Good morning, everybody. Good morning. Morning. Thank you for joining us. Before we start the results, I'd just like to start by paying tribute to our very dear friend and colleague, Martin Angle. He was one of our non-executive directors, and as you may be aware, he sadly passed away last week. As many of you will know, Martin had a hugely successful and distinguished career. He had senior positions in a wide range of companies across banking, private equity, industry, and of course, healthcare. He joined our board in 2019. He was Chair of our Audit and Risk Committee, and he was a member of several of our other committees.
Martin was a personal friend to me and to many colleagues, and I know I speak for many when I say we will miss his knowledge, his experience, his passion for our business, his personal support, his guidance, and of course, his sense of humor and the twinkle in his eye before he asked really difficult questions at the board. So we send our heartfelt condolences to his family at this difficult time. In honor of his memory, I'd like to announce that we are working with the University of Exeter, where Martin was an honorary professor at the College of Social Sciences and International Studies, to establish a scholarship fund to support students who wish to pursue an education in medical sciences or healthcare. Martin was passionate about his connection with the university, and we feel this would be a nice way to pay tribute to him. Thank you.
We're proud of our results, and Martin played a key role in supporting us achieve them. I will now move on with a brief overview of some highlights of H1. Harbant Samra, who as you know, took over as CFO in May, will take you through the detail of the results, and I will return at the end to talk about the remainder of the year. Then I'll open up for Q&A with Harbant and myself. I'm pleased to say that we delivered a strong financial performance in H1. EBITDA of GBP 130.6 million is up 10.8% on H1 last year, and all of our other key financial metrics are also up compared with last year, as you can see here, and it's in line with our full year guidance, which we gave at the start of the year.
Among these metrics, I'd like to highlight that our focus on enhancing margins has enabled us to deliver a 30 basis point increase in hospitals EBITDA margin from 17.7% last year to 18% this year. This is underpinned by the success of our savings and efficiency programs, which are on track to generate at least GBP 15 million of savings in 2024. You will remember our strategy, which we covered in detail at our Capital Markets Day in April, so we won't be covering that in detail again today. But here are some key achievements against the strategy in the first half. As I've mentioned on many occasions, investing in our workforce is key to our success. Our reward strategy is in progress, and investment levels will be similar to last year.
We are, for the first time since I've been here, almost completely fully staffed across our network to our establishment models. Colleague vacancies are at a record low, and turnover is at its lowest level for many years. In the most recent twelve months, clinical staff turnover was 12.7%, down from 16.3% this time last year. This is enabling us to further reduce spend on agency staff, which is down 39% year-on-year. Quality and patient safety is at the heart of everything we do. We remain at 98% of our sites, rated good, outstanding, or the equivalent by the CQC and the regulators in Scotland and Wales.
I'm delighted that we are seeing record ratings in patient satisfaction, with 97% of inpatients and day case patients now rating their overall experience as either good or very good in recent surveys, which is up a point on last year. This reflects the progress we have made to maintain and enhance our high levels of quality of care. Now, with patients' permission, their feedback now feeds live into Trustpilot. You can go online and look it up for yourself, and I'm very proud to say that this is leading to a 4.5 out of 5 rating on Trustpilot. This is the first full reporting period that Vita has been in the group since we acquired the business in October 2023.
I'm pleased to say that Vita is integrating smoothly into our broader business, and the development of our new community and out-of-hospital services is progressing well. H1 saw us take over the provision of NHS talking therapy services in Kent and Medway, with 200 new colleagues coming into the business, and we also successfully retendered for two corporate clients, including John Lewis and two new musculoskeletal contracts. And a good example of integration is the creation of patient pathways from Vita's community musculoskeletal service into Spire Hospitals, and more of that later.
So at half year, we're really proud of what we've achieved in the first six months of 2024, and as always, and most importantly, I want to extend my thanks to all our brilliant colleagues, consultant partners, for their hard work, their compassion, and dedication to making a positive difference to people's lives by delivering outstanding personalized care. So thank you very much. I'll now invite Harbant to go through the detail of the financials. Harbant?
Thank you, Justin. Sorry. All right, so thank you, Justin. Good morning. It is my pleasure to present our results. It is great to be able to say that the group has made strong financial progress in the first half, delivering growth in hospital margins, improving total earnings and returns. I'll start by sharing our key P&L measures for the group as a whole. As a reminder, we acquired Vita in October 2023. Therefore, our half year group numbers reflect a full period of trading by Vita, resulting in a change in the shape of the P&L. We now think about the group as the hospital business and our new services business.
Looking at the two together, group revenue is up by 12.7% to GBP 762.5 million and has resulted in strong growth in Adjusted EBITDA, up 10.8% to GBP 130.6 million. There has been a similar level of growth in adjusted EBIT, with a half-year outturn of GBP 75.7 million. I am pleased by the level of growth further down the P&L, where our continued focus on controlling interest costs and depreciation has led to a high level of flow through to adjusted profit before tax, which has risen by 20.2% to GBP 26.8 million. Finally, our statutory profit after tax has risen by 11% to GBP 14.1 million. Turning now to our hospital business.
Total revenue for the six months grew to GBP 702.8 million. After adjusting for the sale of our Tunbridge Wells site, which took place in March, this represents growth of 5.4% against the comparative period. The growth at an Adjusted EBITDA level and adjusted EBIT level was higher at 6.6% and 6.9% respectively. We are focused on improving margins and converting more of our revenue into higher returns. It is pleasing, therefore, to report that Adjusted EBITDA margin for the six months increased to 18% versus 17.7% for the first half of 2023. We've also delivered an increase in adjusted EBIT margin, which has risen to 10.4% against 10.2% for the prior period.
These improvements in margin reflect our underlying strategy, where we are focused on optimizing utilization, driving revenue growth through higher ARPC, and delivering cost savings, all of which are topics that Justin and I will cover in more detail during this presentation. Before I go into individual payor groups within the hospital business, I will quickly remind you that our approach towards optimizing revenue is done with reference to the payor groups as a whole. It is therefore pleasing to confirm that the overall outturn was in line with the expectations we set out for 2024, 2025. As for the underlying payor groups, for PMI, we saw strong growth. This is underpinned by a growing market and the fact that we benefit from long-term partnership agreements with PMI companies which drive volume and profit.
It is also worth noting that the patient demographic under PMI arrangements tends to be of a slightly younger working age, often requiring day case services as opposed to inpatient treatment. Therefore, while the increases in PMI activity drives profit, it tends to be at a lower ARPC. For self-pay, we said we saw modest growth with some mixed upside. We continue to focus more on orthopedics than in low-value areas such as cosmetics and ophthalmics, where the market is becoming more competitive and we are seeing some switching from self-pay to PMI. As for NHS, we saw a strengthening market. ERS conversion has increased, and as you will see shortly, ARPC has benefited from our focus on acuity.
Private revenue relating to inpatients, day case patients, and outpatients as a whole grew by 5.1% against the comparative period to a total of GBP 509.5 million. This means that private represents 72.5% of the total revenue generated by our hospital business. This is comparable to the prior year and well within the 70%-80% we have guided to. We're increasingly viewing the private market as a whole, especially as more patients switch from self-pay to PMI. A key performance indicator for us is sustained growth across this combined market, and this period saw an increase in volumes, ARPC, and revenue continuing a five-year upward trend. PMI has underpinned the growth in our overall private performance. The market is buoyant, with an increase in the number of lives covered.
PMI revenue was up 9.7% year-on-year, and ARPC was up 4.2%, reflecting both our strategy to seek higher acuity work, as well as benefits from the pricing mechanisms in our partnership contracts. Moving on to self-pay, total volumes are down but remain around 30% higher than in 2019. We delivered ARPC growth of 7.5%, but saw a modest fall of 3% in revenue, partly due to some patients switching from self-pay to PMI. The substitution effect is clearly visible in these charts, where we have set out new outpatient consultations by age. In the case of PMI, the growth is being driven by those aged 64 or less, in other words, by individuals who are likely to be working.
We are also seeing an increase in under 35s using PMI, which is a positive for the sector. As for self-pay, the fall is also linked to those aged less than 64. Whereas volumes for those patients aged more than 65, and so potentially no longer working and unlikely to have insurance provided by an employer, have continued to rise. I'll now move on to NHS activity, which continues to be an important part of our business. Admissions and outpatient procedures have grown by 1.3% and reflects our strategy to increase ERS conversion, focusing in particular on orthopedic activity. By focusing on the right acuity, we have delivered a 6.4% uplift in ARPC, which compares very favorably against the NHS tariff of 0.6% from April earlier this year.
We await further information on how this tariff might be impacted by the recently announced NHS pay uplift. The increase in ARPC, combined with the higher level of volume, has led to an overall rise in NHS revenue of 5.2% against the prior period. Turning to our savings program, firstly, a reminder that we expect to generate additional savings of more than GBP 60 million per annum by 2026, compared with 2023. This is supported by four work streams: digitization, robotic process automation, centralization, and other operational efficiencies. These activities will generate a wide range of savings, including those from enabling operational efficiency and flexibility on how we manage the day-to-day business. We have a high fixed cost base, especially at full employment, and these measures are designed to reduce these costs and give us greater operational leverage.
We said that we'd achieve at least GBP 15 million of cost savings in 2024, with this being weighted towards H2. We're on track to meet this target with a number of changes already delivered or in flight. Examples of this are that we've started to roll out our purchase to pay program, where our pilots for pharmacies are well underway. These will drive procurement savings and reduce stock wastage. We have also continued to consolidate admin functions. Our Brentwood Center is now supporting five hospital locations, and we're also increasing the digital access points for our patients. Let's now look briefly at Vita. Comparing the first half of 2024 on a like-for-like basis against H1 2023, which was before it was acquired by Spire, it is now up on many key metrics.
We said at the time of the acquisition that we anticipated revenue of over GBP 100 million and EBITDA of around GBP 10 million in 2024, and we're on track to achieve this. I'll now turn back to group performance. The group has incurred adjusting items of GBP 5.5 million during the period, up GBP 4 million against 2023. Within this charge, there are three items to highlight. Business reorganization and restructuring charges, amounting to GBP 1.8 million as planned, are mainly one-off severance costs associated with the operational changes that are underway as part of our savings program. The group sold its Tunbridge Wells site for close to GBP 10 million in March of this year. Net of tax, this resulted in a profit of GBP 3.5 million.
Lastly, the group has increased its provision by GBP 4.6 million for the remediation of the malpractice issues linked to Paterson, which go back up to 30 years. This is a voluntary fund, which we set up as part of our commitment to compensate victims, and is managed independently by legal firms. We have finished our review of living patients, and our review of deceased patients is almost complete. The increase in provision is our current best estimate of the total potential costs and also covers claims which were lodged in prior periods but concluded in the first half. The group continues to hold a significant cash balance, standing at GBP 43 million at the end of the first half. This compares with a cash balance of GBP 49.6 million at the year-end.
Much of the movement in cash is driven by timing, and this aligns with what we expected. Take, for example, CapEx, where we've invested GBP 51.5 million versus GBP 31 million in H1 2023. In previous years, we've tended to back-end CapEx into H2, but this year we've smoothed out our investment over the course of the year. Our full-year guidance on CapEx remains in the range of GBP 95 million-GBP 105 million. Secondly, we have seen a working capital outflow in the first half of the year, which is consistent with the comparative period. We typically see an outflow in the first half due to seasonality, and in particular, the timing of NHS receipts. We expect that this will correct itself over the course of the second half. We have made good progress with rolling out our extensive CapEx plan.
We are delighted to have opened our Abergele clinic in March of this year, which is trading as expected. Most of the investment activity to open another clinic in Harrogate has now been completed and will open its doors later this year. We have also recently opened a new minor ops unit at Spire Claremont. Our energy cost-savings initiatives are progressing as planned, with solar and other energy management systems in the process of being installed across our network. We also continue to roll out our extensive program of refurbishment. For example, significant projects have been completed at our Portsmouth and Washington sites, underlining our commitment to ensuring that our facilities offer a high-quality experience.
As you heard from Justin in his opening comments, the business delivered progress in all KPIs across the group, many of which link to our medium-term financial objectives, which we discussed in some detail at our capital markets event. We have a positive story to tell against each area. Starting with revenue, for the first half, this stood at 5.4% for the hospital business, and so was in line with our medium-term target. Vita has made steady progress, as I mentioned earlier. We anticipated margin improvement for the hospital business, underpinned by cost savings for the full year of at least GBP 15 million. As I've just disclosed, the hospital business EBITDA margin has risen to 18%. We expect further growth in the second half as our actions to drive savings start to contribute more benefit.
We invested GBP 51.5 million of CapEx during H1, which is close to the midpoint of what we guided to. Growing the group's ROCE to more than 10% is an important medium-term goal. At the last year-end, we indicated that we would make solid progress towards this goal during 2024, with a full-year ROCE of 8%-9%. Based on the last 12 months of trading through to the thirtieth of June, the group's ROCE has risen to 7.6% from 6.9% for H1 last year. This was in line with our plan, and we expect growth to be weighted towards H2. Our bank debt leverage ratio has fallen from 2.2 at the year-end to 2.1.
Lastly, we guided to a range of GBP 255 million-GBP 275 million EBITDA for the full year, and we believe that our outturn of GBP 130.6 million is a solid foundation for an outcome within this range. In summary, the group has made strong progress in its financial performance for the first six months, carefully managing the significant operational changes that are underway and are gathering pace to drive savings, while always providing high-quality care. We have delivered margin growth in our hospitals and improved the group's earnings and returns, and expect further progress in H2. With that, I'll now hand you back to Justin. Thank you.
Thank you. Thank you, Harbant. So these are our key priorities for H2: continued growth in our hospital revenue, delivering on our hospital savings program to enhance margins, keeping quality at the heart of everything we do, and our integration and future expansion plans for Vita and our new services. I'll then talk about our guidance, which remains unchanged from the time of our full-year results in March. So on revenue growth, our views of trends for 2024, 2025 remains unchanged. Strong growth for PMI and modest growth in self-pay, with mix upside, notwithstanding a softer first half. As regards PMI, I'm really pleased that we've recently been successful in tendering to be part of Aviva's hip and knee network, which will support further growth in 2025. In the NHS, we anticipate modest growth, but there are signs that it could become stronger.
Spire stands ready to work with the new government to help address waiting lists. It is common to think of PMI, self-pay, and NHS as three different consumer patient markets. However, given the movement in many self-pay patients to PMI, we increasingly see the private space as a single market, and in this we anticipate good growth as the population ages, younger people in particular seeking out PMI, and the underlying challenge for people in accessing fast elective healthcare, and patients also switch between the NHS and private healthcare, meaning that the trends in the NHS and private markets are somewhat connected. Taken as a whole, the overall prospects for the hospital and health sector remain strong. We will continue to deliver margin enhancement by growing revenue and mix, and also through our savings, efficiencies, and digitalization programs, which, as Harbant has said, are on track.
These are self-help initiatives. They drive improvements across the business. They also amount to a significant change program, which involves, in some way, nearly all of our colleagues, as well as, over time, a lower employee base, and we are leading this program as a management team from the front. The whole business is engaged, and the program is going well. This program is also delivering improvements in the patient journey, as well as safety and quality benefits. And on quality, we have a number of initiatives in train for the second half. We will continue to embed PSIRF, which is a new mechanism for learning from incidents, that seeks to include everyone involved, including patients, in a blame-free environment, and we are proud to be among the sector leaders in rolling out PSIRF. And we're bringing in new ways of celebrating excellence among our colleagues.
We've introduced the International DAISY Scheme, which recognizes exceptional nursing colleagues, and we've also introduced IRIS, an Inclusive Recognition of Inspirational Staff awards, developed by our Group Clinical Director and Chief Nurse, Lisa Grant, which is similar to the DAISY scheme and designed to recognize our other clinical colleagues, and I was delighted to join Lisa in presenting one of the first of these awards to one of the winners in Liverpool just a few weeks ago. Another priority for H2 and the period ahead is expanding our primary and community care services. We will be trialing a new community-based healthcare proposition in the coming months, bringing together our GP, physiotherapy, mental health, and health assessment services, so patients can access these all in one place, and these services will be found in some of our GP clinics and new Spire clinics initially.
We've just launched Spire Mental Health, in which private patients can access talking therapies delivered by Vita through Spire's website, and this service will ramp up during the second half. We continue to drive economies of scale, synergies, and efficiencies within our small but growing primary care business. And one example of this is the introduction of Spire's fully digitalized pathology services into our GP sites to replace a previously outsourced provider. And we'll continue to grow our occupational health business, which we've been streamlining and focusing so we can lean into the material opportunity in that area. And we'll present a fuller strategy update on our new services in 2025.
So Harbant outlined how our H1 performance was in line with the metrics we laid out at the start of the year, and our group trading is within the guidance range across these financial metrics for the full year. So to summarize and build on Harbant's points, we've had a strong H1. We delivered growth in hospital margins. We improved group earnings and returns. We are trading within guidance on our financial metrics. Thank you very much for your attention. I'll now open it up to questions from the floor and, of course, from our online audience. Thank you very much. And could you please state your name and organization before your question? Seb.
Hi, good morning. It's Seb Jantet from Panmure Liberum. Can I just start off with a question on cost savings? Could you give us the number of cost savings that have been achieved in the first half?
Yes, Seb. So, happy to take your question. So we've previously said that we were going to achieve at least GBP 50 million of the cost savings during the full year. We've also guided to the fact it's more heavily weighted to the second half. We've never given a split of the savings out across H1 and H2, but it is more heavily weighted towards the second half.
Okay. Just moving on to self-pay then. So I'm just trying to understand what's happened in self-pay. It looks like your self-pay volumes are down 10%. If I look at the PHIN data for the first quarter, the PHIN kind of data suggests volume is down 4% in self-pay. So that suggests either that you've underperformed the market or you've been highly selective in what you're going for. So I wonder if you can give me some more color on that and try and explain what's happened.
Sure. So if you dive into PHIN data, have a look at Northern Ireland and London and take it out of the statistics, 'cause those two are in growth, and the rest of the market is down more, by the way. However, we're not playing, and in fact, our market share in all our hospitals, we think, is at least flat. So this isn't, for us, about market share. If you look at what we have been doing also, it is defocusing on cosmetics and ophthalmology. So obviously, ophthalmology is one of the key areas in self-pay. So again, we're not too worried about the overall number. And you'll also see that we have been focusing increasingly on core areas, which is why our ARPC is up.
But I think you'll find if you dial into the analysis, it's a comparable trend pretty much across the piece, and those statistics also only go to March. Now, I think the key underlying trend is what's happening in the market overall is, first of all, it's still up 30% pre-pandemic. So let's put it in the big context. Self-pay is a bigger market than it was before. It's a bigger piece than it was for us before, so it's still a strong market. It is clear, as we've said, that within that younger cohort, there's a big take-up of PMI, and you can see the statistics. The older group is still growing, and that also is where the more complex treatments are, and the smaller group are switching to PMI.
And that's one of the reasons why there's a bit more day case in PMI, 'cause as PMI grows, it tends to be younger people, and they tend to have less complex treatments. So in the older cohort, you might have a knee replacement. In the younger cohort, it might be a meniscus repair. So for us, the trends are very clear. There's a substitution effect and within our discipline around pricing and focus on core procedures, we're comfortable with progress.
Okay. And then last question then, just, you know, traditionally, the business has a stronger first half than the second half because of the seasonal nature of that. Now, the reason I was asking about cost savings is to try and understand, you know, if you look at the numbers and the guidance, there's clearly an assumption things will get better in the second half. So I was trying to understand how much that was gonna come from cost savings differential versus the first half and second half. But maybe I'll ask the question the other way around. Are you assuming an improving market condition in the second half, or market conditions staying broadly the same in terms of kind of volume trends?
Harbant?
So, in terms of, I mean, what I'd point you back to, Seb, is actually how the business performed in the prior years. Typically, you see a fairly stable performance for H1 versus H2 in terms of trading, and I don't think that there's any real reason that we would shift away from that, and then secondly, like I said earlier, in terms of savings, I would look to that particular aspect in terms of, as you, I guess, build your model for the second half, to have a think about how that savings piece will then play out in the second half.
So if I just address the market point, I've talked about it over a slightly broader period, 'cause it's always hard to assess a market over a two- or three-month period. PMI is clearly a growth trend, okay? So we expect that to continue. We still think over the medium term that self-pay will get back into modest growth, by the way, in revenue terms overall. It's a key ARPC contributor. There is clearly a mix effect both in the market and for us, so we still think in the medium term that will come to modest growth again in revenue terms. And in terms of NHS, that could strengthen. There's obviously a lot of conversations about what the independent sector can contribute. We have been working closely with ICBs and trusts, particularly for long waiters, to help them out there, and generally working on making sure.
We have a lot of slots on the ERS that go unused, like the rest of the sector. That trend is improving, so that trend might improve, let's say, over the medium term, 'cause it's very hard to predict exactly what will happen in any one month, but I think probably PMI and NHS will be competing for growth in the market and in us overall, with some recovery in self-pay over the medium term. That's what we expect.
Brilliant. Thanks.
Other questions?
Good morning, Kane Slutzkin from Deutsche Numis. Maybe just to follow up, Seb, just on that sort of second half, on the sort of margins, could you just sort of give us some of the puts and takes around sort of inflation and a s agency spend down 39, that's probably quite significant. And just sort of energy, I remember there was something rolling off, wasn't there?
Yeah, so the way I'd look at our cost base, Kane, is I'd split it into three or four categories, right? So clearly, the biggest element of that is labor costs, and we talked about that before and given some very specific views in terms of how that will play out versus last year. You've also got then the rest of our direct costs, so consumables, prosthesis, that's the way to look at that, and that's been pretty much in line with expectation. There's been a few pockets where, you know, maybe the repricing has been slightly higher, but our procurement team's done a pretty good job in terms of managing that through other relationships or other activities of procurement. So that's been relatively flat.
If you look past that in some of other aspects of our cost base, you've got rent. That's fixed at 4-5%, and clearly, that's capped out for the for this year at least. And then, if you get into the specifics, such as energy, we've hedged through to the end of next next year, December 2025. That was done earlier this year. So clearly, there is an uplift compared to the hedge that we entered into a couple of years ago. But in the context of our P&L as a whole, it's not particularly material.
Thank you. Just on Vita, obviously, it seems like you're integrating quite well. Just wondering, when you bought it, you kind of spoke about sort of potential revenue synergy, downstream revenue synergies with the corporate, so the PMI customer base. Are we seeing? I know it's still quite early days, but could you maybe just talk to that? You did allude sort of future expansion plans, too. What are we talking about there? Is that just winning contracts or?
So, shall I talk about Vita overall a bit, 'cause, and the whole sector? So step back slightly. I mean, if you look, for instance, at the Darzi review this morning, one of the key things that keeps being brought out is the two point eight million economically inactive. And Vita services, combined with Spire services, really center in on that, okay? So the combination of mental health, physiotherapy, and then treatment in the hospital if you need it, the statistics with PMIs for return to work is more than 90%. So when we work with corporates to help them with their colleagues who are off sick, we get them back to work, and that's really quite a powerful statistic, which we're talking about, and we have got work now with corporate clients, which absolutely focuses on combining all of those.
It's also something that we think we can lean into with government. You'll have seen from what I was saying that we're starting to synergize the Vita services and the Spire services, bringing them into clinics, bringing them into GP clinics, offering private offerings for the Vita services, so I would say that overall integration is probably ahead of where I thought it might be. It's gone really well. Derrick's leaned into it, the team have leaned into it. PMI providers and corporate providers, lots of conversations.
You saw that we've been re-winning some really big contracts, which is really pleasing, with potential for more that we're bidding for. So I think it's going well, and I think we are now, albeit it's small, at the very center of where quite a lot of corporate and potentially government engagement is, which is not just about waiting lists, but it's about essentially that primary care provision, and mental health provision.
Thanks. Just last one for, from me. Just on the freehold, there's no update there, is there, on valuation?
No, we will typically release an updated valuation at the year end.
Do you guys have any view on the Assura deal or?
All I know is what's out in the public domain, so was it done at 5.9%?
Yeah.
And I don't know whether that's really reflective of the wider market c ause there are specifics around that transaction, right? So yeah.
Although I would just emphasize, of course, we're talking to them as our new landlord, so to speak. Other questions? Yes. Okay. You're next in line.
Sorry. Thank you. Natalia Webster from RBC. I guess my first question's just on the PMI market. So general market data's been really strong, and you've referenced sort of general market growth. But we've seen data that's kind of been growing into the mid-teens, and your volumes are growing at sort of 6%. So just interested to hear how your market share is progressing there, given your self-pay market share is stable.
So if you look at PHIN overall, our overall private market share is stable or growing slightly. So that's the simple market share answer. A lot of the PMI growth, by the way, is mental health provision, a lot of which they do themselves. So it's quite hard to unbundle that growth because quite a lot of it is primary care and diagnostics. Now, if you look at our diagnostics piece or our outpatients, that's growing very strongly.
But of course, when you weight it in our total business, it looks smaller. So, we're pretty confident we're at least growing with the market. You just heard the announcement about Aviva and hip and knee, which will be a significant, market share, improvement in our core areas where we focus. So as far as we can triangulate the overall data, we're confident about our market share and about the growth prospects in PMI.
Great, thank you. And then just a confirmatory question. You say you're positive into 2025. Just wanted to confirm if you're still confident on your 2026 margin targets.
The 21%, which is a hospital EBITDA margin, by the way, just to be clear, because obviously you've got a group effect going on in our numbers, which is why we now break them out. We're still working towards that number at the end of 2026 .
Great, thank you.
Can we, yes, lady in front. At the front here.
Thanks. It's Victoria Lambert from Berenberg. I just wanted to drill down on the Aviva contract that you mentioned. Sorry if I missed it during the presentation, but did you say you've won this already, or you were tendering for it?
But it kicks in in 2025.
Okay. And it's a new contract because you already do work with Aviva.
But we're not on that particular network, and we now are.
Okay. And do you expect, like, a group-wide, like, a small single-digit contribution to growth or, like?
We won't give any numbers about that individual contract, but it's an important contract for us.
Okay, cool. Thanks.
Other questions? Are there any online questions? No online questions. Any other questions in the audience? Any at all? Going, going, gone. Thank you so much for coming. Oh, Kane's got his hand up. Go on. We have a last-minute bidder.
Just, I was interested. Sorry. I was just interested, sort of looking at Ramsay's results the other day, and they kind of seem to be having quite a big fight with the insurers. Mainly, I guess it's in Oz. I'm just wondering what you make of that, and is that something. I mean, I know you probably have tough decisions either way with the insurers, but it seems like they're calling it out. It's quite a big industry thing, their side at least. I'm just wondering if you have any comments.
I suggest you ask Ramsay about that. Look, we have very constructive conversations with our insurers. I mean, you'll have noticed that we've got centers of excellence for orthopedics, we've got a center of excellence for cancer, and cancer is one of our fastest-growing areas, and that is driven by leaning into a service, which means quick diagnosis, quick movement to treatment, quick movement to chemotherapy. So, I mean, of course, you have commercial conversations with insurers, but I would, I think, without exception, characterize our relationships at this stage as constructive, focused on patient pathways. So in the second half, it's gonna be much easier for PMIs themselves and patients to book online their insurance pathway. That's something we've been working on. That's part of our technology enhancement. And I would genuinely characterize most of our conversations being around. So Aviva is obviously positive.
How can we improve patient pathways? Our mission in life is for patients to be seen quickly, safely, and fast, and I think I can genuinely say that most of our conversations, I'm looking at Peter, are around how do we do that together. That's my answer to that question. With that question, are there any other questions? Okay, well, thank you very much for coming, and we'll see you at full year. Thank you.