Good morning, everyone, and welcome to this conference call, where we'll present Attendo Results for the Third Quarter. My name is Andreas Koch. I'm Communications and Investor Relations Officer at Attendo. Today's presentation is hosted by our CEO, Martin Tivéus, and our CFO, Fredrik Lagercrantz. After the presentation, we'll open up for questions and from investors and analysts, and we'll take media requests separately. By that, over to you, Martin.
Thank you, Andreas. Good morning, everyone. In line with last quarter, we'll put most attention on Finland due to the fact that this is the market where we have the largest driving factor for profitability we can hear. We'll also highlight the cost inflation and other factors that are influencing our performance short-term. I'll start by giving you an update of the overall development and direction of Attendo in the quarter, and Fredrik will then take you through the numbers in more detail. Page two, please. We had a strong moving rate to nursing homes in Sweden, and towards the end of the quarter, also in Finland. Sales in Scandinavia continued to be strong in Q3, and we've been able to increase occupancy with 3 percentage points to 85% in total. At current pace, we are on track to get back to pre-pandemic occupancy levels during 2023.
Reported profits in Scandinavia are slightly lower versus same period last year. Improvement in own operated nursing homes were offset by high personnel-related costs as well as overall cost inflation. We are working actively to manage the impact of inflation through efficiency and through negotiations with local authorities on compensations. Profits in Finland declined SEK 29 million year-over-year due to higher personnel-related costs, such as costs for overtime, recruitment, and sick leave. Also, the overall inflation had a significant impact. Short-term, we expect the challenges in Finland to remain. The main factor to regain profitability is to renegotiate all care agreements effective from April 2023 and onwards, when the next step in the staffing reform is due.
Negotiations came to a halt during the third quarter as the Finnish government announced that they were planning an amendment to the law due to the extensive imbalances of the labor market in Finland. The proposed amendment implies that the shift from 0.6 to 0.7 would instead happen in two steps, to 0.65 from April 1st, and to 0.7 from December 1st, hence allowing for a smoother transition. Now that the revised proposal has been announced, the work to renegotiate the remaining part of the agreement has resumed, with target prices for also 0.65. At the end of September, we terminated most of the not yet renegotiated care contracts to ensure that all nursing home contracts in Finland will be renegotiated prior to April 1st, next year.
Our assessment is that there is now an understanding among local authorities for how the regulation has impacted the cost level, both historically and with what is ahead of us. Far, negotiated contracts for the new staffing law mean an average price adjustment of around 30% to be compared with an estimated cost increase of around 20%. We have not changed our outlook for the negotiations from last quarter, and we assess that the majority of contracts will be renegotiated by the turn of the year and will apply from April 1st, next year. Next slide, please. We achieved organic growth of 7% in the quarter, mainly due to more sold beds in Scandinavia and the higher prices in Finland going into the year. Lease-adjusted EBITDA amounted to SEK 171 million, SEK 37 million lower versus the corresponding period last year.
The overall occupancy, as I commented, has recently increased 1 percentage point to 85%, driven wholly by an increase in Scandinavia, while occupancy in Finland remained unchanged versus Q2. Next slide, please. One important aspect of our quality improvement work is to get external benchmarks. During the quarter, we received the data from an extensive survey collected by the National Board of Health and Welfare in Sweden. This survey is aimed at stimulating knowledge and operational development, primarily at the local level. Precise routines are the foundation of systematic care work. This year's unit survey shows that Attendo, on average, has a clearly higher percentage of existing routines in our nursing homes, service housing, and home care compared to national average. The survey also shows that Attendo's nursing homes provide better opportunities for activities, outdoor visits, housing adaptations, et cetera, compared to the national average. Next slide, please.
This chart shows the openings per quarter and rolling 12-month opening pace. Prior to 2020, we had a strong pipeline on new projects to meet expected demand for new nursing homes in Scandinavia. Since the start of the pandemic in 2020, we opened more than 1,000 new beds in Scandinavia. In the initial phase of the pandemic, we adjusted and lowered our expansion plans with effects from 2022, which is clearly visible in the chart. During the first nine months of this year, we have opened around 300 beds. For the remaining part, we plan only to open a few extensions to existing units. In line with our strategy, our current focus is to improve occupancy and margins in current footprint rather than seeking new expansion.
In terms of new projects, we had 224 owned beds under construction by end of Q3. Beyond 2024, we expect to return to a phase of higher number of openings on the back of the upcoming elderly boom. Slide six. The top chart presents sales on trailing 12-month basis on group level as well as for the business areas. As you can see, the trend is positive. We still have ample opportunity to grow through occupying empty beds in current operations. The lower chart displays the trailing 12-month lease-adjusted EBITDA margin. The past two years, the reported development is heavily impacted by the corona pandemic. Finland is mainly impacted by the higher staffing demand, and margins will turn as we renegotiate the contracts are coming into effect from April next year.
Scandinavia has improved in the segment of own operated nursing homes recent quarter, but the improvement has been more than offset by high staff-related costs, overall cost inflation, and lower contribution from home care. We expect a gradual improvement coming quarters with higher occupancy, efficiency measures, and cost compensation. Slide seven, please. Let's turn to occupancy development. In Scandinavia, we managed to increase total occupancy to 85%. Solid demand has meant that sales momentum has remained strong during the past quarters, and in our own operated nursing homes, we lifted occupancy from 71% to 82% since year-end. With this pace, we will be back at pre-pandemic occupancy levels in next year. In Finland, demand for nursing home beds have been on a healthy level, but previous quarters, we haven't been able to translate this into higher occupancy due to lack of staff.
Towards the end of the quarter, the situation has somewhat improved, and we have had a positive inflow to nursing homes in September. Let's take a closer look into the financials for the quarter. Please go ahead, Fredrik.
Thank you, Martin. Let's turn to page 8. Net sales increased to SEK 3.7 billion, up by 13% compared to the corresponding quarter last year. The organic growth for the quarter was 6.8%. Organic growth was close to 8% for Attendo Scandinavia, driven primarily by more customers in nursing homes. In Attendo Finland, organic growth was 6%, driven by higher prices. Lease-adjusted EBITDA amounted to SEK 171 million, down from SEK 208 million last year. Therefore, IFRS 16 effect on reported EBITDA increased somewhat, mainly due to one-time effects. Financial net was negative SEK 160 million compared to negative SEK 171 million in the third quarter of 2021.
IFRS 16-related interest expenses increased by SEK 4 million, while interest expenses for our borrowing from banks increased by SEK 3 million. Other fees and currency effects had a small positive impact on the financial net compared to negative impact last year. Income tax for the quarter was negative SEK 26 million, corresponding to a tax rate of 21.5%. The adjusted earnings per share for the quarter was SEK 0.80, down somewhat from SEK 0.83 last year. Slide nine, please. The Scandinavian business area continues to attract new customers, resulting in an improved occupancy rate. Net sales for the business area increased by 10%. The strong growth is to a large extent driven by more customers in nursing homes for elderly people. Our new units opened over the last two years have successfully attracted customers.
In the quarter, occupancy increased by 3 percentage points to 85%. Average occupancy is however still below historic levels due to many openings over the last two years and the pandemic. The positive development during the quarter was partly supported by one empty nursing home being open for Ukrainian refugees on a short-term contract. Further, during the last quarter of 2021, we did take over responsibility for four new outsourcing contracts. Acquisitions has also contributed to growth. Lease-adjusted EBITDA decreased from SEK 158 million to SEK 150 million. There is an improvement from more customers and better occupancy in nursing homes, offset by cost inflation estimated at SEK 10 million and some efficiency issues, especially in home care. IFRS 16 impact on EBITDA in the quarter was higher than normal as we have ended some rental contracts.
Looking ahead, units started during the last two years will continue to have a negative impact on profitability, while we expect a continued positive customer inflow. The balance between start-up cost and positive fill-up effects will continue to gradually improve. General cost inflation is estimated to continue to burden the result with at least SEK 10 million next quarter. From January 2023, there will also be a larger rent increase corresponding to roughly SEK 20 million quarterly as most rental contracts are linked to consumer price index. Our current salary agreement is valid until June 2023. The index clause we have in many, but not all contracts with local authority is balanced over time, but not designed for the current rapid increase in cost inflation. We are currently in active discussions with municipalities about price adjustments.
We will have more clarity by the end of the year when municipalities have decided on next year's budget. Slide 10, please. Growth for Attendo Finland amounts to 15% reported and 11% in local currency. Acquisitions contributed with 4% growth and organic growth was 6%. Lease-adjusted EBITDA decreased from SEK 66 million to SEK 37 million. The negative development is primarily driven by higher personnel costs, other cost inflation, as well as somewhat fewer customers, only partially offset by higher prices. Customer inflow was again positive towards the end of the quarter after several weak months. The abnormal cost inflation is estimated to have impacted the quarter with around SEK 50 million. The June acquisition of the rehab hospital Kauniala Hospital contributed positively to profit development.
The significant increase in personnel costs comes from both increased staffing due to new regulations and higher hourly cost due to labor market shortage. As mentioned earlier this year, we have also lost some efficiency in scheduling due to new regulation being more rigid and inflexible. We are working hard to handle the situation with increasing staff costs, but we do not foresee any major improvements in the short term. Instead, the new cost level needs to be absorbed by higher prices in 2023. When discussing and negotiating new prices, we also take into account the high cost inflation impacting both food, consumables, rents, and salaries. Some price adjustments will be seen from January 2023, mainly adjusting for last year's inflation. The full price effect will however come in April 2023. Please also note that salaries were revised September 1st, which will show full effect in the fourth quarter.
Slide 11, please. This table shows our cash flow development. The third quarter is due to seasonality effects on working capital, the weakest cash flow quarter for Attendo. Free Cash Flow was negative by SEK 273 million in the quarter, but positive by SEK 70 million for the last twelve months. Adjusted net debt amounted to SEK 1.9 billion, which equals an adjusted net debt to adjusted EBITDA ratio of 4.1. Both our net debt and our leverage ratio is impacted negatively by the Swedish currency decreasing in value. The leverage is temporarily somewhat above our long-term financial target, but in line with our financing agreement. We don't expect leverage to increase further and start to decline from the second quarter of 2023. With that, I hand back over to you, Martin.
Thank you, Fredrik. Slide 12, please. A few closing words before the Q&A session. Financially, we are delivering solid growth but a rather weak result. The Scandinavian business area shows a relatively stable development, but we are still struggling in Finland. Both business areas are impacted by the high inflation. In Scandinavia, underlying performance in nursing homes in own operations is improving, meaning that the higher sales rate will gradually translate into better performance. In Finland, we need to get better contractual terms to make a significant improvement. We look positively to our ability to achieve sustainable conditions in Finland from April next year and onwards. While the negotiation has been halted during the quarter, we now again see good progress in the negotiations and a better understanding from the local authorities of the need to compensate all providers for the gradually higher staffing demand.
In contrast to many other industries, we could say with high probability that we look forward to many years with increasing structural demand. We're also confident that we have the capabilities to deliver better care to more people and be a preferred partner for local authorities and an appreciated provider for the customers. Thank you for listening, and over to you, Andreas.
Sure. Thank you. We'll now open up for questions. Please, remember to state one question at a time. Operator, please go ahead.
Thank you very much. Ladies and gentlemen, we will now begin the question and answer session. To ask a question, you may press star then one on your telephone keypad. If you're using a speakerphone, please pick up your handset before pressing the keys. If at any time your questions have been addressed and you would like to withdraw your question, please press star then two. At this time, we will pause momentarily to assemble a roster. The first question comes from Kristofer Liljeberg from Carnegie. Please go ahead.
Yeah, thank you. My question relates to Scandinavia price increases and inflation. Just based on the current indexation you have in the contract, how much will prices go up in Scandinavia for 2023? Also, could you maybe give some more details about the negotiations you're having also with municipalities? Is this all of them, and can you say anything about the feedback and why they would agree to increase prices more than current contracts? Thank you.
Thank you, Christopher. The index that we follow in the contracts where we have indexation is called OPI, and that has not been set yet. It's based on to a smaller extent on consumer price index, and that we know roughly where we'll end up. The larger extent is on salary development. There will be preliminary numbers set in December, but then the actual number will be set later on in 2023 when we know the outcome of the collective labor agreements negotiations. That's for the part where we have that indexation clause in place. For the other parts, there are, you know, different mechanisms on how prices are updated. I think there's generally a very good understanding about municipalities, what's happening in the external world of how costs are increasing.
They also understand that if costs are increasing and they're not adjusting the prices they pay for us, that will have an impact on how we can perform the care operations. It's in their interest to make sure there's good quality care performed in the nursing homes or other care operations that we do in their municipalities. Just the last comment on that topic is also that the municipalities are currently working with their own budgets, and they don't have all the conditions. They don't know yet what to expect from the state budget. It is a multi-step process, but we are engaging very actively. Of course, we are targeting the municipalities where we have the largest operations, and also those where there isn't a very clearly defined index clause.
Based on what you know now, do you think you really get more or less full compensation for inflation next year in Scandinavia?
I think it's too early to say, to be quite honest. You know, we will not get the result before late in Q4 due to the budget processes in the municipalities.
Over time, it has been a good balance between cost development and how prices are adjusted. Neither the index clause or the other mechanisms have really been designed for the external environment we see right now with very, very high inflation rate, and where it also increased rapidly during 2022. There is a clear risk of a lag in terms of the 2023 year specifically.
Yep. Okay. Thank you.
Thank you. The next question comes from the line of Jakob Lembke with SEB. Please go ahead.
Hi, good morning. My first question is on the Scandinavia. I'm just looking into from 2023. It looks like you're gonna be in the high eighties in terms of occupancy. With you expecting to also cost inflation, what are the factors that could lead to sort of lease-adjusted EBITDA not being around the 8.5% that we have seen before?
Not going exactly on the margin development. What drives margin, of course, is I mean, occupancy development is key. We're coming from a pressured occupancy level after the pandemic and high opening pace during the pandemic as well. We are currently very satisfied with the sales pace that we had during the past year that we expect to continue. Of course, occupancy growth in own operated nursing homes that would be the strongest driver for EBITDA development next year. In combination with that we also will get gradually sort of back on track on home care development as well. That we hope that sick leave numbers will also eventually subside to more normalized level.
We still have sick leave numbers, almost double what they were pre-pandemic, which is a big cost driver, both in terms of overtime and the shift extras for staff that comes in when people are sick. Also because of lower general efficiency, both in home care and in other segments due to the consequences of sick leave. These are sort of the main drivers of margin development in Scandinavia.
Okay. My next question is a follow-up on the price adjustment in Scandinavia. Can you say what proportion of your contracts are covered by the OPI index adjustment clause?
Slightly less than half of them have clear index clauses.
Okay. On Finland, what proportion of the contracts have you been able to renegotiate at this stage? With the delay now of the full implementation, do you also foresee a delay of the full price increase in Finland?
Yeah. During Q3, I mean, we started off Q3 in the middle of the summer. The negotiations were sort of naturally halted during the summer when politicians and civil servants were also on summer leave. After the summer, when negotiations were resumed, the government in Finland announced based on the imbalance in the labor market and the effect of that to announce a change or potential change of the staffing law. That meant also that negotiations came to a halt on the main part of Q3, awaiting more clarity to restart negotiations. We got that clarity in the end of the quarter, where negotiations were resumed again.
Of course, that meant that, I mean, we had boxed in around 20% of the volume for SEK 0.7 prices. This meant that when we're resuming negotiations, we're of course continuing with the SEK 0.7, and there's nothing has changed there. But we also need to add the SEK 0.65 price to this matter. We are, and we have started the negotiations for the SEK 0.65 price.
What we did in the end of Q3 also to make sure that every contract will be renegotiated is that for the contracts that are not yet where we have not yet started negotiation, we decided to terminate those contracts with a six months notice to ensure that we will get to renegotiate the new price at the latest April next year. Now we believe that we will have concluded majority of negotiations by the end of the year. By the time when we release the Q4 report in February, we should have a fairly clear picture of the result of negotiations going into 2023 and April.
We expect a similar margin strengthening at the 0.65% level as we did on the 0.7% level. We have already started to negotiate 0.65%, we have not reached 100% yet, but we are beginning to get results in. We think that this looks promising. It's clear to us that municipalities in Finland have understood the cost implications of the staffing law and seem to be acting accordingly. We are positive about our ability to reach a sustainable price level for next year.
Okay. That's very clear. Just a short follow-up on that you terminated all of the contracts here. Do you foresee any lost contracts or lost volumes into next year on the back of this?
No, we don't.
Okay. I have two more questions, shorter ones. First on this nursing home that you are taking on Ukrainian refugees in, what sort of duration do you foresee of on this contract, I would say?
Until the end of the year, roughly, what we know for now.
Okay. Finally on working capital and cash flow, it was a bit weaker than usual here in the quarter. Can you comment on this?
Yeah. The third quarter is always our weakest when it comes to working capital, and that relates to the payments of summer holiday vacation payments. It's also so that we were maybe a bit in the beginning of the year. We had a bit more positive development than normally, and it kind of adjusted back to normal level in the third quarter. I would say that if you look at several quarters following each other combined, it is quite a normal development.
Okay, thanks. That was all for me.
Thank you. The next question comes from the line of Victor Forssell with Nordea. Please go ahead.
Thank you for taking the questions. Firstly on Scandinavia, just on the current margin dynamics, given that you state the elderly care continues to improve profits, despite some inflationary pressures. Is it so that home care now actually is running on negative margins? Would like to hear more about that action plan, how you see that developing.
No, no. Home care does not run on negative margins. We have, you look at the past couple of years. I think the margins in home care has been industry-leading, for sure. We have had some challenges in the home care business over the past three to six months with the lower margin, also related to higher sick leave, and also a number of startups in the home care on the home care business, which has led to a little bit lower efficiency and also challenges to fulfill all the hours. We expect that to gradually improve over the next two to three quarters.
Good. Then also rephrasing some of the earlier questions, but in terms of progression in Scandinavia next year, in a scenario where perhaps you won't get fully compensated for current inflation and wages into next year, is it still reasonable that you could match or even exceed this year's margins? I mean, due to the increased occupancy and the reaching pre-pandemic levels on that. Is there such a scenario or are you fully dependent on price, the price cost balance, would you say?
I think it's very hard for us in the current situation to give such guidance on the margin percentage level. We know the factors here that more customers of course will help occupancy and profit development. Then it's also a matter about the business mix internally between the different sub-segments of Attendo Scandinavia. We will not give a forecast or guidance on the specific margin percentage development.
Okay. Just finally from my side, things or at least customer inflows seems to have improved in September for you in Finland. Just touching upon what's the main driver here? Was it access to more staff? Was it anything else? Just a comment there would be helpful.
We have had quite a build-up of recruitment activities and other activities to make sure that we get more staff in Finland. It's been very challenging, of course, over the summer, because during the summer you have people, lots of people on vacation. After the summer, since we've had a slightly better personnel situation, and there is an underlying demand in Finland that has been hard for us to fulfill in terms of higher occupancy with increasing staff density requirements over the past two years. Now, after the summer, we had some capacity, and we managed to fulfill that also with improving occupancy levels in Finland.
If you look at the occupancy curve in Finland, you can see that since the start of the new staffing reform, when it went from 0.5 down to 0.55 in 2021 and to 0.60 going into this year, we have been over time quite flat in occupancy development. It's been about maintaining occupancy while fulfilling increasing staff requirements. That is generally what we expect in next year as well, where we have an increase in April and then a second increase in December. What will drive margin development in Finland will be prices next year. That is main part of it.
While I think that is more likely that we will maintain occupancy levels and then start as we get more in the balance, in 2024, then hopefully start increasing occupancy again. Because long term, of course, this should be a 90%+ occupancy business. We're not happy with 85% long term.
Yep. That makes sense. Thank you so much.
Thank you. Ladies and gentlemen, again, if you have a question, please press star, then one. We'll take our next question from Albert Möller Broock from ABG Sundal Collier. Please go ahead.
Yes. Hello. I was wondering a little bit about the sick leave. You mentioned that it was 2x the pre-pandemic levels. I was mostly asking, do you expect this to normalize and fully or not fully? Is there any differences you notice between the two markets? Thank you.
This is like a weather question because we have studied the past two years. Turns out that we expect sick leave to normalize because we have never expected the pandemic to hold it this long. Yes, we're still expecting better weather, so to speak, and expect it to normalize. Hopefully, it will. Now, I mean, now the pandemic is declared not a pandemic anymore. It's not a dangerous disease anymore with all the vaccines and so forth. Still, in this line of business, you can't go to work with a cold or with a cough or with any sickness, given that we take care of very old people and that are more fragile.
Of course, even though that people are vaccinated or the staff is vaccinated and the symptoms are very mild, they still have to stay at home if they feel sick. We can still see that the pandemic is still there. I mean, the COVID is still there. Of course, yes, we, you know, over time, I'm sure this will normalize. To say when, I don't dare to do that anymore because we've been wrong quite a few times so far.
All right. Thank you very much.
Thank you. This concludes our question and answer session. I would now like to turn the conference back to Mr. Andreas Koch for closing comments. Over to you.
Okay. Thank you very much. I will now conclude this conference call. Please feel free to contact us directly after the call if there are any further questions. With that, thank you for your participation.
Thank you. The conference has now concluded. Thank you for attending today's presentation. You may now disconnect.