Good morning, everybody, and welcome to Terveystalo's full year 2018 results call and webcast. As usual, the presentations will be held by our Chief Executive Officer, Yrjö Närhinen, and our Chief Financial Officer, Ilkka Laurila. We'll follow that with a Q&A. We'll take questions through the phone lines and through the webcast. Without further ado, I'll let Yrjö start with the presentation.
Thank you, Kati. Yes. Good morning, everyone. We'll spend a little bit of time actually looking at 2018 as a whole year. I do want to take the opportunity to stop and take a look back. Just very quickly, Ilkka will run through more of the specific numbers in detail. Something is happening. There we go, good morning. It's the technology that needs to be put on before anyone can hear me. Anyways, good morning and welcome to our annual results webcast. What I would like to do is I would like to spend a few minutes actually stopping and looking back to 2018. It's such a rare occasion to be able to stop and look back.
We'll then also talk about Q4 in more detail. The way we split this is that I'll try to give the context. Ilkka will run through the more specific numbers. Overall, you will probably already seen that 2018 comes together with 8% overall top-line growth, taking our sales to EUR 744.7 million. EBITDA up. Let me see. Let me just look at the number. Already lost it. To EUR 108.9 adjusted and EUR 116.6 absolute, very healthy EBITDA increase, 17.9%. On Q4, we saw 4.2% top-line growth and a 11.9% Adjusted EBITDA growth. I would say overall, a very healthy Q4 rounding up a very strong year. A year with quite little, actually, one-off type of activities are actually allowing us to really build a robust platform for our future growth.
You see net debt increasing towards the year-end. Also that then misses out the Attendo sales that, of course, one would need to add on top. Profitability-wise, a very healthy jump. EPS up from EUR 0.06 to EUR 0.54 overall. If you look at the highlights of the 2018, I would say that the fifth is misspelled, but fifth year of our growth. Actually, if you look at way back, you can see a very steady development on Terveystalo, both financial numbers and operational numbers. The reason why I'm particularly happy about it is that I can see continuous strengthening on several fronts, a very broad scale development across operations, be it sales, be it profitability, but even more so be it the development in our quality, in our operational efficiency, in the way we do customer service. Our customer satisfaction is up.
Resulting a very healthy business increase. We have invested, we will continue to invest in our digital services, and you can see a very healthy pickup on those. We grow high double-digit on both preventative well-being and public services. Our strategy really to look at service areas that go around the core are very much related to deep healthcare delivery quality and that allows us to extend the service portfolio seems to be working very well. Looking at our overall operations, I can see that we're strengthening the way we run our experience, the way we run our clinical quality, our preventative services. We're extending the portfolio that resulting a operational leverage that one can see. You see a robust growth across customer segments. From a numbers point of view, sales up to EUR 744.7.
You have a 6% increase in appointments. You have a very healthy increase and actually to a very high number on My Health Account, My Oma Terveys up to about a million users, which starts to be in a population of 5.4 million, a pretty heavy number. NPS up. Net promoter score up on appointment, up on hospital services, up on digital services. A broad scale development on customer satisfaction increasing focus on prevention. You'll see our personal health plan increasing from about 70,000 to 170,000. That rate we expect to continue. Good operational improvement resulting a financial improvement. NPS, as said, appointments up 71%, hospital services 91%, personnel satisfaction 93%, most desired employer. These elements, I think, are the prerequisite for us to be able to deliver long-term growth.
Customer satisfaction, personnel satisfaction, combined with clinical quality is probably the backbone of our operations. I'm particularly happy about that. This is a slide that we very seldom get to talk. We will release our quality book at the end of February. I think it's a good time, especially given all the turmoil around elderly care of late. I think it's a good time to stop and really look at the work that we do behind the scenes all the time, that is really focused across the organization around quality. The way we split quality is a specific work around clinical quality, that's for medical professionals, but that needs to work hand in hand with operational quality, operational efficiency. We cannot waste resources because that would be away from, I think, quality of care.
Managing quality of care, managing efficient operations is the interplay that we seek to find. At the backbone of it's really managing the payer experience, the patient experience, the physician experience in such a way that we are able to increasingly measure the satisfaction, but actually move our business from sporadic healthcare businesses, even if we would be the primary choice, to more towards prevention, holistic well-being, preventative services that connected to digital services. For us, when we do this work sustainably long-term well, we strike a balance between medical quality experience and efficiency. I think what that results is a superior customer satisfaction and a superior personnel satisfaction, which then secures the, of course, the source for healthcare professionals. That combination allows us to, one, tap into pockets of growth in the market, but also drive operational efficiency, profitability and growth.
That's very important that I'm very happy about the work and I do recommend that you all sign up for us to send you the quality report because we're very proud of that. Customer group growth in 2018 is 8% overall growth. You'll see public customer segment growing 27.6%. Now you then add Attendo on top of it. It actually means that we have broadly EUR 300 million worth of public-private partnerships. That starts to be a significant piece in our business. 2.8% growth on the private and 8.2% on corporate. Corporate closing the year on very healthy numbers and we've all talked about the issues and the pressures that we've seen in private. Actually, if you look at Q4, you'll see that our Q3 trend continues, and I think I increasingly find the balance between supply and demand also on private.
We talked about profitability, but Adjusted EBITDA at EUR 108.9. If you would take the one-off items included is EUR 116. EBITA 11.8% of revenue, so up from 10.6%. Net profit healthily up from EUR 7.2 to EUR 68.7, then resulting in EPS increase from EUR 0.06 to EUR 0.54. Our equity repayment proposal is then EUR 0.20 per share . That's basically our proposal going towards AGM. I think a very healthy year in terms of profitability, and I think continues to underline our ability to drive efficiency out of the operations. There is a clear benefit for us growing.
There is a clear benefit for us doing M&A. There's a clear benefit for us moving into near area preventative services, dental services, because we seem to be able to continuously derive efficiencies of scale, and that then converts into profitability. We're particularly pleased about that. Look at the market.
I would say overall we don't see a major shifts in market dynamics. The only thing, of course, there are two things that everyone keeps talking about. One is, of course, that the reform is still being debated at the parliament level, and I would say we start to approach a timeline when the time will start to run out and this is probably the right time to say that for us as Terveystalo we are prepared for both scenarios and we still see increasing demand on public customer side. Public counterpart is looking for partnerships. The question is what's the shape and form of it? That would be then determined by the reform. If the reform doesn't come, we're all geared up to tap into growth on that area even without the reform.
One cannot at this stage not to highlight the quite heavy discussion around elderly care and whether that would be spilling over to healthcare. There are certain differences of elderly care and healthcare, and we remain very focused on making sure that we strive towards transparency of the operation comparability. We drive towards quality and customer satisfaction. There are lots of work to be done also in healthcare. I think this overall tonality towards private services, this discussion will continue. We welcome the discussion. We do need to look at together with industry associations and with political counterparts, how do we develop the transparency in healthcare? Of course, the discussion is very unfortunate, and I think everyone will need to learn. From our point of view, we continue our journey as a quality provider, continue to scrutinize our operations, and improve on that front.
As said, for outlook for the year, I would say there is no really major change in terms of the underlying dynamics of the market. The key point is for 2018, we have been able to do a lot of work on consolidating and strengthening the foundation of our business. I think the early part of 2019 will partly go into consolidating and integrating Attendo operations into our corporate portfolio. At the same time, I think we'll be able to reap some of the benefits of the development work that we have done during 2018. I'm looking for a steady development on 2019. Withstanding, of course, that the global market is what global market is, that we cannot influence, but in terms of underlying demand dynamics, we look towards a healthy development 2019.
With that, I would like to invite Ilkka to maybe shed more light on the financial performance. Thank you.
Good morning on my behalf as well. We will then take a closer look on the Q4 numbers and development during that period then. First, the revenue was up by 4.2%, deriving that the public segment, again, was up by 27%, which is quite considerable growth, deriving mainly from couple of outsourcing and one hospital outsourcing as well. Service sales and sales for the public occupational healthcare customers has remained rather stable. On the private side, the revenue was quite flat versus the year before, deriving that we were actually able to improve the patient steering, when it comes to the other professionals than physicians, which compensated then the declining number of the physician appointments. We also had a strong development continued in wellbeing and remote services as earlier. On the corporate segment, on the corporate customers, the growth was at 3.3%.
Basically, the same trend continued as in Q3, that we had a good development in preventive services and in wellbeing services. Then on the opposite, the sickness care related services were down, as well as the surgery-related services. Overall, the mix developed during the Q4 that the appointment-driven services were up then the surgeries-driven services were down, and diagnostics remained rather stable. On the profitability, as you can see, we have been able to improve our profitability during each quarter this year or the last year, that both the absolute level of the profitability and relative performance has increased during each quarters. End of the year showed that the EBITDA margin in Q4 was that 13.7 up by 1.1 percentage points versus the year before.
The key drivers for the profitability improvement during this year and during Q4 as well, obviously have been the same as during the earlier quarters, deriving mainly from the synergies and the top-line growth as well as the operational efficiency development in our network, especially. If you take a closer look on the cost structure then, same sort of rule of thumb and trend continues still, so that if the top line has grown to 4.2%, Adjusted EBITDA has grown almost 12%, and materials and services has increased quite well in line with the top line by 5%. Actually, if you drill down on those costs on a more detailed level, you can see that actually the materials has not increased and remained quite stable, driven by both the sales mix impact as well as the decrease in unit prices.
On the other hand, then the services has increased 5.2%, which is mainly driven by private practitioner fees, which is then a result of the increase in appointment sales. Employee benefit expenses then have increased at 5.8%, a bit more than the top line. The key drivers there have been the outsourcing cases as well as the investments both in remote services as well as the digital services. Actually, if you drill down on that cost line item a bit more, you can see that actually the salaries and the fees has increased that 8.8%, and then the social and ancillary costs has remained flat. On other operating expenses, again, the operating leverage can be seen mostly in that cost line item has declined by that 3.1%.
Further drilling down to that cost line item, you can see that actually the premises-related expenses has declined quite considerably, actually 8.4%, and other operating expenses have then remained flat during that period. If you take a closer look on the balance sheet, it is now good to point out that Attendo balance sheet has now consolidated with our balance sheet, and therefore the total assets has increased up to EUR 1.2 billion almost, and the net debt amounts that EUR 413 million post the Attendo acquisition. The impact on the reported leverage number is so that after the Q4, when the balance sheet impact and the net debt impact from the Attendo acquisition has been included in the numbers, but the P&L impact has not included in the numbers, you can see that the leverage ratio is up to 3.8.
If you would adjust that by the P&L impact of the Attendo acquisition, it is down to 3.2, which is quite close to our target level being that three times leverage ratio. Net working capital obviously distorted by the Attendo acquisition, again, also, but still, as we can see later on on the cash flow development, we have had still good development on the net working capital items and operational efficiency in that sense, also on those balance sheet line items. On the CapEx side, same trend still continues as earlier. If you compare the intangible asset investments to the situation that it used to be a year before, used to be EUR 5 million, the LTM number, now it is EUR 10 million. It has doubled since that.
As Yrjö told, the investments in digitalization and on that area will continue, it would mean that it will most likely continue to increase that both in the relative proportion of the total investments as in absolute terms in euro value. The total level of the investment has remained rather stable for the whole period, obviously, as stated, will also increase going forward, driven by the non-recurring items related to Attendo integration as well as the further investments on the digitalization. Highlighting the cash flow, as you can see, the operating cash flow for the year was now, for the full year, was that roughly EUR 100 million.
Still we were able to, even though that the sales was fastest in the public segment than in the corporate segment, which ties up the capital in accounts receivables, especially in despite of that fact, we were able to release, again, cash from the working capital and remain good working capital and level and good cash flow in that sense as well, which is a good sign for the operational efficiency and how we were able to improve the processes during the year like Yrjö already mentioned. Technical issues that I would like to highlight still. One relates to IFRS 16, which will be implemented then at the beginning of 2019. You can see the updated impact now, which is roughly EUR 200 million on the balance sheet side, and the P&L impact on the EBITDA level is that EUR 40 million.
On EBITDA, it's roughly EUR 1.2 million and some impact on the net profit level as well. One more thing, a more technical issue that I would like to highlight considering the 2019 numbers is regarding the purchase price allocations. It should be noted that the business combinations there, the second line from the top, you can see that the capitalized customer relationship is that EUR 65.7 million, that relates to that Attendo acquisition, and that will be amortized since the beginning of 2019 and have impact on the amortization level on the P&L.
The amortization period for that is quite similar with earlier customer relationships, as it comes straight from the length of the customer or the customer contracts, which varies everything between 2- 30 years, the average being between 5- 10 years, the sort of amortization period for that sort of item is similar to that as well.
The second element on the below EBITA line items is that because of the good profitability development that we have had during the year, we have used almost all tax losses during this year, having EUR 11.4 million left going for this year, which would then mean that should the profitability level continue as it is at the moment, we are able to use those unused tax losses at the beginning of the year and post that situation, the P&L impact of the taxes is, I would say, maybe normalized and looks pretty much normal compared to other sort of businesses and other companies, meaning that it's 20% of the taxable income.
One more item or the issue related to taxes when considering those for 2019, it should be taken into account that the amortizations related to those purchase price allocations related to customer relationships and trademarks are not tax deductible, therefore, that should be adjusted when taking a look at the taxes for 2019. It's also good to note that if you would do that kind of adjustment for the net profit, actually our cash, if you want to call it like cash net profit, is quite considerably higher, therefore, the cash P/E is quite considerably lower than the sort of the reported numbers if you would do that kind of adjustment for the non-cash items related to purchase price allocations. That concludes the financial section on my behalf, and I think then we have time for the Q&A.
Thanks you. We are ready to take questions from the phone lines.
Thank you. If any participant would like to ask a question, please press zero one on your telephone keypad now. Our first question comes from Roni Peuranheimo from Danske Bank. Please go ahead. Your line is now open.
Thank you. I would have a few questions. Firstly, in terms of expected kind of growth rates for your businesses, you don't give a specific guidance, but should we assume that the kind of Q4 developments would be something that we should expect for the full year, meaning in the corporate and other segments?
Well, yeah. The past is somewhat an indicator of the future, I guess. I think the point is that we don't really see a major deviation from the existing trends. If you look at this business, if you go and look at the business from couple years back. Oh, again, sorry. I had my off just in case I didn't bother you with the presentation.
No.
Yeah. If you look at our top-line development, if you go back and look couple of years back, it is a really relatively steady state. The development very seldom is dramatic unless there are market shocks. Therefore, we have seen a steady development. I'm not foreseeing any changes to it. Despite the fact that we don't give a specific guidance, I think our business logic is relatively stable. The only thing changing it is, of course, that Attendo comes in, changes all the comparable numbers, in that way, there are some difficulties comparing again, like for like as we go forward.
That's basically it. As we have also stated, the sort of the number of the occupational healthcare end users has remained quite stable and basically flat versus year before. In that sense also, there is no major deviation expected.
My second question is really on the Sote scenarios and the outlook for the outsourcing market. Basically, do you think there will be any change in the demand for outsourcings due to this, let's say, focus on the care industry, even it's not really our business, it's kind of publicly funded business. What are your expectations on how this will impact your kind of outlook for the next years?
It is a highly complex question because at the end of the day, if you look at Sote, the discussion on the Sote reform, the reform in itself is a discussion on how public money is used. This my favorite quadrant where 77% is publicly financed and publicly provided, 4% is publicly financed and privately provided, and then you have 19% private. I think the private continues to develop on its own pace. Sote discussion is much more around the shape and form of how public money is spent. If I take one step deeper, the Sote discussion will determine whether in the future the primary discussion partner will be the county or the region or the community municipality. Currently, outsourcing is done through municipalities. Sote reform would basically move that responsibility up the line for the regions.
From our point of view, when you talk about healthcare, I would say that the shape of outsourcing or the partnering will change depending on who is the partnering counterpart. The higher up you go, the more you talk about entire hospital systems, whereas the lower you go, it's more combining social and healthcare. This social healthcare or this social care, elderly care discussion inevitably will cast a shadow to whether the communities have the right mechanisms to acquire services, to control for services, and whether there is enough money. That discussion, I think will inevitably go towards the role of communities on one end, and on the other one is how do we make sure that these services will be developed or provided for in a high-quality fashion? My point here is, one should separate industry and one company.
In general, private provides for what people buy us from. If you buy certain services, that's what we provide. It's a completely different discussion if a particular company doesn't carry its responsibilities and basically honor the contracts. I think one should not kind of mix these two. Net-net, I would say the growth prospects longer term, mid to long term remain the same with or without the reform. I think the shape of it will have a somewhat different phase. We as a company, thanks to Attendo acquisition as well, are ready already for both scenarios. I am basically more looking at the speed and the type of relationships with public counterparties, rather than whether it will come.
I don't want to sound too confident on it, but I feel that we are ready for the development on that sector, whether there is a reform or not. We have done a big choice on basically saying by through Attendo acquisition that we do want to participate, even recognizing that it is a public service. Thanks to that choice, we will then be more focused on healthcare. We develop our internal processes in such a way that we can always carry that responsibility. That's the choice we've made. Having done that choice, I think it reduces our risk towards the reform, whether it comes or not, but it basically makes us then more convicted to basically the conviction is higher that we will continue to see growth on that segment. Long answer, I'm sorry. It's very complicated.
Yeah, it was. Thank you. My final question is perhaps less complex. It's about margins. If we leave out the Attendo acquisition, do you see potential to improve further in the kind of existing business going into 2019? I mean, because the margin improvement was strong last year, but you had the synergies, which won't reoccur. What are your expectations for the margins excluding that system?
Well, I would say from a contextual point, one thing that is worth noting is that we have demonstrated continuously that as we look for different pockets of growth, we are able to find efficiencies, and that's where we talk about operational efficiency. With or without Attendo, we basically said we continue to look at ways to improve our quality, our customer service, but seek to do it in a way that is more cost efficient. Digitalization is one of those elements that serve that. With Attendo, we basically said we continue to keep our financial targets. This part Attendo comes with a lower margin. That then inbuilt says that we do see pockets of inefficiency that we haven't tapped into.
Yeah, further sort of highlighting still that there is still that operating leverage that is working like Yrjö said also earlier, that the sort of the fee for service model is not changing and we don't see any sort of deviations on that end. However, still would like to highlight that, like said.
Also during this report that the sort of the investments or the effort that we are doing for the remote services as well as the digitalization will also have impact on the cost line items so that there is a sort of the two separate cost development items, I would say there's normal efficiency development in the operations and in the network and in the shared services. On the other hand, like I said, we will continue investing in digitalization and remote services, which will inevitably have impact on the costs on that business as well.
All right. That's all from me. Thank you.
Thank you. Our next question comes from Alex Gibson, from Morgan Stanley. Please go ahead. Your line is now open.
Hi. Thanks for taking the questions. I have three main ones. First one is just to check on the midterm outlook here and your current thinking around that. Do you still stand by the 6%-8% underlying growth and margins in the 12%-13%? Do you think that at the current levels or following the current integration of Attendo changes in market, has this changed your thinking somewhat?
No, our growth and financial targets remain the same.
Okay. For the Attendo asset, now that you have it under management, what is your plan regarding integration? Both with the Terveystalo clinic and hospitals, do you want them to remain privately focused, and not going to mix public and private? The same question for Attendo, but in reverse. Will you keep that focused primarily on the public and not private?
Yeah. From organization point of view, we have quite distinctly made the distinction between publicly funded services and privately funded services. If you look at our organization, customer side, we actually have integrated our public services to former Attendo public services. We have actually put more focus on organizationally to differentiate between private services, out of pocket and private services are corporate. In that sense, we do recognize that the payer difference is significant. That does not mean that there is no synergies, the synergies come from a little bit different way. It's how large is your accessible physician pool? How are we able to create career paths for nurses and doctors? How are we able to match, if you wish, supply and demand in the market?
In that sense, the scale will give us the benefits of both creating digital and physical services, have resources that move based on demand. We're trying to look for ways of managing that expert pool in such a way that we are always able to fulfill the demand elements. The question is, how do you allocate that resource between private, corporate, and the public? In the short term, midterm, we do seek to rather differentiate public, private and private. I think that's from an organization point of view.
Yeah. From the sort of technical perspective, we will sort of combine the corporate segment business, meaning the occupational healthcare customers of the Attendo's, as well as the private dental business during the first half of the year.
During the second half of the year, we will combine the public business of Attendo from the technical perspective.
Okay. Last one is on social care services, you briefly mentioned in your remarks. Is social care something that you will need to bring in-house midterm or even near term? Or is it something you can continue partnering with others to provide? I guess it's going to be less in the private space and more in the public that this is going to be needed.
Yeah. Well, if you start from the top, I would say our primary focus is and continues to be on healthcare. If we look at extending that service offering, we rather look for different forms of therapy or dental things that are tightly connected to, I would say, more care continuum thinking and care chain thinking. The only exception of that is the community-driven public total outsourcing's where in order for us to participate, either Attendo or we have taken on social and elderly care services. That's a relatively mixed bag. There's kind of a ten of those broadly, and in those there is a mix of outsourced services and taken in services and that then varies by situation. We try to make the solution that is best for that particular situation.
There is no real, I would say, black or white decision on that. The key there is we need to stick with our commitments. We need to develop, deliver the commitment with quality. If there is a outsourcing partner, we're happy to partner up. If there is none, then we need to look at providing that in-house. Again, I would say our focus is on healthcare, and even if we look towards the future in public-private partnerships, I would say we seek to develop elements where there is a clear healthcare focus.
Okay. In the scenario that Sote does go through in its current form, do you see something that you think more about building a presence yourself rather than outsourcing?
If Sote in its current form goes through, then basically the focus will be on freedom of choice primary care services, that of course is then basically our heartland of operations. There we can combine and utilize our existing physical network to basically already provide access for that market. I would say if Sote goes through, our focus really is on primary care services as well as partnering up on secondary care and on service vouchers. If it doesn't, then the question is how will communities seek to develop their own services later down the road? Because there actually currently, without the Sote, it's the communities that are outsourcing their entire social and healthcare that has led to the situation where some of us have had taken on total outsourcings. That I think is what we'll see through the reform.
Okay. Thank you.
Thank you.
Thank you. As another reminder, if you do wish to ask an audio question, please press zero one on your telephone keypad now. There appear to be we do have a follow-up question from Roni from Danske Bank. Please go ahead. Your line is now open. Hello, Roni Peuranheimo from Danske Bank. Your line is now open.
Sorry, I was muted. Thank you for taking my question. I have two follow-ups on the numbers. Can you give a number, what will be the level of depreciation amortization for the year? You mentioned this PPA charge , what would be the total number? Secondly, can you comment on the seasonality of the Attendo business you acquired, how will it kind of, the revenues and the margins or EBITDA breakout between quarters? Thank you.
Coming back to this picture. If you take a look at the depreciation line item, it's a sort of cumulative impact on the investment. If you take a look at the depreciations, as the investments have been quite stable, it would remain quite stable as well. In Attendo's business, like I said earlier, the only impact for the depreciation line is actually a small impact coming from the private dental business. There is not much investments in that business, in that area. Secondly, if you take a look at the amortizations, it's a combination from two items. It's a combination of intangible investments, which you can see that historically has increased, therefore the sort of the amortization related to sort of intangible investments, meaning the IT investments will increase somewhat.
On the other hand, the other element on the amortization line item is the customer relationship and the trademarks, which you can see here, and in the balance sheet specs that have been provided for. The sort of the amortization level is pretty much the same on that line item versus year before or versus 2018. On top of that historical line item will come that customer relationship amortization related to Attendo acquisition, which is the total aggregate amount is that EUR 65.7 million. As I said, the sort of the amortization level of that line item is based on the contract level or the contract length of those businesses. As I said, it's somewhere between the 5- 10 years on average, the amortization period for that line item. There you can do the math.
Now I've already forgot what was the second question.
Second question was on the seasonality of the Attendo business you acquired.
The seasonality is such that if you take a look at the There's three elements on seasonality. If you take a look at the outsourcing business, be it then complete or full outsourcing, so be it at health center outsourcing, it's stable. Basically, it's a fixed fee business, fixed fee all year round. There is a private dental business. There the sort of the seasonality is pretty much the same that in other private business, so that the holiday season is like in the corporate business as well. The holiday season is slower and it's explained by that factor. The third element is the staffing business. In staffing business, it's actually a bit opposite because during the holiday season, hospital districts and other sort of customers quite typically need more rental doctors and rental professionals.
Therefore, the top line during the holiday season is a bit higher during the summer or during the holiday season and staffing business. It's a combination of three sort of different type of seasonalities.
All right. Thank you.
Thank you. There appear to be no more audio questions.
Perfect. I think Sami has a question over here.
Thanks. Sami Sarkamies, Nordea Markets. I have three questions starting from the private segment trends. If we look at the underlying growth rate in Q4, working day adjusted, it seems that there was a small deterioration from Q3 growth rate. You've been doing these mitigating actions, but was there something else that did sort of impact you negatively in Q4 in comparison with Q3?
Not really. I haven't seen any sort of negative development in Q4 in private business. Basically, like I said, it has remained quite stable, and the situation is quite similar in Q3. The only sort of impact that we have seen is that we have been able to steer patients better to other professionals and therefore face the demand from the customers a bit better than during the earlier quarters.
Okay. Secondly, continuing on the private segment, we did already discuss the growth outlook for this year. I guess you were kind of suggesting that current trends would also prevail in the future, but if we think about the capacity increase that took place last year, that would suggest that maybe going in the second half of this year.
You start seeing improving growth rates as kind of like the heat is put behind and as you've been indicating that no new capacity has sort of come to the market. Would this be a right assumption?
If you sort of said.
Statistically
Yeah, statistically ceteris paribus, should nothing else happen in the market, if you would exclude all other impacts of the market development, that is then sort of the case.
Yeah, at least we'll. If you look at it exactly on a kind of two annual curves, you will see that the capacity increased, then it halted, then it's been stable, and so you'll kind of catch the lower market, and then you should be able to see exactly if there is nothing else happening in the market, which we cannot foresee, then you should get a normalized like for like.
Okay. Finally, on Attendo synergies, can you open up a bit that when will they sort of become visible in your numbers and whether there will still be any one-off costs related to these synergies?
Like communicated while doing the acquisition, the estimated synergy amount is that EUR 5 million. The estimate still remains the same. We have also communicated that the sort of the implementation will take some close to 12 months from the closing. That is still the plan after one and a half months. The one-off items which were communicated related to integration was EUR 5 million. It's a combination of CapEx and OpEx costs and the sort of the transaction-related items were that EUR 7 million, so the transaction-related non-recurring items, and that most of that has been included in the Q4 numbers.
Okay. Thank you. No further questions.
Thanks. We don't have any more questions through the webcast either. At this point, I thank on my behalf and have a good Valentine's Day, everybody.