Okay, why don't we kick off? I wanted to go ahead and welcome everybody here who's with us in person and anybody joining us live on the webcast. Oh, no worries. We got some music in the background. That's not bad. Maybe later on we'll do some dancing. On a serious note, what I wanna do is, again, just welcome everybody here, and really to kick off the day by just sort of highlighting to you that we really wanna focus today's discussion on how is it that ConvaTec is executing successfully on its strategy, and how that's driving an acceleration in the momentum of our business. In terms of disclaimers, this should be familiar to all of you, and what we'll be doing today is both Johnny and I will be hosting the session.
I'll go ahead and kick off with a brief introduction, and then thereafter, I'll pass the baton on to Johnny, who will give you a lot more color and detail as to how are we performing from a financial vantage point. Thereafter, I'll pick up the reins again and try to give you a lot more color in terms of strategically, how are we driving the business forward? Lastly, try to give you some commentary as to what is the basis for us going ahead and raising our 2023 guidance, and what's the basis for strong growth prospects in the future. From an overarching perspective, there are really four key messages I'd like to leave you with today. The first one is, we are accelerating organic revenue growth, and we're doing that on a broad basis.
The second thing is, we are expanding our operating profit margin. As we drive that strong financial performance, we continue to strengthen our competitive position. As a result of the strong financial performance and the strategic advancement in our competitive position, we're going ahead and using that as a basis to raise our guidance for 2023. At this point, I'm gonna pass the baton on to Johnny, and we're gonna focus more on the financials. Johnny, it's all yours.
Thank you, Kareem. Good morning, everybody. Great to see you again. Here are the highlights of our financial performance in the first half of the year, we're pleased with what we see as a strong performance. Organic revenue growth was 6.6%, which was good growth across all four categories and is accelerating, especially in wound care. The gross margin expansion of 220 basis points was a result of good performance on pricing, improved mix, continued progress on productivity and operations, all more than offsetting inflation in COGS, which we think was 7.7% for the first half. The expansion of operating margin at 70 basis points, that came after a significant increase in operating investments to drive future growth, and it reflected further progress on simplification and productivity, especially in G&A.
Cash generation increased, with EBITDA going up to $262 million, and that enabled us to make investments in inventory, CapEx and M&A, whilst maintaining a strong balance sheet of 2.5x, 2.5x leverage. The organic growth was spread across all four categories. We'll look at each category, individually in a moment, but on this chart, starting from the left, you can see that wound care was 8.7%, and total growth at constant currency for wound care was 13%. The difference was ATT, which was growing quickly throughout the first half of the year, but only became organic growth from April. Continence care grew a strong 7.6%. Ostomy care grew 3%, the new category, including FMS. Underlying, the ConvaTec product in ostomy grew 6.5%.
Infusion care grew 7.5% in the first half year. This is moving past the phasing issue, which led to low growth in the first four months, and back on track to high single digit growth, as we said it would be. All that combined to a group organic growth of 6.6%, and then you can see on the right, there were two deductions in coming to total sales growth. The first being the exit from the low growth, low margin hospital care business last year, and the second being a small FX headwind. By category, starting with wound care at the top of this chart, the 8.7% growth was supported more than two points by ATT, and that helped grow, helped our growth rate in North America.
The remainder of the business grew more than six points, and that growth was mostly in GEM and in Europe, where China and Germany performed particularly well based on strong performance of the Aquacel Ag+ portfolio. Continence care is at the bottom of the chart. This is predominantly in the USA. Strong performance from the Home Services Group, with good customer loyalty and customer retention scores. The sales growth was supported by a favorable reimbursement pricing environment, and ConvaTec product, both Cure and GentleCath, performed well, improving the mix in our portfolio. In Europe and in GEM, we made good progress building our presence. We're still very small, but we're growing nicely. Ostomy next, at the top of this chart. The headline 3.1% includes FMS, our fecal management system, which used to be reported under critical care.
FMS was negative 9% sales growth in the first half of the year because it lapped some tough COVID comparatives. By the end of this year, that phasing effect will have played through, so it will no longer be a drag on the category. Excluding FMS and other products, the ConvaTec product in Ostomy, which is what drives profitability, grew 6.5%. That growth was strong in GEM, in China, and in Brazil and Colombia, in particular, where we are gaining market share. In Europe, the growth was good, although it was moderated by some planned reductions in sales of non-ConvaTec products, particularly in the UK. In North America, there was also growth, as the Home Services Group is now helping to add new sales in Ostomy. At the bottom of the chart is Infusion Care.
7.5% sales growth of the first half. As I said, we're now through that phasing impact, which impacted the first four months of the year, and we're back on track for the high single-digit growth, which we said we expected, and we continue to expect on an ongoing basis. This is based on continued strong demand for our infusion sets for people with diabetes. It's supported by double-digit growth of the Neria brand for non-insulin therapies, such as immunoglobulin or pain management medications. Looking forward, there are some very exciting new customer product launches coming with our infusion sets, which Karim will talk about in his section. Let's look at profitability. Operating margin went up, as I said, 70 basis points to 20.3%. I'll talk through the main features on this bridge from left to right.
Good price performance, 110 basis points of margin impact. The price performance was across the board, but the biggest parts were in Continence Care and in GEM. Strong contribution from mix, 290 basis points. More than half of this is the impact of getting out of the low-margin, low-growth hospital care business last year and getting into high-margin biologics with ATT. The remaining piece of the mix improvement reflects the continuing focus on the profitability of our business across categories and within category, such as increasing the mix of ConvaTec products. There was continued delivery on operations productivity with continuous improvement and other projects leading to an increase in gross margin overall of 220 basis points.
Oh, I skipped over inflation, which was 7.7 points in the first half of the year on our cost of goods, 270 basis point headwind. That inflation was a bit lower than in 2022. We still expect it to be in the range of 5%-7% for the full year, so lower in the second half than it was in the first. Moving to the right of the chart on OpEx, you can see a significant increase in cost to sales ratio. 40 basis points of that is in R&D, where we increased the investment, and 250 basis points of it is in sales and marketing, of which over half is the ATT entry and hospital care exit. Same mix effect as we've got going on in gross margin, but the other way around.
The rest of the sales and marketing investment reflects investments to drive future growth in places like China, in continents outside the USA, and in other areas. These increases were offset by continuing progress on simplification and productivity, especially in G&A, where we are on track to reach our target of 7% of sales over the next few years. We improved another 150 basis points in the first half. All of that with a small FX impact, left us with an operating margin in the first half, now into the 20%. This chart shows that lower in the P&L, we are now starting to grow net profit and EPS compared to the reduction in those metrics last year.
higher finance expenses resulting from the higher market base rates and higher levels of debt from M&A were offset by lower non-operating expenses and tax expenses. Net profit grew in line with operating profit, roughly 5%. Based on the strong operating performance in the first half and reflecting confidence in the future growth prospects, the boards announced an increase in the interim dividend of 3%. Now let's look at cash. I mentioned that cash generation increased, EBITDA of GBP 262 million. This was applied to investments in inventory, CapEx, and M&A. The inventory increased GBP 68 million on top of an increase of GBP 58 million last year.
This was to further improve the resilience of our supply chain. It also included some operational stock builds ahead of summer, ahead of a factory, of the EuroTec factory closure, and ahead of our newly won FMS GPO contract. The inventory will reduce in the second half of the year as these factors play through to be between $20 million and $40 million higher than the year before. Other working capital also increased. Large parts of that was seasonal, and there's also a part, though, which is in ATT, where it's growing quickly and receivables are longer than in the rest of the business. CapEx was in line with guidance, further supporting projects on product innovation, capacity expansion, digitization, and automation. The M&A investments were the ATT earn-out and ThirtyTec, the new nitric oxide technology.
All that left us with a net debt of $1.3 billion and leverage of 2.3 times. Moving on to guidance for the rest of the year. We are increasing our organic revenue growth guidance to be in the range of 6%-7.5%, and this is based on the broad-based good growth across all four categories in the first half, and an acceleration, particularly in AWC, in wound care, driven by ATT. We're also increasing our guidance on adjusted operating margin by 80 basis points to now be at least 20.5% on a constant currency basis. This is based on the good performance in mix, in price, and in operations productivity in the first half of the year.
We do note that at current spot rates in the second half of the year, there'd be an FX translation tailwind on that margin, that might be up to 60 basis points. Yeah, we'll wait and see where FX settles. The rest of the guidance is set out on the chart. We're going to continue to invest to grow the business, we expect to finish the year with leverage around 2.3 times, so a bit lower, absent any further M&A. I'll finish with this chart, which is two time series, organic revenue growth on the left and adjusted operating margin on the right. I think it demonstrates clearly that ConvaTec has now pivoted to sustainable growth, we are expanding our operating margin towards our target of the mid-twenties.
I'll just remind you of what we said at our capital markets events back in December, which is that delivery of those two targets leads to double-digit compound growth in EPS and free cash flow over the medium term. Thanks very much. I'll hand you back to Karim.
Thanks, Johnny. Look, a very strong financial performance in the first half of the year. Let's try to now understand from a strategic vantage point, where exactly are we headed? What are the growth prospects for our business? How are they performing? How are we executing on the FISB strategy? You're all familiar with our FISB strategy: focus, innovate, simplify, build, and execute. In terms of focus now, we've reconfigured the business to whereby over 90% of our revenues are in chronic care. That, in essence, means that we have a high exposure to diseases like diabetes, cancer, autoimmune diseases. That high exposure to chronic care translates into a high level of recurring revenues and a pretty darn solid and repeatable amount of demand out there.
You say, Well, what have you done in terms of driving more focus? We said we're gonna focus on 4 categories and 12 geographies. The USA and China being uber important. Well, guess what? As we've focused our investments on those 12 geographies, we're growing disproportionately in those geographies. That is a deliberate move, it's paying dividends. As we focus in key markets like the USA, we've chosen to utilize our balance sheet to pursue bolt-on acquisitions, such as that of Triad Life Sciences, which we now call Advanced Tissue Technologies. That's where we have InnovaMatrix, and that's doing very, very well. It's strengthened our wound care presence in the USA. Most recently, we went ahead and acquired a better medical care, okay?
A Better Care Medical, which is a home care company in the continence care space in the USA, and further strengthens our position there. What about in terms of innovation? Yes, we've doubled our investment in R&D, but even more interesting is that now we have a rich pipeline. We are in the midst, this year, of launching six new products. Very, very different picture than we had several years ago. In addition, not only are we developing, scaling up, and launching new products across the board, we're also investing in new technology platforms. We acquired from 30 Technology, a very innovative, highly differentiated, and highly proprietary technology platform that focuses on nitric oxide. This is all to do with antimicrobial properties, which can be leveraged across many of our categories. What about in terms of simplification? We've been driving that agenda very, very aggressively.
In fact, in the first half of the year, we reduced G&A by 150 basis points, all the way from 9.7 down to 8.2. It wasn't that long ago that at ConvaTec, we were spending about 13 points of revenue on G&A. Clearly, we are driving simplification and productivity. What about capabilities that we were trying to build? Well, we're embedding those capabilities. We've now embedded our pricing center of excellence, where we collaborate in terms of managing strategic and tactical pricing with the five global business units, and we are able to achieve an increase in price, and therefore an impact of 110 basis points of additional gross margin. What about executing? Again, we've really focused on increasing our do-say ratio.
When you look at the way we're executing commercially, what I would highlight to you is that's improved on a worldwide basis. In key markets, okay, particularly in global emerging markets, where we're growing in the teens, both in ostomy care and in wound care, and you look at a market like China, we are winning share both in ostomy care and wound care. Clearly we're executing. Let's step back for a second now and say, Okay, I've understood the broad picture of ConvaTec. What's happening in each one of the various four categories? Wound care, terrific business, right? First half of the year, strong performance. Aquacel Ag+ Extra, the gold standard when it comes to an antimicrobial wound dressing. 30-plus share of market globally. We're growing Aquacel Ag+ Extra double-digit on a worldwide basis, and I would expect it to continue to grow.
What about the foam segment? We've launched now a very competitive product offering, significantly improved exudate absorption capabilities, significantly improved adhesion properties. That launch is off to a good start in the U.S. We're getting positive feedback. We have numerous clinical evaluations being carried out nationwide. Then lastly, in the whole area of biologics, InnovaMatrix is really growing very, very well. The clinical feedback we get is tremendous. We get clinical feedback from surgeons, podiatrists, who basically say, Hey, it's amazing how quickly these very difficult-to-treat wounds are healing. I'm amazed that I could actually treat that really difficult-to-treat wound, right? The clinical feedback we keep on getting is really positive. Fundamentally, the way I would describe Advanced Tissue Technologies in that portfolio is that InnovaMatrix, that dog really hunts and hunts well. What should you be expecting in the first half of the year?
You should be expecting that we will grow this business double-digit in 2023. What about further out? What are the growth prospects there? Well, let's step back and look at the various segments we compete in. Today, we fundamentally compete in three segments. These are large segments. They're growing anywhere between 6%-7%. In every one of these segments, the antimicrobial segment, the foam segment, the wound biologic segment, we've got a very competitive product offering. ConvaTec now is in a position where we no longer have one hand tied behind our back. We can effectively compete in all three segments, and in fact, we're executing across the board, and we are winning share in key markets in all three segments. Let's double-click a little more on InnovaMatrix and Advanced Tissue Technologies. Again, what you'll see is that we're not sitting on our laurels.
We're not focused strictly now on InnovaMatrix AC. We're introducing new formulations and new indications. InnovaMatrix PD stands for InnovaMatrix Powder. Now all of a sudden, if you have a wound which is very deep, as opposed to having a flat wound dressing, it's actually in a powder formulation, and it has meaning and significance to physicians. In addition, we're also now received approval in a new indication for burns, which is also very exciting, because if you think about it, our extracellular matrix is derived from the placenta of a sow. We're talking about a xenograft. The size of our biological wound dressing is multiples larger than that of many other offerings in the marketplace. That has relevance if you have a particularly large wound or burn, I should say. I don't wish that upon anybody, but just realize.
I think what this really tells you is that the performance of our product offering with InnovaMatrix, whether it be PD or whether it go ahead and be InnovaBurn, is very strong. We're getting a lot of positive clinical feedback. In addition, we find ourselves where our production costs are very low. From a cycle time perspective, we can work rapidly with the FDA. This is a 510(k) approach. We're able to leverage our infrastructure from a development perspective, a clinical perspective, a commercial perspective. Guess what? We're actively now pursuing the development of this franchise outside the United States, in key markets in Latin America, in key markets in Europe, and key markets in Asia.
Bottom line, what I would tell you is that when you think about the advanced wound care business, you ought to anticipate medium term, and on a consistent basis, that this franchise will be growing high single digits, year in and year out. We really see it, and I really see it as a locomotive for growth at ConvaTec. What about Ostomy Care? How's that doing? Again, Johnny highlighted to you, 6.5% growth with our own products. We had good growth in the emerging markets. I highlighted to you, we're growing in the teens in global emerging markets. We're winning share in markets like Brazil, in markets like China. We're growing our business in key markets in Europe, such as Poland and Italy. In the U.S., we're growing that business. We've now stabilized new patient starts.
We're working very closely with the Home Services Group, 180 Medical. We have a dedicated team just for Ostomy Care. They provide exceptional service, patients and consumers in the community setting really appreciate that service. Above and beyond executing well from a commercial vantage point and from a service vantage point, we're also now getting ready to launch new products in Ostomy Care. It's been a long time since at ConvaTec we've launched some new products. Very excited about the fact that in Q1 of 2024, so in less than a year, we'll be launching Esteem Body. What is Esteem Body? This is a one-piece soft, convex offering. It's a large segment, it's a growing segment, now all of a sudden, we're gonna be able to leverage a historical advantage that we've had at ConvaTec.
When you think about adhesive technology and base plates, you don't want skin irritation and you don't want infections, and that's true of all categories, by the way. In this instance, we're gonna leverage that know-how that we further improved and combine it with a pouch, which is a lot more discreet and a lot more comfortable. We're very excited about this launch. Stay tuned. Ostomy Care, what should you be expecting? You should expect that we will grow this business in mid-single digits year in and year out. Continence Care, what's happening here? Strong performance again. Clearly, we've got a leadership position in the United States. We're the number one service company in the U.S. with a 40+ share of market, and we're the number two in terms of being a manufacturing company.
The level of customer loyalty is truly world-class, that the 180 Medical team is able to establish. This business is growing for us, and as I said before, we just acquired A Better Choice Medical, which has further strengthened that home service capability in the United States. Beyond that, we're leveraging a broad portfolio. You'll recall that a couple of years ago, we acquired a company called Cure, now we've got the Cure portfolio and the GentleCath Glide portfolio that originates with ConvaTec. The Cure portfolio is very much focused on the value segment. The GentleCath Glide is much more focused on the premium segment. We leverage those two portfolios on a global basis. Now, above and beyond that, what are we doing?
We're investing in our commercial presence outside the United States, whether it be in Latin America, Europe, or Asia, to grow the business. Lastly, we're launching new products. In the fourth quarter, we'll be launching GentleCath Air for Women 2.0. What does that mean? It basically means that we take the GentleCath Glide technology, our proprietary differentiated technology, which I think of as a polymer, which has a superiority claim in the United States. It's a lot less sticky and it's a lot more comfortable. You don't want a catheter that's sticky, right? You want a catheter that's comfortable. You hardly feel anything. Friction would be bad, and we're taking that GentleCath Glide technology and turning it into a compact, discreet catheter, GentleCath Air for Women.
We're gonna start launching it in France in the fourth quarter, and then in the first half of 2024, we'll be launching in other European markets and in the United States. You ought to expect this business to also be growing consistently, year in and year out, in mid-single digits. What about Infusion Care? Tremendous business. How's Infusion Care performing? Again, we grew the Infusion Care business. We have over 1.1 million patients who are challenged by diabetes using our proprietary and differentiated infusion sets. Now, what's interesting about it is that there's a very dynamic marketplace out there. When you start thinking about insulin pumps, what's happening there? Really, what we see is two phenomena. Phenomenon number one is there are new entrants coming about. Phenomenon number two is there's a lot of innovation occurring.
Let's try to understand the dynamic of new entrants and new innovations. You'll notice that there's a new entrant in the market, Beta Bionics. Who is Beta Bionics? They're making a durable insulin pump. What's so unique about their pump? Well, what's interesting about them is they've developed a pump now that uses prefilled insulin cartridges. No other pump does that. You can now use a prefilled insulin cartridge. I don't have to sit there and extract the insulin, put it into the reservoir, et cetera, et cetera. It's a big deal for diabetes patients, okay? It's a big deal. Second, their algorithm is very simple to use. Why? I don't have to input a specific number of carbs. I just need to tell the pump, am I basically having a heavy carb meal or a light carb meal?
If I decide to have pizza, Coke, and ice cream, guess what? That's a pretty heavy carb meal. I'll put in high carb. It's simple to use. Guess what? We're working now with Beta Bionics. We're providing them with their infusion sets. What about Medtronic? Medtronic also is innovating. They've developed the 780G. It's a whole integrated system, it's an automated insulin delivery system. Guess what? When you look at its performance in Europe, it's doing pretty darn well. It's growing in the teens, and now they've got approval in the U.S. As you think about it being approved in the U.S., how might it do? There's significant interest in it. Why? It's got some new features, some new benefits.
As an example, it can detect if you're just about to have a meal, and therefore anticipate and say, Okay, you're having a meal, I need to have a bolus of insulin to cover that. It's the only one that works with an extended-wear infusion set that lasts a week. We make that extended-wear infusion set. There's a lot of benefits to the diabetes patient. What about folks like Tandem? What are they doing? Well, Tandem now has decided to introduce something called the Mobi. They've gotten approval for it. Now, all of a sudden, look at that diagram. It's really important you look at the diagram. Notice that the size of that durable pump is about half the size of the two on the left. It's about 50% smaller. Now the smartphone is being used as the key input, right? The key control.
That durable pump became wearable, very similar to a patch pump, okay? Notice how the tubing shrunk in a significant manner. The point I'm trying to make here is that there are new entrants and new players, we're working with all of them. What about outside of diabetes? Well, we offer our infusion sets under the brand name of Neria Guard. That business does very well in the areas such as immunoglobulin replacement, in areas such as pain management, we're also poised to frankly grow that business, I'll be telling you more about that shortly, particularly in the area of severe Parkinson's, where we now have collaborations established both with the folks at AbbVie and the folks at Mitsubishi Tanabe, okay? I think the bottom line is, you ought to expect, in 2023, our infusion care business to grow high single digits.
What are the long-term prospects? Many of you have been asking and posing questions as to the long-term prospects in terms of growth for infusion care. I've taken the liberty to go ahead and give you some additional data. Let's focus on diabetes, about 335 million patients worldwide. That's the bar on the left. What proportion of these diabetes patients use insulin in an intensive manner? Think of it as multiple daily injections. I no longer produce insulin, right? All the other solutions aren't working. It's about 10%. It's about 35 million folks worldwide. Now, let's understand that sliver of 10%, what proportion are using multiple daily injections, right? They're oftentimes pulling a pen, right? Multiple daily injections versus a pump. Only 5% are using the pump, right? Only 5%.
The real question is, do you believe that pump users are gonna increase? We firmly do. Why? Only 17% of insulin-intensive users use a continuous glucose monitor. Continuous glucose monitoring is a catalyst for more utilization of a pump. Why? Because now I combine the continuous glucose monitor sensor with the pump, and it becomes the artificial pancreas. Technical term, automated insulin delivery. This 5% has been growing, right, and will continue to grow rapidly, okay? It's a very important point, 'cause if you don't believe the pumps are gonna grow at the expense of multiple daily injections, that ought to affect your thesis, okay? Let's double-click a little more, and let's get some data from a third party. Here's data from Seagrove. Seagrove are experts in the field of diabetes. It's a market research agency.
They've looked at, historically, what's been happening with multiple daily injections and pump growth, what will happen in the future. When you look at it from a retrospective perspective, multiple daily injections have been growing about 3%. That is consistent with the incidence and prevalence of diabetes on a global basis. It's gonna continue. People will continue to use pens, we're not arguing that. What's important to realize is that durable pumps have been growing at about 6%. They'll be growing at about 8%. You might say, Why is there gonna be an increase? Simple. New entrants, like Beta Bionics, new innovations that I spoke about earlier. In the area of patch pumps, we expect them to continue growing in a substantial manner. We also see a convergence between patch pumps and durable pumps. That's what we're referring to as hybrid pumps.
Because imagine if you could get the best of both worlds. Durable pumps tend to carry more insulin. Durable pumps, from an environmental perspective, frankly, have some advantages. How about if I could get a base plate, right, a base plate with a durable pump? The base plate would be disposable, and the durable pump would hold. We see this development happening in the marketplace. The expectation is that durable pumps will grow 8, patch and hybrid, about 16. Relevance to ConvaTec. When you see this expansion of insulin pumps driven by continuous glucose monitoring, driven by continuous innovations in the pump, there's a broadening to address all the market needs, we at ConvaTec have infusion set systems with think of it as modular components.
Our components are relevant across all these segments, so we're well positioned to grow as automated insulin delivery and pump therapy grows at the expense of multiple daily injections. What about outside of diabetes? Well, let's take a retrospective look. In the last several years, we've been growing in areas like immunoglobulin deficiency. That really results from, say, if you've had cancer or autoimmune disease, or say, if you're going ahead and using morphine for pain management in a palliative setting. We've been growing that business in the teens, in the low teens. Now we're adding new applications, such as severe Parkinson's, with AbbVie and Mitsubishi Tanabe. We expect to be able to grow this business not in the low teens, but in the mid to high teens. What does that translate into? Like, what's the bottom line here?
The bottom line here is that this segment of infusion care should be contributing approximately two percentage points of growth year in and year out. Let's tie it all together. If you look at all the developments in diabetes and all the developments outside diabetes, what should you be expecting infusion care to do? Well, what we expect infusion care to do is to fundamentally grow in the pump arena with durable pumps, patch and hybrid pumps, and therapies outside, resulting in a consistent delivery of high single-digit growth, year in and year out. I hope you've gotten a good sense now of the 4 categories and our overarching strategy. Let me try to sum up. In summary, strong financial performance in the first half of the year. We had an acceleration of organic revenue growth to the tune of 6.6%.
Second, we expanded our operating margin by 70 basis points to 20.3. Looking forward, what should you expect for this year? You ought to expect that our organic revenues will be growing between 6%-7.5 percentage points, and you ought to expect that the operating margin that we will achieve will be at least 20.5 percentage points on a constant currency basis. Fundamentally, there are some attractive growth prospects at ConvaTec. You've got a business that has a strong competitive position with a high exposure to chronic care markets. You've got a business now that has a track record of delivery. This will be the fourth year in a row that we're delivering organic revenue growth above 4%, and we're consistently accelerating. It'll be the second year in a row that we increase and expand our operating margin.
Bottom line, my level of confidence is increasing in terms of our ability to grow short term, medium term, and long term. On that note, thank you. Okay, I think we can open up for questions.
Graham was.
Graham.
Like, slightly.
Morning. Thanks, guys. maybe on, on infusion device to follow up there.
Yeah.
Firstly, if you add up the little segments and we know your rough split, that feels like double-digit growth, not high single-digit over the midterm. Just to check my math. Secondly, when we think of 2024, so Beta Bionics looks like it's more of a sort of end-of-year proper launch, and Mobi also looks like it's probably gonna be more of a 2024 push.
Yeah.
Does that give you confidence that actually 2024, you've got reasonable visibility in the sense that you feel like you, you believe in those products, therefore, there should be good demand to, to give you at least that high single digit again, even against a tough comp?
I think the short answer is, I'll take the second question first. What is our level of confidence in 2024 to basically achieve high single-digit growth in infusion care? Bottom line, high. Okay? If you do the math, take your second question, I would say the math would tell you, sure, it could be higher than high single-digit, we all know things can happen, there is risk, etcetera, etcetera. I think that it's important that we be thoughtful in terms of the kind of expectations we set, and hopefully we develop that track record with all of you. I think it's reasonable for you to expect high single-digit growth consistently in infusion care. Could it be higher?
Sure, it could be higher, but I think that high single-digit growth expectation is a reasonable expectation, including 2023, 2024, and beyond.
Maybe just a quick one on ATT. Are there any markets internationally? Well, when, when are you going to launch internationally? Are there any markets internationally where you can move as fast as you have in the U.S.? I mean, it's quite a lot of growth.
Yeah
for the group in terms of the impact so far.
Yeah. I think we're gonna need to learn what is the scale of the opportunity outside of the United States. I think what's fair to say is in 2024, you will see us launching InnovaMatrix outside the United States in some key markets. I don't think for competitive reasons, we don't want to disclose that at this point, but we'll start. I don't think it'll be a flurry of all markets across the world all at one time. We do see opportunities, honestly. In, in Latin America, we do see opportunities in Europe, we do see markets, opportunities in Asia. It's also a matter of doing the necessary clinical work, doing the necessary registration work, doing the necessary reimbursement work, that tends to vary, frankly, country by country.
I think we've got reasonably good clarity as to having an action plan in place that we're executing on.
Stay tuned, and, you know, we'll give you updates. You ought to anticipate that there will be markets outside of the U.S. in 2024 that we do launch in.
Okay. Thank you.
Yep.
I think Veronica was next, and then, Graham, can you pass, oh, the mic?
Veronica's going.
Okay. Yeah, go Veronica.
Yep, excellent. Good morning, and thank you. It's Veronika Dubajova from Citi. Three questions for me. One, the wound care growth, on my math, I think the sort of old AWC business, if I can call it that, grew sort of 6%-7% in the first half of the year, which clearly continues to be above market. Would love to get your thoughts on where you think those share gains are coming from. I know, Karim, you talked a little bit about the products, but maybe regions, channels, competitors, if you can give us a little bit of that thought process and how sustainable you see that growth as being going forward. Then I'll have two questions after that, but maybe we can knock this one out of the way first.
Yeah. Look, we're talking about the antimicrobial Hydrofiber segment. I think we've got a terrific offering in Aquacel Ag+ Extra. Frankly, in that specific segment, we're growing across the globe. In that segment, we see growth in North America, we see growth in key European markets such as Germany. We see growth, frankly, this is share growth, just to be clear, in key markets and global emerging markets such as, say, Brazil or say, such as China. I think it's a, it's a strong business, frankly, as commercial execution just continues to strengthen, we're able to actualize the full potential of that brand.
Any particular competitors you think you're winning from?
You know, I think we're just really focused on our game, honestly, at this point, Veronica. Yeah, I'd leave it at that.
No, understood. Then two financial questions for Johnny, if that's okay. The 1st one is just on the step up in SG&A and R&D. If you can give us a little bit of flavor for whether there are any timing issues or impacts related to that, or is this the new runway? To maybe talk through what are some of the investments that you're making that are driving that growth. Then just a confirmation that the free cash flow should indeed improve in the 2nd half of the year, and maybe a brief word on the working capital, 'cause I know the inventory growth was quite significant this half year. Thank you.
Sure. I think the, the, the way to think about that step up in OpEx is that it does set a new base level. I described that 40 basis points of it was an increase in R&D, and we have an ambition. It's very nearly 5% of sales. We do have an ambition to sustain that in order to keep driving the future product portfolio. The rest was in sales and marketing. Look, there is a step up because of the higher rate of sales and marketing intensity in things like biologics. We're also investing in areas where sales at the moment are relatively low but are growing fast, such as China, continence care outside the USA. Now, that should leverage over time. You know, that will leverage over time.
You know, what we've seen in this first half is a rebasing of both the gross margin and the OpEx ratios as a result of those big M&A transactions that we made last year. Our operating margin of 20.3, that's the basis now from which we will improve going forward towards the mid-20s. On free cash flow, yes, we can confirm it will improve in the second half, both in inventory and in receivables. Some of the inventory investment in the first half was to increase the resilience of the supply chain, but we've pointed to that being kind of $20 million-$40 million increase for this year. That's what we'd expect it to end at the end of the year.
The growth at the half year was 68, that included seasonality and operational factors, which will reverse. Also in the, in the payables and payables and receivables, excuse me, there's also some seasonality, quite normal. You've seen it in previous years, and some of that will reverse. There will be an increase in receivables year-on-year by the end of the year because ATT does have a longer receivables, period. That will be a relatively, you know, GBP low, low tens of millions number. I'll go to the gentleman first, please.
Whoops, thanks for taking the questions. Jack from RBC. A couple on the wound care side of things. First of all, I may have missed it, but could you provide an update on the negative pressure, the single-use negative pressure wound therapy situation, kind of where you are with that? Also on the 30 Technology, just wondering if your thinking has developed since the acquisition about kind of where you see specific opportunities there. I.e., whether it's kind of new markets, whether it's kind of taking market share and helping you take market share in kind of existing markets.
Sorry, Jack, can you just repeat your second question? I want to make sure I understood it.
On the Nitrocox side, technology, has your, has your kind of understanding of the opportunities developed to the point where you can be a bit more specific?
Yeah, look, I'll try to tackle the two questions. One is, first of all, single-use negative pressure wound therapy, what are you planning on doing there? I think the bottom line is we're going ahead and actively developing what we're calling ComvaVac, okay? That development is ongoing, in progress, and we think there's an opportunity on a global-wide basis. You'll hear more in the future, but that's ongoing right now. Clearly, we wanna strengthen our offering. We currently offer in the marketplace a product called Avelle. We think there's significant room for improvement, both in terms of performance of that product and also in terms of cost position, how do you actually go out and manufacture it? But the development's moving right ahead. Stay tuned, we'll tell you more in the future, is what I would say there.
On the nitric oxide technology, what I would say there is that we're actively developing the first application. We see that occurring in the wound care space. We're very encouraged by the performance that we see this technology platform being able to provide, and so we continue to be on track to deliver our first offering with this technology platform in 2025.
The lady, please.
You can go.
Just right along there.
Sure.
Front row, yeah.
Does that work? Hi, Anchal Verma from JP Morgan. I have three, please. Firstly, given the strong H1, could you give us any color on how you see phasing across Q3 and Q4, across the different divisions for growth, and margin? Secondly, on InfusionCare, it would be actually a bit helpful to understand, perhaps, if you could give us a breakdown, how much of the sales come from the double-digit Inaria ex-diabetes opportunities, just to see how the phasing is. I think, at H1, you'd said that phasing will be H2 weighted, so has that changed, or is there lots of scope for growth in H2 as well?
Then finally, on Continence Care, could you please share an update on your market share for the Home Services segment and the product segment, and if you've seen kind of share gains on the product segment in the U.S.?
Okay. Maybe I'll ask Johnny to take the first one on terms of phasing.
Yeah.
I, I don't tend to focus so much on phasing, honestly.
Yeah, I mean, look, I, I'm not sure we wanna get into margin phasing between Q3 and Q4. You know, we're updating on our first half margin now and giving guidance to the second half, and, you know, we don't wanna get into the volatility there. There's nothing in particular, but, you know, what you should be looking for is a further improvement in operating margin in the second half of the year. It will, and it will come from more pricing improvement, more mix, more operations productivity. There is still a significant inflationary headwind, and, and, you know, we're pointing to potentially an FX headwind as well in the second half, if rates stay where they are, 'cause at the moment, the dollar's a bit weaker.
Yeah, look, I think on the InfusionCare business, what portion of our business is outside of the diabetes insulin arena? It's about 10%, so we had that on the slide. Then in terms of Continence Care, our share of market on the service side is 40% plus. I'd say very robust, and we continue to grow that business. On the manufacturing side, we're the number two player. Again, let's call it roughly about 20%, and again, we continue to grow that business, too.
Thank you. Sorry, on the phasing, growth as well, please.
Sorry?
Just on the growth side, phasing for H2.
Yeah. There was a question on the phasing. I think it was InfusionCare, growth H1 versus H2. Look, what we've said for InfusionCare is it's gonna be high single digits for the year. It's a business where sales are uneven, but relatively predictable because we have good dialogue with our customers. You know, mild phasing, perhaps, in the second half, but, but focusing on high single digits for the year is, is the outcome we need to, to stick to, and then every year going forward.
I mean, one, one piece of counsel I'd, I'd give you is, if you're trying to analyze our business, you need to really think about the end markets. The end markets are all chronic, including the InfusionCare business. It's fundamentally a high exposure to diabetes with now this 10%, which is in autoimmune. It'll be in Parkinson's. You know, I could go through it. So yes, there'll be some fluctuation maybe with the InfusionCare business, say, with one customer versus another customer. That's normal. You need to be thinking: What do I think is gonna be happening at the end market level? So if you fundamentally believe that pump therapy and automated insulin delivery is gonna grow, then probably a good space to be. If you don't, then you should have a different thesis. I mean, literally, it's that simple.
I would focus less on short-term fluctuations, because I don't think they are as indicative of structurally what is really happening. That's the way we run our business. We're investing heavily in R&D, in InfusionCare, heavily in capacity, because we fundamentally believe that from a demand perspective, there's strong, robust demand for our offering. Okay.
Yeah, I think we'll get just going that way here.
Good morning. All right, thanks. Morning, guys. It's Sam England from Berenberg. The first one, just on inflation, can you give us a sense for how quickly lower inflation or deflation might take to work their way through to gross margins? How much of a lag there is, sort of, inherent in the business as, as deflation comes through? The second one, you've obviously made big progress on the pipeline in recent years, so how should we think about medium-term R&D investment as a percentage of sales? You know, was it the case that there was a big sort of upfront spend on R&D as you built out the pipeline, and that, you know, will fade away and reduce as a percentage of sales, or, or will you continue investing at the same level? Thanks.
I'll take the first one on-.
Yeah
inflation. We do hedge our costs to smooth the impact on the P&L. Changes in market prices feed through into our P&L with a time lag. Of course, it depends, but three to six months is typical. We've seen some market prices starting to fall in the first half of the year, for instance, in freight and in utilities. As I described, I think, in my section, we therefore expect that to feed through into our P&L in the second half of the year. 7.7% inflation in the first half becomes 5%-7% for the year. You know, the second half is obviously lower than the first half.
At current rates, inflation would continue to subside into 2024, as those effects flow through, when you get the run rate effect, going into the full year of 2024 at current market rates.
Yeah, look, what I would say on R&D investment is, you know, fundamentally, the way to look at ConvaTec is we're a defensive growth stock, right? High exposure to chronic care. There's strong demand there. What you need to do is to make sure that you've got differentiated solutions out there. I deliberately use the word solutions, meaning the device and the service, and link it into digital, okay? If you do well, there's significant growth. When we think about R&D investment, we really sort of say: Okay, well, how do we drive that top line? How do we drive consistent organic growth? The basic premise is, isn't a percentage, in fact.
It really is to say, in each one of those four categories, I need to have a competitive product offering today, and I got to make sure that there's a stream of innovation behind it. I got to sustain it, right? What that's translated into now is a 5% plus, right? I think for modeling purposes, if that's where you're going with it, I would say hovering around 5% is probably a reasonable assumption. You also need to be ready, that if we see an opportunity where there's an unmet clinical need, there's an opportunity to develop a differentiated product offering and to build a proprietary position, we're gonna go for it. Just as you saw us do with the nitric oxide technology in Triad, right?
It would have been easier, frankly, short term, from a pure earnings perspective, to say, I'm going to pass on that. No, we're not going to do that. It's not the kind of company we want to be. We want to drive sustainable and profitable growth year in and year out, and so we'll continue to invest in that manner.
Did he steal your question?
Oh, scraping the barrel. Just firstly, guys, am I correct in saying the medium-term guidance for wound care is now high single digits? You were at mid-.
That's correct.
To high single. Okay. Yeah, I guess with that in mind, at this point today, you know, you must feel pretty confident about the 4%-6% range set out at the CMD. I'm just wondering whether you see any reason to narrow that at all. Johnny, just on, on the balance sheet, 2.5x leverage. I'm just wondering, does that sort of constrain you a little bit in terms of sort of further M&A? I see you're coming down to 2.3. Even at that level, would that sort of be a level you're not particularly comfortable being at for too long? Just finally, Karim, just on the pipeline and innovation, you, the sort of Vitality Index, as you call it.
Yeah
You know, obviously, six launches this year, so I guess that will play out. Where do you see that, sort of, by the end of the year or maybe FY 2024, perhaps?
Yeah.
That percentage.
Sure.
Thanks.
Do you want to take the CMD guidance one, and I'll take the next two?
Sure. Yeah, look, we said 4%-6%. I think what you're seeing is an increasing confidence that we will be, you know, in the top end of that range.
Correct.
You know, you're, you're correctly seeing an upgrade in our expectations for wound care. That has changed. It is more positive than it was at the capital markets event in December. Maybe just on the, s hould I take leverage?
Sure.
Yeah. 2.5x now. What we've said is our target's two. It still is. We, we do allow ourselves to go up higher for appropriate M&A. We're not feeling constrained in looking for appropriate M&A. You know, we're, we're continuously scanning the horizon for M&A opportunities that will increase our competitive position in our key markets, or, and our, and our 4 categories. We're not thinking of transformational M&A, but bolt-ons. I, I think, no, we're not really feeling constrained. We do see leverage coming down. We've said that working capital is going to improve in the second half of the year, and we'll continue to target 2x because, you know, absent M&A, the business does delever quite quickly.
Thanks, Johnny. Look, on the Vitality Index, what I would say is that we're hovering around 26%-27%. We've committed to get to 30%+ of sales coming from new products launched in the last five years. By 2025, we're on track. You ought to expect us to keep on driving that Vitality Index. We see it fundamental to be able to drive that consistent top-line growth.
You got any?
We have one in the back of the room.
Yeah.
One in the back of the room. Please go ahead.
That's me.
Yeah.
Christian Glennie with, with Stifel. Firstly, on, on ConvaFoam, sounds like you've had a good start there. Just remind us maybe in terms of what you think your market share could get. I think you previously had targeted about sort of 10% as a potential. Is that still the case, or might be there, there be some upside to that?
Yeah. I think, look, on ConvaFoam, I would say, off to a very good start in the U.S. Very positive feedback in terms of the performance of the product. Many, many evaluations on a national basis, as I shared earlier. I'd say it's very encouraging. We're looking to also launch it, frankly, in Europe in 2024. We're on track to go out and do that, and then frankly, in other markets on a worldwide basis. In terms of share today, on a global basis in the foam segment, we've achieved about a 5% share of market. I think it's reasonable that we ought to be able to achieve at least a 10% plus. What does the plus equal? Time will tell. Let's first of all, get to the 10, you know, one step at a time.
I'd say just very encouraged by the feedback that we're getting from the marketplace, and we're definitely gonna go ahead and drive investment and focus on this offering.
Thank you, then on infusion care, a couple of quick ones there.
Mm-hmm.
On what, what's, Is there anything in your expectations around growth on the Parkinson's, AbbVie product for the U.S.? Obviously, that would had a CRL early, early this year. Any, any particular insight into the potential, timings and resolution of those issues? Then clearly, the patch pump, in whether it's in, Insulet, Tandem developing, Medtronic also developing, you've you talk about the potential for that also being an opportunity for you.
Yeah.
How do you actually go about leveraging that, you know, with those getting those relationships with those partners? Is that real, and also, is it still the same economics, I guess, ultimately? Obviously, you have all of it apart from the tubing, but just to get a sense for how you actually leverage that opportunity in, in the patch pump.
Yeah. Look, I would say on, on AbbVie, AbbVie now has received approval for the L-DOPA carbidopa pump in Japan. That just happened last month. I think they're on track to receive an approval in Europe this calendar year. I think the best guess is that in the U.S., we ought to anticipate something in 2024. I think you'd have to ask AbbVie, frankly, you know, what their perspective is. From our side, there's a level of optimism that it's a matter of time that they work through some of the challenges. I think on the second question, which was really related to hybrid pumps, patch pumps, you know, how real is that opportunity, and what are the economics there?
I would say, the economics are very attractive, so that's not an issue. It's an attractive opportunity, and I think it's very real. For competitive reasons, it would not be appropriate for me to say anything beyond that. You know, I've clearly highlighted to you that it's within our sights and stay tuned.
I mean, if I just may add to that.
Yeah.
because I think this was sitting in the question. You know, our, our ability to achieve high single-digit growth this year and next is not reliant, for example, on AbbVie.
Mm. Yeah.
Thank you for that. Yeah, sure. In terms of free cash flow, just to follow up on that, the 27% in the first half, what roughly should it be in terms of conversion for the full year? What should this business be doing on a sort of annual basis in terms of cash flow conversion?
Well, look, for the full year, if you work the numbers through, you know, what we've, what we've talked about is an increase in receivables and an increase in inventory, combining to somewhere around $50 million, it gives you a cash conversion, you know, above 50%. 50%-75% for the full year. Some of that inventory increase is one time. It is building resilience in our supply chain, and, you know, as the receivables grow in AT&T, you know, it depends how quickly that, that grows, right? This year's cash conversion should be a base from which we can grow, because we won't need to be increasing inventory into the future going forward to the same extent.
Super. Okay, I think we've got some questions from folks, who've joined us online, and maybe, Kate, our head of investor relations, is going to facilitate, posing these questions.
We do. A couple here from Hassan at Barclays Capital. The first one is just on guidance and phasing. Obviously, the comps get easier in the second half. You're already effectively at the middle of your new organic growth range. Is there any reason why, in the base case, we shouldn't see an acceleration in growth in the second half? Could that be an incremental tailwind, which is sustainable into next year?
Johnny, you want to take that one?
Look, could, could we be at the, c ould we be in the upper end of the range of organic growth guidance that we've just set? We could, yes. You know, the arithmetic shows that. You know, we, we don't want to get ahead of ourselves. You know, we want to be cautious in our, in our guidance. So, you know, that's why we're guiding six to 7.5, but, but there is a good chance we could be in the upper end of the range. Could that set a basis going forward? Well, this year, remember, we have got a particular acceleration from AT&T. And that will continue to grow nicely, but it's growing from a very small base at the moment.
You know, whereas we're expecting wound care to be double-digit growth this year, we're saying it's going to be high single digit growth going forward, because the relative impact of ATT will diminish over time. So, you know, there's reasons to, to, to think that this year might be a bit higher because of that wound care change.
Another question from Hassan. There were a couple. I thought I'd split them up for your benefit. Could you talk about the strong underlying growth in the 6.5%, and in particular, what you're seeing in the U.S.? Are you yet gaining share on the new patient side?
I think that's
Yeah.
wound care, is it? I think-
No, sorry, ostomy care.
Oh, ostomy care.
Oh, specifically ostomy care. Yeah. Look, what I would say is on ostomy care USA, we're definitely improving. I think it's, in my mind, still too early to say that we're growing share in terms of new patient starts. I'm comfortable saying that we've stabilized. I think that's a, that's a prudent way of describing that. I think clearly the collaboration between the ostomy care team, where we're targeting the right accounts, where we are increasing our emphasis in terms of our clinical approach, and then coordinating very tightly with the Home Services Group that has a dedicated team, is working really well, and that is clearly contributing to growth in the U.S. marketplace in ostomy care.
Thank you. Two more. The first one, from Adam Barker at Goodbody. What do you see as the major competitive risk in infusion care? Is there a risk that either there are new entrants or some of your customers choose to backward integrate, some of the components that you supply?
Yeah. Look, I, I think in infusion care, there could be new entrants, and there could be folks that backward integrate. I think what we need to realize is that we really have a strong position. We work at critical mass. We produce over 110 million infusion sets per annum. And you need to remember that these are over 15 different components, and about 20 different steps, and we do this in highly automated lines. Hundreds of millions, okay? The know-how and technology and proprietary position that we have in this area is very strong. That doesn't mean that it's insurmountable, it just means it's very, very strong.
Look, I think that, that risk is there, and the onus on ConvaTec is to ensure that we provide a very high-quality service, a very high-quality product, and ensure that the economics that we're providing to our partners are attractive to them, and at the same time, provide us for an appropriate rate of return. I think if we can find that balance, I'm confident that we'll continue to grow this business, in high single digits.
Final question from Miles Dixon at Peel Hunt. Thinking about the product launches you've described in infusion, in ostomy care, sorry, and the acquisition of ATT, 30 Technology, are there any, any fundamental product areas that you would like to supplement or add to your portfolio moving forwards?
I think the short answer is no. I think that during the course of the next 12 to 24 months, we'll be in a position where across all four categories, we've got competitive, if not very competitive, offerings across the categories and the segments in which they compete in. Then I think the opportunity challenge is to sustain that stream of innovation. You know, we came from where we had gaps. I think those gaps are being rapidly filled. Then we just need to sustain that stream of innovation. I think frankly, the R&D team at ConvaTec is doing a really nice job of driving that, and they're working very, very closely with the global business units. So I think we've got a much better appreciation for the unmet clinical needs in the marketplace and driving that pipeline.
So that's what I'd say. Super. Okay. Anybody else have any more questions here? Uh-oh, we got one more. Seb, okay. Go for it.
Right. Hi, it's Seb Jantet from Liberum. You know, I wanted to just to go back and talk a little bit about the medium-term margin guidance and, and get a little bit of sense about how you're thinking on that's going. 'Cause obviously, we've had very strong revenue growth. You're guiding more confidently other towards the top end of that. You previously said that the target is to get to mid-twenties by the medium term, helpfully defining neither of those terms in terms of when, or exactly how much, but let's just say that that's 25% by 2026. I guess I'm kind of, t he question I'm asking is that, you know, in terms of how that might phase, and of course, I'm not asking for 2024 guidance here, but you've got maybe 20% of margin this year.
You've got another three years to deliver maybe 500 basis points if you're gonna hit that kind of target. Should we be thinking of that as phasing equally over that period, or was there gonna be a big chunk of it? Should we be thinking in terms of your confidence about revenue, perhaps bringing the time you might get to that mid-teens slightly kind of earlier?
Yeah, look, I think, what I would say is the way we're trying to drive the business, and I'll ask Johnny here to join me if he's got any additional thoughts. I think fundamentally, we don't see any structural reasons why we can't get to the mid-twenties, okay? Our confidence in being able to achieve those mid-twenties continues to increase. The reality is that we're trying to balance two elements. One is, what is the external environment looking like? If you believe that this era of sort of hyperinflation is going to rapidly come down, that bodes better in terms of how quickly we get there. If you think the inflationary environment is going to persist at very high levels for a long time, that makes it more challenging, right? I mean, that's something just structural.
The other element is, how do we balance out the level of investment we're going to make? Short term relative to the opportunity, right? What I mean by that is fundamentally, we are focused on driving that top line growth, right? I gave you the example of 30 Technology, right? It would have been easier to say pass on that opportunity, but we fundamentally think that that opportunity is going to contribute to sustained growth. So you're trying to balance those two elements. I would say our level of confidence is definitely growing, and I don't see any reason why we're not going to get there. John, do you want to add to it?
Yeah, look, I think that's a very important point. It's, it's somewhat within our control, but we don't want to go too fast. You know, with a bit of time under our belt now, we are comfortable in giving you a bit more definition. You know, mid-twenties for us, it's 24 to 26. Medium term, you know, we're now saying it'll be approximately three years. It might be 26, it might be 27. There are still some uncertainties out there, but, you know, that's where we are targeting with all of what Karim said in terms of balancing appropriate investment to drive the future against improving margin at the right sort of pace. To your point about phasing, I think even phasing is as good an assumption as any other.
There, there are some external factors, but we're on a we're on a steady course of improvement. If you strip out FX, we've done about 300 points in two years by the end of, you know, by the end of this year. We will, y ou know, what we have committed to is we'll make progress every year.
There you go. Okay. Any more questions? Super. Well, look, just a big thank you. I really appreciate all your high level of engagement, and look forward to seeing you soon. All the best.
Thanks very much.