Smith & Nephew plc (LON:SN)
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Apr 29, 2026, 1:44 PM GMT
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Investor Update

Dec 16, 2021

Andrew Swift
Head of Investor Relations, Smith & Nephew

I can see we have a good number of people connected now, so we can make a start. I'm Andrew Swift, Smith & Nephew Investor Relations. Before we get into the presentations, I'll read out the safe harbor statement. Certain statements in this presentation are forward-looking statements. These statements are based on management's current expectations and are subject to uncertainty and changes in circumstances. Actual results may differ materially from those included in these statements due to a variety of factors. More information about these factors is contained in the company's filings with the Securities and Exchange Commission. I'm sure you've seen the press release that came out half an hour ago, and I'd also highlight there are supporting materials for today's event on the platform you're on now.

You'll find the slide decks for this first session and for the breakouts in the Resources section of the portal. Now to start the first session of the day, I'll hand over to Roland Diggelmann, Chief Executive Officer of Smith & Nephew. Roland.

Roland Diggelmann
CEO, Smith & Nephew

Thank you very much, Andrew. Good afternoon, good morning to those of you calling in from the U.S. Welcome to this Smith & Nephew Meet the Management 2021. I'm actually really excited for the opportunity to present to you today, even if we have to do this remotely still. The timing is right, and we have some positive news to share with you. Before we get into the opening session, let's take a quick look at the agenda. I hope you find it an informative day and come away with a clear picture of how we move the agenda. In the next hour, Anne-Françoise and I will be talking about the group strategy for growth.

You'll have seen in today's press release that we have announced midterm financial targets, and we'll be setting out how we'll deliver that performance. After a short break, we'll then move to a series of small group breakout sessions for the pre-registered participants. You'll receive connection details for your assigned group shortly. Over the course of the day, each group will have a Q&A session with me and Anne-Françoise, and meetings with leaders from the three franchises to get into the details of actually how we'll drive each part of the business. I'm sure you'll find it an informative day and come away with a clear picture of how we're moving Smith & Nephew to the next level. Smith & Nephew is at an inflection point.

In the last few years, we've added new growth drivers, we restructured our commercial model, and we've embedded a new culture. We're now at a point of transforming to a structurally higher growth company. Innovation is truly at the heart of it all. The technology at the company has been strong for a long time, and we're taking it further. We've built a pipeline of disruptive technology. We've established engines to keep adding internal and external growth assets. Delivery will be driven by our work and productivity and by commercial excellence. Optimized manufacturing and supply chain will provide a solid foundation. On the commercial side, two of our three franchises, providing around 60% of sales, are already performing well.

The aim is to sustain the strong profitable growth in wound and in sports medicine of ever higher levels of activity later in life. Growth in wound and in sports medicine, and to reestablish the momentum that we've actually had for many years in Orthopaedics. Now, we understand that you want to know what this all adds up to. We are committing today to a consistent 4%-6% organic revenue growth by 2024. We'll maintain the higher R&D investment enabling that, while also rebuilding a trading margin to be at or above 21% in 2024, and with continued improvement after that. We'll maintain discipline in capital allocation. We will continue to invest in R&D and tuck in M&A.

At the same time, the strong cash flow of the business will also enable us to maintain our progressive dividend policy. Will allow us to stay within investment grade credit limits or metrics. Today, we start the regular buyback with around $250 million-$300 million planned in 2022. Before I go into the detail of the strategy, I'd like to take a moment to remind you of where Smith & Nephew is today. We all know the disruptive effects of COVID, of course, on our industry. When I look beyond the short term, the long-term trends underpinning our markets absolutely remain intact. For instance, the prevalence of chronic health conditions. We also have the expectation of ever higher levels of activity later in life.

The demographic shifts and the aging populations and expanding healthcare access in emerging markets. These trends are all unaffected by the pandemic. Then we can actually add a fifth trend, which is the shift to the decentralized care. This has been accelerated by COVID, as both patients and providers look to move care actually away from the mainstream general hospital. With that comes new opportunities for innovation to meet the needs for simpler procedures, for shorter recovery times, and for new patterns of patient engagements. Slide six is a reminder of what Smith & Nephew is. We are a major global player in all of the key markets of Sports Medicine, of Orthopaedics, and of Advanced Wound Management. The portfolio is also an attractive mix of Orthopaedics and of Advanced Wound Management.

Growth at or above the weighted average market growth rate of 4% can drive leverage for the whole of the PNL in normal conditions. Having the portfolio is actually a well-established and proven model in medical devices. It gives us scale to engage with customers and cover back office costs. It also gave us some resilience in the pandemic. It creates a range of opportunities for us to allocate capital for growth and returns. It also positions us to exploit cross franchise, commercial and technology opportunities such as ASCs, digital and biologics. We'll talk more about these. Then by running the portfolio through our franchise-based commercial model, we retain the focus and the accountability to drive each area effectively. Slide 7 is a bit of a busy slide, but we want it to be as transparent as possible.

It does show where we are by franchise and some of the broad-based performance improvements over the last few years. The areas in green show where our segment has outperformed its market in a particular period. Performance relative to market has improved in more of our segments. In 2021, actually two franchises with around 60% of group sales, that's Sports Medicine and Advanced Wound Management, are clearly outperforming. When we look at the reasons for the better performance, it comes from delivery of our strategy. It comes from innovation, from improved commercial execution, and from synergistic M&A. This performance comes from actions that we have taken rather than from any external factors. That gives us the confidence that we can repeat that success in the rest of the portfolio. Now, as you know, there are still challenges in Orthopaedics. Actually they're quite narrow.

What we need to fix are the short-term supply constraints which have interrupted the progress that we've had in hips and trauma, and then the current slow growth in knees. I think it's important to remember that it came after many years of outperformance. Where we're filling the portfolio gap with the rollout of cementless knees, we're gonna be very successful. The next slide shows the background for our strategy for growth. By concentrating our innovation and culture on customers, we'll consistently deliver 4%-6% organic revenue growth, and we'll rebuild our profit margins. To get there, we'll compound our outperformance in Advanced Wound Management and Sports Medicine, and regain momentum in Orthopaedics. The strategy is based on three simple imperatives, which you see on the pyramid on slide eight . The first imperative is to strengthen the foundation of Smith & Nephew.

A solid base in commercial and manufacturing will enable us to serve customers sustainably and simply, and deliver the best from our core portfolio. Secondly, we'll accelerate our growth profitably through more robust prioritization of resources and investment, and with a continued customer focus. We'll continue to transform ourselves for higher long-term growth through investment in innovation and acquisition. We'll deliver these imperatives through four key value builders. These are productivity, commercial execution, innovation, and M&A. On each of these, we already have a track record of delivery. In the next section, I'll spend some time on each of the four value builders and what we have planned for each one of them over the next few years. I'll start with productivity.

These measures are mainly aimed at strengthening our base and laying the ground for acceleration. I'll focus now on two of these areas, optimizing manufacturing and supply, and driving ongoing efficiencies for the business through simplification. The immediate priority on the optimization side is to resolve the current supply issues. Now, I'm pleased to report that we've made further progress since the update we gave you together with our Q3 results. The initial challenge we had was of product supply from our main global Orthopaedics facility in Memphis, largely as a result of staffing shortages. That's improving. We successfully stepped up hiring and are moving new staff to its full productivity, towards leading, and that will lead to rising output and falling back orders. The second challenge has been around logistics, and that's improving further too.

There may be yet some bumpiness from external disruptions to freight, but our backlog of finished good that we need to get to customers is decreasing. Overall, I'm pleased to say we're making good progress on both of these Smith & Nephew specific challenges, and we do expect the full resolution in the first half of next year. Now, it's a little harder to predict are the widely reported global shortages of some raw materials and components, such as electronics, for instance. We're closely managing supply issues. That's on a case-by-case basis, and we have simplified our processes to be more opportunistic and move quickly when additional supply becomes available. I'm very confident in the team's handling of these unusual circumstances. Here too, I'm encouraged by the progress. The second aspect of optimization is our supply and manufacturing. That's building long-term efficiency.

An important part of that will be delivering the transformation plan that we announced back in February. On the supply side, we've continued to progress the process, and we're moving to a specialist third-party logistics partner. The transition in Europe is now complete, and we're preparing for the Memphis transition in 2022. Eventually, our production facilities will ship directly to three global distribution centers, and they'll in turn ship directly to the customers wherever possible. This will, of course, bring a range of benefits and opportunities that we see in the marketplace. While this simplifies the route from factory to customer, we will bring down lead times, we will better manage inventory, and we will reduce the cost and risk from freight.

In manufacturing, the new Malaysia Orthopaedics facility is on track to supply in 2022. Also, Costa Rica is getting ready to support wounds as part of the shift to a multi-franchise facility. Again, cost efficiency is only one part of the rationale. Multi-sourcing in our network will actually make us more resilient to disruptions at any one site. These changes will also support the arthroscopic tower. When the two sales forces work together to pursue such opportunities, having both franchises under the same leader will enable greater coordination in supply to our customers. Finally, on productivity on the next slide, there are opportunities from increased focus and simplification that can really be an ongoing process rather than to rely on major new restructuring programs.

We have shown the n ew restructuring programs. We have shown the ability here already to deliver savings from simplification. Our global business services organization is a great example. GBS was actually initiated in 2017 as a shared services and business process outsourcing organization, supporting the whole of Smith & Nephew from low-cost locations. Early savings came in the delivery of the APEX efficiency program, but then the benefits, of course, continued, with more savings accruing from other transitions and hosted operations. Two of the opportunities we still have in front of us are shown on the right side of the slide. Firstly, we can more rationally focus on commercial resources to better balance growth and also margins.

Smith & Nephew actually sells into more than 100 countries, but over 80% of revenue comes actually from the 10 largest countries. Global launches will focus now more narrowly on the largest markets first. In some cases, there are even lines of business that are unprofitable in smaller countries. Some of these have strategic value to the rest of the portfolio, but we're also reviewing where it makes sense to just exit. A second opportunity does come from simplifying the portfolio. In some categories, we have multiple product lines serving the same clinical need, either as a result of past M&A, or then just as older product generations were never discontinued. This is particularly the case in Orthopaedics, and one of the examples on the slide is that of UNI Knees.

Clearly this is one way we can consolidate four parallel systems into one and into the modern JOURNEY II UNI platform. We're therefore reviewing the financial and strategic value of the tail of products. We're aiming to reduce commercial costs. We're aiming to simplify distribution and, of course, to better control inventory. I'll now move to the second value build, which is commercial execution. This is truly about maximizing the value of our really strong core portfolio and accelerating the business by aligning our approach to evolving customer needs. How do we do this? Well, I think it's important to recognize that we already have leading technology across the portfolio. Our JOURNEY II knee, for instance, and the INTERTAN Nail in Orthopaedics, our WEREWOLF COBLATION System in Sports Medicine, and ALLEVYN LIFE dressings in wound care are just a few examples.

These are well-established products that are truly differentiated in the marketplace. These are just a few examples. The wound franchise has some very clear examples of what can be done by better driving this core portfolio even before the benefits of our pipeline. The left of the slide shows inflections that we have already delivered in established categories. European wound care, for instance, is one of our more mature end markets. With competition from low-cost regional players, that is a very particular feature there. Even so, the team has successfully returned the business to growth through better execution, through an enhanced tender approach, through a renewed focus on key account management, and also improved employee engagement. All of these factors contributed to the sales growth that you see on the left side of the slide.

The bioactive SANTYL also turned around a multi-year decline. Detailed work on patient engagement, on clinical evidence, and reimbursement first has stabilized, and then started to grow another mature product line. In the franchise sessions later, you will hear more about commercial execution and maximizing our already strong portfolio. I've just talked about wound, now you'll hear how selling the procedure rather than individual products has already been a core part of our successful Sports Medicine strategy under Brad Cannon in recent years. Replicating that success in Orthopaedics is absolutely critical. With our uncemented knee, we now have a strong suite of primary and revision products that are supported by a range of enabling technologies.

Uncemented knee, we now have a strong suite of primary and revision products that are supported by a range of enabling technologies to essentially everything necessary to support the surgeon, and how they actually wish to approach a particular procedure. We've also strengthened the commercial model for Orthopaedics. I did announce that change at the leadership of the leadership structure in November as part of our Q3 results, and it's about bringing both the Orthopaedics and Sports Medicine business unit under Brad Cannon. This does align our commercial structure much better with evolving customer needs and with new high-growth opportunity that we see in the marketplace. While the sales team remains separate, we can go after these targets with a more unified sales approach, and we can leverage our leadership in Sports Medicine and our broad Orthopaedics portfolio.

We all know that care is becoming more decentralized, with joint replacement procedures and the volumes growing rapidly in ASCs. Our U.S. Sports Medicine franchise already generates 40% of its revenue in ASCs, and it has existing deep relationships. In knee, we now have a strong suite of primary and revision products that are supported by a range of enabling technologies, essentially everything necessary to support the surgeon and how they actually wish to approach a particular procedure. We've also strengthened the commercial model for Orthopaedics. I did announce that change at the leadership structure in November as part of our Q3 results, and it's about bringing both the Orthopaedics and Sports Medicine business unit under Brad Cannon.

This does align our commercial structure much better with evolving customer needs and with new high-growth opportunities that we see in the marketplace. While the sales team remains separate, we can go after these targets with a more unified sales approach, and we can leverage our leadership in Sports Medicine and our broad Orthopaedics portfolio. We all know that care is becoming more decentralized with joint replacement procedures and the volumes growing rapidly in ASCs. Our U.S. Sports Medicine franchise already generates 40% of its revenue in ASCs, and so it has existing deep. Now on to the third value builder, which is innovation. Absolutely critical and key for us. We've stepped up our level of investment in R&D from 4.7% of sales in 2017 to around 6%, expected for this year.

I think we're now at the point of starting to realize more of these returns. From here, we'll accelerate our business by launching flawlessly and to scale and transform our longer-term outlook with investments in truly disruptive. In knee, we now have a strong suite of primary and revision products that are supported by a range of enabling technologies. Essentially everything necessary to support the surgeon and how they actually wish to approach a particular procedure. We've also strengthened the commercial model for Orthopaedics. I did announce that change in the leadership structure in November as part of our Q3 results, and it's about bringing both the Orthopaedics and Sports Medicine business unit under Brad Cannon.

This does align our commercial structure much better with evolving customer needs and with new high-growth opportunity that we see in the marketplace. While the sales team remains separate, we can go after these targets with a more unified sales approach, and we can leverage our leadership in Sports Medicine and our broad Orthopaedics portfolio. We all know that care is becoming more decentralized with joint replacement procedures and the volumes growing rapidly in ASCs. Our U.S. Sports Medicine franchise already generates 40% of its revenue in ASCs. Those types of projects are important to having a fresher portfolio and to compete and to drive margins. Then thirdly, the impressive delivery in 2021 reflects only the early stages of the increased R&D investment.

The output of most of the investments and the recent step-up in projects are still to come. Importantly, I think we've demonstrated that when we bring meaningful innovation to the market, it drives visible change in the commercial outcomes that we report to you. Now, I showed this data earlier in the presentation. This is of underlying growth by segment over time and how we compare to the market. Hips, trauma, joint repair, and arthroscopic-enabling technologies have all improved their performance against the market since [audio distortion]. Uncemented kn ee, we now have a strong suite of primary and revision products that are supported by a range of enabling technologies. Essentially everything necessary to support the surgeon and how they actually wish to approach a particular procedure. We've also strengthened the commercial model for Orthopaedics.

I did announce that change at the leadership structure in November as part of our Q3 results, and it's about bringing both the Orthopaedics and Sports Medicine business unit under Brad Cannon. This does align our commercial structure much better with evolving customer needs and with new high-growth opportunity that we see in the marketplace. While the sales team remains separate, we can go after these targets with a more unified sales approach, and we can leverage our leadership in Sports Medicine and our broad Orthopaedics portfolio. We all know that care is becoming more decentralized with joint replacement procedures and the volumes growing rapidly in ASCs. Our U.S. Sports Medicine franchise already generates 40% of its revenue in ASCs.

It has existing deep penetration of REGENETEN in late 2017 and a series of further launches across procedure types moved that line to double-digit and actually to consistent above-market growth. The multiple launches in the arthroscopic tower from 2019 actually returned AET from multi-year decline first to growth and then consistent market outperformance. One of the factors of this success, I believe, are the improvements that we've made in launch excellence, particularly the ability to launch rapidly and at scale. OR3O provides an excellent case study for this. As a launch that actually delivered quick returns with just a two-year payback on our development cost. Firstly, we came with effective marketing. We had a very clear message positioning OR3O as the only advanced bearing dual mobility cup.

We also identified the right customers and the right patients. That's high-impact teaching accounts, and those are revision patients at high risk of the hip dislocating, and that is exactly what OR3O is designed to reduce. We also deployed more capital during the launch, with rapid deployment of instrument sets, and we applied improvement end-to-end, improved end-to-end processes with consistent coordination of product needs with operations. Importantly, we used evidence and medical education early and effectively, leveraging the long clinical history of OXINIUM and running a series of virtual education events. We'll now apply these improvements to the next series of key launches, either on the way or expected. We came with effective marketing. We had a very clear message positioning OR3O as the only advanced bearing dual mobility cup. We also identified the right customers and the right patients.

That's high-impact teaching accounts, and those are revision patients at high risk of the hip dislocating, and that is exactly what OR3O is designed to reduce. We also deployed more capital during the launch, with rapid deployment of instrument sets, and we applied improvement end-to-end, improved end-to-end processes with consistent coordination of product needs with operations. Importantly, we used evidence and medical education early and effectively, leveraging the long clinical history of OXINIUM and running a series of virtual education events. We'll now apply these improvements to the next series of key launches, either on the way or expected, and particularly into platform technologies with cross-franchise applications. Robotics, of course, is one, with a further development of CORI, and you'll hear more about CORI later in the breakout session. The reception in knee surgery have been really excellent, and we're rolling it out globally.

We've recently added regulatory clearance for hip surgery in the U.S. There's much more in development, of course, as we add more indications and more devices to the CORI ecosystem. I really believe the differentiation of a CT-free, small modular platform will become even clearer. We expect to be the first to actually add knee and hip revisions to our platforms. We're working on a novel soft tissue balancing device for knee replacement, and we're working towards shoulder replacement with CORI following our extremities acquisition earlier this year. The unique ability to integrate our robotics platform with our arthroscopic tower will further support the expansion in Sports Medicine. Another platform is biologics, which is a capability we've built up through acquisition in Wound and Sports Medicine .

It's early to be talking about specific projects at this stage, but we're looking at applications across all three franchises and biologics. Finally, there's digital as a true capability. We already have marketed products in all three franchises, such as data analytics in Orthopaedics, the connected tower in Sports Medicine and also wearables with the LEAF Patient Monitoring System. We'll continue to work on digital applications covering the whole cycle of care, both internally and with partners, potential applications for visualization and also artificial intelligence. The final of our value builders is M&A. We've added assets over recent years that move a number of our segments to structurally higher growth potential, such as adding the Osiris platform will become even clearer. We expect to be the first to actually add knee and hip revisions to our platforms.

We're working on a novel soft tissue balancing device for knee replacement, and we're working towards shoulder replacement with CORI following our extremities acquisition earlier this year. The unique ability to integrate our robotics platform with our arthroscopic tower will further support the expansion in Sports Medicine. Another platform is biologics, which is a capability we've built up through acquisition in Wound and Sports Medicine. It's early to be talking about specific projects at this stage, but we're looking at applications across all three franchises in biologics. Finally, there's digital as a true capability. We already have marketed products in all three franchises, such as data analytics in Orthopaedics. Of course, the connected tower in Sports Medicine and also wearables in wound with the LEAF Patient Monitoring System.

We'll continue to work on digital applications covering the whole cycle of care, both internally and with partners, and then potential applications for visualization and also artificial intelligence. The final one of our value builders is M&A. We've added assets over recent years that move a number of our segments to structurally higher growth potential, such as adding the Osiris depending on the asset. That's our strategy. In summary, the four value drivers that will strengthen our foundations, that will accelerate profitable growth, and that will transform the long-term profile of the company. Now, to take you through what that means in numbers, I'll pass you over to our Chief Financial Officer, Anne-Françoise Nesmes.

Anne-Françoise Nesmes
CFO, Smith & Nephew

Thank you, Roland. Good morning, good afternoon, everyone. In the next few slides, I will cover our financial framework, trying to bring together all of the value builders that Roland has spoken about. I'll talk about the levers that underpin and drive our midterm commitments. I'll also cover our updated capital allocation policy. First, let me cover the short term, where there's a number of external factors and influences that we've got to work through. On the positive side, there's more recovery to come from COVID. We know surgery volumes in joint repair and joint replacement and ENT have not yet returned to pre-pandemic levels. For joint replacement, we're still expecting to see a benefit at some point of the pent-up demand when healthcare systems catch up.

Although unfortunately, we all know that new variants of COVID are a reminder of how difficult it is to predict the timing of the recovery. Our assumption is that waiting lists will be addressed over time, but the speed will vary by market and will be generally very gradual. One of the headwinds for 2022 is from the volume-based procurement tender in China for hip and knee, which we expect will be implemented in the Spring 2022. We've been in discussion with our dist-

Roland Diggelmann
CEO, Smith & Nephew

Platform will become even clearer. We expect to be the first to actually add knee and hip revisions to our platforms. We're working on a novel soft tissue balancing device for knee replacement, and we're working towards shoulder replacement with CORI following our extremities acquisition earlier this year. The unique ability to integrate our robotics platform with our arthroscopic tower will further support the expansion in Sports Medicine. Another platform is biologics, which is a capability we've built up through acquisition in Wound and Sports Medicine . It's early to be talking about specific projects at this stage, but we're looking at applications across all three franchises in biologics. Finally, there's digital as a true capability.

We already have marketed products in all three franchises, such as data analytics in Orthopaedics, then of course, the connected tower in Sports Medicine, and also wearables in wound with the LEAF Patient Monitoring System. We'll continue to work on digital applications covering the whole cycle of care, both internally and with partners, and then potential applications for visualization and also artificial intelligence. The final of our value builders is M&A. We've added assets over recent years that move a number of our segments to structurally higher growth potential, such as adding the Osiris.

Anne-Françoise Nesmes
CFO, Smith & Nephew

Shows you the levers of revenue growth that we expect from now till 2024, and sustainably thereafter. Now, I can imagine, I can picture you, although I can't see you, I can imagine that you're already trying to measure the bar. Let me emphasize very quickly that these are directional, and they're not to scale. They're here illustratively to represent where we're heading. Let me put very quickly to the side the fact that there will be a rebasing of our China business as a result of VBP in 2022. Let's look forward. Let's look at how we're building our business. One of the major

Roland Diggelmann
CEO, Smith & Nephew

Platform will become even clearer. We expect to be the first to actually add knee and hip revisions to our platforms. We're working on a novel soft tissue balancing device for knee replacement, and we're working towards shoulder replacement with CORI following our extremities acquisition earlier this year. The unique ability to integrate our robotics platform with our arthroscopic tower will further support the expansion in Sports Medicine. Another platform is biologics, which is a capability we've built up through acquisition in Wound and Sports Medicine. It's early to be talking about specific projects at this stage, but we're looking at applications across all three franchises in biologics. Finally, there's digital as a true capability. We already have marketed products in all three franchises, such as data analytics in Orthopaedics.

Of course, the connected tower in Sports Medicine, and also wearables in wound with the LEAF Patient Monitoring System. We'll continue to work on digital applications covering the whole cycle of care, both internally and with partners, and then potential applications for visualization and also artificial intelligence. The final of our value builders is M&A. We've added assets over recent years that move a number of our segments to structurally higher growth potential, such as adding the Osiris-

Anne-Françoise Nesmes
CFO, Smith & Nephew

Platform technologies. Now, what does it look like by franchise? You can see on slide 27 that the starting point for each franchise is a little different. In the near term, strengthening the foundations of supply and execution is key for Orthopaedics. In Sports, we'll continue to drive the flow of new products. In Wound, the continued improvements in commercial execution will create momentum. What's clear, though, is that over time, innovation will become a more important driver for all three franchises. Now, I won't go into the fine details here. We've got great talented team who are ready to speak with you in the breakout sessions. They'll talk you through their winning strategy. They're prepared to take your questions, so I don't wanna steal their thunder here. There's more to come through their winning strategy.

They're prepared to take your questions, so I don't wanna steal their thunder here. You have more to come. Now, if I turn my attention to trading margin, clearly our trading margin has recovered from the trough in 2020, but we recognize that it's not yet back to the pre-COVID level. Slide 28 shows the margin development up to 2021 with our guidance, which is at the low end of our previously stated 18%-19% range. Importantly, you can also see here on this slide the R&D step up that we've talked about. We've made a choice, a conscious decision to invest behind innovation, maintain our investment through COVID. That we've talked about.

We've made a choice, a conscious decision to invest behind innovation, maintain our investment through COVID, and you see that as a result, R&D is around now 60% of revenue, and it has impacted margin by about 100 basis points compared to 2019. As we've also spoken as well before, there's a further 150 basis points headwinds from the initial M&A dilution. Now clearly, those investments are laying the foundation for our improved growth trajectory. They will both drive revenue and margin in the midterm. Then just to wrap up quickly on the margin, there are other elements in terms of the 2021 performance, like inflation and effects, which we've spoken about, and some of that was offset by a combination of structural and discretionary cost savings.

Again, if we turn our attention to the future, and if we look at 2024, we expect trading margin to be at or above 21%. Slide 29 shows you the levers that will take us there, including our continued maintaining our investment in R&D. Again, there's some initial headwinds to absorb. VBP and input cost inflation, which I've talked about. These will be more than offset by the tailwinds we see. Productivity improvements will provide efficiency gains, and the higher revenue growth from commercial execution and innovation will also enhance positive operating leverage. There will also be the benefit from our recent M&A acquisitions, such as Tusker and Integra.

As their profitability rise, as we drive the sales growth, we will see that flow through the bottom line, and clearly that is the ambition of our M&A activity. Importantly, 2024 is not the limit of our ambition. We do expect further trading margin improvements beyond that, which will then give us choices of how much we invest in further growth or how much we allow to flow through to the bottom line. To finish off, let me come to the capital allocation, where we're announcing today a revised framework for use of cash. This new policy is aimed at supporting our strategy while also maintaining greater balance sheet efficiency with shareholder returns. Our first priority is to continue to invest in innovation and our sustainability agenda, and the second priority is acquisition.

As you can see, continue to invest in innovation and our sustainability agenda, and the second priority is acquisition. As you can see, these are in line with the strategic priority of revenue growth, but they're also essential for sustainable growth of earnings and free cash flow. We will do that while maintaining our current commitments to our equity and bondholder with investment-grade credit metrics and also continuing our progressive dividend policy. We are confident in our growth outlook. We'll start in 2022, when we expect around $250 million-$300 million to be returned to the shareholders.

Amongst all of this, in this capital allocation process, we've also committed to regularly review the opportunity to optimize our balance sheet and maintain efficiency whilst meeting our commitments and investment needs. With that, I'll pass you back to Roland to sum up.

Roland Diggelmann
CEO, Smith & Nephew

Great. Thank you, Anne-Françoise. You've heard our strategy and our Life Unlimited purpose. They unite the team in what we do and how we do it. I firmly believe that we all engage more when we're working for a purpose that we truly believe in. That purpose is, of course, not just limited to doing business. Taking the limits off living also applies to a wider health of society, and we also keep challenging ourselves to continuously do more here. I'd like to leave you with the enhanced pipeline from our investments in R&D and also in M&A. We have a proven track record in driving improved performance from our existing portfolio, and two of the three franchises representing 60% of sales are delivering profitable growth already through execution of our strategy.

In Orthopaedics, we're filling the portfolio gap that has held us back, and we have clear plans to drive growth with improved operations and an enhanced commercial structure to also pursue high-growth cross-franchise opportunities. The growth in margins will also be further enhanced through financial discipline and capital returns, as you just heard from Anne-Françoise . With that, we'll take a few questions, before then moving to the breakout sessions. Thank you very much.

Andrew Swift
Head of Investor Relations, Smith & Nephew

Thank you, Roland. For this session, you can enter questions through the messaging function on the right-hand side of your screens. We'll have time for a few now, and then when we get to the actual breakout sessions, pre-registered investors and analysts will have plenty of time to ask questions in person then. We've received some questions as the presentation's been going on. A few, Roland, around mid-term growth and it being above the levels that the company's been able to sustain in the past, and why that is and what's different now.

Roland Diggelmann
CEO, Smith & Nephew

Well, I think it's a new team. Some of the evidence is coming through now. We see strong execution in 60% of our business [audio distortion] OR3O in hips. We see fast adoption.

Andrew Swift
Head of Investor Relations, Smith & Nephew

If it's a steady progression up to 21% or more backend loaded.

Anne-Françoise Nesmes
CFO, Smith & Nephew

To a sustained margin improvement and a steady margin improvement. We know it's around revenue growth. More to come in terms of specific 2022 margin guidance during our full year results in February. Yes. Clearly, and here maybe happy, Roland back to that level, and we're signposting by 2024.

Andrew Swift
Head of Investor Relations, Smith & Nephew

A few people are asking the views on 2021 guidance, if we still stand by that. Also questions on-

Roland Diggelmann
CEO, Smith & Nephew

The scene which is really exciting now that we are going into full launch. We have some homework to do around the commercial excellence and around operations and supply. This should allow us. Now we're down 6%, and I believe it's at the right place, it's at the right level. We're not thinking of a further step up in R&D. What you'll start to see is the R&D investments that we've made are coming into products that are coming to the market that will drive the sales line. That is what we have mentioned and what Anne-Françoise has also just mentioned. What's so important for us is that we get to a structurally higher sales-

Andrew Swift
Head of Investor Relations, Smith & Nephew

Growth from 2022 to 2024, why we haven't guided to that, and if you're saying that it will be below the mid-single-

Anne-Françoise Nesmes
CFO, Smith & Nephew

Then you see the innovation accelerating and coming through. Again, if you like more-

Andrew Swift
Head of Investor Relations, Smith & Nephew

Another question we have on capital allocation. Does the commitment to buyback indicate that investment opportunities are becoming thinner or simply that the company thinks the shares offer better return potential on the next three to five years?

Anne-Françoise Nesmes
CFO, Smith & Nephew

I think our capital allocation really reflects our strategy. You know, first is innovation, second is acquisition, and Roland has outlined the criteria for that. Then it's return to shareholder via dividends or through the share buyback. What I think the share buyback reflects is our confidence in the business, but also the ability of the business to generate cash. It's something we don't often talk about unfortunately, but we generate cash, we have excess cash, we need to optimize the balance sheet and return funds to shareholders. I think it's very much aligned with the strategy, and it's almost the natural logical consequence of the strategy we've outlined today. Oh, I think Andrew, you've gone on mute, I think.

Andrew Swift
Head of Investor Relations, Smith & Nephew

I'm sorry. Let's probably start with one final question. Could you discuss the interaction of the growth and margin ambition by 2024, what the effect on trading margin would be at the different parts of the revenue range, and how that relates to the 2021 target. Sorry, not the 2021, the 21% target. Sorry.

Anne-Françoise Nesmes
CFO, Smith & Nephew

As I said, the margin will be driven by the revenue growth. First, you know, it's that looking for that operating leverage from getting momentum in that top line growth. Then secondly, you know, driving the productivity. We've outlined in the presentation some of the levers we will have. You know, an example was the prioritization of the most profitable markets, being super disciplined on where we launch, which also simplifies your business. The second, although it takes a little bit more time to achieve, but it's the portfolio rationalization. We've done some work already around the EU MDR, but there's more to go after. You know, the example we know is in Orthopaedics franchise, you know, 25% of SKUs generate like less than 2% of revenue.

Now, clearly, some of those SKUs will be needed 'cause you need your bag as you know, the team tells you we need the complete tool to be able to perform a surgery or for the surgeons to perform the surgery. There is more we can do in terms of simplification, and that will all flow to the bottom line. As our margin recovered, then it gives us the choices. Do we want to reinvest further, or do we let it flow to the bottom line? That is the position we need to be in.

Andrew Swift
Head of Investor Relations, Smith & Nephew

I think given time, there are more questions that people have, but there'll be time to cover that in the breakout sessions as well. We'll close this session. There's now a short break before we move to the breakout sessions, which will start at 1:45 P.M. U.K. time. If you're registered, you'll have received a personal link to connect to the breakouts in the last hour. When you do connect through that, you'll be moved to the right room by a moderator. To make sure that's run smoothly, we'd ask that you log in 10 minutes before the session begins, and you can stay muted until the start time.

As a reminder, the materials for this session and to support the breakout sessions are in the resources section of the portal, and available to you. Thank you all for joining, and we'll speak again in a moment.

Anne-Françoise Nesmes
CFO, Smith & Nephew

Thank you.

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