Netherlands and France. In Berlin, looking after Central Europe, so Germany, Austria, Switzerland and Slovenia and various smaller countries markets. Italy. These are all subsidiaries with our own employees, located in them and varying different sizes of sales teams. Hong Kong, China, Shanghai, Malaysia, Kuala Lumpur, Singapore, and then in Melbourne, Australia, and Tauranga, where the test match has just been played in New Zealand. During the period, all of them have registered double-digit growth, with the exception of China.
China itself, over the course of the last several months, has transformed in the sense that the staff can go to the office, the staff can travel outside of the province that they're, they are located in. For the first time, our managing director who presides over China and is located in Hong Kong, can travel to our Shanghai office, and she'll be there in the course of the next week or so. Even in China, things are back to a normality. In all other countries in which we have a direct presence, we've had a very strong first half. We are looking at entering new markets, so we've appointed a distributor in the Philippines.
We are in talks in Indonesia, expanding our presence through distributorships and partnerships in India, where we have registration of all of our products, but we haven't done very well with the first distributor that we appointed, which had a focus upon ultrasound, but it's not really gone anywhere at the moment. We're looking now at ear, nose, and throat and ophthalmology for the India market. Canada is coming on stream as a new country market. We have a good distributor throughout GCC, throughout the Middle East. They're looking to take our products into North Africa, so Morocco and Algeria, principally. There is still a lot of activity to build out the geographical footprint.
In the Nordics, we're present through distributors in Norway, Sweden, Finland, and Denmark, but only Denmark and Finland are really doing anything in terms of fulfilling the potential of those two markets. We could do a lot better in Sweden and in Norway. We were in Russia and withdrew. There's a lot of activity outside of North America, and I'm glad you asked the question 'cause it's great that, you know, we can look away from the West because we're very busy in the rest of the world.
This may be an awfully basic question. What do the Americans do to sterilize or sanitize or whatever the right technology word would be, the invasive probes to date, and what's your advantage?
There's one product in America that is approved by the FDA, and it was the last approval that was granted by them some 12 years or so ago. Many of you will have heard me mention the product by name before. The name of the product is trophon, and the manufacturer is an Australian company called Nanosonics. They have developed, built a very successful business in the United States. Now, we do compete with them all around the world, including Australia, which is their home market, and we fare very, very well against them. The difference between our product and their product is theirs is a box, so it's power driven, requires electricity. It's has a fixed installation, so it can't be moved. Our DUO product goes in the sonographer's coat.
It can be walked around a hospital by somebody, who's the clinician who's using ultrasound as a diagnostic technology. There are different features and benefits of the two different products, Tristel DUO and Nanosonics trophon. They use hydrogen peroxide, which is a very effective disinfectant, and they fog it. Inside the box, it's actually a fog. Of course, it has to stay inside the box because if it were to leak out of the box, it would not be very good for the user. As I said earlier, the reason why chlorine dioxide can be deployed by the hands in a manual process is because it's very safe. All the other competing chemistries have to be kept in boxes.
We can actually sort of reduce the whole competitive landscape down to manual application of a high-level disinfectant Tristel standing alone, people who are keeping effective chemicals but having to keep them behind closed doors. One. It defines the landscape. Boxes, power. Yes, push a button, and it all supposedly happens properly, or use the hands. There are a lot of benefits from using the hands. It's quicker, it requires no capital, you know, a whole host of advantages.
If you were not to get FDA approval, what would be your next steps? Would you try potentially to get FDA approval for a different product, your ophthalmology product or something like that?
We have to understand that, how one of the reasons why we're gonna spend some time in the course of the next week with the lawyers based in Washington, just so that we can start to scenario plan. We believe that we would find out why they couldn't see it, they couldn't give an approval. Manual application may be a difficulty for them. The generation of chlorine dioxide may be a difficulty for them fundamentally. That, those concerns would not be unique to the FDA. Every other regulatory body in the world has had exactly the same concerns. Every user, prospective user has exactly the same concern.
How can I be sure that I can put the disinfectant onto the surface of the ultrasound probe and you, and that user every time will cover the surface of the instrument perfectly, completely? We have in development some technologies, dyes, and various other methods by which we can cover the instrument and then remove the instrument through the disinfection process. I don't, we don't know what happens in that eventuality, but we have it quite possibly through further technology, development and innovation, we could cover off the concerns that might be shared with us. Of course, then there is plan B, which is to take our learnings with respect to ultrasound and look at ophthalmology. The devices are far smaller, the numbers are just still. It's a huge business opportunity and we would look in another direction.
I don't think it's game over, and we have a presence in ultrasound because we have DUO approved for ultrasound with the EPA.
Not only the data that we generated is totally specific to ultrasound, so it means that the work that we've done could read over in some cases to other applications.
Oh, hi, Paul.
Hey.
Yeah, should you need to expand in the future, having won, say, approvals and all that, what likely method are you going to use? Are you going to do a capital raise or take on debt, or have you got other facilities already?
No, I think we've got GBP 9 million of cash. We have no debt. Expansion doesn't absorb much capital. Working capital is very manageable. Inventory, because these are consumable products, we don't hold enormous amounts of inventory. Receivables, very stable level, you know, it grows as turnover grows. Our clients are hospitals. The great majority are state-owned and, or funded in one way or the other. We have an impeccable history of receivables collection. We could treble the size of the business, and I think it would be self-funded.
Brilliant. Okay. Is that all the questions in the room? Yeah. Okay. Given the time, we'll just take a couple of questions that have been submitted online. Do you anticipate the current industrial action in hospitals will materially impact Tristel's sales into the NHS, and can any impact be quantified?
We can't quantify it. We look very closely. We have great intel through the financial systems that we've got in place as to usage almost day by day. There's no impact from this industrial action that is taking place across hospitals and unquestionably in some of the areas in which we're involved, but it's not impacting the numbers that we can see.
You have previously said that you regard the U.K. Market as mature with little opportunity for growth. Can we therefore assume that the 24% increase is a one-off to revert to the pre-COVID position?
Well, we've grown in the U.K. if we were to compare other results with the corresponding period, which would have been the six months up to December the 31st, [19, not 1999],
2019 rather. That was the last six months that wasn't affected by COVID, and we've grown since then. We've grown through COVID in terms of client acquisition and more use of our products within hospitals. I, it's an almost an unanswerable question. I don't think U.K. s ales will grow next year by 24%. I hope they do, I don't think they will do. It's certainly not ex-growth, so it slows down. I don't think the U.K. Will or ever has gone sideways and goes flat, will go flat.
Okay. I've one more. In the U.K., what's the split between high-level product sales and intermediate level products?
That's a distinction to interpret that for the room. There are three levels of disinfection in the world of instrument disinfection. There's low level, it means that you can kill bacteria and some viruses. There's intermediate level. You can kill those same bacteria and viruses, but also mycobacteria, which would be the cause of tuberculosis. It's a more difficult to kill organism. There's sporicidal, which is killing bacterial spores on top of mycobacteria, viruses, and bacteria, and that's what defines a high-level disinfectant. In the U.K., we only sell chlorine dioxide as a high-level disinfectant. In fact, all around the world, with one exception, which is purposeful product positioning in Australia, we only sell chlorine dioxide with a claim set of high-level disinfectant.
There's no need for us to do anything other than describe it in all its full glory as a high-level disinfectant and the best of the best.
Brilliant. Okay. Well, that kind of brings us up to the hour. If there's no more questions in the room, then we'll bring the formal meeting to a close. Any other questions that are submitted online, we'll make sure those are responded to in due course.
All right. Lovely. Thanks ever so much, everybody.
Thank you very much.
Thank you.