Good morning, everyone. My name is Nishant Singh. I head the IR and Strategy for the group. I welcome you all to this special call organized to discuss our latest acquisition, PPG Hospitals U.K. In this call, we also have with us, Dr. Emmanuel Rupert, our MD and CEO. Mr. Viren Shetty, our Vice Chairman. Dr. Anesh Shetty, MD of our International Operations. Ms. Sandhya Jayaraman, our Group CFO, and Vivek Agarwal, Senior Manager, IR and Strategy. With this brief introduction, I will hand over the forum to, Anesh to take you through a brief introduction of the target, [crosstalk] which we can start the Q&A.
Thank you, Nishant. Thank you, everyone for joining us. We thought we'll begin the call by spending the first five minutes just giving an overview about why we decided to enter the U.K. market, and within the market, why we decided on Practice Plus Group Hospitals. As most of you who have been following the company for a while know, it's been about 12 and a half, 13 years since we first entered the Caribbean and the Cayman Islands. The asset has been operational for about 11 years now. Once we overcame the initial three to four years of settling into that market and things started looking very positive, we've always been on the lookout for our next international operation, our next international opportunity.
Through that process, over the past, I would say, five to six years, we have been to almost every developed country which has an opportunity for private healthcare. We've considered definitely every market in the vicinity of Cayman, which is in the Caribbean, as well as most other markets elsewhere as well. It is challenging for us to settle on something, simply because home is in India, a market we are most familiar with, which many would agree is currently one of the world's, if not the world's, most attractive investment market for healthcare globally.
Whatever else we found, it has a very, very high bar to compete against. It has to be meaningfully more attractive than us deploying capital in India, which makes us very, very selective. Even though we came across several opportunities over the past few years that were good across all sizes and shapes, we never did anything meaningful until today. We're very happy to report that after a long search, we believe we've arrived on not just a country that is very, very interesting and attractive, but also an asset within that market, that we believe will be very, very accretive to our larger picture.
Coming to the U.K. market, what makes this attractive for us, aside from the obvious aspects of being a stable country, a developed country, clear rule of law, business certainty, policy certainty, and things that are more common across various industries, for us, particularly in the business of private healthcare, it is very reassuring to know that across political cycles, irrespective of which party or which orientation was in power, the role of the private sector in being a key pillar of addressing the healthcare needs of the country has been widely and universally acknowledged, and is now seen more as a matter of fact and one that will take on an increasingly important role in the years to come.
Within that industry as well, we are also comforted by knowing that there have been meaningful success stories with the other large operators, many of which, or I would say most of the top large players, are owned by international multinational corporations or international investors. We find an interesting market, which not only has growth potential, but which is stable in its broader conditions, which has a track record of other operators who are doing wonderful work and who have seen good success, as well as a long-term future w here we can build essentially a multi-decade business scaling and operation. Within that market, within the U.K., we considered several assets.
Some of you may know, or over the years we've spoken or had fairly early discussions with a whole range of providers, some of whom are very small, some of whom are very, very large and some in between. We believe Practice Plus fits into the sweet spot in terms of its size. If the asset is too small, then there's not much we as NH can do to add value. At the same time, if it's very, very large, there are certain other complications where it becomes unwieldy. There are other complexities in running that.
In terms of size, this is a good sweet spot where we believe it is large enough for us to not only own 100% of it, but large enough for it to have the critical size, for us to make a meaningful difference with what we bring to the table, which I'll come to shortly. Yes, we also note that this asset has certain aspects of the business, in terms of its payer profile that are meaningfully different than other peers. We see this as an interesting opportunity. There were certain assets we considered, that had a very, very privately oriented payer mix, which is great from a profitability standpoint, but that also leaves less room to improve and less value for us to add.
More importantly, it is very, very important for us that we buy a business which has a management with a proven track record that is safe and secured with the new ownership. W e're happy to report that the fantastic management, the entire senior leadership of this organization, is going to be staying with us, even though we are buying only one division out of the three. It's a company with three divisions. We're just buying the hospitals division, but we've secured and aligned the key people in the senior management. W e're very confident in our ability to work with them, and they're very bought into the larger vision of what we bring to the table as well. I'm just going to request Mr. Rakesh to go on mute, please. Yeah, j ust continuing. We're very confident and eager to get started with the management team under new ownership.
This is the capable group of people who've been running the business so far. We feel that there are all the ingredients in place for us to essentially make a good attempt at replicating what we've done in Cayman, but on a much larger scale and in a much larger market. I think that addresses the two largest questions we got, which is why the U.K. and why this particular asset. Also happy to get into the question- and answer session and answer any specific questions, or take this any other direction that you guys want. Nishant, maybe we can start.
[crosstalk] the Q&A.
Yeah. Sorry, Sandhya. Go ahead.
I just wanted to clarify one more financial point, which was n't there in our earlier deck. The numbers which we had shared in our deck earlier were pre-IFRS. When we reported GBP 20 million as the EBITDA, it was pre-IFRS, which means after adjusting the lease costs. If we take the like-to-like post-IFRS EBITDA, which is before the lease costs, it is GBP 29 million for FY 2025. We' ve since added this in the deck, and we will be uploading the revised deck shortly.
Nishant, how do you want to do this?
Yeah, s o we can start the Q&A session now. We request everyone to now use the raise hand feature to start posing the questions. I think we already have a raise of hands from Ravindra. Ravindra, can you please go ahead?
Hello. Am I audible? Hello?
Yes, you're audible.
Yeah, we can hear you.
Yeah, this is Ravindra from Bangalore. I'm a retail investor. Actually, over the weekend, I got hold of the annual report of the acquired company, right? I was going through that. I have a few questions around that. Firstly, I want to clarify that we are going to acquire only the hospital division, t hat's the secondary care division. Am I right?
That is correct.
Right, o kay. I'm looking at the revenue for the financial year [crosstalk].
This meeting is being archived.
Okay. As per that, the revenue in terms of Indian rupees is around INR 2,660 [crosstalk] . I'm taking an exchange rate of 116. In million terms, it' s INR 229. That has been reported in the annual report last year. In your deck, I think the numbers are not matching as such. That's the one thing. Am I correct on that?
Yeah. We're happy to take that question offline. Nishant, I think he will reach out to you to reconcile that currency conversion.
[crosstalk]. Not just currency conversion. It is 229. Al so, the EBITDA numbers, everything looks very, very different. I am looking at the annual report of the reported company.
Sure.
Okay. B ased on that, I have a few questions, r ight? I think it would have been better if the deck had been prepared with the updated numbers, so that it could reflect real value of the company as such. W hen I'm calculating all the numbers, for example, the secondary care margins, it's coming around 11.8% for me, b ased on the annual report reported numbers of September 2024. When we look at the deck, it doesn't give me that bullish stance as such, r ight?
Ravindra, if I may, the thing that was announced was of the overall holding company, yes? The one with three business verticals?
Right . I'm just taking the secondary care.
We understand, y es. The thing about disentangling a business that has three verticals into one, is that there will be cross-charges. There are certain things that reflect across multiple balance sheets. The company is in the process of disentangling, which may lead to slight adjustments here and there. As we close down this process over the next quarter and so, we'll be able to give you a much better picture of the hospitals-only business. Right now, the businesses within themselves also render services to the subsidiaries. That may be part of the reason why some few million here and there may be a discrepancy. As far as the audited numbers that we have, this is what is there. The next quarter will give us a much better picture.
What we have given you, Ravindra is, in our deck, what we've given is the carved-out financials that has been diligenced by our diligence partners and extrapolated for the full period. Therefore, this is the number that we will be acquiring and integrating with our balance sheet. What you see in the public domain has, like Viren said, other than hospital data also mixed up, and therefore you will not be able to reconcile it. You should take the number we are presenting as the correct number.
Because they have [bifurcated] everything. That's why I'm having this question, because it gives a lot more bullish stance than what has been reported. I don't know, but it should have been better that if you had [crosstalk].
Any other questions, Ravindra?
Yeah. If I again, so I have a few questions. For example, what happens to the liabilities on books? How much liability? H ere, as you say, you are taking only one division.
Yeah. That's fine. We can answer this now.
Yeah. Ravindra, other than the liability for the leases and the regular liabilities for creditors, we are not taking on any liability on our books. We are acquiring the company on a debt-free basis. Whatever liabilities you are seeing in the balance sheet, which is uploaded in the company house, those will be left behind. Only the regular creditors and lease liabilities we are taking over. This also answers [Rishabh] Doshi's question on the chat.
Okay. That means the term [loan] as such, we'll be repaying or we'll not be taking over the term loan as such, that's what you're saying?
The seller will take care of the repayment. We are acquiring the company on a debt-free basis.
Okay. Again, i f I take that point, it's giving a very bullish stance as such.
Any other questions, Ravindra?
No. I think what about the dividend distribution as such? T he company has been paying regular dividends. Is there any stance on that, like how that will be accounted for, whether we'll get some part of the dividend as such?
We can answer that.
Our current plan, we do intend to continue with our current dividend policy.
No, I'm not talking about NH as such, because this company has been paying a dividend regularly. Last year, they paid around GBP 34 million as a part of the entire company. We are taking a part of the company. That means there is an embedded dividend within that. Has there been any [crosstalk]?
We have not taken a call yet on what the intercompany dividend would be between the subsidiaries and the main. We are still in the process of merging and acquiring these companies, and consolidating the account sheets and taking over the finance department. We will have a much better sense of this over the coming quarters. As of now, it will be hard for us to comment.
Okay, f ine. Apart from that, yeah, actually I had a lot of numbers related.
It's fine. Maybe we can move on to the next person. If the queue exhausts, you can join back again.
Sure, y eah. Thanks.
Thanks, Ravindra.
Yeah.
[crosstalk], any other question, please?
Yeah. Anesh, just a couple of questions. Obviously, the first one, you mentioned about U.K. Saying stable government or stable policies, growth, track record of international investors, etc., t hat is going to be the case with even other European nations, right? Why particularly U.K.? How is the U.K. market different, o r what kind of growth levers are you looking in the U.K. market?
Sure. We did consider other opportunities in various other markets. Just with regards to the country itself, we see a track record of every larger, if you take the top five healthcare providers, barring one, which is a not-for-profit, the others have demonstrated consistent growth in revenue terms as well as in earnings, with some volatility. T hey're all owned by international investors as well, for the most part, barring one or two.
The second thing is that, in terms of the total health spend, the percentage contributed by the private sector is still in its infancy. There is, we believe a long journey ahead, and meaningful change could happen in the decades to come. If you combine the entire spend by the private sector, it's approximately 16%-17% of the grand total. It is still relatively the benefit of a low base. Having said that, it's not just the market that is the country. It's also the asset. There are certain other markets that also have certain similar favorable dynamics or certain other favorable aspects. It's also a question of identifying the country, as well as the asset within that country that fits our criteria. For most part, Practice Plus within the U.K. was a good intersection of many things that we were looking for.
Okay, g ot it. You're mentioning that the country might incrementally move from NHS to private, and the private sector will benefit from that.
I mean, it's not something that one would obviously be able to predict in the short term. There are periods where it's taken the other way as well. If you look at historically, there are periods when the dependency on the private sector increases. There are periods where it decreases. For the large part, we think that this is a relatively low base. There is certain safety, that we're not going to see a drastic reduction in the levels where it is right now. We don't want to be fighting against the headwinds of a decreasing, shrinking market. That's always hard to do. From that perspective, this is an option we narrowed down on.
Got it. One of the key reasons why Cayman has done exceptionally well for you people, is that you were able to replicate more or less Indian cost structure for the international realizations. How should we look at the U.K.? I mean, can you take Indian doctors, Indian medical staff to the U.K.? How are the laws there? Can you import equipment from India? How does the entire cost structure work? Also, because the hospital is currently at 8% EBITDA margin, how do we look at margins in three to five year down the line?
Sure. Just addressing the comment on Cayman, we do have clinical as well as non-clinical staff from every other country as well. Even to the extent that we are able to take people from India, we can't pay them an Indian salary, obviously. They earn just as much as they would in any other equivalent opportunity in that market. We' re not looking at essentially an on-site labor arbitrage opportunity in healthcare services. That' s very difficult to do.
For example, for decades now, India and other South Asian countries have been sending thousands, tens of thousands, in fact, of nurses to the U.K., and obviously, they earn just as much as any other nurse. The reason we were able to drastically alter the cost structure in Cayman and have a lasting competitive differentiation in cost compared to peers in the region, is because of the entire ecosystem of operational changes we were able to begin, which is for the most part, underpinned by our technology platform, which does scale across markets.
As you know, in Cayman, we operate on an entire technology platform that' s built and owned by us, that gives us the opportunity to perform every single transaction with far fewer human touchpoints or far fewer people involved, and far fewer steps than competitors. Whether it' s a revenue cycle process of processing an invoice, whether it is processing payroll, whether it' s admitting or discharging patients, every individual process is done with fewer touchpoints. When you add it all together, we just get a very different, simpler, leaner operation. We think a lot of this is replicable in the U.K. Obviously, the scale is different. The market is larger. We will have to go through that learning journey. In Cayman, it took us a while to get there.
That was also the first time we were doing that. We' re confident we will not take as many years as we took in Cayman. You are right in the broader sentiment, that with what we have done in Cayman, which is meaningfully alter the cost structure on the backbone of our technology and other broader capabilities, that' s also what we hope to do in the U.K. Through the process of our diligence on this asset, we' ve developed a good degree of conviction working with the management as well, that this is possible.
We had senior members of their team come to Cayman, see what we've done and really pressure test the hypothesis that, can we replicate this or largely replicate this in the U.K.? There was a unanimous agreement that many elements of this, what we've done in Cayman from an efficiency standpoint, can be replicated here. Of course, they have to be adapted. Directionally, I think you are right.
If I have to ask you for a number, right, some broad-based number, s ay five years down the line, once you implement all these things, how should we look at EBITDA margin as well as revenue growth?
Yeah. I think it's very, very early to say that. What would help is you do have the historical growth rates of the company, both revenue and margin. It's early days for us to comment on that. We hope to develop a view that we'd be happy to share in the quarters to come, when we meet next time. I think for now, the direction that we have is, we are internally quite confident that there are advantages we bring to the table, both from a revenue trajectory as well as earnings. The management is confident in the path they are on. They've started many things, even predating us. Even if we did not close this transaction, they are already at an inflection point with certain investments and changes they are making to improve their revenue trajectory. We're lucky to be entering at the right opportune time.
Okay. Let me put it this way. If you have to look at ROCE, eventually everything has to translate to returns. Given that it's such a large investment and you have India as an alternative market, what kind of ROCE are you looking at?
Yeah. J ust, I mean, our conservative base case is by FY 2029-2030 or so, w e want to be in the range of 20%-22% from an ROCE perspective, is where we see. A lot of that is driven by the entry price, which we know certain assumptions around the trajectory the company is on, as well as certain assumptions around the difference we can bring to the table. We would not have entered this, if that was not a high conviction thesis that we had, that by FY 2029-2030, approximately in that range, we will be within the 20%-22% ROCE level.
[crosstalk].
[crosstalk] for the reason you said, because of the alternative opportunities for us, yeah.
One final question before I get back into queue again. A fter resuming the interest cost for the entire GBP 150 million debt, will it be EPS neutral in the first year and then it will turn positive o r will it be earnings [sa y elutive] in year one?
Yeah. There's a little bit of nuance to that question. I'll hand it over to Sandhya to walk you through that thinking there.
As far as EPS is concerned, it will be neutral, maybe mildly favorable also in the first year. How it picks up from there, we'll have to see, based on the performance of the business.
Okay, t hat answers. I'll join back in the queue.
Thanks, Rithvik.
Thanks, Rithvik. [crosstalk], can we have your question, please?
Hi. Good morning. Thanks for the opportunity. In the presentation, you've talked about attracting more private pay patients. Currently, the mix is around 93% coming from NHS. If you can talk about how this mix has trended over the last few years. Do you expect this to change or improve materially in the next few years? What are some of the steps that you're looking at in terms of attracting more private pay patients?
Yeah. No, thank you. If you just look at the competitive landscape, if you look at the only publicly listed asset that's available where robust data is, there's Spire. Spire currently has as of the recent half year, about 35% of their payer mix being NHS. The rest is a combination of self-pay and DMI, which is their private medical insurance. The other assets have the other equivalent assets at Circle, which is ADQ owned, around the similar range. Ramsay Health, which is, I would say, closer to PPG than the others, has about between 60%-70% NHS. Practice Plus is definitely an outlier, being at 93%. This is a factor of where they've started off, the journey in the origins of the company and where they've trended.
To your question on, they started out being 100% NHS, t his movement to 93% is a little more, 90%, 93% is a little more recent. It is our intention, as well as the management's intention, which point they [crosstalk] on as well, even if this transaction did not happen, they are on the trajectory to increase the percentage of their payer mix from private sources. We are definitely going to enable that journey. It's a little hard to give you a hard number as to where we'll be in six months and a year, etc. It's still early days for us. That is definitely the intention. They've taken some very concrete steps and decisions, not just on individuals, but also on asset selection and certain assets they've recently acquired as well to enable that.
Okay. Within the NHS part of the business, given pricing is set by the government, what are the steps that we can undertake from a margin improvement standpoint?
Yeah. I t's a very fair system t o be honest. Broadly, in a nutshell, NHS England would pay you, that is a private hospital, the same as they would pay themselves, which is their own hospital. T his is also largely inflation-linked, accounts for changes in wages. Aside from HCA, which is, I would say, next to zero NHS, all the other players that are privately owned as well as publicly listed, do vocally state that there is a meaningful role for an NHS in a broader payer mix, because it is stable, it is secured, it is sustainable, and it is largely inflation-linked. It's not something that we would individually do to influence reimbursement, etc., because we're just a very small cog in a very large wheel.
In terms of improving margins within an NHS framework, you have all the levers of cost around cost structure and operational efficiency, because, in some way, the price is set to be largely sustainable or close to sustainable for the government themselves. As long as we can execute on a strategy that improves our day-to-day operations and our cost structure, and differentiates ourselves compared to peers, both public and private, then the profitability, even being a predominantly NHS payer mix, starts looking very, very different from what it is now.
Okay. One last one, more of an observation. When I look at the specialty mix, it's skewed towards orthopedics. I understand that NHS backlog could be a reason here, and then the high number of elective procedures in the ortho specialty. Are there any other specialties where you think a similar dynamic exists, where there's a high proportion of elective procedures which you can target and you see as an opportunity?
Yeah, that's the right way to think about it. The existing specialty mix, not just for us, for other private providers as well, is largely reflective of what the NHS chooses to outsource, as well as their backlogs and the other factors as well. This is heavily skewed towards orthopedics, ophthalmology, general surgery, these kinds of things. There are certain other services and specialties where other providers have a good chunk of their revenue mix coming from, which Practice Plus doesn't.
That's an easy opportunity for revenue enhancement, without any additional investment in infrastructure. To your question, there are several services that we've already identified, where it is possible to start in the existing infrastructure without adding hard infrastructure, just some operational execution and some people and teams, and clinical orientation. We definitely will be assisting the company to start these services, and grow within the same property footprint.
Got it. Thanks, Anesh. I'll get back in the queue.
Sure.
Thanks, [crosstalk]. Raman, can we have your question, please?
Yes. Thank you, sir. I just have two, three questions. First is, i t's more or less like a follow-up on the previous participant's question. Majority of our revenue comes from NHS. I just want to understand the payment cycle. I s there any plan to shift more towards private players? My understanding is, the margin mix between NHS and private players, private players have better margins. If you can help me clarify that.
Yeah, s ure. [crosstalk].
Yeah, g o ahead.
Yeah. In terms of payment cycle, NHS pays within 15 days on an average. The company almost operates on virtually zero working capital. As far as the private pay piece is concerned, I think Anesh just explained to the previous speaker the dynamics around that. I think that question is answered.
Yeah, happy to essentially just answer quickly. Essentially, yes, you are right, t he private payers do pay a rate like-for-like basis that is more than the NHS. Each has its own attributes that would make it attractive. A good mix between all would be the ideal outcome. To your question on whether our intention is to increase the non-NHS sources, that is DMI and self-pay, yes, that is our intention. We hope to make good progress on that.
My second question is, are total bed capacities 330 beds with respect to the acquiring entity? What's the operational bed out of this?
They're all operational. In fact, the way the market is oriented there, because the procedures are more shorter stay care, lower in acuity, unlike in India, which is the market, we're all familiar with, the bed isn't the fundamental unit of measuring capacity, etc. There are other units that are more reflective of capacity. Yeah, in our parlance, when we say capacity and operational beds, all these beds are operational.
Are we having any CapEx to increase the number of beds?
No, we don't need to increase the number of beds because the bed wouldn't necessarily be the bottleneck or the driver of throughput or capacity. In the current footprint, we don't anticipate any CapEx being spent on a bed addition.
The larger question of, can the existing infrastructure do more? The answer is yes.
Yes.
There is a hope for significant throughput enhancement, both through the existing specialties, adding more volumes and adding more bolt-on specialties.
My final question is, with respect to the Birmingham Center, when will it achieve break-even?
Yeah, Raman. That' s a center that was recently acquired by one of the other peers as part of a merger and disinvestment. It' s in a great location. The center is our newer center, I would say the newest center. It' s still in a sort of pre-commissioning phase, and that is why you have operating losses. Some aspects are commissioned, some have not. We hope to update you and the rest of the callers maybe in a quarter or two, once we get a better sense of where we are in that.
I just have one question with a technical question. What's the difference between center EBITDA and adjusted EBITDA?
Yeah. E ssentially, center EBITDA would just be the profitability at the business unit in aggregate, combining all the business units. Between the center EBITDA and what we would finally land up with is our corporate costs, things like our IT contracts, central staffing, payroll, everything that forms a central shared service. These hospitals, unlike what we see in NH in India in isolation, are small units. They're relatively small. A lot of their costs are shared across the entire organization. That would be the difference. Sandhya, you want to add anything there?
Yes. There are divisional overheads and corporate overheads that come between the center and the adjusted EBITDA. The only item on the adjusted EBITDA is the adjustment for the Birmingham losses, which we have called up. Other than that, the adjusted EBITDA is equal to the EBITDA as we measure pre-IFRS and NH parlance.
Yeah, go to the next one.
Yeah. [crosstalk] may we have your question, please?
Sure. Firstly, congratulations, guys. I think it's very heartwarming to see an Indian entity make global presence, so k udos on that. I have a couple of questions. The first question is, NH in India is known for its focus on throughput, the DNAs of throughput, which is very counterintuitive to the industry versus what the other peers track, right? A, would it be essentially the same kind of DNA and focus that you guys will be able to implement in the U.K. entity? What will be the benefits that you guys can derive from integrating Athma, which is your tech stack, in the U.K.-acquired entity? Is there any quantitative versus qualitative target, or some projection you guys have made internally to determine the benefits that come from integrating Athma?
Thank you, Kaustubh, not just for your initial kind words, but for asking our favorite question. One reason we like this company is, because there is a very good philosophical alignment and match in terms of the importance of operational efficiency and throughput. I will call out an important fact about this company that we really, really admire. There is no private provider at this scale and above, so they may be smaller, but at this scale and above that we know of, that can operate at a 90%-93% NHS payer mix and have the margins that this asset has. Even before we come in, this is a management team and a company that is efficient, that is focused on throughput, that understands the value of simplifying processes and automating either with software or with other interventions. That' s very much how we like to think of it.
It is very, very heartwarming to see that. That really attracted us to this company, because we are not trying to bring in a very large culture change. We' re just enabling them with our platform, with our tools, with what we bring to the table to just turbocharge what they are already doing. To your second question around the Athma technology platform, yes, absolutely. It' s very similar to what we have been able to do in Cayman. We believe that in time, hopefully sooner than later, we are able to infuse our technology and digital capabilities, to automate away things that do n't need to be done, to simplify the way a lot of processes happen.
In markets where, which like Cayman, like the U.K., like Europe, there are many, many steps to take a patient from admission to discharge, that have nothing to do with the clinical care, that have nothing to do with their disease . It' s just administrative steps and functions to either record the care, document the care and get paid for it. This is ideal fertile feeding ground for us to come in with our broader capabilities, and what we' ve already built to identify opportunities for improvement and efficiency.
Splendid. Thanks for that. My next question is, in India, Narayana is known to be one of the most efficient and most capable hospitals for robotic surgeries and robotic capabilities. Do we have any plans or if you can comment on the same robotic surgery capabilities of the U.K. entity?
It's slightly different market dynamics. In India, private hospitals, especially the larger private hospitals, generally tend to do tertiary care and complex care, organ transplants, open-heart surgery, etc. In the U.K., for the most part, there are exceptions in some of the London hospitals. For the most part, the private providers are doing work that isn't that high in acuity, but they're doing it at scale at throughput, largely helping the NHS with their backlog.
Your robotic work, your organ transplants, these kinds of things would still tend to happen in the NHS, not in the private sector. It's a meaningfully different level of acuity that we would see, either compared to Cayman and India. There's nothing wrong about it. It's just the nature of the market. We're happy to identify where we can add value in terms of enhancing the scope of services they have with our clinical background. If it leads in a direction where it leads to more complex work and someday robotic and advanced work, so be it, but I don't think that will be the initial focus.
Sure, g ot you. My next question is, is price discrimination subsidizing the lower end of the pyramid? A, is it even relevant in the U.K., given it's a developed market with essentially well distribution that is not as skewed as India? Is price discrimination subsidizing the lower end of the pyramid in terms of customers? Is it possible? Is it on cards for you?
No, that's not really how it works, because the NHS has essentially a tariff that you get paid. You don't decide that. That's what you get paid. You can obviously influence volume and quality, etc. but that's a centrally decided tariff. There are self-pay patients, which essentially like in India, they're paying cash. They're shopping around because they don't want to wait on a waiting list, etc., so they're paying cash. Over there, yes, there is more of a free reign in pricing, which is within reasonable limits.
Got you.
On the other end, which is privately insured, again, it's like in other markets, where you have a negotiated tariff with the insurance company and the patient is not responsible for that. In the non-NHS, there are two buckets, self-pay and DMI. In the self-pay bucket, there is some element of what you're saying, but it's not that prevalent. In DMI, it's also a fee schedule.
Understood, f air enough. My last question is, since we already have been operating in Cayman , which is a U.K.-administered territory and now we are in the U.K., do we have any benefits in terms of our learnings from our operations in Cayman, dealing with the U.K. regulator? Do we at all have any benefits in that direction?
I don't think so because they're differently regulated. I mean, Cayman is a British overseas territory, but that doesn't slow down in any meaningful way in terms of clinical regulation. Of course, a ll providers in the U.K. are wonderfully regulated by the CQC and related bodies. It is a very robust, time-tested, fair system in our experience. Another good attribute about this company is it's in a good group of a select group, where every asset we operate, every unit is rated good or excellent by the CQC, which are the top two ratings. Every asset that this company operates is good or excellent. They're doing a phenomenal job with regards to their regulatory requirements and compliance. We definitely look to continue that.
Amazing, t hat's all of my questions. Thanks for answering, and congratulations once again.
Yeah, take the next question.
Yeah. Ramesh, please go ahead.
Ramesh, I think already asked.
Ramesh has already asked. We'll move to Shivam. Shivam, can we have your question, please?
Sorry, if we could just request, if anybody has asked a question and wants to get back in the queue, if you could lower your hand please and then raise it again, so we can keep track of who's next. Than. you.
Yes, Ramesh, here. I haven't asked a question yet.
Yeah, Ramesh, go ahead, please.
Just to understand the transaction.
We're not able to hear you, Ramesh. Can you please be a bit louder?
Just hold on. Can you hear me now?
Not well, Ramesh.
Yeah. Just hold on.
Yeah , it's fine, but go ahead.
Yeah. If you look at your overall transaction cost, is it all-in cost? Is there any other adjustment you expect? In terms of other charges and asset valuation, everything is included in the valuation?
Yeah, Sandhya .
Sandhya, you want to take that ? Sandhya, y eah.
The cost is all-in cost. However, typically, as is in every deal, there is a 4%-5% deal cost which comes. For diligence, for stamp duty, for lawyers, etc., s o that will come on top of the costs that we have indicated.
Okay. T his cash cost is already paid and already done in the second quarter?
In quarter three, yes, w e will pay. We have signed, we have not closed. Closing will happen by end of week. At that point in time, we will make the payment.
Okay, f air enough. T hat means your three Q results will show the consolidated impact of this acquisition, right?
Yes, f rom the date of closing.
Okay. If you look at the value of this acquisition, obviously you mostly have done the homework. You would have possibly assessed similar acquisitions elsewhere in the world or in India. Have you also considered similar acquisition opportunities in India? T that's your home market. That's the reason why I'm asking this question. Why is the private equity firm, which has owned this asset, selling it ? Is it just because they're cashing in on their value over the years, or is there any other structural reason why they are [crosstalk] ? The NHS itself has been going through a lot of political debate in the U.K. In terms of your own value proposition, what is it that you're adding to that business? Why is the existing investor se lling a primary asset ?
The second question first, Ramesh. The investor is Bridgepoint, which is a private equity fund. They reached the end of their life cycle. They have to return money to the investors and they need to offload this asset, as well as the other two that are part of Practice Plus Group. That is why they are selling, and that' s why we are taking up. To the question that you asked first, are we looking at opportunities in India? Yes, of course. We look at opportunities constantly in our core markets. We' ve identified quite a few.
We' ve tied up with real estate developers. We bought land. We are building in Bangalore, Calcutta, Raipur, in the projects that we ave disclosed. Here and there, M&A opportunities do come up. A lot of the time, private equity-backed M&A opportunities in India tend to be priced very, very aggressively. In all the calculation that we make, the payback tends to get quite stretched. That' s why it is still something we do consider. Either they are too small and not that we are able to do much with it, or the few opportunities that get written about in the newspapers, the ones in India are beyond our ability to afford.
Okay. If you look at the manpower cost for this U.K. asset, it's about 39%, d octors plus the others. What are the controllable levers you have in terms of pension liability? Given that there's also a currency risk involved, when you look at your overall ROCE target, have you built in any increase in this manpower cost? Assuming that consumables and the other operating expenses are something which possibly is within your control. To the extent to which you're talking about the NH patients, they're accounting for more than 90%. Is all the increase in the cost built into this overall revenue mix? To what extent can you make up any increase in margins required to the self-paying patients?
Yeah. Anesh, if we can talk about the inflation-linked tariff, please.
Yeah. To Ramesh's first question, the composition of the P&L to various cost edges is not very different from what we see in India or in other larger markets. As Viren mentioned, the NHS sets its tariff the same for all providers, largely. A tariff increase does reflect the cost of inflation of medical goods, wages, and other services. There is that element of being insulated from that. That' s also passed down to the private insurers as well, with some delay.
Is it fair to assume that your Indian asset, U.K. asset, is going to be something of an annuity business over time?
It's a bit early to say that, but let's address that maybe once we're settled in there, y eah.
Okay. Thank you very much and wish you all the best.
Appreciate it. Thank you. Thank you very much.
Shivam, can we have your question, please?
Yeah. Am I audible?
Yeah.
Yeah.
Yeah. Actually, I was asking that, there's a shortage of healthcare workers in the U.K. Given that the NHS isn't very keen on letting people come from outside, what stance do we have on that?
As a private provider, you're slightly more insulated from the workforce shortages, compared to the public employers who have a lot of other factors to consider and wage constraints. For the most part, because of the acuity of services not being tertiary and above, and because of the attractive workplace that private workplaces offer compared to public workplaces, the shortage, the larger shortage is not that much of a concern for the private sector and particularly for PPG.
Thank you. Given the NHS is very tight on their budget, do we have a process in which we can get away from the NHS payer mix?
Yeah. We answered that previously as well. The intention here is to move away, with certain changes that have been made on the ground with regards to people as well as asset selection and marketing efforts. We will continue to do that. The intention will be to increasingly attract more private and self-pay patients.
The way we have started the insurance, providing insurance in India, will we be doing that business as well there?
No, w e're just entering as a provider now. It's still early days.
Okay. Sure. Thank you.
Thank you.
Thanks, Shivam. Shayans, can we have your question?
Yeah. Hi, I had a couple of questions. The first one is, of the 330 beds, what's the kind of utilization currently for the beds?
Yeah. As earlier mentioned, bed isn't the unit of utilization. There are other capacity levers about theater sessions and theater utilization. If you take beds as well as theater, other metrics of utilization, it'll approximate to closer to 50%-55%. As Viren mentioned, there is adequate room to accommodate additional volume in the same properties.
Got it. Since it's 50%-55%, so trying to understand, what stops us, given the backlog that NHS has, from increasing this utilization? Why is it at that level?
Backlog does not translate into NHS willing to pay for it. They need to have funds to pay for it, because the backlog largely exists because they do not have the funds to render the services within their own property or to pay for it in the private sector. That is one constraint. Also, the intention would be to attract non-NHS patients as well. That, like in any market, whether India or otherwise, has its own learning curve about understanding the patient acquisition journey. It is more consumer choice, because they can go wherever they want and addressing those levers.
Got it. My last question is, so by when do we expect the tech systems to be integrated into the U.K., into the hospitals?
I would say i t's a journey. We'll start immediately with the low-hanging fruit, certain things that are easier to do. Certain core systems will take more time, a couple of quarters maybe longer than others. It's a journey. It will not be one date when systems transition. It will be module by module, application by application. The benefits will, we hope, correspondingly flow incrementally over the years as well.
Got it. That's all from my end. Thank you so much, and all the best.
Thanks, Shayans. Nidhi, can we have your question, please?
Yeah, sure. Hi. Thank you so much for taking my question, and congratulations on the strategic partnership. Just wanted to understand, how is the ecosystem for private hospitals versus NHS and who would be our targeted customers?
Sorry. Nidhi, could you be a little more specific, please? What do you mean by ecosystem for private hospitals? Sorry about that.
When we talk about all the major services being catered by NHS, and what type of services we would be catering to.
Yeah, o kay. L argely, the biggest success story in private outsourcing is ophthalmology and cataracts. That's well served. The others would be, what you'd expect, orthopedics, a lot of joint replacement, arthroscopy, gastroenterology procedures, general surgery, etc. These would be the more, think of anything that's elective, short stay, and is not life-threatening or critical. It's not an emergency trauma and things like that.
Right. Fundamentally, what we would be catering to over a longer period of time, given that we are going to reduce our dependency on NHS on catering to non-NHS segments. Who would be our audience with regards to the cash payment patients, or is it going to be more on insured sites where corporates do not have coverage on those insurances where they are going to cater the services?
If I understood your question right, the non-NHS typical patient profile is somebody who has private insurance. This is in the country largely, for many people, employer-provided, for some, individually purchased as well. I think that's fairly similar to what we see in India as well. That kind of person would be the target demographic.
Right. Just the last one, on margin side. Our consolidated margins would be diluted with this acquisition. Even on a longer term, let's say we are able to achieve 8%, 9%, or maybe 10% kind of margins, which the industry is catering at the moment, h ow do you see this planning on a longer term? Where are we going to find a pace on our consolidated books?
Yeah. Sandhya, you want to take that?
Yeah. It's a forward-looking view we don't want to give, but we have given a certain idea on how we look at the next 12 months' margin. In the deck that we have shared, we're hoping that we can build on that and improve on the margins. Anesh spoke about all the cost and efficiency levers that we have. Over a period of time, we will have to build on these levers. We have shared a kind of an indicative number in the deck we have put up for the next 12 months.
Right, g ot it. Thank you. I'll get back in the queue.
Thanks, [crosstalk]. Now we'll go to [Niranjan and Kapil] because Ravithik, we've already answered, and we'll get back to them again. Niranjan, can we have your question, please?
[crosstalk]
Niranjan, can you hear us?
Yes. [crosstalk]
Maybe we move to Kapil and come back to Niranjan.
Yeah, f ine. Kapil, can we get your question, please?
Yes, please. I would just like to get some more clarity on the answer relating to the impact of the acquisition on consolidated EPS. Now, just considering the present profitability rate of Practice Plus Group, and after considering the interest to be borne on funding costs, would this acquisition to the EPS be it mild or moderate or more? If you can, please give some indication.
Broadly flat, if at all mildly positive.
I see. All right.
That's it, Kapil?
Yes, please. Yes.
Thank you. [Damyanti], please.
Yeah. Hi, t hank you for the opportunity. I just want to understand, y ou are getting already an established doctors' team there, and the incremental update which will come from this transaction is that you will bring in more efficiency. Two points, y ou do n't need to add on any doctors. Even you do not need any infra in near term. Just with the existing capacity which they have, you try to bring in more technology to drive the growth. Is my understanding correct? At least this should be the setup in medium term.
Largely, but once we get in and understand more about the market, if there are interesting opportunities, straight off the bat, we will look at starting other services, new services within the same properties, which would require new doctors. If there's anything, the company has been exploring certain other opportunities as well. We will evaluate them as and when we get settled in.
Okay. There is good headroom to add on more services. For that, you might need to expand your team a bit.
Yes.
Okay. J ust from the segments or categories which is currently served, you mentioned about a few segments. From NHS outsource work, will that be the key opportunities which will continue or you think since the backlogs continue to increase at the NHS, you can see more businesses coming in other categories as well?
No, I think the services that usually form the bulk of what private providers do is fairly known and constant. Of course, certain things may change here and there, but not in the short term.
Okay. My last question is, what will be the key offering to you when you target more of these private or self-funded patients, apart from, they do not have to wait for the treatment, which is the case with NHS? From your perspective, what will be the key pull factor, if you can help us understand?
Sure. For the private patients, the competition is not the NHS. It' s other private providers, and the standard levers such as quality, brand, location, etc. More importantly, we believe that cost, either to a private insurance, to a DMI provider or to a self-pay patient, cost of treatment is something they are very, very sensitive to. If we are able to meaningfully lower the costs and offer an equivalent quality option at a meaningfully different price, then that becomes very interesting. Even in markets where Practice Plus is successful in attracting private patients, they' re doing so at a price advantage to the others. We hope to continue to build upon that.
Yep. My last point is, the other players who are in the private space, I understand they might be also investing a lot in technology, right? What will be the key offer from you? In markets like Cayman, I understand you are the only player, right? That is why your focus on technology, etc., led to great results. Maybe in the U.K. market, things are very different on the competition part.
Yeah. In Cayman, we're not the only player. We wish we were the only player in Cayman. There are others, but it's a small market. There are a few other players. You are right. U.K. is a much larger market. In different locations, obviously there are going to be more players. Yes, like anybody, any business, they continue to invest in technology and some of them have very good systems. We believe that the efficiencies that we are able to derive, we hope will be better than the competition, but let's see.
Okay, t his is helpful. Thank you, Anesh.
Thank you so much.
Thanks. Okay, c an we move to Niranjan now?
Yeah, [crosstalk].
Yeah, Niranjan, can you hear us?
For the previous question, you mentioned we are planning to [crosstalk] .
Niranjan, we're not able to hear you.
Okay. Maybe you can type your box, Niranjan. We'll move on to Alankar.
Viren, what do you want to do about the questions on the chat? Should we address them offline?
No, we'll finish up the queue and [crosstalk].
Okay.
Alankar.
Yeah. Hi. Good afternoon, everyone, and congrats on the acquisition. Firstly, you spoke about increasing the private mix gradually over NHS. You also spoke about margins. Can you comment a bit about the growth aspect for PPG? Asking this question because if you look at the five-year CAGR, it was about 12%. If you look at the last two-year CAGR, it's about 9%. Did PPG see any COVID-linked bump-up in the earlier part of the five-year cycle? T he 9% growth which we've seen over the last couple of years, is it more indicative of what the asset can deliver without any significant increase in the private contribution?
Yeah. Thanks, Alankar for the question. COVID did not play a meaningfully different role compared to usual for this asset. Having said that, they are on a growth trajectory, like you said, which was in the longer term, 12%-14%, nearer term 9%, with their existing payer mix. By the way, none of this is with adding sites except the Birmingham, which is not yet operational.
They've been largely static with the number of sites. This, you can consider as the organic growth year- on- year. We see no reason why that should slow down. In fact, there are certain interesting opportunities with adding more services now, that we are involved, within the same properties that would further build upon that. It's still early days. We'll get a better grip of the growth that we can expect to see on a shorter term year-on-year basis, maybe in a couple of quarters.
Understood. The second question is more on the transaction. Actually, two questions there. Firstly, how should we look at the purchase price allocation for this acquisition? Possible to share any broad split between goodwill and intangibles?
Sandhya?
It is too early, actually. We are still working through with the auditors. We have just signed the transaction. After closing, the auditors will go through the details and then we'll have a better view of this. We are not in a position to answer this question at the moment, but we will answer the same as soon as we have better visibility on this.
Got it. The final one, apart from the GBP 150 million debt, will the rest of the acquisition be funded entirely by Cayman's balance sheet?
The entire acquisition is being funded by Cayman's balance sheet. GBP 40 million is going as equity. The rest of it is a leveraged buyout, and therefore it is a debt on the books of the target.
No India balance sheet cash will be used to fund the acquisition?
No.
[crosstalk]
Okay, u nderstood. Thank you. That's it from my side.
Thanks, Alankar. Niranjan, would you like to speak ?
Yeah. Yeah. Am I audible to you?
Yeah, g o ahead.
Yeah. For the previous question you mentioned, we are planning to increase the non-NHS part, right? What are the strategies and plans for increasing the non-NHS part?
Sorry, s trategies for increasing?
The non-NHS patient mix, yeah.
That has been answered already. I think just in the interest of time, maybe we'll move on to the other questions. Any other question, Niranjan?
Yeah. A lso, o ne more question is, the PPT, it is the fourth largest player in NHS. Also, f or the other three players, what is the percentage share of non-NHS part?
That also, we answered previously, y eah.
Thanks, Niranjan. If we can go to Ravindra, please.
Yeah, h ello. Am I audible?
Yeah.
Yeah. Thanks for the opportunity once again. This is one kind of a broader question. As per last year's annual report, there is a cash on books in the company around INR 400 crores. Is there any arrangement between the parties, that how this cash is to be used? Do we get any benefit out of this deal to NH for the [crosstalk]?
We are acquiring the company on a zero-debt basis. There is working capital of about GBP 5 million that is being left behind in the company. Other than that, the rest of the cash and the debt will be cleared by the seller.
Thank you. Okay, t hat's fine. Just one last question. What's the interest cost that we are going to operat for this acquisition, for like GBP 150 million, as you said? What would be the interest cost?
We have borrowed at about SONIA + 200 bp s on an average.
Okay. Currently, I think they are having 6.25%. I think it's a floating rate interest rate. That's what they are operating
Their interest rate is not relevant for us, be cause we are acquiring on a debt-free basis. We are acquiring at a SONIA + 200 b ps kind of range.
Yeah. What would be the ballpark? Just for the calculation?
SONIA + 200 basis points, Ravindra.
Six plus six [crosstalk].
Okay, m ore or less the same range.
Yeah. In the interest of time, if we can move on to [Prithvi] .
Yeah. [ Prithvi]?
Thanks. I just have a couple of questions. One, g oing forward, if you have to move cash from Cayman to U.K. for CapEx, etc., is the cash taxable a nd what will be the tax rate?
Equity is not taxable. At the moment, we do not intend to move cash from Cayman. The target is sufficiently cash flow positive, to take care of its own CapEx requirements, [Prithvi].
Okay, g ot it. Second, Viren, I mean, obviously, it took seven, eight years for you to get into another geography. Can we assume that for the next few years, the focus will be on U.K. before looking for something else?
If you're worried about our inability to stick to one geography, please rest assured, the U.K. is a very large market. There's a lot of learning that we have to make, and there is tremendous scope for growth. We are pursuing still in the Caribbean, opportunities there because it is highly synergistic with the Cayman Hospital that we run, as well as in India, which is our core target market. Whatever we're spending in the U.K. is small compared to how much we're planning to invest in India, in expanding our core market here. This came about because we see a good opportunity to grow in a developed country, where there's a very large and growing need for private healthcare. We can't give a commitment on seven to eight years, but just that we made a commitment here and we will continue to invest in this.
That's clear. One final question. Anesh, you mentioned about Spire Hospital, that has 35% payer mix from NHS. If I look at margins, they may close to 18% kind of EBITDA margin. Is it fair to assume that that's something that you will look forward for this acquisition, maybe in five, seven years down the line, i f the payer mix changes?
Yeah. I think the more fair comparison would be to say, to best-in-class like say, Circle, which has the same capital structure, which is all leased asset. Spire has half their assets, approximately half owned and only half leased. One would have to account for a lease effect, which I think you've not done to arrive at that figure. Yes, I mean, to the broader question, I think that there are other competitors in the market operating at a meaningfully higher level of profitability, accompanied with a different payer mix. We see no reason why we shouldn't get there sooner or just as much.
T o squeeze in one more question, w hat will be the realization difference between NHS and a private insurance and a self-pay in U.K.?
Yeah, i t's a good question. It depends on location, who the hospital is, who the insurer is. B roadly, for many procedures, DMI would pay anywhere from 20%-30% more than NHS. It just depends. These are individual contracts. It's not publicly available, but it's just a broad industry guidance. This is a consensus number.
Okay, t hat's [perfect]. Thanks, [crosstalk].
Nathan, you get the last word.
Thank you so much. Congratulations, team for a very interesting acquisition. Just a couple of housekeeping questions to start out. One is, from a CapEx perspective, with the plans that you have right now, do you [crosstalk] any meaningful CapEx for the business over the next say, three, four years?
Yes. The business has regular routine maintenance and refurbishment CapEx, which the business will continue to incur. It will be in the range of GBP 10 million-GBP 20 million every year, but that's baked into our financial plan.
These businesses are fully asset-light. All the buildings are leased from private lessors, as well as the NHS. A lot of the equipment is leased as well. The growth will happen in a very CapEx-light manner.
O bviously, [very early days] for you, but for example, the Birmingham Center , a re we on the lookout for adding centers over the next short term, or i t's going to happen over a period of time?
It is a bit of both. Anesh can talk about the consolidation and expansion.
Yeah. The Birmingham Center is something that is yet to be fully commissioned. We're eagerly working towards that. The management has looked at certain centers, but nothing that is imminent or that can happen right away. These are things we'll look at. There are one or two opportunities. As Viren mentioned, these are structured from a capital structure perspective, very different from what we're used to in India where they're very, very light and loaded towards the end, just pre-commissioning when you're bringing in medical equipment. They're largely leased, and that appears to be how the industry broadly operates there.
Sandhya, what kind of cash break-even period do we look at for this transaction? I mean, how many years do we start to sort of cash break-even from an investment perspective?
It's a leveraged buyout. We are positive that we will be able to pay for the loan that we have taken on the books of the target from the cash flows of the target itself. From an IRR point of view, it is crossing our threshold IRR, high double digits. With that, I think you can understand the payback, because it's not a number we are officially disclosing. This, I think, gives you an idea.
Perfect. From a PBD perspective, when do you think this transaction on its own starts to make a meaningful impact to our consolidated numbers?
From the first quarter of integration, full integration, it will be significantly material in our consolidated number. From a PBT point of view, it will take maybe two years because of the margin profile of the rest of the businesses.
Something like FY 2028 or thereabouts?
Yes.
Okay. Thank you so much.
There are a couple of questions on the chat. A lot have been answered. I will skip those. In terms of, how does this align with NHS global expansion and delivery priorities? Anesh had answered that already, because this is something that's highly in sync with our value system and it is a growing market, and it is a place where it is stable, where it has a very strong and secure market.
The question about, are we planning to do cardiac care or oncology? We are not ruling it out. As of this point. the Practice Plus does not offer cardiac care nor oncology. It offers more general surgery. It's something we'll definitely be in discussions with the NHS as well as with the existing service plate, but the buildings are simply not configured for this sort of work. On the existing asset base, it may not. As we get more comfortable, both in terms of the leverage this has and what expansion would actually look like, we would consider other service lines. The EBITDA margin guidance.
We have given a next 12-month broad guidance in our deck itself, for the pre-IFRS EBITDA. The lease costs, you can assume similar to what is there in the balance sheet today, because there aren't any additional lease costs that are coming on board. That will give you a post-IFRS indication. Those are indicative numbers. We cannot give forward-looking guidance.
This is a good question. How much of the NHS contract influences or constrains the growth of operations? The answer is it does not constrain. This provides the base of every hospital, which assures you a level of break-even. Everything we do above that is either through volume growth in more NHS contract revenue, adding more departments, or increasing the private pay business.
It is a very useful thing to have for the entire hospital group, and it is something we will not materially alter. In fact, we will try and grow as much as we can. Private pay and other service lines add on top of that. Nidhi's question of, what percentage can afford private hospital services? As of our understanding, in London, it is slightly higher, but across the rest of the U.K., it is much lower. Anesh, d o we have a % figure that is publicly available?
I mean, not in that exact sense, but the amount of people who privately access care has been steadily growing over time. What we'll be really looking to do is lower the cost of self-pay care and DMI care. Hopefully, that improves this number.
The next question is, what is the component of absolute depreciation for the acquired entity?
It's about GBP 8 million.
The net assets that we'll be acquiring?
About GBP 30 million. The rest are the right-to-use assets.
Yeah. The next question is on impact on near-term EPS. We said it's slightly positive to neutral. [Viren's] question, is there correlation between NHS waiting list and hospital capacity? I think Anesh answered that. The waiting list is more in terms of ability to pay. The NHS waiting lists are because they are challenged in the current way the whole thing is structured, and their ability to pass through. It does mean that there is an assured business, yes, because as a more efficient, low-cost operator, the NHS would be very happy to partner with hospital groups like us to be able to clear the waiting list. It' s something that we will continue to grow on. The debt level and consolidation.
Sure. We have given the debt that we're taking on the books for this acquisition. We have also given the long-term debt plan for India and Cayman. We are in a silent period, and we cannot disclose a forward number at the moment, but I think you can calculate with the data that we've made available.
As for the question of other QIP plans, as we mentioned earlier, there is no real need for it now, but it's not something we will rule out at some point in the future, because we do not want the debt level to constrain our expansion, provided it is done in a measured and conservative manner.
Are there no more questions? We would like to conclude our session. Thanks. There's one more question on the chat. Whether Tamil Nadu is an expansion?
I cannot comment right now on the NH business strategy because we are in a silent period. If you have any specific questions, please dial into our investor call- in two weeks from now, and we will answer questions relating to NHS strategy.
If you have a hospital in Tamil Nadu that you'd like to sell us, then please get in touch.
Okay. Thank you, everyone. Please feel free to reach out to us in case you have any further follow-on questions. Thank you.