Ready to go? All right. Good morning, everyone. I hope you've enjoyed the tours, presentations, and conversations over the last twenty-four hours, and that it's given you a good sense of the size, scale, and breadth of our hospitals in Perth. The superior position we have at Hollywood, particularly in the key therapeutic areas of cancer, and orthopedics and cardiology, and the huge opportunity we have at Joondalup Hospital, as the only public and private facility in North of Perth. This is our agenda for today. We're going to cover our strong foundations as one of Australia's leading healthcare providers, the market fundamentals that underpin healthcare and our growth strategy. And following my presentation, we'll have a presentation by our Chief Transformation and Digital Officer, Dr Rachna Gandhi, and then go on to questions.
We'll leave you today with our thoughts on why Ramsay is well positioned to take advantage of strong long-term industry fundamentals and deliver improved operating performance, leveraging our strategic and diversified portfolio to drive our competitive advantage. In 2024 , we celebrate our 60 year anniversary, ten years since Paul passed. We're a business created with a strong purpose of people caring for people, and we have incredible endurance. The past few years have been some of the toughest the industry has faced, I won't lie. It's been challenging, that's why my photo looks a lot better before, but in challenging times, I think the stronger get stronger. Ramsay is meeting these challenges head-on, using the opportunity to strengthen our business through investment in people, facilities, and processes, and we haven't strayed from our strategy. We have kept on investing in our portfolio.
We don't apologize for that, where opportunity and growth lies, and applying financial discipline as we always have. And we're investing in our people and systems and in the expansion of our services to ensure we emerge from this period even stronger. The breadth of our network today is extensive. In Australia, Ramsay partners with 9,000 accredited doctors, and shortly we'll have 10 EDs, with a further to open in 2026. And we currently have 1.2 million admissions to Ramsay's 70+ hospitals, including 12 surgical centers around the country each year. While we remain a hospital-centric business at our core, we believe that to continue to be successful, we must build an integrated and cohesive network of healthcare services, both upstream and downstream, to our hospital network, creating local scale and local scope of services.
This creates value for patients, value for doctors, and value for payers. Our important hospitals are really important infrastructure with leading positions in growing cities, major regions, and urban corridors right across the country. This is our competitive advantage. Our strategic and diversified portfolio of hospitals, supported by surgical centers and integrated care, creating local healthcare services and networks in high-growth markets. Many of our hospitals are comprehensive facilities, like the two you've been through in the last few days. Undeniably complex centers providing highly acute surgical, medical, clinical critical care, and psychiatric services, which is our unique competitive advantage. Paul Ramsay always said: "Look after the patients, look after the people, and the rest will follow," and Ramsay does that in spades.
Despite the challenging times we've faced over the last few years and our unrelenting focus on operational performance, Ramsay facilities have continued to deliver world-class NPS scores, which we're really proud of. Our customers right across the business tell us that they experience great customer care. And central to the patient experience and our success is our dedicated focus on staff and patient safety. We ensure our hospitals and healthcare services are delivering high quality, safe, and effective care through evidence-based, contemporary, and robust clinical policies, procedures, and risk management frameworks and systems. We have an unrelenting focus on speaking up and managing behavior that underpins our safety culture. Vanderbilt University Medical Center developed a part of our program, which addresses poor behavior that could lead to adverse outcomes.
Vanderbilt has noted that Ramsay's version of its Speak Up for Safety program is one of the most successful implementations of its program outside of that university. Our work health and safety figures are the lowest in the industry on the data available, and we continue to strive for the highest levels of patient safety through the implementation of best practice programs, education, and training, like you've seen at these two sites. We've recently rolled out a new national maternity safety program to enhance the monitoring of heart rates in unborn babies, with 900 midwives trained in this program. We've also launched a new patient and family program, RAISE, which encourages our patients and their loved ones to escalate any concerns that they have.
These investments are designed to ensure we lower the risk for patients, we have fewer serious incidents, and we lower our claims cost, which we are doing. Finally, our investment in clinical trials is not only about offering hope to patients, which we do, but it's also, there's also significant evidence to show that patients treated in hospitals with a clinical trials program will have better outcomes and significantly lower mortality for all patients, not just those on a clinical trials program. Our clinical trials network contains 22 sites, supporting hundreds of trials at any one time, making Ramsay one of the largest provider of clinical trials in the country. So the things that have made Ramsay successful don't change: delivering high-quality clinical outcomes, partnering with our doctors, and empowering our people through the Ramsay Way. But we believe our core business has more growth potential.
Over the past year, we've gone through a thorough and complete assessment of our business. We believe that there's an opportunity to optimize our business and drive more value from the core. This will look similar to what we've done before, expanding our hospital network through financially disciplined investment, but also investing in outpatient services to drive local scale and local service scope, particularly across our major therapeutic areas of cancer, orthopedics, mental health, and cardiology. Secondly, we think we can extract more value from the core by reinforcing our strong business, operating our physical and digital infrastructure as healthcare networks, in which hospital centers of excellence operate as hubs alongside lower acuity services and in-home spokes to provide superior, digitally coordinated, and integrated care more locally.
Finally, we have the opportunity to transform our business, taking advantage of the data and digital investment to unlock more value, strengthen our competitive advantage by deploying new care pathways, enhanced doctor models, and more funding options. This is our sustainable growth strategy, and this flywheel illustrates how we are executing on the strategy. We will develop coordinated and integrated healthcare networks and pathways that deliver high-quality outcomes for patients. These networks will be supported by enterprise capabilities enabled by our data and digital investment, but also leveraging our scale and the trusted Ramsay brand. The Ramsay Way culture has helped us to navigate the challenges we face and continue to face, but is also enabling us to adapt for the future. The Ramsay Way combines our core strengths, our discipline, financial management, exceptional clinical outcomes, and our deep relations with doctors.
Our strong operational experience on all of this will help us to execute on our strategy. I'll talk to the market fundamentals now, that underpin our outlook. There's been a lot of noise in the market, media on the sustainability of private hospitals, closure of services, the interactions with health insurers, government, unions. But for decades, that's happened, and it's always been changes in the healthcare industry. What's certain is that private hospitals in Australia remain a critical part of our healthcare system. It is the unique capability and durability of Ramsay, our experienced management teams who you've met over the last few days, and our longevity and strength in the market, as well as our strong and constructive relationships with government and doctors, which have enabled us to traverse these challenges better than others. Strong industry fundamentals continue to underpin the sector.
We have a high population growth rate of 3.3%, with the over 65s growing three times faster than the rest of the population, and 50% of our admissions are 65 or older. Chronic disease and cancer incidents continue to grow, and we believe that this aging and growing prevalence of chronic disease and aging of the population will continue to outstrip physical and virtual capacity, so we still need to sustainably and strategically invest. Private hospitals are a critical part of the healthcare system in this country, delivering 66% of all elective surgery and 61% of non-subacute, non-acute services, and private health insurance remains strong.
After fifteen quarters of decline, we've had sixteen quarters of growth in private health insurance membership, with an absolute number of over 12 million insured persons, the highest ever, insurance rate, with more young people joining, and approximately 70% have a Gold or Silver policy. In FY 2023, more lives are covered with a Gold or Silver policy than ever before, at 8.5 million. Public hospital waiting lists for planned surgery, that's Category 2 , are at their lowest or longest on record, with a median of 49 days today, compared to 27 days in 2003, while the proportion of patients seen on time has plummeted.
There are 250,000 people on the waiting list across Australia, not including Categories four, five, and six, and this is not including people on the waiting list to get on the waiting list. The waiting list to see a specialist in one state alone is 300,000. So it's a lot of people waiting in the public sector. Some of the bed stock that could be released by hospital-in-the-home programs, like we heard yesterday in the KPMG report, is great, but it will just be filled by more patients, and so there's a big waiting list for those beds. Given we have the capacity and workforce, Ramsay sees public work as an addressable opportunity. In 2022, we established an experienced public contract division to drive improved relationships and longer-term growth.... This contracting unit centralizes our commercial arrangements and contracting and reporting requirements.
The team proactively engages with local and state health public servants on a regular basis, and provides insights regarding Ramsay's capacity and capability to admit public patients. This has been a great unit that we've established, and they have really strong relationships with the state governments in every state that we operate. Commercial terms, pricing, indexation, and contractual frameworks for public in private activity are trending favorably, and we're going to continue to improve on this. Public work undertaken in Ramsay's non-public hospitals, so not including Joondalup, and not including Peel in the past, have approximately doubled over the past eight years, and we expect this growth to continue despite the short-term drop-off in New South Wales and Victoria.
Initially, discussions were focused on elective surgery, and more recently, they've transitioned into medical, mental health, and other non-surgical activity, which so far in FY 2025 is making up 55% of our public and private admissions. We're seeing longer term contracts emerge for medical beds where we have capacity, such as repurposing Cairns Maternity for public medical beds. One of the older Hollywood wards, which you heard today from Andrew, is a public medical ward, and those awaiting placement at Figtree in Wollongong. So we're using Figtree in the Wollongong catchment to provide beds for those people awaiting placement in that region. In the last two examples, Hollywood and Figtree, these are leased beds, and so the admission numbers don't appear in these numbers.
And that will be the case for the Hollywood Mental Health Unit that you heard about this morning as well. On our public-private partnership hospitals, you heard yesterday at Joondalup that we have finalized our long-term public contract at Joondalup Health Campus, which, with the addition of the private hospital on that campus, take us through to 2048. This is a great outcome for Ramsay and shows that we've been a well-respected operator of this hospital for 25 years. The finalization of this contract allows us to confidently invest in the large expansion of the private hospital on this campus. Recently, we've also reached agreement in principle with Queensland Health in regard to Noosa Hospital, that once finalized, will assure Ramsay's future in this area for another 20 years + for this hospital.
On workforce, we've seen growth in the workforce post-COVID, and this has largely alleviated the demand imbalance that we had during COVID. Turnover in Ramsay, I'm pleased to say, is at an historic low, below 12%, which has meant less impact from workforce shortages in recent times. We're working on managing agency and skill mix to optimal levels, and we've been investing in our future workforce to grow and retain top talent through leadership programs and funded scholarship places. Our people are fundamental to access, to our success, as Andrew talked about this morning. So it's really important that funders pay us appropriately, such that we can reimburse our staff at appropriate levels. Above-inflation wage cost increases have prompted out-of-cycle, as well as in-cycle negotiations with payers to ensure we can meet wage cost inflation now and into the future.
I talked earlier about extracting more value from our business, and this has been a big focus for the management team over the past year. We've undertaken a thorough review of our business to see where we can deliver greater efficiency, reduce costs, accelerate our growth, and put ourselves in the best position to negotiate appropriate funding with payers. We're aiming for the changes that will be sustainable for the long term. We've implemented a full business transformation program that we call our Sustainable Growth Strategy. Fundamental to this strategy is that we believe there's more potential to grow our business, improve returns, and under these three pillars that I talked about earlier. Rachna is going to go through the first couple of years of this transformation in some detail a little later.
Our immediate focus areas, though, are on improving margins through the key areas shown here: driving volume growth, achieving appropriate payer terms and indexation that reflects the cumulative impact of healthcare inflation over the past few years, as well as inflation moving forward, delivering sustainable productivity and operational efficiency, and driving procurement savings, so I'll go through these in a little bit more detail here. Ramsay's in a really unique position to drive growth. Our hospitals are well-positioned in high-growth corridors. We've invested in theaters and equipment that attract doctors and provide improved access for patients. We've developed data and analytic tools now for managers to optimize their theaters and to better target doctor recruitment.
There are higher barriers to entry to private hospitals and expansions than ever before in terms of costs of construction and increased regulation, which will slow private hospital expansions into the future. We are investing in technology for doctors, such as improved practice management software, improved referral management tools, and AI that will improve our value proposition and create stickiness for doctors. All of this will drive more growth to our business. On the payer side, we're in the process of achieving improved terms with payers on both contracts that are reaching the end of their terms, but we are also in out-of-cycle negotiations. Through this process, we're remediating funding shortfalls arising from recent cost inflation, exceeding historical trends. We're implementing indexation models that better reflect current cost inflation and for future changes in costs, and we're developing and implementing contemporary funding models.
We've achieved some recent success in this regard, and we're looking forward to the current and upcoming negotiations that are underway. Thirdly, we've worked hard over the past year to achieve sustainable productivity savings. Our Performance Acceleration program that I spoke to you about last year has driven higher labor productivity than that we've been able to sustain. We've a systematic and disciplined daily focus on labor metrics, and we're supplying our management teams with improved data analytics tools. Finally, we have an extensive multi-year focus on driving procurement benefits across all our spend with suppliers. This is a really exciting area and something I'm really focused on. There's more we can do in procurement. This program includes transforming how we move our inbound supply chain from being site managed to a more centralized approach, along with center-led purchasing.
We will focus our buying on fewer suppliers and products and put greater controls in place. We believe there's more value to extract through investment in digital and data capabilities. This will allow us to leverage our data, redesign our process, and digitize our workforce, workflows. We can't digitize the workforce. The evolving technology agenda that we're investing in will provide us with vastly improved capabilities. Rachna will explore these in more detail in a moment. The next few slides will go through how we are thinking about the development and expansion of our local network and local services, given the market fundamentals I talked about earlier.
Ramsay is constantly conducting systematic and ongoing assessment of our markets, and all the areas in which we operate, thinking about how we reinforce our core hospital business through growing centers of excellence like this one, and building out our upstream and downstream services. While there are certainly similarities in how we develop our network across markets, there are also local differences, which mean that our strategies might vary. Our hospitals are the core of our business, where we generate most of our earnings. We have large centers of excellence in key geographies, but we're also thinking about how we develop facilities and services and hubs or access points of this core hospital network, meeting the demand and building our market share in strategic locations. Finally, we have services for our patients being discharged from hospitals.
Downstream services like rehab, which is growing in line with the aging population. Hospital in the Home, in which we're on track to deliver 60,000 bed days saved in FY 2025. And allied health center, centers and psychology services for our mental health patients. And of course, our pharmacy business, which supports our patients both in and out of hospitals, particularly our clinical trials and our cancer services. And then we have this wraparound network enablers, services like our GP liaisons, care navigators for cancer, and easy access booking lines for mental health clinics, and a range of support services like I've talked about earlier for VMOs, practice management, teaching, and research. This is the impressive and unique healthcare ecosystem of Ramsay Health Care. All of these services provide greater value for patients, value for doctors, and value for patients, payers.
So this is what it looks like in WA and where we've been the last few days. One of the ways I think we think about this market, I spoke to you about this last year, all of our markets, is how we continue to expand our market share in the markets in which we operate, and what that market share looks like. So, you know, we aim to get over 25%, close to 30% of the markets in which we are. And these markets, we're concentrating on Perth, South East Queensland, which we talked about last year, Mornington Peninsula. There's a variety of markets in which we have, really good market share, and that's important.
And if we look at the Victorian market over time, you know, where we were traditionally smaller, you know, there's lots of big hospital groups in Victoria, Epworth, and others. But we have significantly grown our market share over the past seven years in that state because of the investments we've made in expanding our network there. And we have the major development at Warringal to come on stream shortly, which with an emergency center, I expect to see market share in that state for Ramsay really drive forward. We talked about South Queensland last year. So in terms of how we invest, Ramsay's always taking a disciplined approach to investment, and that hasn't changed. What has changed in it is a shift in where we are committing funds.
A focus on theaters, expanding in our growth corridors, bolstering our leading position in clinical areas with upstream and downstream services, planning our next EDs and surgical centers, and optimizing our portfolio outside the key center, outside the key centers of excellence. We're committed to growth, driven by strong demand and demographics, as I discussed earlier. The escalation in construction price has necessitated a very prudent and focused approach, and I think I've talked to a few of you that we've increased our hurdle rates. We've introduced stage gating to the development process. So we're really focused on how we ensure that we're maximizing our ROI through those developments. We're not apologetic about extending purposefully in key geographic areas at hospitals that continue to see growth like this one, and where we already have scale, and we can continue to meet the high growth markets....
Regions like Ipswich in Greater Brisbane, and the Sunshine Coast in Queensland, North Perth, Mornington Peninsula in Victoria, and the growing northwest corridor of Melbourne, all high growth markets where we are aiming to get highest market share. We're adding six theaters on the Sunshine Coast, two theaters at St Andrew's in Ipswich, which now has a very busy ED, and a new comprehensive cancer center at that hospital. And we've plans to expand our theaters at Caboolture, rehab beds at North West in Brisbane, where we're repurposing our existing bed stock. And in Victoria, the stage one of Warringal's major development is only recently completed, and the further capacity we're currently adding and will open next year is the new operating theaters and a private ED, and they're expected to see a lot of growth at that facility.
Our strategy of concentrating on key centers of excellence continues, leading hospitals like Hollywood and Joondalup, and in Lake Macquarie, where we operate arguably the most advanced New South Wales private hospital outside of Sydney. Our plans to expand this hospital are well underway, with two new theaters recently open. Ramsay has the largest regional portfolio. Paul Ramsay started in regional hospitals, and I'm really proud of our regional hospital portfolio. In some regions, we're the largest employer in the city, and that's, it's been a really important area that we've tried to continue. It's, these are really important hospitals for the local regions, and they also are important to payers. And so we continue to expand in those areas, but we're also constantly, systematically assessing these markets to ensure we're offering the right services in the right place at the right time.
So we've progressed a number of opportunities to consolidate our services in recent times. We sold off Murray Valley Hospital, which we acquired with the Affinity acquisition. It was a rehab hospital, and rolled rehab into Albury-Wodonga earlier this year. We purchased Orange Day Surgery from the liquidators and rolled that surgery into the now only private hospital in Orange, Dudley Private Hospital. And that also meant considerable investment required at Dudley for sterilizing remediation works was saved, so that was good. We closed maternity services in Cairns and have used that ward, as I said, to provide important public services, and we've got a long-term contract with the base hospital, and that's working really well. We're expanding our main hospital at Port Macquarie, and we'll sell off the Kooloonbung Day Surgery in that town.
We closed maternity services at Glengarry recently in North Perth and rolled that into Joondalup Hospital, and we're repurposing that ward for higher growth services. We're also expanding our surgical center capacity where it makes sense, to have bolt-ons in more convenient locations to our major hospitals, in key regions, or where we want to take a foothold in a new high growth and high opportunity market. Ramsay currently has 12 surgical centers, including those under development, and we've established a Surgical Centre division that's driving a new model and new relationships with doctors. Our ED strategy is important part of our growth strategy. As an entry point to the clinical capabilities offered by our major hospitals, they're a major driver of our business. In FY 2024, 21% of our total inpatient admissions, right across the business, were driven by EDs.
Ramsay has nine existing EDs, with the tenth to open in 2026 at Warringal in Melbourne, and we've also got a few other EDs in the pipeline, and EDs mean we're attractive to specialists who want to grow their business with us, but they're also critical to our major therapeutic areas in cardiology, as you heard, with Hollywood this morning. We couldn't do what we do in cardiology here and have expanded what we've expanded without that ED in place. Orthopedics and cancer. We see EDs as a very important part of our future, and comprehensive knowledge of how to run public and private EDs is a competitive advantage for us.
They're also a front door to our business, so, you know, as we see GPs decline and less GPs, which is a concern, we're able to ensure that we're offering a service so we can see patients. With these focus areas in mind and a focus at the moment on theaters over beds, we're pushing along with a number of planned developments, the largest ones underway being Joondalup and Warringal. I won't go into detail, but you can read these in your own time. Over the past five years, Ramsay's developed a deliberate and systematic approach to expanding our clinical capabilities, particularly in four key therapeutic areas. Our goal is to broaden and deepen our services in these areas through integration and expansion, through teaching and research, and through a focus on clinical excellence.
Ramsay today is the leading private provider of services in four major therapeutic areas: cancer, orthopedics, cardiology, and mental health. And we've taken a deliberate approach to these four service lines to build infrastructure, attract doctors to work with us, build our teaching and research capabilities, and wrap around upstream and downstream services, and we scale and replicate this model right across the country. In orthopedics, Ramsay is the leading provider of joint replacement surgery in Australia, delivering one in five knee replacements and one in six hip replacements, public or private. We have five hospitals in the top 10 hospitals doing joint replacement, hips or knees, in Australia, public or private. We have invested in 60 robots across our Australian network and the wraparound rehabilitation and downstream out-of-hospital services, including Hospital in the Home. Ten years ago, we took a deliberate approach to expanding our cancer services.
Today, we have over 50 hospitals delivering cancer surgery, 25 co-located chemo units, including six comprehensive cancer units, and the full range of radiation oncology, day oncology, pharmacy, and inpatient services. We've invested in clinical trials, as I outlined earlier, and we've also continued to invest in care navigators, with 15 across our network, to provide patient support and navigate them to downstream support services. In cardiology, we deliver 12% of all cardiac surgery procedures in Australia and 15% of all TAVIs, public or private. We have two major public contracts for cardiac surgery through Wollongong and Warringal, but also a contract with New Caledonia to treat patients from this country through our specialist cardiac surgery facility at Strathfield in Sydney.
Our growth in EDs will continue to position Ramsay as a leader in cardiac services, and I expect Hollywood here to be the leader in Perth, if not the country, in the years to come. You saw this morning, after only three years' commencements of cardiac surgery here, they're already in the top five hospitals for cardiac surgery in this country. Finally, in mental health, we have seen a decline in admissions in recent times, mostly in day admissions. However, we're working on a number of transformational plans and are confident of returning to growth in activity here. We expect to see some consolidation in this sector in the coming years, and Ramsay's is doubling down on mental health.
We're looking to invest in practice management and AI solutions for doctors and investing in teaching and research on our campuses, and we are seeing a lot more doctors come back to our mental health sites. We're also working with public departments on state mental health services that supports them, and we have contracts at Albert Road Clinic in Melbourne, Shepparton, in the regions, Hollywood, as you heard this morning, and Adelaide Clinic, and we are seeking more of these across our network. There's a big demand for mental health in the public sector, and we are getting a lot of traction with government. On to investing in our people and communities. As I said earlier, we've seen a reduced turnover in our workforce and fewer staff shortages impacting our business.
This is because of the investment we've made in growing our own and investing in professional development and career enhancement opportunities. We're also preparing a workforce for the future, where we will see scope of practice changes in pharmacy, nursing, and allied health to deliver more services. Ramsay will have close to 100 nurse practitioners in our system by the end of next year, ready to deliver expanded services, and we're currently providing supervision for our pharmacists in Queensland to meet the requirements of delivering increased scope of practice services, supporting public EDs. On our Ramsay Care strategy, we've progressed our sustainability agenda since last year, now with close to 90 million single-use plastics saved from landfill, 37 sites with solar panels, and we're reducing our desflurane usage. I think Joondalup talked about that yesterday.
In this state, at 0% desflurane usage, where currently we were at 17% a year ago, we're at 8% desflurane usage now across the group, which is really great. That 90 million single-use plastics doesn't include all the water bottles we took out of the hospital. I know Andrew talked about that earlier, taking 380,000 water bottles out. We used to give all patients water bottles. Now, we went back to jugs, which is quite good, and that saves a lot of plastic water bottles across the country each year, about 6 million. So finally, I leave you with some key takeaways. Ramsay's competitive advantage is in the strategic and diversified portfolio of hospitals that we operate, which are geographically well-placed in high-growth markets.
We think strong industry fundamentals will continue to drive demand, and we're focused on expanding our healthcare networks to support this demand, but we will continue to apply financial discipline to investing and expanding our hospitals. We're absolutely focused on driving margin improvement through improving our operational efficiencies, sustainable labor productivity, and improved revenue rates from payers, and our future potential is significant. I'm really excited about how we can further optimize our business through evolving data, digital, and transformation agenda. Thank you for listening, and I now welcome Rachna to the stage to present more details on our transformation program. Thank you very much.
Hello, everyone. Thank you for joining us today. It's my pleasure to present to you the comprehensive transformation program that Ramsay Australia has embarked on. We have a great business. Our transformation is designed to improve returns in an era where there is pressure on margins. It is designed to ensure we remain an industry leader into the future and innovate to enhance experiences for our people, our patients, and our doctors. As we steer towards a future of sustainable growth and innovation, your support and confidence remain pivotal to our journey. Over this session, I will provide further detail on our transformation, how it is designed to deliver impact, including demonstrating real case studies of value being created today, and provide an overview of our investment profile....
We will leave you today with confidence that our core business still has potential, significant potential, and our transformation is designed to realize this potential. That our transformation is well considered and has targeted key areas to immediately create more momentum in our core business, reinforce growth and margin over the midterm, and over the long term, create competitive advantage, setting us up for sustainable growth and industry leadership. That we have hit the ground running, and performance to date has translated into tangible outcomes, which we will continue to scale, and we are focused on maximizing value as we minimize risks on delivery. Ramsay's long-term track record is unparalleled. However, the healthcare industry is evolving, and we need to proactively respond and invest to maintain our position in the market.
As Carmel mentioned, over the past year, we have comprehensively reviewed industry trends, now and into the future, and completed a thorough assessment of our business. These insights have helped shape our sustainable growth strategy that Carmel covered and how we need to adapt and transform. Realizing our strategic ambition requires disciplined execution and sustained investment, particularly in digital data and AI. Standardizing, optimizing, and digitizing our workflows and processes, and maturing our data to unleash insights to inform decisions within the business, are critical to realizing and sustaining margin improvements, fostering growth, and improving our returns. End-of-life systems and paper-based operations that have lost pace with growing complexity, constrain insight and intelligence, need to be addressed to unlock further efficiencies. Our multi-year business transformation is meticulously planned to create value for investors, doctors, patients, and employees.
It is deliberately phased to immediately generate momentum, further momentum in the business, reinforce midterm growth and margins, and secure long-term new competitive advantages. The transformation comprises three pillars, and I'm going to cover this at a high level because Carmel's gone through it as well. This first pillar of optimizing the core is about continuing to accelerate performance in our core business. We will be applying this through disciplined focus on volume growth, increased productivity, and standardizing procurement practices, all enabled by advanced analytics and targeted insights. The second pillar, reinforcing the core, is about strengthening our networks: acute, non-acute, and virtual. Establishing referral channels across this network, digitally joining up quality episodes of care by acting as care navigator for patients, thereby creating local market leadership positions.
We see this as enabling us to continue to attract best doctors because of our enhanced value proposition to them, referral pathways, coordinated data flows, and leading-edge treatment protocols. We also see this as critical to ensuring our partnerships with payers. The pillar is also about scaling digital solutions and maturing data assets to create value. Finally, the third pillar, transforming the core, sees us mature differentiated infrastructure around digital and data and enable platforms to strengthen competitive advantage by deploying new care pathways and enhanced doctor models. Our digital maturity under transforming the core also gives us flexibility to adapt as the industry evolves.
Delivery will unfold over multiple years, and we have far more certainty in the initial few years, which is what I will be sharing, and specificity, noting that the longer term will depend on industry settings and how we see that evolve around us. The seeds of a long-term success will be sown by activities starting now in FY 2025, and it is a sequential process which must be orchestrated appropriately from the onset. The first couple of years of the program predominantly focus on two pillars: optimizing the core and reinforcing the core. This is a pragmatic approach we are taking to deliver value from the existing network to fund the transformation in a practical and prudent and disciplined manner. In these first couple of years, we have six priorities.
The first four, which is volume growth, improved payer terms, improving productivity, and procurement optimization, are focused on optimizing the core, accelerating growth and margin improvement. The remaining two, digital and data enablement and integrated care, start to lay the groundwork for longer-term growth and competitive advantage. Now, as I mentioned, we have ensured that we've designed the program to deliver impact by maximizing value and minimizing risk, and I'll cover both of these in a bit more detail now. Across all six priorities, we have hit the ground running, registering significant progress in optimizing the core and testing and learning to expand integrated care propositions in the future. Over the next few slides, I will share some case studies of how our performance to date has translated into tangible outcomes, which we are continuing to scale.
Now, I want to be clear that this is not an exhaustive view of all our initiatives underway, and initiatives are at varying levels of maturity. We will share some that are in pilot stage and showing very promising outcomes, as well as others that are well on the way to being scaled. We wanted to give you some practical examples of the disciplined way we are approaching the work and the real value that it is creating. So let's get started with a transformation initiative targeted at volume growth. While there is significant amount of excellent work happening across the business aimed at growth, and we talked about this at Joondalup and at Hollywood, our potential has been somewhat constrained by varying approaches to growth and importantly, lack of sophisticated target data and digital tools to support and enable these activities.
Over this financial year, we have worked with pilot sites on embedding an aligned approach across all functions that support growth activity. We have leveraged generative AI capability to create sophisticated local market insights and our internal new data platform for stronger site-level insights, steering growth decisions in a more targeted way. In mental health, we are also optimizing a new referral or optimizing referral pathways on our website. The early pilot is already starting to show positive outcomes. We've seen a 32% growth in robot utilization, new lists allocated to existing VMOs, and successful engagement targeting new VMOs. Through these activities, over the past couple of months alone, we have captured AUD 1.5 million - AUD 1.1 million and are targeting over AUD 5 million for first financial year results of this initiative.
Continuing on the topic of driving volume growth, increasingly, the feedback from our doctors show a growing need for support to run and grow their practice and access for more, or access to more modern digital tools. The transformation is addressing this, these growing needs by expanding on our doctor proposition. So we have a strong doctor proposition for doctors today, and we're looking to expand that based on learnings and insights from discussions with them. We are actively testing solutions with doctors and only scaling those based on compelling value to them. There's a few that are underway, as you can see on the slide, but I'll just elaborate on one, which is the practice management service.
As of this quarter, we will be launching practice management as a service to support our doctors across mental health and hospital consulting suites with a complete service offering across people, process, technology that is needed to support their practice. Regarding the technology, we are delivering a contemporary cloud-based practice management system, accessible by doctors from anywhere, with modern features including e-bookings, telehealth, and integrated AI clinical documentation. These features reflect the changing needs of our doctors. Moving to productivity, and I'll share a few initiatives or case studies around how we're further driving productivity to improve margins. As Carmel mentioned, we have set up a Performance Acceleration program specifically designed to focus on initiatives that will deliver value in the near term.
This program is resourced by very talented internal leaders with deep operational experience and trained in agile delivery to work in short sprints, to test solutions at a local site, and then rapidly scale these. The program works on identifying, and identifying best practice for a site and taking it to other sites to accelerate performance. It looks at pain points at sites that are holding site performance back and puts in clear actions to work through them, and works on identifying and supplying data and insight that is missing to make faster decisions. This program is being delivered in partnership with operations to ensure the changes are sustainably embedded into the business and deliver enduring value. A couple of examples called out there from Performance Acceleration that we are seeing already and ones that we hope to scale across all sites.
Talking a little bit on data, we have been significantly uplifting our data capability over the last year. We have developed a secure cloud-based platform to provide a single source of truth for our data and a quality controlled, safe space for all our data, automated and updated near real time. As this capability matures, it is better enabling real-time analytics and predictive modeling. For example, in Q1, we have captured AUD 2.5 million in value across three initiatives that are shared there, and we aim to achieve AUD 10 million in FY 2025 to these three initiatives, scaling and continuing to deploy these three initiatives. We are also looking at how we can improve productivity through innovation, and I'll talk to a particular case study, or a pilot that we've been running in Joondalup.
Clinicians today are required to scribe consultations in clinical settings. This is less than ideal because it creates delays in terms of time to send letters. It reduces clinician time to treat patients and creates a requirement to use administrative resources to create medical notes and letters. We have been testing use of ambient AI documentation at Joondalup across two clinics, powering clinicians and AI, with AI clinical documentation, both in an ambient and a dictation setting. Results from the pilot are very positive. We've had 100% adoption by clinicians, really high adoption rate by patients, and we've dramatically reduced the time to send letters, enabling issue of referral letters at discharge. We are now looking to extend this pilot into mental health and a couple of other facilities before we can scale it.
This idea of testing, learning before we scale is something you'll continually see, and I'll talk to when I talk about how we're minimizing risk. It's a key approach we are taking to make sure that we only scale once we've proven that the solution delivers the value that we were testing in the pilot. Moving to patient experience, which we've been working on through Ramsay Health Hub for over a year now. We have opportunity to enhance our patient and carer experiences through innovation, and this has been a key area for this program. Patients have traditionally encountered confusing, complex, and long admission and discharge processes, lack guidance, and are burdened with repetitive administrative task. So we've created the Ramsay Health Hub.
This now provides end-to-end digital patient admission experience, real-time patient tracking, significantly reducing calls to facilities and to our nurses, and more importantly, also offering valuable data insights to our hospitals to optimize the patient flow and the experience and efficiency. Ramsay Health Hub is now live at 38 sites, and over a hundred thousand patients have used this capability. On average we are already averaging about 52% in terms of digital admissions, and this is growing, and we have 82% adoption on the patient tracker capability within our sites. We are recording around 7.8 out of ten on patient satisfaction. We will be scaling Ramsay Health Hub to all our sites or most of our sites this financial year, and are now working on digitizing the discharge process end to end as part of Ramsay Health Hub.
Ramsay Health Hub, it also starts our journey on enabling digitally enabled integrated care and care navigation because it'll sit off this platform. Finally, Carmel spoke to procurement optimization, which is a very key priority area for our transformation, particularly in the first few years. Today, procurement, given our supply costs today, are the second highest cost in the hospital P&L spend after labor costs. We have good practice around procurement, 60% of our supply spend, with decentralized approach leading to proliferation in suppliers and products and upward pressure on supply costs as a percentage of net patient revenue. We are unlocking procurement opportunities through data, process, and systems, and moving to best practice procurement across our spend, and better leveraging our scale through standardization. We are already starting to see positive results.
We have seen a 50% reduction in rate of new clinical products being introduced, so reducing the proliferation I was talking about. And to date, AUD 5 million in savings have been captured in quarter one from procurement, optimization of clinical activities, and a target of AUD 20 million is what we're pursuing for FY 2025. Now, as I mentioned, this is not an exhaustive list, but a representation of the types of initiatives and outcomes that we are working on to drive real value as part of this transformation. Now, moving to how we, the other part of the pillar. So we talked about optimizing the core, just moving to the pillar around reinforcing the core. We have started work on integrated care because patient expectations are shifting. Patients are fatigued by high-friction handoffs between care settings and increasingly expect integrated solutions.
90%, in fact, prefer a single point of care. We are designing digitally coordinated and integrated patient journeys across the pre-hospital, hospital, and post-hospital by joining up quality episodes of care by acting as a care navigator for patients. Our focus in Horizon One is to test and learn a digitally integrated care within mental health and cancer. Enabling care navigation requires maturity across several digital capabilities, which will be built in the coming years. And what you see in the outer circle, the care navigation piece, they are ones that we have already started to have significant traction on, like Ramsay Health Hub, enabling digital referrals, the launch of the integrated practice management software solution this quarter, and setting up of our core data capabilities.
So we are well on the way to enable the digitally driven integrated care and care navigation capability within Ramsay. So moving now to what we're doing to de-risk delivery. As I mentioned, the transformation is very much designed to minimize risks on the road to value. De-risking has been carefully considered across three key dimensions: one, modernizing our foundational tech, applying disciplined delivery methods, and focus on value management. You will recognize one of the photos here from the record room you visited yesterday at Joondalup. So reflective of the industry, we have significant foundational technology gaps, as well as outdated systems impacting our run costs, employee and doctor experience, and speed of transformation. We have predominantly paper-based processes, and our people are often the patch to the system. And this imposes significant time they spend on administrative tasks as well as documentation.
What I've found through years of experience in transformation is foundational capability gaps or foundational technology gaps can often be ignored in large-scale change programs, which result in constraining the benefits. The benefit of our transformation program can only be achieved when the technology and data foundations are actually in place. As such, modernization of the foundational technology plays a critical role in enabling us to de-risk delivery of this transformation. Approximately 30% of our investment in the next few years is focused on modernization of our foundational technology. I'll share with you an example of a foundational technology gap we are closing this financial year or closing part of this financial year, which is our human resource information system.
Today, we have manual, paper-based workforce management, and we lack employee digital access, which is impacting employee engagement as well as our ability to scale digital solutions across all sites. We will successfully implement a human resource information system this financial year, a unified platform providing core people data, automated processes, and self-service functionality, and enabling more efficient workforce management across the business. Further, it will enable unique digital access point for our employees, which actually is a key dependency for us to scale a lot of the digital solutions I've been talking about in the previous slides. Now, a transformation of this size and scale also requires build of capability and requires culture shifts. We have carefully thought through the challenge of successfully delivering such a complex whole of organization transformation and developed and embedded building blocks that will be critical to driving a successful outcome.
I won't go through all the building blocks, but I do wanna talk to the critical underpin. The critical capability underpinning the building blocks is a comprehensive stage gate process, ensuring projects move quickly and regularly through regular checkpoints to confirm that the original outcomes can actually be realized. The first step for any project within the transformation is to define a business case. Funding is typically not approved. It's only approved for a pilot to start with, but the decision to scale based on the benefits proven during the pilot. This results in funding for most projects being uncommitted until value has been tested. So you will often see that for our projects, there is a small amount of funding committed, but most of it uncommitted until we've actually proven that the project can deliver the value that it is set out to deliver.
Finally, as you would expect to see, value management is a key component of our transformation program. Every initiative or effort made will have a clearly defined purpose and objective. This means that everything that is being considered or executed is tracked and measured, and that's how we've been able to show you some of the case studies that I was sharing before. Our success measures have been carefully curated to ensure a balanced perspective across financial, people, and operational dimensions. Now, transformation is actually an ongoing journey, and as many of you are aware, what is important for you to take away today from our perspective, is that we apply a value creation lens to all our programs. All these improvement initiatives, when combined, will build the foundation for further benefits to flow.
Over time, the negative impact of EBIT that is being experienced now through the investment will change into a net positive EBIT impact by 2028, FY 2028. Margin tailwinds from FY 2026, as investments remain largely flat, but benefits continue to increase, and as we have said previously, the mix of OpEx and CapEx may change as we make decisions around different solutions and vendors. Our investment is multifaceted, as you can see in the stack bar, and has been considered and deployed for strategic reasons. Modernization of foundational technology is a critical part of this journey, and over time, will be a smaller component of our investment. Based on our stage-gating approach to de-risk, majority of the total investment to FY 2029 is uncommitted. This is what you see in these bar charts here.
EHR investment is included in our transformation OpEx and CapEx, but is mostly uncommitted at this stage, as we are working through options and solutions that meet our business needs in a pragmatic and importantly, in a future-focused way, so to summarize and the key takeaways, our transformation program is a comprehensive and well-considered strategy to improve returns amid margin pressures, secure future market leadership, and innovate to enrich experiences for our staff, for our doctors, and our patients. This disciplined execution and substantial investment in digital and data capabilities will underpin sustained margin improvements and drive long-term success. The ongoing performance improvement efforts have already delivered tangible outcomes, which will scale further over time. As we navigate this complex journey, we remain steadfast in our commitment to balancing the pursuit of value with minimizing delivery risks, and ensuring capital commitments are made judiciously.
Thank you very much for your time.
Thanks, Rachna. I'll now get Andrew, Martyn, and Craig to come down the front, and Rachna. Grab some chairs, and we're going to go through a Q&A. I believe Kelly has got a microphone, so this time, because of the people online, you'll have to wait for the microphone before you ask questions. Thank you. We look like we've got Andrew Goodsall first. Thank you, Andrew.
Yeah, thanks very much. Andrew Goodsall from MST. Just, with the decision to open the additional EDs, if I've got this right, there is, you've got 21% of inpatient admissions coming through the existing 9. Is that 21% just related to those 9 hospitals?
No.
It's across the group.
Across the group.
Okay.
Yeah.
Wow.
Yeah.
And could I ask where that number was pre-COVID as a percentage of admissions, roughly?
Look, I don't know if I could tell you, 'cause we've had that growth in the number of EDs put on, and we expanded them. So, you know, you saw in that chart how many, you know, we've expanded and grown. I think Hollywood came on in 2021, which was in the middle of COVID. Yeah, we'd have to go back and look, Andrew, but it was... Obviously, it was 22% when we had Peel.
Yeah.
We lost Peel, and so now it's 21%, but yeah, it's still, you know, it sits around that number, so I'd have to go back and have a look at what it was.
Just trying to get a ratio.
Yeah.
If you're adding 10 more, where that number could go to, so-
Yeah, sure. I mean, the three that we're looking at are sites where Warringal, for example, will come on, and that's a big cardiac site. You know, so it's important. It's across the road from the Austin. The Austin's got a busy ED. You know, it will take patients, you know, a lot more private patients through that area. But and then the other two are Sydney and Wollongong. Yeah, and both big cardiac sites. So it's really about that. You know, what I talked about before, EDs are a front door. They drive a lot of admissions. A big part of the admissions are cardiac, you know, cardiology, not just neurosurgery, but cardiology admissions and respiratory, as well. So, you know, really looking at how we expand that service.
I think, you know, it also means I control who comes into my hospital, as opposed to a health fund controlling it or something else, you know? So really, it's... You know, we do a lot of marketing with GPs, GP liaisons, you know, going out and seeing GPs and making sure that our referral network's strong. But emergencies are another point. If you look to, you know, HCA in the States and those sort of organizations, you know, ambulatory care, urgent care centers are a big part of their investment as well. So, I think they're, you know, they are driving good throughput. Yeah.
Thank you.
Steve?
Steve Wheen from Jarden. Based on the presentations that you've done today, there's a big focus on doing a lot of public work-
Yeah
... and Ramsay's ability to be able to help out with that.
Yeah.
I just wanna understand, has something changed? Mainly because the FY 2024 result was sort of talking about various state governments pulling back from-
Mm
... providing-
Yeah
- funding to allow Ramsay to be able to do that. In particular, I think Victoria-
Yeah, and New South Wales.
- and New South Wales.
New South Wales is particularly bad. Look, don't get me wrong, public work is still a small part of our business, so it's not, you know, gonna be the panacea. But what we are trying to do is look at where we can smooth out those times when doctors have gone on holidays, and you've got more, and we've got capacity, and so where you can actually look at public work filling those gaps, that's important, I think. In mental health, where we have capacity, it's important, and what public work does is brings. You know, what we're finding in mental health particularly, it brings other doctors into your business, and all of a sudden you get the private work flow on as well. So there's two facets to it.
You get more public doctors who hadn't thought about, particularly mental health, haven't thought about coming in to private before, and now you come in and they start to do private work as well, so there's a bit of that. So it's definitely... What we've done, I think, Steve, is said we didn't manage it before. It was just like, whatever, you know, this local health service wants a bit of work, and, you know, you do a bit of work, and we didn't-- we weren't managing it effectively. So not only have we increased the number of admissions, but the revenue is better because we're, A, getting better indexation and stronger. There's a, you know, we've bundled in doctors, and we get, you know, pathology and a whole range of things, but we're doing it right. Through COVID, we weren't being paid correctly.
You know, it was low, you know, low margin work. So we had to really look at it, get some really. We've got a great team of people that understand that market, that the public's different. You know, we've always, we've had a great understanding of private. We haven't had as good an understanding of public outside of Joondalup and our public hospitals. So we've established a team that now looks at it properly, makes sure we're getting the right revenue for what we do, and that we're, we're doing it efficiently, and providing a good service to the public, and they want that. So Queensland's always been really strong. You know, we've had Surgery Connect for a long time, but it's even getting stronger and the relationship stronger, and so that's, that's been good.
New South Wales have turned off the tap, you know, for a while, but I think, you know, they've got a big waiting list and that will come back on. There'll be pressure at some point, and the pressure valve will have to be released. So, we'll see that, you know, return, and we'll be in a position to make sure we know how to do it properly and we get the right revenue from it. And also just in terms of how they pay, public payers have been pretty hopeless. So, you know, making sure we get all of that sorted, the contractual terms are right. So, it's really just looking at it much more efficiently and better and making sure we leverage it and then grow it.
Understood. Thanks. With respect to the-
Yes sir.
First comment to Carmel, still a small part of the business.
Yeah.
But it's an opportunity to, into the future to grow.
Yeah.
Unrelated, but just a question on the last presentation regarding the data and digital spend. In, again, FY 2024, there's disclosures have been made, and 2023, around what the OpEx and CapEx is. Do those numbers that would have been provided in those presentations, do they represent only committed data and digital, and therefore, the peaking that you're showing in that chart in 2027 is something else that we need to consider?
I can take that. Well, obviously, you mean what we've said going forward?
Yeah.
Yeah. No, it's committed and uncommitted. Yeah.
Okay.
Yeah.
Yeah.
What you'll see in the slides is you've got the net OpEx on that first slide. That'd be a net positive in FY 2028.
Yeah.
Some of those, the costs will be pretty much the same flowing through, but the benefits start to get better. Not all of that's committed at this stage because a lot of the people in the team working on are on two-year contracts, for example. There's new programs coming online that haven't started yet, and the whole concept that Rachna was talking about in terms of piloting before we then launch into programs is there. Then you may. The next page, the slide there, that's OpEx and CapEx, the one where we've got committed and uncommitted. So that's why it goes up, because they've got the CapEx coming online. We really don't know what that's gonna look like at this stage, because a large part of that is the EHR.
As Rachna said, we haven't decided on what that solution's gonna be, let alone then what the contractual terms are gonna be, and whether it's gonna be a SaaS, OpEx accounted or server-based CapEx accounted, et cetera. That's why we haven't really put any numbers on that, because we don't really... It's directional, but that's what's in our plan. But that's kind of what the plan is now, but it could change. Yeah.
It will change.
Yeah.
Dave Stanton-
Dave
... Jefferies. Look, you highlighted an ongoing focus on procurement. And I guess, what has been the sort of highlights of changes that you've done in the past couple of years? And perhaps you can give us some concrete examples of what you've been able to do, perhaps a little bit better. And then, I guess as a second question, you know, is there an inclination to use overseas collaborators like you have done in the past to sort of maximize that opportunity globally, please?
You take the first part, and I'll take the second part.
Yeah.
Yeah.
So for the first part, for Australia, I think, one of the things that the suppliers have done successfully is go into each of our hospitals and provide some of the solutions to the doctors directly, and get the foothold in there and then sell the option that, "Hey, you're already buying from us." So by centralizing, we then have been able to reduce the numbers that are doing that significantly. So Rachna spoke about 50% reduction already in the last 12 months. So that scaling of a centralized approach means that we can get a better buying power coming through and just alleviate some of the cost pressures there and get better solutions being rolled through the organization.
I mean, that's about putting more eggs in less baskets. I mean, you know, it's concentrating our supply with a reduced amount of suppliers will get us better terms. In terms of overseas, the relationship we have with Ascension's pretty much being wound up. They've got a whole bunch of issues they've got to deal with in the U.S., and we worked through it. We did some concrete examples and did some testing with them, but it actually turned out they were probably gonna get about 95% of the savings out of the JV than us, 'cause their costs were actually quite big. It doesn't mean we won't look at other opportunities going forward, but there's nothing at this stage.
What we have done effectively is taken a lot of those global contracts that we had with suppliers that had significant rebates on them and bake those pricing back into the local pricing. Some of these global suppliers, they're very, very hard. Having worked for a big global company before, it's very hard to pick them off. But the business has done a great job in the past doing that. But as we've now have got that baked into local agreements, which they prefer, it's probably easier for us to manage as well.
Yeah. Understood. And as a follow-up or a second question, unrelated: Carmel, did I correctly hear you say you were looking at doing more outpatient department work as well or building up the outpatients? Was that correct?
No, not really. More, Ramsay Health Plus and psychology services, that sort of outpatient area. Ramsay Hospital in the Home.
Yeah.
You know, the areas that we've had that support the downstream, they're the downstream services, but not outpatient clinics as such, with the exception of mental health-
Yeah
... where we already have that. So mental health, we're expanding that, improving on it, delivering better practice management solutions to our current mental health psychiatrists, and that's attracting more in. But no, not outpatient department outside of Joondalup.
Thank you.
Yeah.
David Lowe from J.P. Morgan. Just a quick one to start off with. On the slide deck, there was quite a few numbers there, savings here. Just trying to work out what do those numbers mean? They're up to about fifty million.
What do they mean?
Yeah. I mean, is this EBIT? I mean, is that AUD 50 million-
Yes. Yeah, that's cost savings.
Savings already delivered.
Or volume growth in the first example. Yeah.
Okay.
Yeah.
So just trying to make sure we can put that into context, 'cause best part of fifty million added to EBIT this year is quite impressive. I mean, it's quite, it's a couple of % margin-wise.
So just to emphasize that Rachna did highlight that some of those benefits in the Horizon One are there to support the investment into transformation. So yes, they're there, and there are tangible benefits coming through, but that's part of the way we're funding the Horizon One and Two in the transformation.
... Thanks. Just a couple of other quick topics. Health fund negotiations, should we expect more public conflict?
Always. I love-
Always.
You know I love bashing them up.
Is that, is that what's required? I mean, Look, we hear a lot of commentary about margins not being where they were.
Mm-hmm.
Health funds' margins-
Yeah
are better than they were.
Mm.
What's the pathway?
Yeah. Look, we're currently in a number of discussions. We've recently finalised some contracts, which are good. And, you know, there's quite a number of negotiations underway as we speak, so they're positive and ongoing, and I hope we don't have to bash them up, David, but if we have to, we will. So we are seeking, you know, to cover historical costs and costs going forward and looking at automatic indexation where health inflation exceeds, you know, what we expect as well. So, there's a lot of things going on at the moment and a lot of discussions with health funds. Probably the, you know, we've got a number of EBAs underway as well, so we're balancing out what, you know, what is that going to look like, and so it's a, you know, timing issue.
But we are negotiating, in negotiations as we speak, and with the, with all of them. So it's ongoing. I can't say that there won't be a fight, but, you know, if that's what it comes to, it does.
Longer term, the fight that the health funds are having with the New South Wales system for private patients going into public is actually beneficial to us. So as we build out that ED strategy, we become far more attractive for the private patient to go into a Ramsay ED setting. So I think there's some positive signs there that we can solve for some of their cost pressures as well.
Okay, look, and last question, yeah, probably similar, speculative. The competition really feels like it's been weakened quite significantly. I mean, they're really not making money-
Mm
... struggling really to cover-
Mm
Maintenance CapEx from some of the messaging we hear.
Mm.
I mean, what, what's Ramsay's strategy to take advantage of that, and how long is the time frame to see that benefit, do you think?
Look, I think it's... You know, we are, like you saw here today, and we talked about one of the hospitals that Andrew has, you know, completely decimated almost. So, you know, we are doing that where we can, and it is a strategy, you know? Absolutely. I can hold services open for longer because cross-subsidisation and, you know, whatever. So I can hold on to a service where there might be a competitor down the road, and I think they're gonna struggle at some point, and I can wait a bit longer. So I think that is, that's definitely a strategy, and like I said, we're always assessing our markets in each and every individual market, and every market's different.
And you know, you make a value judgment on what you're going to do. And you know, I don't want to close maternity services. It's the last thing I want to do. You know, you want to offer a complete service, but Cairns wasn't so much about you know, not enough obstetricians or babies. It was about toxic culture and the obstetricians there, and so it actually ended up being. That was the problem. But we've ended up being better off, really. But you don't want to do those things. So you really just... You know, we're actually you know, we're the only player in some markets, so that's where we are. Orange is a perfect example.
You know, we had a new, shiny Taj Mahal built down the road, and we're in the old fifty-year-old, you know, Dudley Hospital. Quite nice. It's done its job and really good, but we stood there, stood our ground. That hospital didn't survive, so that's going to continue to happen. I see there's going to be a lot more consolidation.
The flip side to that, David, is some of the Catholics who own their property might be making accounting losses, but their cash flows are not too bad. Apropos AUD 311 million being invested by St John of God in a brownfield here, so there is it depends on who you're talking about.
Yeah.
Yeah.
It's important that there is. You know, we can't be the last man standing. You know, because we need a good private hospital network in this country. And, you know, I'm the Vice President of Private Hospitals Association. I spend most of my time talking to government, et cetera, about why the private hospital system is good here. They support it. It's really strong, and I'm representing the private hospital sector. So it is important that we have a viable and strong private hospital sector, and everyone knows that, and government's really positive about that. It's just, you know, we'll see some consolidation, I think, and that's what happens, and like I said, the stronger will probably get stronger.
Thanks very much.
Hi, Liane Harrison from Bank of America. Just to follow up on David's question about that AUD 50 million in EBIT savings for 2025, how far through the organization do you think you'll be at the end of 2025, and what can we expect in terms of further savings in future years?
I'll answer this last part. More is the answer-
Mm
... Leanne. I mean, I think what I said before is the cost going through, so the AUD 80 million-AUD 90 million is net of benefits.
Mm-hmm.
Do your own math on what the cost is. But the cost will remain relatively stable, but it is ramping up quite significantly and will continue to ramp up in terms of the benefits going forward as it gets rolled out through more and more sites. So, I mean, some of the stuff that Rach and his team are doing in terms of growth activity, we're still in a pilot in one site. So, you know, there's a lot more activity to be rolled out across the business, and that's why we anticipate seeing the benefits increasing year in, year out as we go through.
Okay, so just to confirm, the estimates for the full year impact of twenty-five is based on the pilot sites that you're working through at the moment?
It's based on everything we're doing.
Okay.
Yeah, yeah.
... to think about it is that there is, there are initiatives that we have progressed, that we are confident and we are scaling, and that's delivering, outcomes or financial benefits at scale. And then there are others which I shared a few examples on, which are in pilot stage, where we're seeing those early returns in maybe a handful of sites, and you would expect that to grow in subsequent years. Not all of these initiatives can be scaled overnight. Like, some of them are near-win, you know, quick wins, which we can scale rapidly. Others do require systematic change to our processes, the way people work, quite extensive training of our teams, and will require a couple of years to scale to all our sites.
That's why you see the ramp-up of the benefits to accelerate after FY 2026, is because we know we can get to the scale by then.
My final comment would be, the other thing we're looking at is the business as usual. So when you're asking the business to go through a heck of a lot of change, there's no point having transformation deliver the benefit without BAU also continuing to perform. So part of that assessment for this year is ensuring we're not seeing a decline because of the focus change onto something different. So it's a two-pronged approach in terms of that benefit realization.
Thank you. And just another question on the payer side: you mentioned contemporary funding models. You know, what does that look like? What's the rollout been with payers, and what's the feedback been to date?
Yeah, in contemporary funding models, more looking at how we get bundled services for, say, joint replacement. So, you know, in this state, you traditionally have a lower length of stay because we have a much better funding model around how that's funded, so the case payment model that Andrew talked about earlier. That's not the case for a whole lot of health funds that aren't up to that stage yet, too. So it's really about talking about, "Okay, well, let's look at this as a case payment-funded model, and you fund, you know, downstream services better." So, you know, what does that look like moving forward, and as we build out those services, that's where you'd want to start those discussions. We're having some discussions with some of the health funds around psychology and other services.
So how do you start to bundle in services that are more valuable to their members? So it's really, I suppose, a better relationship with health funds to talk about growing their membership as well, what's valuable to their members, and we can provide those services that are, you know, more comprehensive, not just the hospital service. Yeah.
Hi, Craig Wong-Pan from RBC. Carmel, you made a few points about volume growth and some of the initiatives there to drive that.
Yeah.
Just wanted to understand the timing, like, when we could expect to see some of those benefits come through.
Yeah. We're already driving a whole lot of strategies around volume growth. So, you know, public, for example, you know, where we can fill gaps. Rachna talked about the theater optimization project, so really driving a lot more theater utilization through just, you know, consolidating theaters and making sure we're using, you know, maximizing, sweating the assets, getting more volume through that way. Doctor recruitment, really targeting those doctors that are unhappy, maybe at other sites, and there's a lot going on. So, you know, really just there's a whole lot in that volume bucket that we're looking at better with better data and business development managers. You know, we've gone through a stage of appointing a few more business development managers to really look at that, doctor recruitment as well.
Looking individually at the services, mental health, how are we turning around mental health in a really targeted approach there. So, so all of it is, you know, about driving better volume, and we are, I think, seeing, you know, better admissions, and the type of volume as well, so, you know, what, what volume are we targeting? You know, high, high acuity, high cardiac, orthopedics, et cetera. Saul?
Yeah. Thanks, Saul Hadassin, Barrenjoey. Carmel, just some comments around the 12 surgical centers and just that strategy that's being rolled out.
Mm.
We've seen pressure on some standalone facilities because of rates.
Yeah
... that they get from-
Yeah
insurers. Can you talk to, are these centers co-located? Are they sort of similar to standalones? And when you go to negotiate rates on those new facilities, how does that work in terms of what you then get?
Yeah.
Is it a Ramsay-based rate or a lower, how economic are those centers?
So there's two parts to that strategy. So one of, one of them is to lock in our market share in key regions. So, for example, Brisbane, East Brisbane, Greenslopes, Cleveland's about, you know, making sure we have that market for us, and that's a, that's a, you know, that strategy is about, I suppose, not just defensive, but really betting in that market. And then there's the new market areas, like, you know, South West Sydney, growth, big growth markets we haven't been in before. You know, we haven't, haven't expanded much in Sydney other than brownfield, so, you know, is that, that trialing out those new market areas that I, you know, in, in those places. So there's two parts to it.
The other thing is, we haven't been in ophthalmology, really, so it's an area that I'm keen to do more in. So, we're building a couple of centers. We've got a particular focus on that, and so setting up the surgical center division with a dedicated CEO who's really targeting new doctors and looking at ophthalmology in a bigger way. Because we haven't been in those, you know, efficient, smaller sites, that's an area that I'm interested in growing. So one of our sites, Caloundra, has 12 ophthalmologists starting in January. We've repurposed that facility. It was an existing Ramsay facility. It was just an endoscopy unit. We built 3 theaters there. They'll have a big ophthalmology unit. So it's sort of trying to look at those specialties where we're not.
So it's not really about, you know, I don't think that orthopedics is gonna go into surgical centers, right? It's. That's not gonna happen. They do their stuff together in these hospitals where you have. You know, you need a massive theater for a robot now. They all do their stuff on robots. You are not going to be doing orthopedics in, you know, small surgical centers. They have to be in big hospitals, so that's not gonna be it. But it's where we have, you know, plastics, ENT, ophthalmology, those sort of services, that we traditionally haven't been in. So it's new business for us, that will grow through those centers.
And then some-
But even... Sorry. No, you go, so.
I was gonna ask then, the contracting then for rates when it comes to engaging with insurers?
Yeah, they're just part of our normal hospital portfolio, so we're not negotiating them separately. We may look at, you know, in some cases where we say, "Okay, well, let's look at a different rate," in those centers where it makes sense. But in most cases, it's just part of the, you know, part of our normal contracting process, so we're not looking at it differently.
We have an all-in-
Yeah
... contracting position, so everything in the portfolio needs to be in.
Yeah.
But I was just gonna make the point that the economics of standalone greenfield day surgeries is extremely difficult.
Mm.
So even though we've got the focus on what we need to do in that, we can't get a lot of them to stack up.
Thanks, Gary, and just one more from me. So ED's been, you know, a strategy for the business across certain states. We were talking about this earlier as it relates to New South Wales. You've got some key facilities there-
Mm.
But realistically, do you see yourselves opening emergency departments in some of those facilities, or is it, do you think it's just too hard in that state?
We are looking at one. We are looking at two in two new ones. We opened Lake Macquarie in 2015 or something, and that's been successful for that hospital. That's our only ED in that state. In that state, we are looking at a couple more. You need a lot of beds, so you know, like Andrew said, you have 120 patients at one time coming through that emergency center. And remember, in Sydney, we're on co-located campuses that are pretty landlocked, so you've got to get the land and build out. I'd like to see, you know, that we do have more emergency centers in Sydney, but you need beds and you need physicians, and it's not something that you're used to in Sydney.
So you know, I think from a patient perspective, I don't know how people live in Sydney without emergency centers, 'cause I'm, you know, used to having private emergency centers. I get calls all the time from friends saying, "Hey, I need to go to Greenslopes ED," or, you know, and then you hear from people in Sydney, you know, Kelly rang me up, "I need to take someone to a private ED. Where do I go?" And you've only got St Vincent's . Like, it's pretty tough. So I find that unusual, but it is something in Sydney that we'd, you know, will have to change in the long term, but yeah.
We would do an ED at North Shore tomorrow if we could.
Yeah.
But given the approval mechanism through the public system, you know, it's just-
Yeah
... it's just hard.
But certainly places like St George , Westmead, Wollongong, we should be able to do it. It's just getting the land, it's a time. It'll take a bit of time. Yeah.
Thank you.
So are there any other questions in the room?
Thanks. Carmel, I just wondered if you could give some comments as to any further developments around the private hospital review that the government's doing. Any developments there or most favored sort of strategies that they're looking to implement to go forward?
Look, no, it's the short answer. There's not much coming out. They, I was expecting it this week. I asked them last week, and the secretary said, told me that it might be this early this week, but we haven't seen anything yet, so it's still going through. Look, I don't. I'm not expecting much, Steve. I don't think there'll be. They'll, they will come out, and they've always said this was a diagnostic. It's a diagnostic to see what's happening in the industry and to confirm, you know, what was already thought to be the case, but to confirm that there's been issues. So it's a diagnostic only. I'm not expecting solutions from the government, but I think there's a bit of pressure on them with closure of maternity services like Gosford announced today.
You know, there's certainly you'd imagine be MP pressure in some of those regions that will necessitate some thought, and so definitely maternity, mental health, regional hospitals, you know, are the three key big areas. Yeah, we'll just have to wait and see, but I don't think there's a bailout coming for hospitals that aren't doing so well, so you know, that's, and I can't see that happening. Yeah.
Anybody else? We've just had a couple of questions through the website on productivity, labor productivity in particular, so maybe you could just talk through, you know, obviously through COVID, and then how it's improved and some of the things maybe coming through the transformation programs that are gonna help-
Yeah
... improve.
Does anyone else want to take it? I'm happy to.
No.
Yeah, you do.
Yeah, so I'd say it's a fairly targeted approach. So looking at the big acute hospitals where there's greatest opportunities post-COVID to see where there's been inefficiencies in the system. So starting with theaters, that's been a major area of focus all the way through into the ward setting. So and then from the nurse side into the allied health side. So just making sure we've optimized the ratios that we've got for those settings has been key. And hence why in one of the slides, we said we're back towards the FY nineteen pre-COVID levels.
Yeah, and then data and digital. Do you want to talk about that?
Yeah.
Yeah.
So there, there's quite a few initiatives in the transformation stream around productivity. We shared Performance Acceleration , which is focused on that, but also there's work we are looking to scale, which is underway, but we're looking to scale on how we optimize our processes and take out waste from the processes, either through digitization or simplification, which will lead to significant productivity. One area of, or couple of areas of focus that we are kind of doubling down on in FY twenty-five is our revenue cycle management end-to-end process and our workforce management end-to-end process. So, leveraging what we can from a digitization and simplification perspective to reduce waste in terms of how we operate today, that should be a key driver of productivity benefits for us from a transformation stream perspective over the next couple of years.
Great. Any other questions?
Great.
Yeah.
All right. That's good. All right. Well, thank you very much, everyone. It's been so great to spend the last twenty-four hours with you. I hope you enjoyed your hospital tours in particular. Thank you to Andrew today for organizing everything, and it's no mean feat to get a webcast live from a hospital. So thank you to the AV team up the back. They've been here for two days or more, sorting it out. So thank you everyone. Thanks to Kelly for organizing us all and keeping us up late last night. That's great.
Great.
All right, thank you. Look forward to seeing you again next time.