Good morning, everyone, and welcome to Ramsay Health Care's Full Year Results Presentation for the 12 Months ending June 30th, 2026. I'm Natalie Davis, the Managing Director and Group CEO, and I'm joined today by our Group CFO, Anthony Neilson. Today, we will share our financial results and the significant progress we have made over the past year in transforming the business.
I'm pleased that we are maintaining high patient NPS scores and clinical excellence in every region, building transformation momentum in the Australian business, and improving performance and capital returns across the group. I'd like to thank our incredible people and our clinicians who dedicate themselves to our patients and are the foundation of our success. Turning to slide four.
We've made good progress delivering against our three key priorities. First, the multi-year transformation of our market leading Australian hospital business. Second, strengthening capital discipline and improving returns across the portfolio. Third, evolving our culture to innovate and accelerate delivery.
Our strengthened group executive team and the capability they are building in key commercial and operational areas has enabled us to accelerate the pace of our transformation. In Australia, our high acuity growth focus, improved theater utilization, revenue indexation, and cost management has delivered underlying EBIT growth of 11.2% and a +30 basis point uplift in EBIT margin. Importantly, we're also well progressed with our proposed separation of Ramsay Santé, which is on track for completion in late 2026, subject to a shareholder vote in November.
Turning to slide five, and looking at the headline numbers in constant currency movements for the full year. Revenue was AUD 18.6 billion, reflecting 4.2% growth compared to FY 2025, driven by 8% revenue growth in Australia.
Underlying EBIT increased 11.8%, and underlying NPAT increased 22.9%, reflecting focus on improving performance through transformation programs in each region. Reported NPAT was AUD 329 million. We've strengthened capital discipline, focusing growth and development CapEx on Australia and procedural capacity, reflected in Group ROIC increasing by 30 basis points and Funding Group ROIC +60 basis points to 6.3%.
Our focus on performance improvement and cash conversion has seen Australia and both U.K. businesses net cash flow positive for the period and improved our Funding Group leverage to less than 2x .
The board has determined a final fully franked dividend of AUD 0.485 per share, which is up 21.3% and taking the full year dividend to AUD 0.91 per share, up 13.8% on the prior period and representing a payout ratio of 60.3% of underlying earnings. These results highlight the momentum building across our business and the positive impact of our strategic initiatives.
Slide six provides more detail on our underlying result and the split between the Funding Group contribution and Ramsay Santé. All regions improved performance. Australia reporting 11.2% growth in underlying EBIT on 8% growth in revenue. Both U.K. businesses reporting growth in earnings through operational initiatives, mitigating the impact of lower funding by the NHS.
Ramsay Santé's improved EBIT was driven by its Swedish business and performance improvement initiatives, more than offsetting the difficult funding environment in France. Moving to focus on each region.
Starting with Australia on slide eight, our transformation continues to build momentum driven by our big five hospital operations improvement initiatives. Our strategic focus on growing in high acuity and priority therapeutic areas, improving theater utilization, and focus on procurement initiatives has driven admissions and revenue growth and margin expansion. Pleasingly, we achieved this alongside improved patient, doctor, and team NPS scores.
With the new executive team in place, we have started to accelerate the execution of our 2030 strategy. We are looking forward to National Capital Private Hospital joining our Ramsay network next week and serving the local community.
During the year, we also signed a new partnership agreement with one of our major insurers, which will enable us to focus on collaborating to strengthen the private health proposition. We have grown our Ramsay Research & Development Network to 22 sites and continue to grow clinical trials activity with a 28% increase. Turning to the Australian results in more detail on slide nine.
The business delivered 11.2% growth in underlying EBIT, driven by higher activity and acuity levels, and improved utilization of treatment capacity, improved private health insurance indexation, and effective cost management. We reported a 30 basis point improvement in underlying EBIT margin to 9.4%.
The impact of the new funding mechanism at Joondalup Health Campus was partially mitigated to approximately AUD -26 million by actions including a focus on timely discharge of patients, agency reduction, increased winter activity as our clinicians continue to provide excellent care to the local community. Underlying labor costs were flat as a percentage of revenue and lower excluding the impact of Joondalup funding, reflecting a focus on reduced agency use over the period. We were also able to lower supply costs as a percentage of labor through procurement savings.
Our portfolio optimization efforts have continued with four sites closed and excess land holdings put up for sale. Before moving to the key drivers of our results, slide 10 details some of the underlying trends in the Australian private healthcare market. The market is showing improving fundamentals with hospital coverage continuing to grow as Australians prioritize their healthcare, growing by 2.5% per annum in the last three years, and payout ratios gradually improving, however, with some way to go.
Acute private hospitals remain the predominant setting for private healthcare and are evolving their services to include day procedures. Down-tiering from Gold policies to Silver hospital coverage continues, impacting private mental health and maternity in particular. Now delving deeper into Ramsay Australia's activity trends on slide nine, sorry, slide 11.
Excluding the impact of Peel and Border Cancer Hospital, which have both returned to public operation, you can see we observed strong growth in our core surgical and day activity, coupled with higher inpatient acuity. Surgical admissions, which account for more than half of our total admissions, grew 4.1%, increasing 40 basis points as a percentage of our total admissions, reflecting our focus on growth in key therapeutic areas. Medical admissions were up 3.2%, and rehabilitation admissions increased by 3.8%.
Mental health admissions declined by 3.9%, but this was mainly due to declining day admissions, with overnight mental health admissions, which contribute the majority of our revenue in mental health, increasing by 0.9%. Looking at funding types, private admissions grew 2.8%. Public admissions increased by 9.5%, reflecting strong activity at Joondalup, and a 7.7% increase in public and private activity. Day only admissions increased by 3.8%, boosted by new surgical centers at Charlestown and Caloundra, while overnight IPSTTR increased by 3%, reflecting a higher overnight acuity mix.
Moving to slide 12, our strategic use of data insights and the uplift in our sales force are supporting growth in the number of Visiting Medical Officers or doctor partners, our share of complex therapeutic activity, and improved theater utilization. We achieved 3.3% growth in meeting VMOs enabled by improved catchment-based data insights.
Our theater utilization improved to 70% in FY 2026 from 69% in FY 2025 as we opened an additional 22 new theaters during the 12-month period, indicating our success in increasing utilization of theaters at our key sites. We increased robotics usage supported by improved robotics utilization tracking. Slide 13.
Total CapEx was AUD 365 million, which was flat on the prior period and below the original forecast of AUD 410 million- AUD 440 million, reflecting lower than forecast development spend as we focus on improving utilization of existing facilities and the timing of reimbursements from landlords of AUD 30.8 million, primarily associated with the developments at key lease sites, Peninsula and Ballina. Our development investment in Australia remains focused on increasing procedural capacity in major hospitals within growth corridors.
In total, we opened 22 theater and procedure rooms during the period. The increase in routine and maintenance CapEx reflects an investment in existing facilities to ensure strategically located sites are fit for purpose in the future and continue to meet high clinical, safety, and amenity standards. In financial year 2027, we are planning to open 11 new theaters, Cath Labs at sites including our largest hospital, Hollywood in Perth and St. George in Sydney.
We are in the final phase of our Warringal Private expansion, including our recently opened emergency department. In financial year 2027, we will continue with our key programs to drive the transformation of the business with our initiatives underpinned and enabled by our investment in data technology and AI.
We have defined our technology roadmap with priorities including the upgrade of our patient administration system, which will be part of our broader revenue cycle management transformation to speed up cash collection, improve accuracy to reduce rework, and streamline administrative manual processes, and a smart rostering system and team app to enable flexible working, reduce administrative burden for our hospital teams, and improve effectiveness of our rosters. Moving to slide 15 and the outlook.
As we continue to focus on delivery of our multi-year transformation, Australia is targeting incremental year-on-year EBIT growth, both including and excluding the NatCap acquisition. Margin expansion driven by activity growth, improved capacity utilization, revenue indexation in line with cost indexation, operational improvement initiatives, and including a AUD 10 million to AUD 15 million increase in investment in IT, technology and transformation.
National Capital is expected to be underlying EPS accretive in the first 12 months of ownership. Transition operating costs are expected to be in the range of AUD 9 million- AUD 11 million in financial year 2027. Total CapEx for Australia is expected to be AUD 380 million- AUD 410 million, inclusive of NatCap.
Moving to the U.K. region on slide 16, where both our U.K. hospitals and Elysium businesses are focused on performance improvement plans to mitigate weakness in NHS funding. Pleasingly, both businesses delivered an increase in underlying EBIT and were net cash flow positive. U.K. hospitals focused on acuity, private activity growth, and cost management to mitigate NHS funding headwinds from Q2.
The Elysium turnaround is beginning to gain traction under the leadership of new CEO, Joe O'Connor, in weak market conditions through a focus on right-sizing our services to local demands and cost reduction. Moving to each business in turn.
Beginning on slide 17, our U.K. hospitals delivered underlying EBIT growth of 10.3% in constant currency, successfully mitigating an 8% decline in NHS activity and tariff indexation below cost growth. The result was achieved through a focus on higher complexity NHS work and private activity growth of 2.9%, which drove a 6.7% increase in average revenue per admission. The business focused on disciplined cost management program, resulting in labor cost as a percent of revenue declining by 30 basis points, and the EBIT margin improving 80 basis points. Turning to slide 18.
We expect Ramsay UK to deliver EBIT growth in financial year 2027, with the focus on driving higher acuity and growth in private medical insurance and self-pay activity. Ongoing delivery of efficiency transformation programs across finance and operations, including rostering initiatives and creation of finance shared services hubs, and continuing to work closely with local and national NHS stakeholders to attract NHS work and target acuity.
NHS tariff guidance for the year beginning April 1st, 2026 has been recently lifted to 1.24%. The backdated amount related to April 1st, 2026 to June 30th, 2026 will be included in the financial year 2027 results.
Turning to slide 19, Elysium's turnaround plan gained traction in the second half of financial year 2026, delivering a 43% growth in underlying EBIT for the year. This was achieved through site and ward closures to match local demands, reduced central and agency costs, including a reduction in FTE, and an average fee uplift of 4.4%, reflecting complexity of patient services.
There was also a strong focus on working capital and a reduction in debtors, which combined with reduced CapEx drove positive cash flow. Elysium's reported result includes a net AUD 13.2 million of costs associated with its restructure, including site impairments of net AUD 9.9 million.
Our ongoing focus for Elysium on slide 20 is to continue delivering on the turnaround plan, which includes increasing conversion rates of new patient opportunities, including a focus on complex recovery services. Further improvements to labor mix, including reducing agency costs further, negotiating with payors for appropriate fee uplifts, reflecting service complexity. We're targeting EBIT growth in financial year 2027 as the business turnaround continues to progress. Heading now to Europe.
On slide 21, we're on track with our separation plans for Ramsay Santé to support long-term value creation for Ramsay shareholders as we move towards a Ramsay shareholder vote in late November. The business has continued to focus on performance improvement in both France and the Nordics.
Moving to slide 22, despite funding headwinds in France, Ramsay Santé reported a reduced underlying loss in Europe. The Nordics region delivered a strong result driven by Sweden's performance improvement, which included the impact of the new S:t Göran eight-year contract and improved performance in its other services, including proximity care. France has multiple work streams on foot focused on operational efficiency, which partially mitigated the funding shortfall.
On slide 23, Ramsay Santé's focus in financial year 2027 will include cost control, efficiency and cash generation. Growing profitable activity, including growth in Sweden and the full-year impact of the new S:t Göran contract, and sustained advocacy for fair tariff outcomes in France.
Turning to slide 24, the proposed separation of Ramsay Santé is well on track with the Demerger meeting for the shareholder vote progressing towards November 24th, 2026. The benefits of the Demerger proposal include, it simplifies Ramsay's portfolio, enabling us to focus on transformation and growth potential of our core Australian hospitals business. It also simplifies our reported financial profile through deconsolidation of Ramsay Santé from Ramsay's financial statements. Demerger should improve Ramsay Santé's focus.
An already established, independently managed, and publicly listed business to continue to pursue its European focus, strategy and transformation. There is limited separation complexity given Ramsay Santé already operates independently of Ramsay, including separate financing and balance sheet arrangements.
It gives our shareholders the opportunity to retain ownership interest in Ramsay Santé. Assuming shareholders vote in favor of the separation, Ramsay Santé will be treated as a discontinued business line item in our financial year 2027 half and full-year results. Costs associated with the Demerger will be detailed in the scheme booklet.
Moving to sustainability on slide 25, Ramsay remains on track with both our 2030 Scope one and two greenhouse gas emissions targets and our 2028 supplier engagement targets. We are committed to working with our partners to understand and address emissions across our supply chain. However, our progress in this area is limited to how quickly our suppliers are able to reduce and manage their own Scope one and two emissions. As a result, we revised our long-term net zero greenhouse gas emission targets, taking into account the current and anticipated commercial and operating environment.
We will now target net zero Scope one and two emissions by equity share by 2050 instead of 2040. Ramsay UK and Elysium Healthcare will target net zero Scope three emissions by 2050. Our net zero Scope three group target will be considered following engagement with our suppliers in line with our near-term target. I will now hand over to Anthony to provide a more detailed look at our financial performance.
Thank you, Natalie. Good morning, everyone. Moving to our group financial performance on slide 27, it is important to note that all regions reported EBIT growth in local currency, reflecting positive transformation momentum in Australia and a focus on operational improvement programs across all regions.
This drove a 30 basis point improvement in EBIT margins to 6.2%, with cost discipline resulting in a 20 basis point improvement in employee costs as a percentage of revenue, and a 10 basis point improvement in medical supplies and consumables as a percentage of revenue. Underlying EPS grew 27% in constant currency. The underlying effective tax rate was approximately 35%, consistent with our guidance. Reported tax was slightly higher at approximately 37%.
These rates are higher relative to corporate tax rates in the jurisdictions Ramsay operates, reflecting the impact of French CVAE, which is a corporate value-add tax, and Ramsay Santé's loss before tax result in the FY 2026 period. The final dividend of AUD 0.485 per share brings the full-year dividend to AUD 0.91 per share, up 13.8% from FY 2025, with a payout ratio of 60.3% of underlying earnings. Turning to slide 28.
We continue to maintain a strong focus on cash generation. Operating cash flow reflects a 46% improvement in the Funding Group, coming from Australia and both U.K. businesses, offset by a negative working capital variance in Ramsay Santé, primarily reflecting the timing of payments from the French government versus the prior period. The decline in CapEx spend reflects capital discipline in development expenditures in Australia and the U.K. operations.
This resulted in free cash flow of AUD 697 million, which was relatively flat compared to the prior year. Net cash inflow from divestments mainly relates to sale and leaseback of four sites in France and the sale of HotDoc investment in Australia. Dividends paid increased, reflecting the suspension of the dividend reinvestment plan for the final dividend in FY 2025. Moving to slide 29.
Our consolidated balance sheet remains stable, with key changes relating to the net impact of currency translation on the balance sheet was approximately AUD 300 million reduction in net assets. An underlying increase in property, plant, and equipment includes the completion of developments in Australia, partially offset by the restructure of portfolios in all regions.
Working capital movements mainly relate to movements in Ramsay Santé associated with the timing of government receivables, and the Elysium portfolio restructure resulted in a AUD 300 million reduction to the right-of-use assets. ROCE increased 110 basis points to 11% for the group.
Turning to slide 30 and the Funding Group, which excludes Ramsay Santé, delivered underlying NPAT growth of 17.9% to AUD 398.4 million, with a 5.2% increase in revenue in constant currency. The result was driven by underlying EBIT growth across all businesses, with an improved performance in Australia of +11.2% in underlying EBIT, a +10.3% underlying EBIT contribution from our U.K. acute business, and a +43.5% increase in underlying EBIT for Elysium.
The result included a 7.3% increase in depreciation, reflecting the completion of major projects in Australia over the period, higher financing costs reflecting the increase in base rates over the period and reduced hedging compared to the prior period, and an underlying tax rate of approximately 29%. ROCE for the Funding Group increased 124 basis points to 14.8%. Moving to slide 31.
The Funding Group's leverage has decreased to 1.83x and remains well below our target range of 2.5x . Interest cover is also strong at 8.94x . All businesses in the Funding Group were net cash flow positive for the year, showing a strong focus on improving cash flow, working capital management, capital allocation, and returns across the Funding Group. We maintain liquidity of AUD 1.066 billion, some of which will be utilized for the AUD 251 million acquisition of NatCap next week. Leverage is expected to continue to be below our target range post this acquisition.
The weighted average cost of debt in FY 2027 is currently expected to be approximately 5.5%, and approximately 60% of our Funding Group debt is hedged for FY 2027. In FY 2027, total net interest costs, inclusive of AASB 16 lease costs for the Funding Group, are forecast to be AUD 280 million-AUD 300 million.
On slide 32, Ramsay Santé remains well supported by its own funding arrangements. In July 2026, they announced the completion of a refinancing of EUR 1.75 billion of senior debt, extending their tenor by 2 years to 2033, and including a change of control provision, which is consistent with our proposed separation. Its bank leverage ratio was 4.7x at June 30, and liquidity stood at EUR 487 million, comprising EUR 185 million in undrawn bank facilities and EUR 302 million in cash.
Turning to slide 33, as I have shown above in the results, our focus on improving capital management and cash flows delivered improved returns and lowered leverage for the Funding Group over the period. Disciplined cost management across the Funding Group resulted in underlying EBITDA margins of +60 basis points and underlying employee benefits as a percentage of revenue declining 20 basis points.
Activities over the period included a focus on revenue cycle management and improved working capital across all businesses, with cash conversion in Australia improving by 4 days over the period and further work to do. Focus on utilization of facilities and portfolio optimization resulted in a decrease in CapEx and improved capital allocation across the business. Cash generation from portfolio optimization will continue in Australia and Elysium. These activities and focus on improved results drove an improvement in the Funding Group ROCE to 14.8%.
Turning to slide 34, Group CapEx was AUD 734.2 million, a decrease of 6.1% in constant currency, reflecting disciplined development spend in Australia focused on expanding procedural capacity, lower CapEx in the U.K. and flat in Europe, reflecting our capital discipline in the current funding environment, mainly due to lower development and growth expenditures.
Routine and compliance spend was increased in Australia to ensure our hospitals are future fit, our high clinical quality and safety standards, and the amenity of our hospitals is maintained. Our forecast range for Funding Group CapEx in FY 2027 is AUD 480 million-AUD 520 million, consistent with the FY 2026 spend of AUD 488 million in constant currency. Overall, we made good progress from a financial perspective in FY 2026, with the company in a strong financial position to continue to deliver in FY 2027. With that, I'll now hand back to Natalie for the outlook and closing remarks.
Thanks, Anthony. Turning to slide 36. In closing, I want to reiterate our commitment to continuing delivery of our strategic priorities. In FY 2027, we expect to continue the positive momentum with EBITDA growth expected in Australia and the U.K. businesses. We're looking forward to completing the National Capital acquisition, caring for the local community, and welcoming the team to Ramsay next week. We're preparing for the proposed separation of Ramsay Santé in December, subject to Ramsay shareholder vote on the November 24th.
The group executive will host an investor day on the November 30th to share our progress and plans as we continue to evolve Ramsay for the future. I'm proud of the progress we've made as a team and our unwavering commitment to providing excellent care for our patients. Thank you for joining us, and we'll now open the floor for questions.
Thank you. If you wish to ask a question, please press star one on your telephone and wait for your name to be announced. If you wish to cancel your request, please press star two. If you are on a speaker phone, please pick up the handset to ask your question. Your first question today will come from David Low of UBS. Please go ahead.
Thank you for taking my questions. Just starting with slide 12 and the utilization trends. I can see that you've got much higher utilization in the top five sites. Where do you think you can take the utilization to? What's maximum, and is it possible to get the lesser sites up to levels that you're seeing in the top five hospitals?
Thanks for the question. If you look at our distribution of utilization across all of our sites, what you see is we have five sites, and they tend to be our very large hospitals that have utilization in that range of about 80%-85%. That's broadly in line with what you would see as best practice around the world in the sector. Our focus has really been particularly in our large hospitals that are often adjacent to a public hospital and attract that complexity of work that we're known for.
Our focus has really been particularly at those sites, trying to attract more doctors and serve more patients and increase utilization of those hospitals. That's in areas like cardiology and cancer care and orthopedics. That 80%-85% would be our aspiration for a really good level of utilization in one of our major hospitals. When we get close to that's when we consider increasing our procedural capacity.
Okay, great. Thanks for that. It would seem that at the top five sites, you're quite close to needing additional capacity.
Well, some of those sites we're already in the process of adding capacity. You would have seen in the presentation later on, we talk about where we're adding sites, we're adding theaters or Cath Labs over the next 12 months. They include a focus on some of our major sites, like Westmead, St. George, and Hollywood. We're adding two theaters and two Cath Labs. We've already been effectively prioritizing our capital investment based on levels of utilization.
Okay, thanks. Just the other topic I wanted to touch on was the OpEx, the IT OpEx that you've laid out for AUD 10 million-AUD 15 million. Could you talk a little bit more about what you're spending on, will that be a headwind to margins effectively? Or do you expect that that investment will pay back quickly enough that it would be offset?
Yeah. What we've done with our technology roadmap is very clearly defined a sequenced approach. We're thoughtfully investing in technology. We know we need to invest in technology to enable our clinicians in our hospitals, to reduce their administrative burden, to improve our processes. We're particularly prioritizing two things at the moment. One effectively is an upgrade of our patient administration system, which is the backbone to revenue cycle management.
That starts with the patient admission itself, and then goes all the way through to coding and sending the bill out. That needs to be upgraded, and that will really help us, in terms of the speed at which that process works, and also make it much less manual than it is today and free up time for our clinicians. We will get started on that.
That is quite a big system upgrade, and we'll do that progressively hospital by hospital. It'll take a while for that to translate into benefits. Those benefits are significant. At the same time, we are focusing on effectively a new smart rostering system for our team. We have a workforce of 35,000. We have effectively legacy systems that our NUMS are using to roster team members at the moment.
It's probably the thing that takes up a lot of their time that, when I first joined Ramsay , I heard very clearly from the NUMS that they would really appreciate a better way of doing that. That's another one which we will start implementing over the course of the next 12 months.
Again, these things will take time to fully implement because it's not just about the system, it's about the change management and the processes around that. We have thought very carefully around which investments to prioritize, and we are working towards a plan where we can still invest in these investments, but also simultaneously continue to focus on delivering year-on-year margin growth.
Great. Thank you very much for that.
The next question will come from Sacha Krien of Evans & Partners. Please go ahead.
Good morning. Thanks for taking my questions. I was hoping for a bit more color on the Australian EBIT growth outlook. You are talking about incremental growth excluding NatCap. I am just wondering how that compares to your language, in FY 2026 of EBIT momentum. It sounds like weaker growth, but I am just wondering whether I am reading that wrong. If maybe you could clarify.
I think we are not giving guidance to the level that you are asking for. What we are saying is, we have been focusing over the last 18 months really on building our transformation momentum, and we will continue to focus on those same initiatives that we have outlined today. Really focusing on growth and targeting growth above market growth, and in particular in the high acuity areas that we are known for.
We will continue to target revenue indexation in line with our cost indexation. We will continue on working on our own operational improvements, including procurement, and increasingly as we implement our new system, a revenue cycle management process. We are working towards margin growth year on year in the Australian business.
We will be investing in a stronger business as well as we do that, and we have called out the AUD 10 million to AUD 15 million increase in OpEx that we are planning to make for IT and technology spend over the next 12 months as part of that.
Yep. Okay, thanks. Just wondering if you could talk a little bit about the admissions trends in the second half. That surgical number of 4.1% looks a bit softer than the 5.4% in the first half, but I think maybe you have made a couple of restatements there. If you could just talk about some of the trends in admissions in the second half and whether you are still seeing strong growth as you saw in the first half.
Yeah. Thank you very much for that question. You will see in the footnote to that page that we have called out that we did reclassify some admissions that were made in the first half from surgical to medical, and those were a part of the work that we do at Joondalup Public Campus, which is one of our biggest campuses. What you are seeing there for the year is more broadly reflective of what we also saw in the first half once we account for that.
Okay. That is all for me.
Does that help?
Yeah. That is great. Thank you.
Your next question today will come from David Stanton of Jefferies. Please go ahead.
Good morning, team, and thanks very much for taking my questions. Perhaps we could focus on revenue growth for 2027. Australia saw very impressive revenue growth. Do you think it can match that in percentage terms, that kind of growth level in 2027? Then perhaps I could follow up by asking the same questions for the U.K., both the U.K. hospitals and Elysium.
Revenue growth in the U.K. as well, specifically?
Yeah, sure. Basically in the U.K., whether you think you are going to see positive revenue growth in constant currency in 2027 for both the U.K. and for Elysium, please.
Okay. If I start with Australia, what you are seeing in the revenue growth number there is broadly 8% revenue growth, and admissions growth on a like-for-like basis of around the 3% mark. We have excluded the impact of Peel, but also the impact of Border Cancer Hospital, which we handed back to the public earlier this year.
The rest of the 8% growth, therefore, is accounted for through both revenue indexation, which we are targeting effectively our revenue indexation in line with our cost indexation, as well as a focus on acuity of work and the focus on the work that we do very well and we have high market share in, and that is what we do in our big major hospitals, so cardiology and orthopedics and cancer care in particular. That focus will continue.
Those components, effectively, we will continue to target into the next financial year as we already are. We will continue to really focus on growth and specifically in the areas that I just mentioned. We are increasing our focus on our business development managers, who go out and talk to specialists about why they should choose Ramsay to perform their surgeries. There is a number of enhancements we continue to do in terms of the data we are providing our hospital teams around catchments and GP referral patterns.
We continue to set an ambition for ourselves of growing above the market, particularly in the areas that we are focusing on. We will continue to aim for revenue indexation broadly in line with our cost growth. We also continue to target that acuity mix, which supports that revenue line.
If I turn to the U.K., I will speak to both businesses separately because it is quite different. In U.K. hospitals this year, we had a very strong start to the year, and then we had the pullback of NHS funding from about November, December, and the team managed that very well in terms of flexing the cost base towards that lower level of activity, but also focusing on private work, as well as making sure that the work we are doing for the NHS is high acuity.
Again, those components support the revenue number you have seen today. When we look at the U.K., at the moment, in terms of the indicative activity plans that we are being given by the NHS for our hospitals, we are seeing growth there in those indicative activity plans.
We will continue to focus on acuity, and we will continue to focus on private work. We think that is a significant opportunity for us, particularly in some of our hospitals that are in those commuter belts around the London area. That we will continue to do. If there is any uncertainty on funding, we will continue to really make sure that we are flexing our cost base, and focusing on efficiency so that we can deliver the EBIT growth that we have got in our outlook statement.
With Elysium, we have experienced weak demand, and what we have done over the past 12 months is really right-sized our available beds by geography effectively and by service line. We closed about 239 beds over the last 12 months. Broadly speaking, we are not planning on any more significant closures.
We think we've probably done the most significant degree of right-sizing that we need to. The focus now will be continuing to make sure that we're converting as many referrals as we're getting, and really developing differentiated services. We've started to do effectively personalized services for very complex patients. That's our complex recovery services that we've called out. We will continue with our turnaround plan and operational efficiency focus there as well.
Understood. I guess, put it in a nutshell, potentially, maybe Australia, that level of revenue growth is potentially a stretch target for 2027, what you did in 2026, and it sounds like you are targeting sort of positive revenue growth for Elysium in the U.K. in 2027.
I'll leave you to draw your own conclusions from what I've said, but I think I've given you a good idea of what we're trying to balance and how we're going to achieve the profit growth in those businesses.
Understood. Thank you.
Your next question will come from Davin Thillainathan of Goldman Sachs. Please go ahead.
This morning, Natalie and Anthony, thanks for your presentation. I just want to start on the Australian business and the EBIT margin improvement that you have guided to. Thinking about the building blocks there, from my perspective, it looks like the timing of capacity coming on. You did more openings in FY 2026, and then there is less going to 2027. I would think that should help your margins, just given it does take some time to ramp into those capacity.
Then you have procurement savings that happen into FY 2026. I assume that should continue into 2027. Then you have a Joondalup headwind that reduced in the second half, which I assume is going to help again into 2027. I would think those three blocks are going to help your margins. Could you just comment on that? Secondly, any other key drivers we should be thinking about?
Okay. Thank you. That is a very thoughtful question. If I start on capacity utilization, yes, you are right. We did add 22 theaters over the last year. Some of them we have only just recently opened. Strathfield, for example, in Sydney, we have just recently opened. The capacity we have added to hospitals like Joondalup Private, for example, means that we are still very much focused on driving increases in utilization around that hospital catchment. As you say, the more that we can fill the existing capacity, the more that supports marginal contribution into the Australian result.
On procurements, I would say in the second half, we started to get some traction in terms of what we're trying to do, and there is overall a very significant opportunity there, as I have discussed before, because even though we are the largest private hospital operator in Australia, we traditionally have really been leaving most procurement decisions to individual hospitals. On both the clinical and the non-clinical side, we have been focusing on how do we actually create national tenders and national approaches, and more transparency to our hospital teams so they can also make better decisions.
We did have success in the second half, and you would have seen that that supported a decrease in our cost of supplies as a percent of revenue for the year. Procurement is something that we will continue to target over the next 12 months.
We have just, over the last couple of weeks, rolled out what the teams called a switch and save dashboard for hospitals. This really gets down to a very practical level of medical consumables that hospitals are purchasing and provides the hospital teams the data on exactly the same type of consumable, which is very complex to do, as you can imagine.
It prioritizes effectively for each hospital the opportunities they have if they switch to a different supplier and the amount that they can save, so that they can then effectively have conversations with clinicians in the hospital around switching over to better product. That is something that we have just started to roll out to our 20 major hospitals that will support procurement benefits over the next 12 months.
In terms of the Joondalup impact in 2026, it was relatively equally phased, the impact of that funding agreement and our mitigation over the two halves. Looking forward, we had a very significant impact from the change in the funding agreement because we shifted to the state price, and historically, that state price had not been increased enough to cover cost inflation. There was a step down effectively in what we were paid. This year, the state price in W.A. has gone up by, I think, almost 3.9%, so it is much closer to our labor cost and cost increases in that hospital.
That will not be a significant drag in terms of our FY 2027 performance. We are very much focusing in Joondalup on partnering very closely with the local health district and continuing to serve that community. There is a growing need for healthcare there.
It is a growing catchment. The government has funded the new public capacity there. There are two wards that opened there in the last few months, known as Caboolture. That has been funded for the new year. We have also been progressively opening and getting funding for the mental health capacity that was built there. We have received funding this year for the remainder of that capacity as well. We will continue to work with the LHD there to continue to meet the needs of that community.
Thanks. Those are all great levers into 2027. If I think about some of your EBAs and the wage indexations that could come through, there is a step up in, say, periods like FY 2028. How do you manage, I guess, the business to ensure you've got that recurring EBIT growth to occur into 2028? What are some of the drivers you think that will start to help beyond a 12-month window?
Yep. If I step back and talk a bit about where we're up to on our EBAs. Just recently, we've had our Queensland EBA proposal endorsed by the team there. It follows relatively closely the public EBA, so it still needs to be endorsed by the Fair Work Commission. The team has endorsed effectively a 14% increase over four years there, just to give you a sense of the Queensland uplift. We will be beginning very soon the negotiation of our New South Wales EBA.
The current EBA ended on the June 30th. We enter into that negotiation in terms of our current wage rates in New South Wales being at parity, largely speaking, with the public sector. The public agreement there, which was recently agreed, it gives about a 3% yearly uplift for the next couple of years.
I think the uplift that you're referring to is probably the Victorian EBA. We did, in the last 12 months or so, finalized our Victorian EBA. As you'll be aware, that public EBA there had a very significant uplift in wages around November, December of 2027 calendar year. Our EBA has been agreed and approved by the team. It's actually a four-year EBA. It will have a step-up around that period.
The overall increase is around about 24% over the four years. That gives you a sense of the different EBAs in the states at the current state. Our labor costs in general at the moment are running fairly closely in line with our revenue indexation.
Broadly speaking, again, if you do broad maths and you have a look at the employee cost growth that we've disclosed for FY 2026 at 7.9%, broadly speaking, our labor costs are growing at about 5%. We expect that level to continue over the next few years. That's before we probably foresee some impacts from the Fair Work fair value case as well flowing through. Our corporate plan effectively forecasts out our wage growth, and we use that to inform our private health insurer negotiations.
If there's any differences, then we will go back and renegotiate with our private health insurer partners. We've also, as I've spoken to previously, been in a process of trying through those negotiations to negotiate effectively year-on-year revenue indexation, which is linked to sector-wide metrics. We're making good progress on that. You've seen the results.
We have four agreements that effectively have a level of mapping towards or formula links to sector metrics year-on-year. Just to give you a sense of the size of that roughly when we look at our private revenue, so PHI related revenues, that roughly covers about 48% of our revenue at the moment, those type of contracts.
Thanks, Natalie.
Your next question will come from Andrew Goodsall of MST Marquee. Please go ahead.
Thanks very much for taking my questions. Just looking at the Australian business, just trying to understand where you are in your digital and data. I know you've spoken to this a bit, and you've given us your CapEx spend. Could you give us a sense of what your OpEx was for digital and data in 2026 versus 2025, and then just that OpEx go forward?
We really have stopped providing specifically what we are spending in that digital data transformation space. What we did say last year as we were entering this year is we were actually going to reduce some of the investment. If you recall in the previous transformation effort, we had significant resources around things like project management and change management. We are really focused on slimming down the team and then resetting the technology roadmap going forward.
As I have kind of described, we have got, I think, a very well sequenced plan that is going to help us and help support effectively those what we call the big five hospital operations initiatives. Those initiatives will help to deliver value.
At the moment, I would say the value from our investment so far has really come through on the data side in terms of the data that we are providing to our hospitals, particularly to support their discussions around growth, both in terms of catchments and referral patterns, but also in terms of utilization of existing theater and Cath Lab capacity. We have also added some data there on robotics utilization as well over the last six months.
That data has been very heavily used by the hospital teams because it lets them make very practical decisions around where they have opportunities to better utilize the existing capacity, where they are backfilling that capacity when we have cancellations or holidays. Also how we are continuing to grow and attract new doctors to the Ramsay network. That has been a fantastic foundation.
Just recently, as I mentioned, the procurement data insights that we are provided are very similar in terms of very actionable by our hospital teams to make better decisions. We have also rolled out over the last 12 months, a remote central monitoring system, which is supporting our clinicians. We are also in parallel to some of those business technology initiatives, continuing to look at technology initiatives to enable our clinicians. We are in the process of rolling out a system to support some of our oncology infusion services as well.
We will continue to very thoughtfully sequence what we are investing in and try and manage overall at a business level to make sure that we are growing our margins for the overall business as we continue to make those much needed investments.
Would the net of all of those initiatives be below where you were in 2025, and would you expect that to sort of stay at these levels?
I think to your first part of that question, yes, there were savings relative to FY 2025, as I described. We are now at the point where we're starting to increase that investment in the targeted areas in a thoughtful way.
As we've said, Andrew, we'll look at guidance next year from the savings we've achieved this year, an extra AUD 10 million-AUD 15 million coming into FY 2027.
On that OpEx?
Yes.
Then just quickly on U.K., you've given us a lot of color on turnaround. It's been a good turnaround, particularly Elysium, but just trying to understand the environment there or just your understanding of last year, we had that November overspend, I guess, and shutdown. Is that plausible this year or are things in place to make that a bit more clear?
I think Elysium and U.K. hospitals have different dynamics. Let me just separate those. It was U.K. hospitals that really saw that pullback in activity funding around November, December last year that we then had to, the team did a great job effectively tailoring and flexing the business based on that pullback. I think what we are seeing this year so far is the indicative activity plans that we are getting at a hospital level are supporting activity growth.
We are also, I guess, spreading out that activity growth more evenly or planning to spread it out more evenly throughout the year. We have also seen, just last week, the NHS lift the tariff to 1.24% as well, which will support revenue growth in the U.K. hospitals business. I guess at this point we are planning for activity growth, but we are also very conscious that things can change.
We know we need to develop our private work, and that is both self-pay and private health insurance work, in the U.K. business to really diversify our revenue streams. The team again made very good progress in the second half around self-pay in particular. As that pullback happened, there were obviously patients on the NHS waiting list who needed to have their surgeries done, and so our self-pay growth was higher in that second half.
We do have a very attractive proposition for private health insurer partners in the U.K. as well because, we drive very high-quality hospitals and we are a very efficient operator. We will continue to really grow that part of the business and provide a level of diversification. Elysium was more of , I guess it was less of that kind of pullback in November, December.
It was more a shift in NHS policy towards more community-based care. We found we were experiencing fewer referrals into inpatient facilities and also faster discharges into the community. That is really been a shift, I guess, in the approach by the NHS. As I said, the team feels like we have done the substantive realignment of our supply of beds to the demand at a local geography and a local service level. The focus now really is on filling the capacity that we have and continuing to make sure we work on our costs.
Great. Thank you.
Your next question will come from Craig Wong-Pan of RBC. Please go ahead.
Thank you. There was mention of a new partnership agreement with a major insurer. Just wanted to see if you could elaborate more on this and the benefits you could expect.
Look, we don't tend to get into specific details of specific commercial arrangements. What I would say is, it's been very pleasing to, over the last 12 months, really discuss with private health insurer partners the opportunities we have to really modernize the care that we're delivering and to modernize the funding, therefore, of that care. One of the things we've worked on with a few of our private health insurer partners is really changing the way, for example, that mental health is funded.
We've had a traditional, I guess, inpatient care model and an inpatient funding model, and we're normally in legacy contracts paid in line with length of stay in one of our mental health clinics. It might be 21 days in terms of a mental health stay. We know the community is changing. We know that there's a preference now towards community-based care. We know that a lot of our workforce also, and psychiatrists, are also treating people in different settings and using telehealth more. That follow-up from an inpatient stay is very important.
We've been working with a number of our private health insurer partners to effectively change the way that we're funded, so we're not just funded for that inpatient stay, but that we're funded and incentivized to support people post that stay into the community.
That means that we actually can deliver better patient outcomes because we provide continuity of care, and we are reducing that risk of that same patient being readmitted into a mental health clinic. That is a good example of, I think, the shifts you will see us continuing to make together with private health insurers around modern care delivery models and the funding then to support that.
Okay. Thank you. That is helpful. Just wanted to touch on the admissions growth, like within rehab, there was quite stronger growth in the second half. Just wanted to understand if something had changed to drive that high growth in the second half.
Not specifically, but we have continued in rehab. If you look at our last two years of results, we have continued to see strong growth in rehab. This really is an aging population, and a population with more chronic diseases and comorbidities. If you do unfortunately have a fall and you live at home by yourself, it really does make a difference to be able to access that rehab treatment post-surgery.
Our teams do an amazing job, actually, getting everyone literally back on their feet, exercising in the gyms and really able to go home and live an independent life. We continue to see the strong demand for rehab facilities. There is still an opportunity for us to do a better job of connecting our own rehab facilities with hospital care. Really providing, again, that continuity of care from hospital into rehab, and really to help Australians live more independent lives for longer. I think broadly speaking, that is what we have seen in that number.
Okay. On the U.K. businesses, both Elysium and U.K. hospitals, there was good improvement in margins in the second half. There were a few different factors that impacted in the period. I was just trying to understand, is that second half margin a good level to indicate for FY 2027, or is there puts and takes there around the initiatives you've experienced, the funding changes? I am just trying to get a sense of if that second half margin is a good indicator for 2027.
Just one general comment on the U.K. and actually the European business is that the second half always looks stronger than the first half because of seasonality impact. That impact is obviously there in the result. With Elysium, we did, though, see an improvement in the margin in the second half, and that really was the impact of the right sizing of our facilities, which led to significant cost reductions, as well as our ongoing focus on central costs coming through and the fee uplift being supported.
I think we are seeing more momentum, but what we're effectively saying is take the overall EBIT for Elysium and assume we have growth in that overall EBIT for the year, just knowing that we do have that seasonality impact in the overseas businesses.
Okay. Just my last question. The net interest expense, the guidance there for a AUD 20 million to AUD 40 million increase, just wanted to understand what's driving that. I see base rates are assumed to be a bit higher, but is that also being driven by National Capital or what's driving that increase?
Yeah. Both. Base rates are higher and yes, we will draw down and increase leverage a small amount due to the NatCap acquisition.
Okay. Thank you.
Your next question will come from Laura Sutcliffe of Citi. Please go ahead.
Thank you for taking my question. Just going back to EBIT margin expansion in Australia. Across the call, you've mentioned quite a long list of drivers, but which are the one or two that are really going to move the needle at this stage in the transformation process? Or perhaps another way to put it is, which one or two do you absolutely have to deliver on for the plan to work?
I think it's hard to just call out one or two things that we need to land next year. We've set out effectively five focus areas for the Australian business, and they're at different stages. We do need to continue the momentum. We do continue to focus on growth in high acuity areas. We do need to maintain our revenue indexation in line with our cost indexation.
Then we do need to work on our efficiencies, and procurement is the one that we've probably started to get some traction on, that we're well-positioned in terms of the initiatives that we're launching at the moment into the business, to create impact in this current financial year. Revenue cycle management, I think, is more kind of in the earlier phases where we're really building the foundation to then begin to deliver impact.
I think that the visibility of the benefits in the P&L will probably be largely FY 2028 and beyond. There are some benefits of agency reduction that we expect to come through in the next 12 months as well, and that continues to be a focus. Really managing our workforce and optimizing rostering, we will only be able to do fully in terms of realizable potential of that once the smart rostering system is implemented, and that is still a while away.
Hopefully you can get a sense of, we are working on a number of things and there are very clear focus areas in the business to make sure that we are sequencing our efforts and seeing those benefits come through in year-on-year margin improvement.
Thanks. That is really helpful. Just one more. In Australia this year, are you seeing lower flu-related admissions this year than you did last year?
Look, I think overall it is very public. It has been less of a serious flu season this year. We are obviously continuing to focus on growing our hospitals and our admissions and medical as well as surgical. We continue to grow and we continue to target above-market growth.
Thank you.
Your next question will come from Chris Cooper of JP Morgan. Please go ahead.
Morning. Thank you for taking the questions. The new partnership with the major insurer, that process seemed to start and finish more quickly and probably more amicably than some examples in the recent past. Are you able to shed any light on why you think those discussions seemingly are getting wrapped up a little bit more efficiently nowadays?
Well, there was a lot of work on. I think we spoke in February around entering into that negotiation and the preparatory work happens even before then. I think we have been talking to our private health insurer partners about the need for us to have our cost inflation reflected in revenue indexation. I think it's very well understood that the costs across the sector in healthcare are rising and that there is sustained cost pressure.
Private health insurers are more understanding of that and are beginning to come to the table. The more that we can negotiate around an element of effectively year-on-year indexation that is linked to sector metrics, what that does is it basically then frees up time for both teams to actually talk about how we change the funding structure itself and how do we strengthen the private health proposition.
That's ultimately what we're trying to do here. We're trying to provide a very strong private health proposition to encourage more Australians to take up private health insurance. We need to do that collaboratively with our private health insurer partners. If we can avoid having to go back each year in the middle of a contract and renegotiate indexation, then that does mean that we can spend more time actually on trying to find the opportunities to strengthen that private health proposition and the mutual benefit of growing private health insurance coverage in Australia.
In terms of those contracts that have built-in indexation, you said three of the smaller ones after the half year results. You are now saying four, and that comprises, I think you said 48% of your PHI revenue.
Yeah.
We infer from that, the new one that has just been renegotiated, the large one that is now got inbuilt indexation in it.
I am not making any specific comments on any one particular contract. We have given you that 48% just to give you a sense of the coverage now that we do have.
Understood.
Yeah.
Okay, thank you. Just one on cash. You made the comment, yourself or Anthony, that each of the different businesses within the Funding Group were all net cash flow positive. I assume that is the first time that has happened. You are guiding to EBIT growth for each of them in FY 2027. Can I just confirm that there is no sort of foreseeable reason why these businesses will not therefore continue to be net cash flow positive through 2027 and probably 2028 at this point?
Again, we're not giving specific guidance on each business. In answer to your first part of the question, I haven't been here that long, but Kelly's nodding, saying, "Yes, we believe that's the first time that the businesses have been all net cash positive." It is a fantastic effort across the board with all the initiatives and performance in U.K. and Australia that Natalie has talked about, and hopefully we can continue that momentum.
Okay. Just one final one. Lots of talk on the theater utilization. 22 new operating theaters in the year. Obviously, a decent uplift, about 5% or so. Some of those appeared to be quite late in the year. I guess the question is, would you anticipate continuing to grow OT capacity around that sort of mid-single digit level in 2027, or are we now in the process of focusing more on utilization of that additional capacity rather than building more capacity?
We're definitely focused on filling that capacity, but we've also got 11 new theaters or Cath Labs coming online this year. We're adding capacity where we've already got high utilization. I mentioned some of the hospitals where we're adding the capacity, Hollywood, where we've got two theaters and two Cath Labs, St. George, and Westmead. They're all hospitals that have a high level of utilization already. They need the new capacity, and so when the new capacity opens, we'll be filling that capacity.
At the same time, we've got to still fill up some of the capacity that we opened in the last 12 months, particularly where we've got very significant investments on one site. Joondalup Private, in particular, that'll be a focus for growth over the next two to three years to really ramp up the private side. Even, if I think back to the Northern, which we opened a while ago, we are still focusing on ramping up that facility. We're doing both at the same time.
Great. Thank you.
Your next question will come from Steve Wheen of Jarden. Please go ahead.
Yeah, good morning. I just wanted to talk to margins in Australia. When I look at first half 2026, adjusting out the impact or the headwind from Joondalup, it looked like the EBIT margin is up 30- 40 basis points. Turning to second half, it is up 100 on the, stripping out Joondalup. I am just trying to understand, is that gap or that acceleration of the margin improvement, pricing related?
I know there are a number of contributors to this, but, you indicated in the first half that you were pursuing, perhaps clawing back some of the lack of indexation you had not received from insurers, and is that part of that? Now that we are moving to dynamic pricing, can we sort of maintain that sort of gap that allows that margin to improve? Thanks.
There was a higher margin uplift in the second half, but that can partially be explained by impacts last year, including, in particular, the cyclone that you will recall that impacted Queensland. That impacted, in particular, some of our big sites around the Gold Coast and Greenslopes as well. Part of that uplift effectively, it is really related to prior period impacts rather than what we have done in this year. There was an improvement in procurement benefits that started flowing through in the second half to support that uplift in the second half as well.
We have been on revenue indexation that broadly speaking, looking forward, we expect revenue indexation in line with our cost indexation for 2027. We will continue to focus on acuity to support further revenue growth per admission ahead of that.
Okay. Do you expect to be able to shift that 48%, or is that sort of dynamic pricing not likely to be achieved across the whole PHI base?
We are trying to implement a level of dynamic indexation in all of our negotiations. We basically negotiate with different insurers at different moments in time. Every time we will come up for a renegotiation, we will try and create an agreement where we can put that in place. I think it works for both sides. It really is a fair mechanism for indexation because it's referencing externally available benchmarks.
It does mean, as I said, that the teams on both sides, instead of almost every year, which has been the pattern over the last few years, going back to the table to renegotiate annual indexation, the teams can instead spend time actually thinking through how to create partnership agreements and how do we really modernize funding and modernize healthcare delivery, which is the conversations that we really do want to have with our private health insurers. We'll continue to try and effectively make that part of our agreements going forward.
Okay. Thanks, Natalie. Second question for me is just on the portfolio review, in particular Australia again. I noticed that you've been able to make some small divestitures. I just wonder if there's further to come, and then as part of a portfolio, I'm just interested in the allocation of some immediate CapEx to National Capital.
Is that to expand the operating theater capacity within that hospital, given how the strong levels of growth it enjoys? Also as part of the portfolio, sorry, is Warringal and Northern Hospital, are they at a point where they're going to drive margin, or are they still ramping to be a little bit of a drag in FY 2027? Thanks.
Okay. Well, that is a lot of questions in one question, but I will have a go. First of all, on our portfolio review of our hospitals, we do see the ownership of our hospitals as a strategic advantage. We have been reviewing the portfolio, really having a look at some of our smaller sites.
What you've seen us do in a few examples, and I might talk through a couple, is look at sites that were really not being heavily utilized, where we have neighboring sites that can provide that service and transferring the patients and the team and the doctors to nearby Ramsay sites. If I take Glenferrie in Victoria, that is a surgical center that we closed. It is close to The Avenue and Masada Ramsay hospitals.
Effectively, the vast majority of our patient services, our team and our clinicians have shifted to other Ramsay hospitals. Several in New South Wales, when we actually looked at the patients that we were serving, most of them were actually coming from Sydney. We will be able to provide that continuity of service to those patients from our Wentworthville Clinic and our Northside Clinic. We have been making these decisions effectively at some of our smaller sites where we can consolidate our services, and continue to provide services to the local community.
We will obviously continue to review our portfolio, but we do not have a significant plan of closures looking forward. NatCap CapEx. NatCap, we are very excited next week to be finally having NatCap join the Ramsay network.
Obviously, once NatCap becomes a part of Ramsay, we will have a much better idea of exactly where and when we want to invest. The plan at the moment actually on capital is to focus on building a kitchen at NatCap. At the moment, the NatCap hospital gets its food from the public hospital next door. The team has basically told us that the quality of that needs to be improved.
We are scaling up, as you know, across our Ramsay sites, our new food offer, which will be at your request dining offer. At NatCap, we are building a kitchen there to be able to provide that offer to patients, which will improve experience, and we also think that will pay off in terms of financial returns.
As we get to know the NatCap team and the clinicians, and the doctors in that area, we do understand that it has quite a high level of utilization. It has got a very strong reputation, and we have seen opportunities in that hospital to expand either theater or Cath Lab capacity. We will put that in the plan once we get a little bit closer and understand exactly what is needed and what the opportunity is. The Warringal and Northern, they are quite different.
The Northern is a brand-new greenfield hospital, that is really still focused on ramping up, in terms of impact. It is delivering profitability. We continue to focus on really maximizing the potential of the Northern, and we will be ramping it up over the next few years. Warringal is a well-established hospital in Victoria, right next door to the Austin.
It's a significant development, but we have been progressively opening that development, including three theaters last year, and including the emergency department, which we effectively have soft launched as of a couple of weeks ago.
It's very pleasing to hear from the team that we're already getting quite a large number of people accessing that service, which will really provide rapid access to emergency services in that part of Melbourne. Then, where necessary, we are then also treating those patients in the hospital. Warringal is, I wouldn't call Warringal a drag. It's a very successful hospital that we're continuing to grow.
Fantastic. Thanks for answering all those questions.
Your next question will come from Saul Hadassin of Barrenjoey. Please go ahead.
Yeah, good morning. Thanks for taking my questions. I'll try and stick to two. First one, Anthony, maybe for you, the portfolio optimization. Just wondering, where does retail pharmacy fit into Ramsay these days? We haven't heard much about what's happening with that footprint. Does that still remain a core asset, or does the retail pharmacy component, does that become part of some type of review as well?
From a pharmacy performance in FY 2027, it was part of the whole focus around improving cash flow and improving returns. Pleasingly, there are initiatives in the pharmacy business that have been underpinning performance in FY 2026, and that will continue into FY 2027. We will continue to do performance improvements, and that does include reviewing the whole portfolio and seeing how it fits in to continue performance.
Thank you.
Just on that one, if you think about pharmacy, we have hospital dispensaries, which are clearly part of our hospital operations and integral to that. We then have pharmacies that are within the actual Ramsay hospital, very close by. Then we have some community pharmacies that are in places where we do not have hospitals, and we still really have an opportunity with the pharmacies that are on our sites or within our catchments to strengthen that connection again between the hospital care and the pharmacy care that we are providing.
Thanks for that. Then just to follow up, again, maybe one for you, Anthony. Just reconciling from EBITDA impact for the wholly owned Funding Group. Is it correct that there is about an AUD 8 million outside equity interest in the wholly owned Funding Group?
Sorry, minority interest in the wholly owned Funding Group?
Yeah, that's right.
There's a small portion.
Around AUD 8 million, I think, is what I'd calculate.
Yeah. Correct. I'm just looking for the page.
Thank you.
Yeah.
Thanks very much. That's all I had.
Your next question will come from David Bailey of Morgan Stanley. Please go ahead.
Thanks. Morning. I will try and be quick. Very strong underlying margin performance in 2026, about 70 basis points. Just wondering if you think you can replicate that again in FY 2027.
Well, as we have said on this call, we are not providing specific guidance. I think I have already spoken through the plan we have to deliver year-on-year margin improvement. Noting that we will be investing AUD 10 million-AUD 15 million in IT and technology.
I might have missed it. Did you say what the saving was in 2026 on that digital and data spend?
No, we did not.
Okay. Maybe just in terms of the comment around indexation to offset cost inflation. Looking forward, are you expecting the insurers to be able to pull out cost, or are you thinking that premiums will increase, going forward? If there's perfect pass-through on the hospital side, just wondering your thoughts as to the implications on the insurer and the other consumer side.
Well, I think, first of all, we're looking to see the level of the payout ratio still increase back to levels that it was pre-COVID, and there is still a long way to go on that, as you've seen on the chart. I think that's really important for Australians to know that the premium increases that they are being asked to pay are being passed through to hospitals to cover costs. Yes, it's important for private health insurers to run efficient businesses, just like it's up to us to run efficient and effective hospitals. That needs to happen as well.
We're very conscious of the affordability of private health insurance. We'll continue to engage with the government on sector-wide reform and providing more transparency and simplicity around private health insurer products. I think the whole sector really needs to work on doing everything that they can to make sure that premiums continue to be affordable for Australians and hospitals and insurers are running as efficiently and effectively as they can.
Looking forward, given the wage increases coming through, it's your expectation you'll continue to be able to offset the cost inflation through indexation, 2028, 2029?
We are not giving specific guidance on 2028, 2029 at this point. What we are saying is we will continue to seek revenue indexation that is in line with our cost indexation.
Got it. Thank you.
Your next question will come from Christine Trinh of Macquarie. Please go ahead.
Morning, Natalie and Anthony. Thanks for taking my questions and for the thorough answers so far. I will also try to be quick here. To start, just on utilization of theaters up 70%, including the new sites. What was that on a like for like basis, just excluding those new sites, please?
We haven't given the like for like, but obviously, it's been a very significant improvement on a like for like basis, because we've added [crosstalk].
Higher than the 70?
The 70 includes the impact of the new theaters. The 90 basis point improvement would have been a lot higher if we had only taken a like for like.
Perfect. Then just on the provision, AUD 21 million for the Fair Work Commission case, just your assumptions in that provision and maybe the number of nurses that might impact out of the 35,000 workforce, please.
Okay. That is a provision we've made, which we've outlined in the accounts. It's specific to a clause in our New South Wales old EBA. In the current EBA in New South Wales, that clause has been amended. What you see in the accounts is a remediation provision for annual leave loading related to a clause that was in the previous New South Wales EBA.
There was an interpretation of that clause that was different to the way that we had historically been applying annual leave loading in New South Wales to nurses. That Fair Work Commission ruled, in a decision in December 2024, that our interpretation was not correct, and we accept that decision. We have been working since then on effectively the calculations to remediate.
It has to be done on an individual team member level because you have to understand the roster that person would have been rostered on during the time they've taken annual leave. We've been communicating with the team around our progress on that, and we'll be remediating that in the next couple of months.
Just one final one. Just given the recent step up in EBAs across the states, do you think we've reached a bit of an equilibrium here? Just trying to understand whether, I guess, future EBAs will come in at more standard levels, providing, I guess, less of a cost shock other than what we've seen over the last 12 months.
I think we're still going to see the pressure on wages coming through. We are trying to, effectively, as you've heard me talk to today, negotiate EBAs with a longer tenure. The Victorian and the Queensland EBAs that we've negotiated are for four years to give us and the team more certainty around wages over the foreseeable future. I do think that we just need to be conscious of the Fair Work value case and the impact of that. We're still waiting for that decision.
We expect that impact will be phased over a number of years and probably more towards, for us, the impact will be more towards the outer years of our planning period, both because of the phasing of the decision, but also because of the, effectively, the buffer we have between the rates that we pay and the entry-level award rate that's the subject of that decision.
Yeah. Sorry, just one quick follow-up. Just the number of nurses that are on award wages compared to EBAs at the moment. I would assume it's a small proportion.
Yeah. Our nurses are on EBAs.
Yep. Okay. Thank you.
Okay.
There are no further questions. Mm-hmm.
Apologies to the operator. I think that's the end of the questions. Thank you very much, everyone, for your thoughtful and very thorough questions today. We look forward to welcoming NatCap's hospital next week.
It's an exciting moment for us, a hospital with a leading reputation in the Canberra catchment. As you've heard from today's call, the whole team is very much focused on continuing to deliver great healthcare right across Australia and in our global operations and continuing the transformation of Ramsay. We look forward to speaking more about it. Thank you.
That does conclude our conference for today. Thank you for participating, and you may now disconnect.