Okay. Thanks a lot. Thanks all of you for joining this Q1 Ramsay Santé conference. Today, as just stated, we will comment the results we have just been releasing yesterday evening, and I am with Clément Lafaix, the Group CFO. Entering into this Q1 result on the page number four, if we were to summarize in a couple of seconds, we would say that we have delivered a solid Q1 performance with continued revenue growth and improved operational performance. As a matter of fact, the revenue has reached EUR 1,233 million, which is a +2.9% growth versus the same quarter of last year. Were we to compare in constant FX, it is a 2.6% growth. What has driven this growth? In fact, it has been driven by higher MSO activity.
As an example, for France, the MSO admission has increased by 4.1%, targeted efforts driving a huge increase in day medicine care development in France, and continued strength in the Nordic. Beyond this growth, we are pleased to share with you that the EBITDA for Q1 has been issued at EUR 121 million versus EUR 112 million last year, which represents a 9.8% margin. Please keep in mind that we are talking about Q1 with the seasonality effect of July and August. So, an improved profitability driven beyond this revenue growth by productivity gain, disciplined cost control across all geographies, and as you may recall, the rolling out the execution of the St Göran contract despite all these tariff headwinds. Beyond that, the leverage ratio has decreased versus Q1 last year, continued deleveraging by 0.2 points. We will come back to this later with Clément Lafaix.
In this context, Ramsay Santé, we maintain our short-term and mid-term financial outlook. Besides, in this slide, by the way, number four, there have been during the last quarter an important business development, a very old, I would say, litigation going back to 2002, 2004 for one of our huge important hospital in Lyon called Jean Mermoz. There was an appeal ruling that took place, and that confirmed that the group has no liability regarding the topic of the building more than 20 years ago. It means that there is a EUR 57 million in damage that remains to be received pursuant to the decision and subject to further appeal by the opposite, I would say, opponent.
That being said, if we go on the next page, during the Capital Markets Day we held on September 17th, we have shared with you our ambition for the next years up to 2030, our strategic plan, Connecting Care 2030, to unlock the full potential of integrated care and reinforcement of the active portfolio management and efficiency measures. We are pleased to share with you a couple of deliveries that took place during Q1 on the five avenues. As an example, in order to keep on strengthening the integrated care offering, in Sweden, the referral from a huge St Göran hospital to discharge patients or to advance home care, inpatient palliative care, and inpatient rehabilitation.
The number of patients that have been proposed when discharged because they needed to be followed by one of our business unit, one of our team, has increased by 70% compared this one to Q1 2024, so two years ago. Talking about, once again, accelerating the additional profitable growth through new revenue stream, pleased to share with you that regarding imaging for France, in the last month, we have been rolling out two new units, one PET scanner and one radiotherapy, by the way, in the Hôpital privé des Peupliers in Paris. Regarding the third pillar, which is digitalization and AI, we keep on rolling full speed regarding the rollout of ambient scribes, scripts, sorry, on them. Speech-to-text to relieve, I would say, the administrative burden and to free up some patient time for the doctor.
It is done for all the primary care in Sweden, and now we are increasing the speed in the mental health business unit in France and with our own AI Ramsay Companion tool. It once again ticks the box of better medical excellence and better efficiency. As an example, Ramsay Companion, now there is over 100K prompts per month in September, a couple or so of days ago. Talking about portfolio management, we were committed during the CMD to say that in Valence, south of France, we will go from three facilities to one facility, reducing, by the way, the number of beds by roughly 50 beds, delivering additional EBITDA. It has been done as planned on October 1st. Regarding the continued cost optimization initiative, choosing wisely, which is better for the patient and efficiency, is rolling out once again through various countries.
Three weeks ago, we have been relocating the group headquarter. We used to be in Paris, we are now in the suburb of Paris, and with a good, I would say, a good setting. Another news to share with you on the next slide, during, once again, the CMD mid-September regarding the new board, once again, would the demerger take place and would the Ramsay Santé AGM on December 12th validate this content? New governance framework, we were saying. Once again, we confirm that the majority of the board will be constituted by independent director through a very rigorous selection process. The Chairman of the Board will be independent. I am going to come back to this in a couple of seconds. The Chairman of the Audit Committee will be independent, and all this refers to the AFEP-MEDEF French Governance Code.
Talking about the Chairman, will be proposed, by the way, to the Ramsay Santé AGM, Frédéric Collet, Independent Chairman of the Board. Frédéric Collet has a long, long experience in the healthcare industry in France and on the international base, having been the Chairman of Novartis France, has been working in Sandoz, the Head of the Oncology Worldwide. He has been, by the way, for four years in France, the Chairman of the Association of the French Pharmaceutical Industry. By the way, since a couple of years, is on the board of the Institut Imagine, the largest institute for genetic disease in France, TT, I would say, institute. He knows well Ramsay Santé because, as you know, we are a mission-driven company. He has been part of the last three years of this committee and very involved.
He is, by the way, founder and the president of Bionnassay-Consult, senior advisor at Eurazeo, and chairman of AI and Cancer Consortium. This is the key news in a nutshell I wanted to share. Now, to give you more granularity regarding the financial performance during the last three months, I am giving the floor to Clément.
Thank you, Pascal. Good morning, good afternoon, everyone. Before presenting the next slide, a reminder of the key message. Revenue growth has been resilient and predominantly volume-driven, and the line of stability has improved at a higher pace than revenues over the last quarter, thanks to performance plans despite a constrained tariff environment, and we continue to deleverage the company. If we go to the page eight, let us deep dive in a couple of figures. Revenues increased by 2.9% over the last quarter, 2.6% at the constant FX basis, growing all geographies and all segments of activities. As you can see on this bridge, the growth is quasi-exclusively organic-driven.
Organic revenue growth remained resilient at 2.2% in France, with no tariff increase, supported by 4.1% increase in MSO volumes, notably supported by day medicine, a growth that has been quite significant at around +40% over the last quarter. This has been partly offset by the continued negative mix effect, with a shift from full hospitalization to ambulatory care. In the Nordics, organic growth is at 4.2%, driven by primary care developments, as well as St Göran robust volume, as well as the effect of the new contract. If we go into next page, let us have a look at our profitability. EBITDA has improved by 7.5% over the last quarter versus last year, +EUR 8 million, in spite of increasing inflation, and notably within France, minimum wage increase of 2.4% in June 2026. This inflation is not covered by the tariffication, not that in France.
How we achieve this profitability improvement? Organic growth, I mentioned it already. St Göran new contract in Q1, and we expect to see a further effect in Q2 because we will be on a like-for-like basis on this contract only starting from January next year. I mentioned it as well, structural performance plan and cost containment initiatives. Clearly, in order to navigate a constrained tariff environment, performance and operational execution is key. I will give you a couple of examples of what has been delivered in this area over the quarter. First of all, we mentioned it, the imaging units, so two new imaging units. So, continue to accelerate in this area. I mentioned as well the day medicine care developing at a very significant pace. Further improvement in coding accuracy with AI. Staff, non-medical staff reduction in France over the last quarter.
In the Nordics, very good cost control in pharmaceutical, in primary care, benchmarking between the units and with a further use of generic drugs. We moved our headquarter, Pascal, you mentioned it. Finally, we made also good progress in our portfolio management with the transfer of the activities of the Valence unit, as well as also some transfer of maternity wards. We are not stopping there. Additional actions have already been identified and will continue to accelerate in this sense. If we go to next page, regarding the leverage is typically higher in September than in June, reflecting the normal seasonality of the business. Patients do not undertake non-emergency care during the holiday and summer period.
We compare September with September last year and two years ago, as you can see on this graphic, we are continuously deleveraging the company, - 0.2 over the last two years. Thanks to EBITDA generation, operational cash flow improvement, we observed over the last quarter a positive working capital variation, because last year variation was negatively impacted by the reimbursement of French state advances, which was not the case this year. We also continue to work on the French DSO to reduce our delays. This has been combined with a selective capex policy, 4% of gross capex on revenues this quarter, stable versus last year, with a clear priority on high-impact investments and on strategic priorities. So we further develop imaging radiotherapy, and we also dedicate our capex to portfolio management initiatives. Regarding the financing, a key update of the quarter.
Obviously, in July 2026, we need to mention the completion of the refinancing of our senior debt, EUR 1.75 billion, including EUR 200 million RCF undrawn . We pushed our senior debt maturities to 2033. We simplified our balance sheet structures as well, providing higher flexibility. We also recharged our real estate financing on Hôpital privé Dijon-Bourgogne in France, drawing a new tranche of fiducie-sûreté loan. It's an illustration on how real estate is a way to secure good financing at attractive conditions. Maybe a last update on our hedging policy in a context where we see the interest rate increasing. We proactively manage and we optimize our hedging policy today. 80% of our gross financial debt is hedged again versus to hedge and face the context of increasing interest rates.
As a conclusion, good start of the year, both in terms of ability to secure organic growth, translation into financial performance, and deleveraging. Maybe a word on the key perspective for the months to come. First of all, executing, sorry, if we move to next page 12, yes. Executing the performance plan, clearly it's a priority. Delivering the new strategy, sustaining top-line growth, notably by leveraging our integrated healthcare offering, maintaining high standards of care, enhancing the medical outcome, and all of this combined with a strict capital allocation will contribute to deleverage the company. As announced by Pascal, if we move to the page 13, we maintain and we confirm our guidance for the short and the midterm. FY 2027 revenue growth between 2% and 3% at constant FX and stable EBITDA margin versus last year.
By FY 2029, revenue growth at 3% CAGR per annum and gradual EBITDA margin improvement. Gross capex at 4% of our revenue on average over the next three years, and continued deleveraging, targeting a ratio net debt on EBITDA pre-IFRS below 4.0. Thank you for your attention, and Pascal and I will be happy to take any of all your questions.
Okay. Thanks, Clément. As just stated, please feel free regarding any question you may have.
Thank you. As a reminder, to ask a question, you will need to press star, one, and one on your telephone and wait for your name to be announced. To withdraw your question, please press star, one, and one again. If you wish to ask a question via the webcast, please type it into the box and click submit. Please stand by while we compile the Q&A roster. Thank you. Our first question comes from the line of Craig Wong-Pan from RBC. Please go ahead. Your line is open.
Hi, and good morning. I just wanted to ask about the net debt. I understand the leverage ratio usually increases from June to September due to seasonality, but if you just look at the net debt figure, that also increased by about EUR 145 million from June to September. Could you just explain why that's increased?
Yes, sure. Thank you for your question. I think when we compare with June, we have to consider the seasonality effect of our activities. Traditionally, we know that in the first quarter of the year, we have two summer months where, again, the patients do not undertake specific surgeries that are non-emergency, I would say, needs. We know the activity is lower. Usually, our first quarter of the year in net debt increase versus June. But again, we need to compare September with September. That is why we presented this vision, I think, on the page number 11 of the presentation, which shows Page 10, sorry, which shows a decrease in the level of net debt versus last year versus two years ago. Again, seasonality is the right answer to your question, I think.
Okay, thank you.
Thank you. As a reminder, if you would like to ask a question over the phone, you will need to press star, one, and one on your telephone and wait for your name to be announced. To withdraw your question, you can press star, one, and one again. If you wish to ask a question via the webcast, please type it into the box and click submit.
If I may, while we are waiting for maybe some questions, we have received a couple of written questions, maybe to deal with some of them. One of the question is, how do we explain that in spite of admission growth for France, 4.1%, the revenue growth is a bit lower? What is true, by the way, we are more in the range of 2.2%, 2.4%. Well, first, there are two reasons, I would say. The first one is the activity mix. Day surgery keep on increasing versus inpatient.
Just to remind that during the last 12 years regarding surgery for Ramsay Santé in France, we have been growing from 49% of day surgery to 74% of day surgery, which means that today, many, many surgeries, the patient is leaving the hospitals the same day, whereas 12 years ago, he was spending maybe one or two nights in the hospital. Long story short, day surgery, on average, is less paid than inpatient surgery. There is this activity mix value, which is the first driver. The second driver is that the tariff has been very constrained, even, by the way, decreasing in some specialties such as imaging. These two factors combined explain, if I may, why the MSO admission for France, 4.1%, does not translate exactly in a 4.1% revenue growth.
By the way, there is a couple of same questions regarding the day medicine for France, just to explain what it is. Day medicine has been promoted, I would say, pushed by the French government in order to initiate pathways the same day. There are many day medicine pathways, e.g., obesity, e.g., pain management, et cetera, et cetera. If you see the right full specialist the same day, it can be a doctor, a physio, et cetera, et cetera, but as long as you see the full specialist the same day in the same unit, you are paid, I would say, by a better price, a much better price. It is a huge need from a patient standpoint, and it has, I would say, very positive economic impact for the company.
Yes, we are running, we are growing, I would say, on this specific segment, not, well, at double digits, but really in the range of 35%-40%.
We have a next question regarding cost initiatives. Elaborate on these initiatives, and should we expect non-recurring cost for those initiatives? We will turn every stone, clearly, behind the different lines of the P&L, but clearly, we are working on every caption, I would say, of the cost, being personal cost, adapting the actual staffing to activity, reducing temp staff, reducing non-medical staff as well, increasing our productivity. Regarding medical purchases, we have also a couple of initiatives to centralize and make sure we optimize the cost per reference, working notably in France with doctors to make sure to reduce the number of references and increase and improve our purchasing conditions. Within these performance initiatives, we not only have cost, but also some mix improvement initiatives regarding the coding accuracy.
Regarding, you mentioned, Pascal, day medicine, which is clearly also a way to improve also our mix in terms of margin, because we believe these kind of pathways are very attractive to our margins. So, behind these performance plans, we also find the portfolio management initiatives that are, as you know, a very important part of the strategic plan in Connecting Care 2030. Behind this portfolio management, we might have a couple of non-recurring costs to implement these measures, but we believe these costs will remain quite limited, because basically, it's about to optimize our portfolio and again, to reduce, when we can, the footprint and to accelerate on the segments that are the more profitable.
Yeah. Thanks, Clément. There are four, if not five, question regarding the budget for France for next year and the healthcare budget. What we can say is that there is currently, as of today, a total budgetary and political uncertainty in France. The dedicated healthcare budget for 2027 for France called the PLFSS has been, by the way, rejected two days ago. So back to the parliament. First, well, I mean, Ramsay Santé, of course, we don't speculate, I would say, on political outcomes, but we don't know. Nobody knows. That being said, by definition, we are always engaged actively with healthcare authority and policy maker, I would say, to advocate and just to remind that the private healthcare provider in France, a systemic backbone regarding the French system.
Now, I think it's worth to share with you once again, as we did during the CMD, that Ramsay Santé, our group, does not rely solely, I would say, on tariff support. We've got multiple levers within our hands, I would say, within management control, being the volumes, the capacity, utilizations, the procurement, so workforce management and productivity, beyond, of course, the fact that outside of France, the other countries represent now one-third of the total activity with at least here, clear visibility. So, we don't know. It's a short answer, but once again, we are concentrated in what is in our hands, I would say.
We have a specific question regarding the CapEx, 4% of our revenues. Does it include greenfield or is it just maintained CapEx? So, 4%, it is the total gross CapEx before the leasing that we implement to finance, notably, the imaging equipment. So, 4% gross CapEx is the total, bearing in mind that approximately 3% is regarding, related to maintenance, IT, and regulatory, and 1% on average is dedicated to development, and that's this pocket of development CapEx that we will dedicate to our strategic priorities. We have one question regarding real estate, how much to be owned, how much debt associated with this real estate. So, as we discussed during the CMD, so real estate is valued EUR 1.5 billion at the end of June of euro.
It represents 20% of our square meters operated within the group, quasi-exclusively located in France, 42 facilities, half of it being located in prime locations such as Paris region, Lyon, and Lille. Thanks to this real estate, we have been able to draw approximately EUR 350 million of real estate debt, and this amount had slightly increased at the end of September to roughly EUR 400 million after the refinancing of the Hôpital privé Dijon-Bourgogne that I mentioned earlier in this presentation.
Okay. Thanks, Clément. Any other question?
As a reminder, if you would like to ask a question over the phone lines, you will need to press star, one, and one on your telephone, or you may type your questions into the box via the webcast and click submit.
Okay. Well-
No further questions via the phone lines.
Okay.
Okay.
Okay. Thanks a lot. I think we have tried to cover the written question we have received. I hope so, at least with Clément. Well, thanks once again for having joined this morning our Q1 result, and as always, I would say, we stand at your disposal. Would you have some specific question, we will do our best to answer. Thanks once again, and have a very good day. Bye-bye.
Thank you.