Good morning, everyone. Nice to have you online and on the call this morning for Ambu's Q1 results meeting. Together with you on the call, I'm Britt Meelby Jensen, the CEO of Ambu, and with me today I have Thomas Frederik Schmidt, our CFO. Let's start the meeting by reminding ourselves about Ambu's purpose, something that is very close to our heart and our everyday work at Ambu. We help healthcare systems and healthcare professionals both improve, save lives and improve patient care in the hospitals. The agenda we have for today, I'll start by going through our business update for the quarter, and then I'll hand over to Thomas to go through the financials. At the end, we'll wrap up with a Q&A session.
Also, I'd like to remind you that we have today opened a registration for our capital market day, which we'll host in our head office in Ballerup on the 21st of March outside Copenhagen. Let's dive straight into the results. In Q1, we delivered organic growth of 4% corresponding to reported growth of 10%. The growth came from our endoscopy solutions business that grew 3% and our anesthesia and patient monitoring, which grew 6%. Looking at the EBIT margin, we had a 6% growth in the quarter over last year, where we had 3.9%. Overall, I believe it's a good start to the year. I'm very excited as we embark on the next quarters and the opportunities we have ahead of us.
Let me update you on some of the key events that we had in the quarter and the progress on our ZOOM IN strategy. Mid-November, we launched our new strategy, and we are well underway rolling that out in the organization. When it comes to innovative solutions, we had a couple of product approvals in the period and this quarter. First of all, we had regulatory clearance in Europe of our Ambu aView 2 Advance, our endoscopy, newest endoscopy system. Also in the U.S., we had FDA clearance of our aScope 5 Broncho HD Sampler Set, also a very important solution together with our aScope 5. As one of the first medtech companies, we are very proud that we now have 100% of our portfolio fulfilling the new MDR regulation requirements in Europe.
When it then comes to execution, this is a key focus in our strategy and a key focus in Ambu every day. We launched a transformation program together with the strategy, which I'll update on in a minute. At the same time, we are continuing to ramp up our production in Mexico and also selling to customers and more and more customers from this side. Lastly, when it comes to commercialization, the two big launches we had of aScope 5 and aScope Gastro in the last year, we are continuing to roll that out, something that I'll also update you on later. Sustainability is a very important priority for Ambu, and we are fully dedicated and working on making plans to be more focused on sustainability, identifying key initiatives that we are going to roll out in the years to come.
At the same time, something I'll come back to as well, we saw the launch of a results in a new study comparing reusable to single-use and actually showing that it's more environmental friendly to use a single-use endoscope, cystoscope. I'll come back to that. When it comes to the organization, we have worked a lot internally on rolling out the strategy, making sure that it's clear to each and every employee how they contribute not only to customers and better patient care, but also how they fit into the strategy. That rollout is going also as planned and very well. Let's take a look at our transformation program.
We launched the transformation program mid-November with a clear focus to sustainably increase both growth and profitability in the years to come, and we have a much better balance between achieving maximum growth and profitability than we have had in the past. This is a program that I'm personally very close to and where we are fully on track in identifying initiatives that will deliver on these ambitions. It's also a program that is taking time. We expect to gradually, both in this fiscal year but also in the next fiscal year, to see improvements from this program. It's something that takes time, and we are very focused on making sure that the improvements that we're making are improvements that are sustained in the organization and fully anchored.
We already in November identified a couple of areas that are very important, and that's the four areas that you see here. It's about a focused go-to-market approach. It's about making sure that we drive even more commercial best practices. Improving our gross margin is a major focus for us as well. Then it's about strengthening our operating model. I'm going to update you on the progress on this program in the quarters as we move forward, but overall, off to a strong start, but also a program that is reaching out in the next many quarters. Let's get back to the business results. Going forward, we will report on our endoscopy business on two main categories. One is pulmonology, which is our biggest segment, and the second is our endoscopy solutions excluding pulmonology.
The latter category comprises of urology, ENT, GI, and our endoscopy systems. I'm very excited to report that compared to Q1 last year, this segment has grown 47% and now make up 44% of our total endoscopy solutions. When it comes to pulmonology, that remains the largest endoscopy segment, and there we had, in line with expectations, a decline of 17%. This is due to the high comparables that we have from last year due to COVID. The numbers are also positively impacted by the flu, which we saw peaking earlier than we have seen in previous years.
Despite this negative growth, which we expect to continue into Q2, that we are in the middle of now, I'm very excited about this segment when I look ahead, both due to our aScope 5 launch, due to our increased focus on this segment, as we have allocated more resources some months ago. We also have a couple of other new launches coming up. The slim versions of our aScope 5 Broncho. We have VivaSight 2 relaunch coming up. We have our video laryngoscope that we are working on bringing to the market.
If we look at the flu, just to make sure that we all look at the same picture, what you see on the graph here is influenza-like influenza-like illness, where you see the red curve, and this is U.S. data, peaking at a high peak compared to previous years and also peaking much earlier, which is exactly what I referred to before that we benefit from, in particular in the U.S. in the Q1 of this year in terms of higher revenue. It's also clear from this graph, as you see, that the sales is or the flu, sorry, is declining, and that means that basically what we had anticipated to get of benefits from the flu in Q2 came in Q1, so slightly earlier than we anticipated.
If we look at the flu pattern in Europe, it's somewhat a similar pattern that we see as we see in the U.S., with a slightly lower peak, but also on its way down again here in Q2. Let's look at some of the other drivers of the attractiveness of the single-use segment. There continues to be stronger and stronger evidence that shows both the cost benefits and sustainability benefits and patient benefits of using single-use endoscopy solutions. What we have on this picture here is three new studies that have come out, the first not being published yet, that shows benefits and attractiveness of using single-use endoscope systems. If we look at the first one, it's a study done in the U.K. in
with our ENT study comparing a single-use ENT scope with a reusable scope, it shows that the average cost per procedure using a single-use scope is declined or is 35% lower than with a reusable scope. There are clear cost benefits of using single-use endoscope solutions. The second study looks at the patient outcomes, patient safety. This is a retrospective study that is done in the U.S. in over 800,000 patients using Medicare claims, where it basically looks at the infection rates following an ERCP procedure using a single-use scope versus a reusable scope. What the study shows is that there is 60% fewer infections when patients are being treated with a single-use scope compared to a reusable scope. The last study is the sustainability study that I referred to earlier.
This is in urology with a cystoscope using our cystoscope compared to a reusable scope that basically shows that the impact on the environments measured as CO2 impact is reduced by one-third when using a single-use endoscope compared to a reusable scope. These results are in line with some of the feedback that we hear from our customers every day. On top of what we illustrate here from the studies, we also hear clear efficiency and workflow benefits being more and more in focus in with our customers. A lot of that driven by the fact that we do see significant staff issues in hospitals, both around Europe and in the U.S. We look at our two new launches, it's the aScope 5 Broncho and the gastroscope. We are also progressing in Q1 as planned in line with expectations with these two launches.
To remind you, the aScope 5 Broncho expands the total addressable market by 2 million procedures, from 3 million- 5 million procedures. We have launched this product in U.S., Europe, and Australia. In the recent months, we have seen major U.S. GPOs adopting the product, we see continuous, very strong feedback from our customers also when it comes to the workflow benefits, more importantly, also the clinical performance. It's a product that we continue to focus on, we have now major hospitals, in particular in the U.S., using the product. When we look ahead, there's no doubt that the pulmonology segment remains a very important area for us.
With the launch of aScope 5, combined with the new launches of our video laryngoscope, slimmer versions of aScope 5, and the relaunch of VivaSight 2, we are very excited about the future position that Ambu has in this segment, which we were the first to enter. When it comes to our aScope Gastro, we are also seeing strong progress with this product, which we have also launched both in U.S., Europe and Australia. We do see DPOs also adopting this product. We see initial success with our customers. A lot of this being outside the GI suite, where we are focusing initially on customers that benefit the most from the workflow benefits and the performance that we see with our product.
GI remains a focus area for Ambu, and as we said in connection with our ZOOM IN strategy mid-November, it's also an area that we are addressing niche by niche, so we are balancing the resources in this area relative to the return as we continue to gain traction. I'd like to finish off with an overview of our portfolio in endoscopy, both the products that we have on the market and those that you see in the boxes, those that we have in development. It's very clear that as the only company being present in the four major endoscopy segments, we continue to focus in these segments, both on strengthening the position of the products we have in the market, but also of bringing new products to the market that has clear benefits for our customers and for patients.
We are well on track with some of the new products that we have in development after we late summer refocused and rebalanced our portfolio. We continue to drive the progress on these in line with also additional features on our endoscopy systems that supports the full portfolio that we have. This concludes my part of the presentation, and I'd like to hand over now to Thomas to go through the financials.
Thank you, Britt, also a warm welcome from my side. I'm glad to present the key financial figures for the first quarter of our financial year 2022-2023. It's been a good start to the financial year as we for the first quarter delivered 4% organic revenue growth, and reported revenue growth of 10% positively impacted by the appreciation of the U.S. dollar versus the Danish crown. Looking at our business areas, the combined endoscopy solutions business, excluding pulmonary, have posted very strong growth rates of 47% growth in the first quarter. The growth rate has, however, and as expected, been offset by a 17% decline in our pulmonology business, which means the organic growth for the endoscopy solution business for the quarter was 3%.
Our anesthesia and patient monitoring business for the quarter was positively impacted by increasing pent-up demand and recovery post-COVID and continued reduction of our backlog orders. In terms of organic growth, anesthesia posted 4% growth, and patient monitoring posted 6% growth for the quarter. From a geographical perspective, the Q1 was characterized by some significant differences across our regions. Our biggest region, North America, has delivered strong growth of 9% driven by endoscopy solutions. Europe saw negative growth of 4% due to high COVID comparables from Q1 last year. Rest of the world delivered 14% growth, also strong growth within endoscopy solutions and patient monitoring business. With 4% revenue growth, our EBIT margin ended at 6% for the quarter compared to 3.9% quarter last year.
The increase in EBIT margin has been driven by revenue growth, operational efficiencies in our sales and marketing organization, tight cost management, and positive impact from our cost reduction program. The selling and distribution as a percent of revenue have improved by 5.3 percentage points compared to last year. A good achievement. This has, however, been partly offset by a decline in gross margin compared to Q1 last year, where the main reasons for that decline relates to change in sales mix as sales growth has been higher in anesthesia and patient monitoring business than for our endoscopy solutions business. Secondly, we've seen higher input prices and higher distribution costs due to high inflation and higher cost for sea and road transportation. Last but not least, we also have higher ramp-up cost related to our Mexico production site.
We ended the quarter with a negative cash flow of DKK 174 million and a gearing ratio of 3.9x EBITDA. The main reasons for the negative cash flow relates to our net working capital. We are yet to see benefits from reduction of our inventories. We've seen in Q1 cash outflow related to non-recurring cash items such as severance costs. It's important to say that this is in line with our expectation. Improving our gearing ratio and cash flow over the coming quarters remains a key focus of ours. We have a plan to improve the free cash flow in range of DKK 350 million-DKK 450 million for the full year. We are addressing net working capital, our cash conversion, cost containment, and profitable revenue growth.
Within net working capital, we have a clear plan of how we will reduce and normalize our inventory levels. In Q1, we've started to see initial and early inventory reduction. However, we will over the coming quarters accelerate that reduction, and we will be reducing both our finished goods and our raw material inventories. Initial benefits have also been seen from our cost reduction program and tight cost management in Q1. This has helped improve our EBITDA, and it has helped improved our CapEx ratio to sales, and we will continue to have full focus on this throughout the year. Finally, last but not least, we will drive profitable growth and accelerated revenue growth is expected and planned for the quarter-over-quarter, and we will therefore improve cash flow from operating activities, especially in the second half of this year.
This brings us to our financial guidance for the financial year 2022, 2023. We maintain our guidance for the year. It's also at the same time important to stress that this year is still a transition year for Ambu. Our guidance for the organic revenue growth is maintained at 5%-8%. As we've earlier mentioned, the growth is expected to accelerate quarter-over-quarter, with higher growth expected in the second half of the year. Our guidance for the EBIT margin before special items is maintained at 3%-5% of revenue. Gross margin is expected to decline for the year by approximately 2 percentage points. This is due to higher production costs, continued Mexico ramp-up, and also product mix for the entire year. My last slide is, as Britt has mentioned earlier, we really highlight.
She's highlighted focus and execution in our strategy. This also means that we'll be more focused in our capital allocation, where we aim to have high return on invested capital and, as a result, create value for our investors. We will drive strong, profitable growth, and we have an aspiration to be a company that delivers long-term, sustainable double-digit revenue growth and a company that has an EBIT margin that is continuously trending upward to industry levels. With that, I hand it back to you, Britt.
Thank you, Thomas. I'd like to conclude the session again by inviting you and putting attention on our Capital Market Day that we host the 21st of March at our headquarters outside Copenhagen. It's from 10:00 A.M. - 3:00 P.M. CET, followed by a product demonstration. The meeting can be followed online, but the product demonstration session from 3:00 P.M. -4 :00 P.M. will only be for people that are there live. We hope to see as many of you in person for this day. With that, I'll like to conclude the presentation and open up for the Q&A session.
At this time, if you would like to ask a question, please press star and one on your touchtone phone. Again, that is star and one if you would like to ask a question. You can remove yourself from the queue at any time by pressing the pound key. We'll take our first question today from Christian Ryom with Danske Bank. Your line is open.
Yes, good morning, and thank you for taking my questions. I have two, please. First one is on the outlook for the gross margin. Thomas, you kindly restated that you still expect these 2 percentage points lower gross margin for the full year. How should we expect that to come through during the year? Here in the first quarter, you did of course come out better than the gross margin you delivered last year. That's the first question. The second question is to the pulmonology business, and maybe a bit of a split question. First is any commentary you can make towards how the pulmonology business developed in the U.S. relative to where it was in Q4.
More broadly, how we should think about the phasing for the pulmonology business over the year. You already alluded a bit to this with the flu season, but any additional commentary would be helpful. Thank you very much.
Thank you, Christian. I think, Thomas can start with the first question, and then I'll take the second question.
Yeah, very well. Thank you, Christian. Yes. The gross margin we do expect, as also earlier communicated, that for the full year that we have a reduction versus last year of 2 percentage points. This will be driven by product mix throughout the coming quarters, and also our production costs, including the input prices that we have seen and that we are expecting. On top of that, we also see, of course, costs coming in in our production, as we also are reducing inventories over the coming period. That will obviously also increase our production costs based on production variances.
The mix is an important factor to mention as we also, over the coming months, will continue to increase our newly launched products that has an impact on our gross margins.
Thank you, Thomas, and maybe I'll comment on the pulmonology revenue and the pulmonology segment, and you asked specifically also about U.S. I'd say overall, if we look at the pulmonology, it's very clear that we have high comparables from H1 last year. This is also why we are very clear that we are expecting a continuous in this quarter on Q2 decrease versus last year. What we do see is not only Omicron, but we also see, as we have talked about before, competitive pressures in the U.S. and we see some of that in the U.K. and to a minor extent in the rest of Europe. That continues, you can say.
If we look at the overall, we do expect that we return to growth in the second half of this year. Then again, our product pipeline with aScope 5 launch progressing video laryngoscope, VivaSight, makes us very confident that we have a strong position in this segment. Commenting specifically on the U.S., it's clear that in the U.S. we had also a fairly good quarter in Q4. That continued in Q1, very much driven by also positive flu impact. You can say if we look at the overall business in the U.S. and where we are, late summer, we put more sales focus on the pulmonology segment.
We are also training our people much more, as we have different competitive dynamics. We used to be alone in this segment as the first with very limited competition from single use. Now those dynamics are changing. That's of course also one of the drivers behind our stronger focus on in the sales. We do see results from that kicking in, and it will continue to remain a big focus where in all fairness, when we were very focused on GI last year, our that had taken our foot a bit off the pedal in pulmonology in the U.S. That's where we are coming back, and we do see an impact from that, which makes me very optimistic.
Again, the competitive dynamics are of course, bigger than what we saw in the past.
Great. Thank you very much.
We'll take our next question from Rickard Anderkrans with Handelsbanken. Your line is open.
Right. Good morning, and thank you for taking my questions. First of all, on the positive impact from the flu season, could you perhaps quantify that a bit more, both in terms of top line, but also perhaps on a gross margin basis? Obviously, pulmonology segment typically brings, you know, higher gross margin profiles. That's the first one. Thank you.
Yeah, and I can maybe comment on that. We do not quantify, I mean, the actual impact from the flu. What happens with the flu, just to clarify for everyone, is that in some markets, in particular the U.S. and also some markets in Europe and elsewhere, when you have the flu, these countries tend to use bronchoscopes for more patients where we see this to a lesser extent in other markets. That's where there are some differences across the markets. Having said that, I mean, U.S. is a market where the bronchoscope is used a lot in compared to, or in connection with the flu. That's of course the impact that we have seen.
That's also where, again, I'll repeat what we said before, because the flu season peaked earlier than what we expected, it means that we still expect Q2 pulmonology sales to be negative. The effect that we had baked in for Q2, we saw more of that coming in in Q1 than anticipated. On the gross margin, it's right what you say, Richard, that our gross margin for our aScope 4, so the product used for, in connection with the flu is high, so that also, I mean has a positive impact on our gross margin, which is still why what Thomas alluded to as our full year guidance being, our full year expectation being slightly lower than what we, what we have in Q1.
Driven by that product mix, and then of course also to some extent increasing raw material prices.
All right. Thank you. That's very helpful. The final one from me. You mentioned in the report that the aScope 5 Broncho and aBox 2 has been on par with previous launches in the first month of sale. Can you help add some flavor? Is that on par with previous pulmonology launches or, you know, broader endoscopy launches or just add some flavor would be super helpful. Thank you.
This is a very good, a very good and relevant question because obviously what we do is that I mean, the products that we launch are not directly comparable. What we do see, and we of course track the launch curves that we have because the big uncertainty is when you bring in a new product in an area that used to use reusable, which is the case with aScope 5, where we are addressing the bronchoscopy suite and the more advanced procedures that we did not address before. It's very difficult to see or to predict how fast they will adopt. We are still early in the commercial launch. We are seeing an increasing number of rebuying customers.
We are seeing positive clinical feedback and also from some of, as I mentioned, from some of the major hospitals, in the U.S. as an example. I think that makes us very confident, and this is one of the most important parameters for us that the product actually works. We, we had a forecast which we built on previous launches for Q1, that we delivered on, and then we have of course built in an increasing forecast over the year. Again, since we are still early in the year, we are following this closely as we are still too early to make predictions. But I think I'm overall very confident also that this product addresses the needs in the advanced procedures which no single-use endoscope has done before.
I think that's definitely promising for the years to come. With the launch of the slimmer versions that I referred to, maybe just to clarify that, I think there are customers that are reluctant to switch to a product before they have the full range that can be used for the different patients. Having the smaller sizes is also beneficial that we expect to gradually see a benefit from.
All right. That's super helpful. Thank you for taking my question.
We'll go next to Ed Ridley-Day with Redburn. Your line is open.
Good morning. Thank you. Firstly, Thomas, if I could, I'll just ask about the structuring, you've highlighted it again today. Could you just give us some color on what the contribution in terms of the cost savings were in the first quarter to the margin improvement? Also, if you could remind me of the expectation you have for the contribution from efficiencies for the full year, and also any related costs. That'd be my first question. Secondly, just to follow up on the pulmonary competition, we have heard a discussion of price cuts in the market. Could you give us some color on the pricing in your pulmonary number in this quarter? That'll be helpful. Thank you.
Yeah. I think I'll let Thomas comment.
Yeah.
On number one. Maybe I can start with number one. Basically, I mean, it's a pricing pressure. When you see more players, additional competition, I mean, that tends also to be an increased focus on price. We had, as we have previously indicated, we had a more volume-based strategy in the past, meaning that we also went out ourself with aggressive pricing in some cases, very much in the way of rebates, and that's what we ended, I mean, some months ago, as also communicated. It's very clear that, I mean, overall, If we look at the ASPs, we do not see any decline or any change, so that remains unchanged.
We are, of course, in a market that is expanding, as you know, with co-competition coming in. I think it's very encouraging for us to look at the fact that both we can keep the ASP that we have right now, but also that we have been able to achieve a premium of 30%-50% for aScope 5, reflecting the added value and quality of that product. I'm not so concerned as such about the price pressure and the discounting, but we of course follow that closely. Then we clearly benefit from our expertise and our 15 years in the market.
Our own strategy has slightly changed by being more focused on the right price and rebating less than we did in the past. Thomas-
Thank you for that. Just to confirm, the 17% decline is primarily volume?
Yes. Exactly. That is volume, and that's again based on the high, COVID comparables, that we saw.
Yeah. Then just your, your other question was related to restructuring costs and the impact that we see, the benefits that we see from the structuring program. Obviously, as mentioned and also shown in my slide earlier, within the sales and marketing, sales and distribution, I should say, of our cost, we do see quite an improvement that boils down into our EBIT ratio. Of course a part of this as I also mentioned, is very specifically coming from our cost reduction program. If you remember, we also communicated earlier that we had targeted a cost reduction for a full year equivalent of DKK 250 million that we have actually achieved.
A third of that, roughly, as also earlier communicated, is what we see benefiting our OpEx side of things. The other benefits we see within the more the CapEx side of things. It is a good mix of cost reduction program, tight cost management, but also efficiencies that we are pulling out of the sales and marketing organization throughout. And that correlates into this 5.3 percentage point improvement in our EBIT margin in Q1. So it's a mix of things, of course, in that bag. Definitely our cost reduction program is impacting and positively impacting our profitability. Again, that's helpful. Just a quick follow-up on that.
In terms of the sort of the phasing of those costs, savings, as you say you've previously guided to, but should we effectively assume a bigger contribution in the second half? No. No, I think most of that we have been quick to realize. Of course, we will continue to look to see how do we optimize, how do we pull out more efficiencies within our cost structure. But most of what we've achieved from a cost reduction program, we have realized also in Q1 already.
Yeah. I mean, to add to what Thomas says. Like, I mean, this was the phase I with the cost reduction program we did in this summer. The phase II is more, I mean, is the transformation program that we launched where we will quarter-over-quarter, both this fiscal year but also into next fiscal year. I mean, this is a more long-term thing to improve our profitability towards the industry level as we have talked about.
That is going to take some time, but that is what we work very diligently with different initiatives that I shared earlier, in order to make sure that we should steadily improve our margins and our profitability, while of course balancing that, with growing, the business and the revenue.
Great. Thank you.
Maybe just one last comment, just to be a clear reminder. OpEx, we of course will starting OpEx-wise also salary increases in our Q2. Since we, the first quarter, was in the latter part of the calendar year, you should expect slight increases in our OpEx spend also. We will work diligently in terms of managing our cost base throughout the year.
That's very helpful. Thanks.
Our next question comes from Niels Leth with Carnegie. Your line is open.
Good morning, thank you for taking my questions. In order to understand your cross-margin development, I guess we need to pay attention to your inventory changes as well. Could you talk about what proportion of your inventory value, which would consist of indirect production costs, which obviously affects the gross margin? My second question would be on your freight costs. You mentioned on page 11 that you still have some headwinds from higher freight costs. Could you talk about how much would be the tailwind from lower freight costs, given the current freight rates that you're seeing during the second half of this year?
Thank you, Niels. On the first and foremost, on, if I take your first question around indirect production cost, it is clear that when we will reduce now over the coming quarters our inventory, of course, some of the indirect production cost will rather come in and hit over the P&L. That's also what impacts our gross margin in the coming quarters. That's also relates back into the 2% lower margin that we expect, that we have calculated and planned with the reduction in inventories, and therefore also higher indirect production cost over our P&L side of things. That's included in the 2% guidance or outlook for the remaining part of the year.
lie, I'm a little bit nervous about this new project." "Why? What's got you so on edge?" "Well, it's a huge undertaking, and I'm worried about whether I have the skills and experience to pull it off." "I understand. It's natural to feel that way when you're stepping outside your comfort zone. But remember, you've tackled challenging projects before and come out on top. You're resourceful and determined, and I have no doubt you'll rise to the occasion." "Thanks, I needed to hear that. It's just that the stakes feel higher this time." "They might be, but that also means the potential rewards are greater. Think of all the valuable lessons you'll learn and the new skills you'll acquire. This project could be a game-changer for your career." "You're right. I shouldn't let my fear hold me back. I'll embrace the challenge and give it my all." "That's the spirit! And remember, you're not alone in this. I'm here to support you every step of the way." "I appreciate that more than you know. Let's do this!
Previously you quantified the headwinds from higher freight costs as compared to before the pandemic, I think 2 percentage points, 3 percentage points or so. Is this still a fair estimation?
Yeah. That is still a fair estimation, yes.
When it comes to the indirect production costs, is it fair to estimate that indirect production cost makes up around 20% of your inventory value?
We've not commented on the level of indirect production costs, so that I will not comment on, but the absolute number of that. It will of course impact as we lower our inventories, the P&L.
Okay, great. Thank you.
We'll take our next question from David Adlington with JP Morgan. Your line is open.
Morning, guys. Thanks for the questions. Sorry, I may have missed it, but I just wondered if you had any more specific updates on the timing of the laryngoscope launch and how important that was to turn around the bronchoscope sales in total. Sort of following on from that, Verathon also recently quite vocal about getting to number one market share in the U.S. Bronco. Do you think the combination of the laryngoscope and aScope 5 can prevent that? Thirdly, just a housekeeping one. I don't think there's any disclosure on the number of scopes sold in the quarter. Is that something that we're not gonna see going forward? Thanks.
Thanks, David, and I'll comment on those. Starting from the last question. Going forward, just to clarify that, we have decided not to report a number of scopes anymore. The reason being that we find it's a bit of comparing apples and pears because the value of the different scopes is very different. I think we have had a lot of questions relating to the inconsistency between number of scopes in the past and growth in that versus revenue growth. That's why we decided instead that we think it's more transparent and meaningful to report on the categories of the segments, so pulmonology and then we pool the other segments together as one. That's how we'll report going forward and not on number of scopes.
In terms of the U.S. dynamics, the laryngoscope, video laryngoscope scope launch, we have not commented on when we will launch the video laryngoscope. I would like to clarify that we still have a very strong position in the U.S. We expect to return to positive year-over-year growth in the second half of this year. We continue to ramp up our aScope 5, which is clearly superior to any other single-use scope out there. Pulmonology remains a high priority area where we have also put more commercial focus on in recent months. The VivaSight and the video laryngoscope 2.0 will give us a position as a leader.
Where we see the most competition in the U.S. and is basically from a company that has both the video laryngoscope together with a bronchoscope. We believe our offering that we have in development is clearly a very high quality and will be a very high quality winning solution with our customers. They are definitely looking forward to us having also a video laryngoscope on the market. For competitive reasons, we do not comment on the timing.
Okay, perfect. Maybe just a follow-up on the rest of the business. I just wondered if you're able to quantify the contribution to growth from pent-up demand and clearing the backlog for both anesthesia and patient monitoring and whether if you thought that backlog was now fully cleared, and the impact sort of saying through backlog has probably quite helped with your gross margin. Again, just wondering if the impact of any impact of gross margin in the first quarter. Thanks.
Yeah. I think overall, I mean, we see nice contributions from these two segments, as you see, and there is clearly a contribution from clearing the backlog. I think, I mean, we have, I mean, our backlog down to very minimum levels. I think our supply situation is working very well. That is, I mean, that is a big driver of some of the increase this month of the 5% in Q1. We have, if we look at the three-year cake, we are looking at a number that is we expect to be slightly lower more in the range of 2%.
What we do see is that we continue to see, as I alluded to, health systems being challenged, and then they're working through all their challenges in terms of both, strikes, staff shortages, and then on top of that, their own backlogs, if you will.
Great. Thank you.
We'll take our next question from Yiwei Zhou with SEB. Your line is open.
It's Yiwei from SEB. Thank you for taking my question. Most of the question has been answered, but I have two left here. First a question on gross margin. You have not talked about the margin dilution from the new products as you did in the last quarter. Could you maybe elaborate a bit here what has happened in Q1?
I do a second question, afterwards.
Okay. I can thank you Wei, I can speak to that. What we've mentioned also, it's been a little bit covered within the question around our gross margin for the remaining quarters and for the full year, where we do expect that we come down 2 percentage point versus last year. This is, amongst other things, also driven by lower margin on the newer launched products. That's included in our expectations around the reduction, further reduction of the 2 percentage point for the full year on our margins. As we continue to grow those two products, of course that will be more and more dominant.
Great. Can I just follow up here? If you're looking at the gross margin for aScope 5 and Gastro, compared to last quarter, have you seen an improvement already on contribution margin or gross margin?
I can comment on that. I think what we have also said before is that on these products, I mean, we do expect. Because they have a lower gross margin compared to our other scopes, we do expect a dilution impact over the quarters as these products ramp up. That's, of course, something that we are fully focused on improving. That doesn't happen from one day to the other. It will happen medium term, both as we have more focus on it and also as we ramp up the scale of these products.
Great. Very helpful. My next question is probably in the, for the coming quarter. Now we see a client has opened, reopened, then there's a lot of hospitality, a lot of patients, ICU patients. We have seen some other med tech companies talk about increased demand for the ICU medical device. Should we expect any COVID related demand for your bronchoscope and the resuscitators driven by the China demand in Q2?
Very good question. It's very clear that when it comes to China, I mean, and I want to clarify also, we don't reveal specific revenue for China, but it is, China remains a small part for us. What we clearly see in China is that access to hospitals is starting to improve. That's a very good indicator for us. We see that China, it's, I mean it's still early days, but we do see a slow improvement. We have also seen a positive impact with our scopes from from COVID. We remain, I mean, focused on China, but again, as a smaller part of our business. It's definitely, I mean, we see the improved access to hospitals being a good sign.
Just to clarify understanding, you have not seen any COVID related demand so far from China?
Yes. Okay. Sorry, yes, we have. Sorry if that was not clear. Yes, we did see COVID demand both on our bronchoscope and on the resuscitators. We, we have seen that. Again, because China is still a relatively small part, it's relatively modest in the global picture. We see the increase as the hospitals are opening up and have opened up. That has definitely given us some tailwind.
Great. Very helpful. Thank you. I jump back to the queue.
As a reminder, that is star and one for your question. We'll go next to Martin Brenøe with Nordea. Your line is open.
Hi. Thank you. It's Martin Brenøe from the Nordea. I just have two brief questions. Just first of all on the aScope Gastro, I know it's super early stage, but, can you maybe, help us understand if you have had any actual orders yet or maybe even some reordering of the aScope Gastro? That would be very helpful to understand sort of the dynamic when you say you have positive customer feedback. Secondly, I would like to understand a little bit better perhaps how we should understand the phasing of the cash flow for the year.
I think that it's clear that you still have sort of the cash flow improvements for the full year. How should we think about the next quarter coming in? I think that the most important part here is the network and capital. Should we already from Q2 expect that inventory is going down? Is there anything sort of, like this quarter, anything in terms of payables or receivables that we should be aware of when we do our models? Thank you.
Thanks, Martin. I'll take the first question and hand over to Thomas. I mean, we definitely have both customers that are buying and we also have rebuying customers, and that number is continuing to increase. Also, I mean, we do see increased positive feedback among customers. We have some larger hospitals that are both ordering and reordering. From that perspective it's actually, I mean, very encouraging. It is very clear and also to put in perspective to our, some of our previous launches like the duodenoscope in GI, I mean, this is a very different product. It's addressing very different Much simpler processes or procedures than the ERCP procedure.
That's also where you can say, I mean, the use of our product is much more smooth, and we can see that it's working, it's addressing some clear unmet needs with our customers. I think we are very encouraged with that development. Then again, we do take a slightly different approach than we did with the duodenoscope on more a niche by niche segment as we ramp up the sales here. Definitely, I mean, it is out there with both buying and rebuying customers.
Yeah. To the question, Martin, relating to net working capital and cash flow. We did also in the beginning of the year communicate that you should expect our cash flow to improve over the years, over the quarters of the year, which also means that Q2 should be expected to be negative. That we have commented also earlier and is still also in line with our expectations for Q2. We are, as I mentioned, also focusing on very, very much so on our inventories, and you should expect to see reduction of inventories also in Q2.
It takes us maybe a little bit longer than most other companies because we also have a quite good, strong, and long agreements also with some of our suppliers. We are working very hard and diligently on reducing our inventories and that you should expect to see in Q2, further in Q3, and also further in Q4. Every quarter, you should expect to see a reduction in our inventories as we move forward.
Okay. Thank you so much.
We have no further questions in queue at this time. I'd like to turn the program back over to our speakers for any additional or closing remarks.
Thank you very much. Thanks to everyone who participated in the call and online this morning. Thanks for great questions. Wishing you a very nice day. I hope to see as many as possible live face-to-face for our capital market day. Thank you very much.
Thank you.