annual report 2008/09 - apax partners healthcare group annual r… · 4 annual report 2008/09...

Annual Report

2008/09The UK’s largest independent healthcare provider

Annual Report 2008/09Annual Report 2008/09

Contents1 Achievementsandhighlights

2 Chairman’sstatement

4 CEOstatement

6 Businessreview

8 Operatingcompanyperformance

12 GPengagement

14 Newspread

16 TheConsultants’Choice

18 Patientcare

20 Qualityaccounts

22 Cleanasawhistle:infectionpreventionandcontrol

24 Magnetforthebest:ourpeople

26 Corporatesocialresponsibility

28 Environmentalinitiatives

30 Corporategovernance

32 Executivecommittee

Our mission

TogrowourpositionastheUK’slargest

independenthealthcareprovider,

workingwiththebestconsultantsto

deliverthebestqualitypatientcare,

thebestclinicalpracticeandthebest

possibleclinicaloutcomes.

General Healthcare Group 1

1

67

89%

99%

115

7,000+

9,200

2,900

250,000

1million

TheUK’sNo.1independenthealthcareprovider

hospitals&treatmentcentres

oftheGBpopulationlivelessthananhourfromaBMIhospital

patientsatisfactionratingofgood,verygoodorexcellent(Patient satisfaction

survey carried out by Howard Warwick & Associates, Jan - Sept 2009)

specialties&services

consultantspecialists

permanentemployees

beds

inpatientvisitsperyear

outpatientvisitsperyear

Key highlights

General Healthcare Group at a glance

n Integratedsevenex-Nuffield

hospitalsintotheBMIestate

n Acquirednewhospitalsin

DarlingtonandincentralLondon

n Openedsixnewoutreachclinics

andoutpatientunits

n Refurbished30wards,25hospital

receptionsandopenedthecountry’s

first24-7privateemergencycare

centre

n Invested£25millioninimaging

equipmentincludingfourMRI

scanners,fourCTscannersandone

ofonlyfourgammaknivesinthe

country,invested£7millioninnew

theatresand£8millioninclinicalIT

systemstoensurewecontinuetobe

‘TheConsultants’Choice’

n Continuedourcommitmentto

clinicalexcellencebypublishingour

‘QualityAccounts’demonstrating

ourongoingcommitmenttodeliver

qualityservicestoourpatients

n Providedanextra3,000stafftraining

daysin2008/09

Annual Report 2008/092

Chairman’s statement

Position

Our focus has clearly been on maintaining our position as the UK’s number 1 independent healthcare provider whilst ensuring we deliver excellent service to our stakeholders, consultants, GPs and patients.

“

“


2008/09hasbeenanexcitingyearforGeneralHealthcareGroupandayear

inwhichmuchhasbeenachieved.OverthelastthreeyearstheCompany

hasbeentransformedintermsofscaleandquality;andfinanciallyitiswell

positionedtocontinuetotakeadvantageofpositivefundamentaltrends.

Therefore,Iampleasedtoreportthat,againstabackclothofeconomic

turbulence,GHGhasagaindeliveredexcellentresults.

During2008/09wecontinuedtoacquireandexpandourfootprint.Wecannow

proudlysaythatcirca90%oftheUKpopulationlivelessthananhourfroma

BMIfacility.Weareonlynowbeginningtoseetherealbenefitsofthescaleand

nationalcoveragethatwehavecreated.

OurfocushasbeenonstrengtheningourpositionastheUK’snumber1

independenthealthcareproviderwhilstensuringwedeliverexcellentserviceto

ourstakeholders,consultants,GPsandpatients.Maintainingandextendingour

leadingpositionrequiresustoinvestinourbusiness.During2008/09weinvested

£45m,andoverthelastthreeyearswehaveinvestedcirca£150millioninour

existingestateandafurther£150millioninnewfacilities.

Duringthisyearwewereoneofthefirstindependentoperatorstopublishour

‘qualityaccounts’tocommunicatepubliclyourexcellentpatientsatisfaction

levels,ourclinicaloutcomesandourrigorousmanagementofinfectioncontrol

withinallofourfacilities.

BMIHealthcareremainscommittedtoservicingtheindependenthealthcaresector

andthemajorityofourrevenueandcaseloadisderivedfromourprivatepatients.

WehaveacollaborativeandproductiveworkingrelationshipwiththeNHSand

arepleasedtoworkwiththepublicsectortodeliverChooseandBookservicesin

manyofourfacilities,helpingtheNHSdeliveritscorebusiness.

Forthefullyear2008/09ourcaseloadgrewby5.9%andourrevenueby7.6%.

Ouroperatingcompany(OpCo)delivered£220.6millionofEBITDARand

£93.9millionofEBITDA,anincreaseontheprioryearof8.3%and13.3%

respectively.

Westrivetobethemostefficientoperatorandweareveryproudthateachof

ourkeymetricsareindustryleading-reflectingthehardwork,dedicationand

experienceofallourstaff.OnbehalfoftheBoardandshareholdersIwouldliketo

expressourgratitudeandpraisetothem.

Withanageingpopulationweanticipateanincreasingrolefortheindependent

sector.Lookingforward,thecompanyenjoysgoodprospectsasfundamental

trendsarepositive.GeneralHealthcareGroupiswellpositionedtotakeadvantage

ofthis.

Notable achievements this year include:

nGeographicalgapshavebeenfilled

throughacquisitionorbuildandacentral

Londoncorecreatedtoserviceour

hospitalswithintheM25

nAnincreasedinvestmentincapital

equipmenttoensurethatwestayatthe

forefrontofindependenthealthcareand

respondtoconsultants’requestsforthe

mosttechnologicallyadvancedequipment

andfacilities–underpinningour

positioningas‘TheConsultants’Choice’

nAnincreasedfocusonGPengagement

withtherecruitmentofPrimaryCare

Managers,focusingonfurtherenhancing

ourrelationshipswithGPslocaltoeachof

ourhospitals

nTheexpansionofourNationalEnquiry

Centretoservicebetterconsultant,GPand

patientenquiriesandensurethepatient

iswelllookedafterfrominitialenquiryto

finaldischarge

nFocusonprovidingcareerpathsfor

internalmanagementanddevelopment

ofemployeeskillsetsthroughadditional

training.

1 The UK’s No. 1 independent

healthcare provider

Sir Peter GershonChairman,Nov2009


Commitment

Ensuring our hospitals’ commitment to delivering the highest standard of service and care to patients, consultants and everyone associated with us.

“

”

IamdelightedtoreportonceagainthatGeneralHealthcareGroup

hasdeliveredanotherreallysolidperformanceacrossallourkey

metricsintheyear2008/09.Thisisthethirdsuccessiveyearof

outstandingperformance.

CEO statement


Theimprovementsputinplaceoverthelastthreeyearshave

demonstrablydifferentiatedthebusinessbyquality,scale,employee

capabilityandcustomersatisfaction.

Ourcompanyisanefficientbusinessthatcontinuestohave

significantopportunityandpotential.Thisisabusinessevery

stakeholdercanbeproudof.

TheUKeconomyhashadaturbulentyear.Neverthelessdemand

forprivatehealthcareremainedstrongandwithanageing

populationthisdynamicissettocontinue.

Wearepleasedtoreportindustryleadingresults

nTurnoverup7.6%

nOperatingCompanyEBITDAup13.3%*

nPatient/customersatisfactionmaintainedatalltimehighs–99%

good,verygoodorexcellent,with98%recommending

tofriendsandfamily.

nContinuedfocusoninfectionpreventionwithnohospital

acquiredMRSAbacteraemiasinthelast12months**

In2008/09wehaveseenprivatelyinsuredandcorporatebusiness

remainfirmbuttheselfpayelementreducesharply.Tomitigatethis

wehaveaugmentedandgrownourcapacitybyofferingChoose

andBookincarefullytargetedhospitals.Itisexpectedthatthe

NHSfundedactivitywillcontinuetoplayanimportantroleinthe

independentsector,asthelegislativepolicyofChooseandBook

rollsoutfurther.BMIHealthcarehoweverremainsverymucha

privatehealthcareproviderthatmakessomecapacityavailableto

theNHStoserviceitscustomers,whereitisefficientandeffective

todoso.Thisnowrepresentscirca10%ofourcaseload.

Theobjectivefortheyearwastostrengthenfurtherourpositionas

thenumber1healthcareproviderintheUK,furtheremphasising

ourcommitmenttodeliveringthehigheststandardofserviceand

caretopatients,consultantsandallourstakeholders.

Wehavecompletedamajorrefurbishmentprogrammeofwards

andreceptionareasacross23ofourhospitalsandhaveinvested

significantlyinleadingedgescanningandimagingequipment.

Wealsosoughttoexpandourgeographicpresenceandintroduce

newservicestomanyofourhospitalsthroughourongoing

investmentprogramme.

Intheyear2008/09wehaveacquiredfacilitiesinDarlingtonand

Oxford,andopenednewunitsincentral&westLondon,Aberdeen

andSwindon.Wealsowonamajorcontracttomanagethe

CoombeWingPrivatePatientUnitwithinKingstonNHSTrust.

Wehavedoubledspendonstafftrainingoverthelastthreeyears

andinthecomingyearwewillcontinuetoinvestinthetraining

anddevelopmentofourstaff,recognisingthemasthebestpeople

intheindustry.

Iampleasedtoreportthatinthelastyearbothourclinicalstaff

andourmanagementhaveagainbeenrecognisedasleadersinthe

sector.

12ofourhospitalswerelistedintheNursingTimesTop100and

individualstaffhavereceivedsignificantemployment,leadership

andmanagementawards.Mostpositivelyhowever,asitunderpins

ourbusiness,wearenowdeliveringpatientsatisfactionalmost10%

pointsclearofthemarket–arealbarometerforfuturereferrals.

Inshort,BMIHealthcarehashadanotherstrongyearandweare

wellplacedtocontinuetoleverageourmarketleadingposition

andexploitthemanyincrementalgrowthopportunitiesasthe

marketconsolidates.

Thebusinessreviewthatfollowsgivesfurtherdetailaboutwhathas

beenhappeninginourbusinessandtheindustry.

Iamproudoftheachievementsofthiscompanyandits

transformationintoanefficientservice-ledbusinessthathasthe

potentialtoextenditsleadershipandgrowsignificantly.

Adrian FawcettChiefExecutiveOfficer,Nov2009

“ ”Our company is an efficient business that continues to have significant opportunity and potential.

*Seefinancialreview**ToAug09


Business review

BMIHealthcare,theacuteprivatehospitaldivision

ofGeneralHealthcareGroup,isthelargest

independentproviderofprivatehealthcarein

theUK.

TheGrouphas67hospitalsandtreatmentcentres

throughouttheUK,eachhavinganenviable

reputationforprovidingexcellentmedicaland

surgicalfacilitiessupportedbystate-of-the-art

equipmentandahighstandardofnursingcare.

BMIhospitalsreceiveover250,000in-patientand

1,000,000out-patientvisitseachyear,andperform

morecomplexsurgerythananyotherindependent

privatehealthcareproviderinthecountry.Nearly

halftheproceduresundertakenforpatientsareof

amajororcomplexnature.

BMIhospitalsattractconsultantsfromawide

rangeofspecialties,mostofwhomhaveextensive

experiencegainedwithintheNHS.Supportedby

BMIHealthcare’shighcalibrestaff,theyareableto

undertakeawiderangeofproceduresfromroutine

investigationstothemostcomplex,highacuity

casessuchascardiacsurgeryandneurosurgery.

BMIHealthcareiscommitted

toprovidingaconsistent,

highqualityservicetolocal

communities.89%oftheGB

populationlivelessthanan

hourfromaBMIhospital.

Totalhealthcarespendingin

theUKreached£136billion

in2008,comparedwith

£60billionadecadeearlier,

withtheshareofgrossdomestic

productgoingtohealthrising

to9.4%from6.9%in1998,

puttingtheUKroughlyon

parwiththeEuropeanUnion

average.

PressuresontheBritish

healthcaresystemarelikely

togrowandforecastslooks

challenging,withpublic

spendingacrosstheboardlikely

tobecurtailedbycrippling

governmentdebtoverthenext

fiveyears.Exacerbatingthe

problemarethedemographic

realitiesofasicker,ageing

population,andtheadditional

expenseofnewtechnologies

beingdevelopedtotreatthem.

AJune2009paperbytheNHS

Confederation,themembership

bodyfortheinstitutionsmaking

uptheNationalHealthService,

predictedthattheNHSwould

facea“veryseverecontraction

initsfinancewithan£8-£10

billioncutinrealtermslikely

inthethreeyearsfrom2011.”

TheKing’sFund,inaJuly2009

report,discussedthreepotential

scenariosforfundingofthe

EnglishNHSfrom2011/12to

2016/17:a“tepid”outlook,with

annualrealincreasesof2%for

thefirstthreeyearsand3%for

thefinalthreeyears;a“cold”

outlookofzerorealchange

infunding;andan“arctic”

scenariothatforeseesannual

realreductionsof2%forthefirst

threeyears,fallingto1%forthe

finalthreeyears.Giventhislack

offundinggrowth,therewillbe

anincreasingrolefortheprivate


BMI Healthcare’s core focus remains the private sector and providing quality healthcare for insured and self pay patients.

“

”Focus

sector,evenifNHSefficiencies

canoffsetsomeofthebudget

pressure.

FallingNHSbudgetswillprevent

capacityexpansion,andcost

savingsmayimpactonquality

intheNHS,furtherincreasing

demandforhighqualityprivate

sectorservicesofferingchoiceof

consultants,andhighstandards

ofcleanliness.

In2009GeneralHealthcare

experiencedtoughtrading

conditionsduetotheweak

economy,anditisexpectedthat

challengingmarketconditions

willcontinuetoimpactgrowth

ofthecorebusinessinthe

shortterm.Howeverexcellent

opportunitiesforbusiness

developmentremainand

smalleroperatorsareseeking

securitythroughpartnerships

withlargerorganisations.

BMIHealthcare’scorefocus

remainsontheprivatesector

andprovidingqualityhealthcare

forinsuredandselfpaypatients.

BMIhospitalsareconnected

totheNHSChooseandBook

serviceandofferarangeof

servicesundertheExtended

ChoiceNetwork.Wehavebeen

veryselectiveinlistingChoose

andBookservicestoensurebest

utilisationofoursparecapacity.

InBMIHealthcarewe

recognisetheimportanceof

ourrelationshipswithourkey

stakeholders,theconsultants

whoworkinourhospitalsand

theGPswhorefertheirpatients

tous.

In2009wehavefurther

expandedourteamsofPrimary

CareManagerswhoare

responsibleforliaisonwith

GPslocaltoourhospitals,

ensuringtheyarefullyaware

ofourproductsandservices

andfacilitatingandeasingthe

referralprocess.

GHGGROWTH

Qualitybusiness&sites

Newfacilities

Efficienthospitals

Newservices

Stakeholderengagement

Capitalinvestment


Operating company performance

Financials8 Directors’reportfor

financialstatements

8 Corporatefinanceactivities

8 Capitalprojects

8 Financing

9 Operatingperformance

10 Groupprofitandloss

11 Cashflow

11 Borrowings

Directors’ report for financial statements

GeneralHealthcareGrouphasproduced

strongrevenueandprofitgrowthduringa

challengingyear.Revenuehasincreased

7.6%from2008levelswhich,coupledwith

improvedefficiencyhasseenitsEBITDA

marginincreasefrom10.7%to11.3%.

EBITDAgrewby13.3%to£94m.

Corporate finance activitiesDuring2009GeneralHealthcareGroup

hasstrengtheneditspositionastheleading

privatehealthcareproviderintheUK.The

Grouphasbroadeneditsgeographical

coverageandimproveditsperformance

throughthestrategicacquisitionsofCity

MedicalandFitzroySquareincentral

London,TheThornburyRadiosurgeryCentre

inSheffieldandTheWoodlandsprivate

hospitalinDarlington.

FinancingTheoperatingcompanyhasnetdebtof

£180m,lessthantwotimesheadlineEBITDA.

Inadditionundrawnfacilitiesof£69m

remainavailable.Thereisnorefinancing

requireduntil2013.

Capital projectsTheGrouphascontinuedtosetasidea

significantproportionoffreecashflowfor

improvementsintheinfrastructureofthe

business,investing£45mduring2008/09.

TheGroupundertookabalancedportfolioof

schemes,focussingonthefollowing:

nimprovingand/orextendingclinical

services

nimprovinghospitalinfrastructure

nenablingbusinessprocessthrough

improvedIT.


RevenuegrowthwasdrivenbyariseinbothNHSandinsuredcaseloadmorethancompensatingforafallinself-pay

volumes.Efficiencyinitiativesimplementedduringtheyearhaveensuredthatmarginhascontinuedtoexpand.

Therentreceivedbytheproperty

companyownedbytheGrouphas

increasedby5%perannum.Thisis

madeupof2.5%annualincrements

withintheleasesplusthepositive

impactofanincreasednumberof

propertieswithintheportfolio.

Thecompanyhascontinuedtogrowtoplinerevenuestrongly.Anincreasingproportionofthisisfallingtothebottomline,

deliveringEBITDAgrowthof13%intheyear.

2009 2008 Growth

Total cases 261,195 246,589 5.9%

£’m £’m %

Revenue 832 773 7.6%

Headline EBITDA 94 83 13.3%

EBITDAmargin 11.3% 10.7% 0.6ppts

Profitbeforetax 35 25 40.0%

Profit after tax 36 22 63.6%

Operatingcashflow 128 131 (2.3%)

Property company

Operating Company

Revenue9008007006005004003002001000YR05/06 YR06/07YR07/08 YR08/09

632 689 773 832

EBITDA1009080706050403020100YR05/06 YR06/07YR07/08 YR08/09

43 62 83 94

EBITDA margin12

10

8

6

4

2

0YR05/06 YR06/07YR07/08 YR08/09

6.8% 8.99% 10.7% 11.3%

130

125

120

115

110

105

100YR05/06 YR06/07YR07/08 YR08/09

110 113 121 127

10%

30%


GP engagement

“ ”Our company is an efficient business that continues to have significant opportunity and potential.


FeedbackfromGPshasunderlinedtheimportanceofaneasyreferralprocessfor

theirprivatepatients.Asaresultofthiswehavelauncheda‘GPHotline’giving

doctorsatotallysecureandeasywayofreferringtheirpatientstoaBMIhospital

usingeitherwebortelephone.

BMIHealthcare’snationalGPHotlinestreamlinesthereferralprocess,providing

significantbenefitsforbothpatientsandGPs.

Whereasthetraditionalreferralprocesscantakeuptoaweektosecurean

appointment,BMIhasreducedthistimetotwohoursviathenewservice.

Bearinginmindtheoverflowingin-traysinmedicalpracticesacrossthecountry,

thisreductioninpracticeadministrationtimehasbeenwelcomedbyGPs.

Followingaconsultation,aGPcanphoneBMI’sNationalEnquiryCentreand

dictateareferrallettertoaprofessionallytrainedadvisor,whowillthenmakea

courtesycalltothepatient.

Thefasttrackingsystemprovidespeaceofmindforpatients,whocanrelax

knowingthattheirdiagnosisisunderwayandaconsultationisbeingarranged.

ThemedicalknowledgeofBMIadvisors,coupledwiththeirpracticeexperience,

allowsthemtounderstandthepressuresfacingGPsandhasresultedinafast

andefficientservice,whichmeetstheneedsofGPsandtheirpracticestaff.

The Primary Care TeamAPrimaryCareTeamhasbeenestablishedwithin

BMIHealthcaretobuildstrongrelationshipswith

GPswhoplaythepivotalroleinreferringpatients

toBMIconsultants.The10,500GPpracticesinthe

UKaresegmentedandtargetedbytheteamwitha

viewtodevelopingongoingactivitytostrengthen

thereferralpathwaytoBMIhospitals.

Thekeyfocusistopromoteourhospitalservices

andrelevantconsultants,theteamengageswithGPs

andpracticemanagerstoactivelyreferpatientsto

BMIhospitals.ChooseandBookisanotherareathat

isdiscussedandGPsareveryoftenkeentoselect

usasaprivateproviderofNHSservices,duetoour

lowinfectionratesandthefactthatpatientscareis

ledanddeliveredbytheconsultants.

AlargepartoftheworkofthePrimaryCareTeam

isgettingconsultantstoengageandnetworkwith

localGPs,asthiswillsupportandgeneratefurther

referrals.Aprogrammeofeducationaltalksis

conducted,withbothin-surgerymeetingsandlarger

seminarsbeingheld.Otherhealthcareprofessionals

arealsovisited,suchasphysiotherapists,

optometristsanddentists,andwehavedeveloped

someexcellentreferralpathwaysintoourhospitals

fromthesealliedgroups.

Withastrongstrategicfocusinthecomingyear,

targetedsellingofourcoremessagesandfurther

enhancementstotheGPandconsultantinterface

weareveryconfidentthatthePrimaryCareTeam

willbeaninstrumentalpartofthesuccessof

BMIHealthcarein2009/10.

Dr John Tobias, Elmwood Medical Centre

”“ I have been using the GP Hotline for the last three months or so. It has

enabled me to arrange an appointment for my patients with a consultant of my choice within minutes of seeing the patient, in an extremely efficient way. I know that one telephone call will generate the appointment, the referral letter and the patient contact/notification. It’s a ‘one-stop shop’ solution for me.


Theinsuredmarkethasproventoberobustinaverychallengingeconomicclimate.BMIcontinuedtogrowitsinsuredrevenueinthe

financialyeartoSeptember30thandalsogrewitsmarketshare.

BMIprovideshealthcareforpolicy-holdersofeveryinsurerinthemarket:companiessuchasAIG,Aviva,AxaPPP,Bupa,Cigna,CS

Healthcare,PruHealth,SimplyHealth,StandardLifeandWPA,amongothers,coverover70%ofourbusiness.Ourdeservedreputationfor

qualityhealthcareandoutcomesmeansthatBMIisthepremiumhospitalproviderofchoicefortheinsurancemarket.

BMIalreadyprovidesmoreservicestoPMIcompaniesthananyotherhospitalgroupandin2008/9hasmadestrongprogressindeveloping

relationshipswithanumberofthekeygroups.Tobuildonthispositionwearefocussingonensuringthatourproductofferprecisely

matchestheirrequirementsandrepresentsthehighestqualityoutcomes.Wehaveworkedcloselywithinsurerstoassistthembymanaging

theirclaimsrisk,providingqualityperformancemeasuresandimprovingthepatientjourney.

Comprehensive coverage:

Private Medical Insurer relationships


BMI’sgrowingnetworkofhospitalsandclinicsisalsoparticularly

attractivetoInsurersbyenablingthemtooffermembersa

consistentlyhighqualityserviceonanationalbasis.Our

acquisitionstrategyisinpartdrivenbyadesiretocloseany

remaininggapsinournationalcoverage.Thisisparticularly

apparentinLondon,wherewehavegrownourinfrastructureto

include14hospitalsandclinicswithintheM25.

BMIHealthcareisincreasinglyknownfornotonlyourtraditional

secondarycaremarket,butthecompleteend-to-endclinical

service,fromfirst-linediagnosticsandearlyinterventionthroughto

surgicaloutcome.

Ourextensivenationalfootprintandstrongclinicalfocushas

alsoallowedustoenternewcorporatemarkets.Forexample,the

expansionofourIntelligentHealthproductrangeallowsusto

supportemployers,eitherdirectlyorviatheirinsurerorbroker,

byofferingprimarycare,healthassessments,physiotherapy

andemployeehealthriskmanagementcapabilities,aswellas

clinically-evidencebasedwhiplashrehabilitationpathwaysforthe

medico-legalmarket.

IncreasinglyinsurersarealsolookingtoBMItoprovidenational,

tailorednetworksfortheircustomers,wherebecauseofourreach

andflexibleproductoffer,largebusinessescanrelyonusforatotal

healthcaresolution.

Case study

Working with Honda’s HR team and the group’s Insurer,

BMIHealthcarehascreatedabespokesolutiontomeetallits

corporatehealthcarerequirementsincluding:

nFullservicecapabilitycentredaroundthehighqualityfacilities

oftheBMIRidgewayhospital

nSimplifiedbookingforHealthScreening

nRapidaccesstodiagnosticandoutpatientconsultations

nExcellentemployeetreatmentandminimaldisruptionto

employeeandemployeralike

nCorporateratesreflectiveoftheBMI-centricnatureof

relationship

Honda recognises that private healthcare is a valuable benefit for employees, whatever the economic climate.

Ourinvestmentinfacilitiesandequipmentishighlyinfluencedby

theneedsofourInsurancepartnersandtheirclients.Allparties

willshareinthebenefitstopatientcareandcasemanagement

fromover£25mofnewimagingandsurgicalequipmentandmore

than£8minsystemsandprocessdevelopment,during2008/9

alone.

“ “

Bishops WoodHospital

The Garden Hospital

The Clementine ChurchillHospital

The King’s Oak Hospital

The Cavell Hospital

The Blackheath Hospital

The London Independent Hospital

MaryleboneConsulting

Rooms

Fitzroy SquareHospital

City Medical

Princess MargaretHospital

The RunnymedeHospital

The KingstonHospital

Shirley OaksHospital

The SloaneHospital

Chelsfield ParkHospital

Fawkham Manor Hospital


The Consultants’ Choice

7,000+ Consultants choose to work with GHG


BMIHealthcareisproudtobeabletoclaimitis‘TheConsultants’Choice,’

withmoreconsultantschoosingtoworkinourhospitalsthananyother

independentprovider.Consultantsconsistentlyrateusbetterthanthe

competitioninkeycategoriessuchasthequalityoffacilitiesandnursing

staff.*

Aspartofourcommitmenttoprovidingexcellentequipmentandfacilities

weregularlyconsultwithourdoctorstoensureweareinvestinginthe

supportservicestheyneed.

Anexampleofoursupportandinvestmentisintherecentopeningofthe

firsthi-techoperatingtheatreofitskindinstalledatBMIMountAlvernia

Hospital.

TheStrykeri-suitetheatreopensasthesecondstageofa£6mdevelopment

atMountAlvernia,andfeatureswidescreenhigh-definition(HD)monitors,

HDimagingcapabilitiesandisthefirstinEuropetouse“shadowless”

lamps.

TheHDmonitorsintheoperatingtheatreenablesurgeonstoseefromevery

anglewhenoperatingandthehigh-techinstallationallowssurgeonsto

performnewer,morecomplexsurgerykeepingupwiththelatesttreatments.

Thetheatreisfuture-proof,allowingforupgradestokeepupwiththevery

latestadvancesinsurgeryandMrIainJourdan,ConsultantSurgeonatBMI

MountAlvernia,saidofthei-suite:“Iamveryimpressedwiththisnew,state-

of-the-arttheatre.Everythingisintegratedand,veryimportantly,mobile,

whichallowssurgeonstoperformmoreefficientlyandtothehighestlevel.”

ElieenScrase,ExecutiveDirectorofthehospital,commented:“Weare

pleasedtobeleadingthewayinsurgeryandtechnologyinSurrey.”

“Ournewergonomictheatrewillallowsurgeonstoperformmorecomplex

surgeries,whichmeanspatientswillbeofferedthelatesttreatments

availableandthehigheststandardofhealthcare.”

* Source ORC research June 2007

I have treated private patients at BMI The London Independent Hospital for 10 years and can wholeheartedly recommend it. The cardiac catheterisation suite is a state-of-the-art facility with expert, helpful and friendly staff. Their positive and flexible attitude helps me and, more importantly, provides an excellent environment for my patients.

Dr Charles KnightConsultantCardiologist

“

”As part of our commitment to providing excellent equipment and facilities we regularly consult with our doctors to ensure we are investing in the support services they need.

“”


Patient care


After64-year-oldadvisoryteacherGeoffMartelofGuernseywas

diagnosedwithlocalisedprostatecancerinthesummerof2008,he

knewhewantedtofindtheprocedureandsurgeonthatwouldprovide

himwiththebestpossibleoutcome,sohetravelled150milestobe

treatedbyMrChrisEden,ConsultantUrologistatBMITheHampshire

ClinicinBasingstoke.Today,Geoff’scancerisinremission,andheis

praisingMrEdenandthehospitalfortheexcellenttreatmenthereceived

torestorehishealth.

Geoff ’s story: “My GP was astounded by my recovery”Duringaroutinecheckupin2008Geoffreceivedablood

test,whichrevealedahighProstateSpecificAntigen(PSA)

reading,anearlyindicatorofprostateproblems.Geoff

thenunderwentaseriesoffollow-upbloodtestsand

examinations,whichconfirmedapositivecancerdiagnosis.

Geoffknewhehadtomakesomeseriousdecisionsabout

histreatment.Hewaspleasedtofindhewouldbealikely

candidateforlaparoscopicradicalprostatectomy(LRP),the

minimallyinvasiveproceduretoremovetheprostategland.

Geoffhadreadthat,comparedtotraditionalopensurgery,

LRPofferedgreaterpatientcomfort,shorterrecoverytimes

andreducedbleeding.

Geoff’sdaughter,aphysiotherapist,recommendedhelook

intoseeingMrChrisEden,whohadsuccessfullytreated

someofherclients.Afterspeakingwithanotherpatientwho

wasfullofpraisefortheurologist,Geoffwascertainthat

MrEdenwasthesurgeonhewanted.

Geofffeltitwouldbewellworthpayingtobetreated

privatelyandhewenttoseeMrEdenatTheHampshire

ClinicinMay2009.Geofffeltimmediatelyreassuredbyhis

knowledgeandlongexperienceinperformingLRPsandtwo

weekslaterGeoffreturnedtothehospitalforhisprocedure

andwasextremelypleasedwiththecarehereceived.

“EverythingwentjustasMrEdensaiditwouldandevenat

theprecisetimes,”saidGeoff.“ThestaffatTheHampshire

Clinicwerealsoexcellent.Nothingwastoomuchtrouble

andtheirattentiontodetailwasamazing.Theyexplained

everythingthatwentonbeforeandaftertheprocedure–I

couldn’tfaultathing.”

Geoffwasalsosurprisedathowquicklyhestartedfeeling

betterfollowinghisprocedure:

“Thescarshadhealedwithintwoweeksand,now,you

wouldhardlynoticeathing.Iwasupandwalkingaround

within24hours.Iactuallyfeltmorediscomfortandpain

duringandaftermybiopsythanIdidaftertheoperation.I

wasabletodomostthings,includingwalkingmostmornings

andevenings.”

Geoffreturnedtoworkonlytwoweeksandtwodaysafter

surgery.“Mydoctorwasastoundedbymyrecoveryandwas

delightedwhenhesawmelookingsofitandraringtoget

backtowork!”

Today,Geoff’scancerappearstohavebeencuredwithonly

a1%chanceofitreturninginthefuture.“Ifeelrelieved,and

verypleasedtohavebeenseenbyMrEden.”

“

Mr Chris Eden, Consultant Urologist BMI The Hampshire Clinic

The staff at The Hampshire Clinic were also excellent. Nothing was too much trouble and their attention to detail was amazing. They explained everything that went on before and after the procedure – I couldn’t fault a thing.

“


AstheUK’slargestsupplierofacutesurgicalservices,BMIHealthcare

hasbeenattheforefrontofthedrivetoimproveclinicalandnon-

clinicalstandardsacrosstheindependentacuteprovidersector.Ithas

calledforandcontributedtoregulationinapositiveway,improved

itsreportingprotocolsandwelcomestheopportunitytodemonstrate

itscommitmenttohighqualitypatientcareandcontinuous

improvements.

Quality accounts

“ ”Our patients have a justifiable expectation of the highest quality, safe and effective service.


Duetothenatureofhealthcare,complicationsareunavoidablein

somecasesbutwestrivetoensurethatwehavereducedthistothe

minimum.

Thefollowinggraphfortherateofunplannedre-admissionand

unplannedreturnstooperatingtheatredemonstrateanongoing

yearonyearreductioninanyadverseincidents/complications.

Overallthesereadmissionandreturntotheatreratesarearound

halfthelevelsexperiencedintheprivatesectorasawhole*

Patient SatisfactionEmphasisonclinicalexcellence,patientcareandoverallqualityhasledtoBMIrecordingmarketleadingcustomersatisfactionscoresinindependentsurveysruninallofourhospitals.SimilarsurveysarealsorunintheNHSandtheresults

BMIreceivedsatisfactionsurveysbackfrom43,584inpatientandday-casepatientsinthelast12months.Thiscomparesto72,000acrossthewholeoftheNHSreceivedbyNHS.

Satisfactionwithoverallquality–NHS75.6% BMI98.4%

Ouroverallratingofourcareandourintentiontorecommendscoreshavebothimprovedyearonyearinsertnumbersandsource.

Notonlydowemonitorqualityforthepurposeofongoinganalysis

andimprovement,buttheresultsarealsousedtomonitortheeffect

thatanychangesinserviceorcorporatecostefficiencydrives,which

areasdemonstratedbelow.

Newinitiativeshavebeenundertakeninnursing,wherea

recruitmentdrivehasledtoincreasingthenumberofemployed

nursesandswitchingawayfromAgencynursesaswellasthe

introductionofsmarterworkingpractices.Thishasledtoimproving

patientsatisfactionscoresoverthelast9monthsof2008/09.

Duringthesameperiod,wehaveachieveda5%pointincreasein

satisfactionwithourcatering,wherenewmenusandpresentation

havebeenintroducedandhavebeensupportedbystaffawareness

andtraininginitiatives.

“”

BMIhasbuiltupacomprehensivemulti-disciplinaryclinical

governanceframeworkencompassinglocalhospitalandcorporate

levelsinorderto:-

nEnsurethesettingofstandardsinlinewithregulationandthe

latestevidencebasedprotocols.

nSupportimplementationwithskilledstaffwhoundertake

ongoingprofessionaldevelopmentandinvestmentinequipment

andenvironmenttokeepupwithfastmovingtechnological

developmentsinhealthcare.

nMonitorallaspectsofservicedeliverybycollectionofpatient

feedback,clinicaloutcomeandadverseincidentdata

nAnalyseandreviewthedatatofacilitatetheplanningand

implementationofappropriateactionsforimprovementandthe

minimisationofanyrisksidentified.

Over three quarters of patients rate their consultants and over two thirds rated their nursing and overall care as excellent.

Complications

0.500

0.450

0.400

0.350

0.300

0.250

0.200

0.150

0.100

0.050

0.000

0.443

0.402

0.266

0.1810.1870.201

0.011 0.009 0.007

2006/2007 2007/2008 2008/2009

BMI Healthcare complications per 100 patients

Re-admissionwithin31days

Unplannedreturntotheatre

DVT

October2008-September2009Source: Howard Warwick patient satisfaction survey

Excellent

Verygood

Good

Fair

Poor

Patient satisfaction overall rating scores100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%

Consultant

Nursingcare

Accom

modation

Catering

Qualityofcare

Valuefo

rmoney


infection prevention & control

Environmental cleanliness is an important factor in infection prevention and our patients rate the cleanliness of our facilities highly.Prof. Duncan Empey GroupMedicalDirector

“ Cleanliness

”

Clean as a whistle:


Hospital acquired infectionInfectionpreventionremainsakeyconcernforpatients.An

opinionpollcarriedoutinAugust2009forBMIHealthcareshows

thatcleanlinessandhygienearethebiggestconcernsforthepublic

inreceivingtreatmentinNHShospitals.Fearsoverriskofhospital

acquiredinfectionandsuperbugssuchasC.DifficileandMRSA,as

wellasgeneralhospitalcleanlinessnowtopthelistofconcernsfor

prospectivepatients(29%),followedbystandardsoftreatmentand

care(26%)andthenwaitinglists(20%).

TheCOMRESpollwasconductedusinganentirelyopenquestion

andthepublicwereaskedtonametheirbiggestconcernsabout

beingtreatedinanNHShospital.

EffectivenessBMIHealthcare,incommonwithotherprovidersofacute

healthcareintheindependentsector,notonlyfocusesonthe

immediacyofservicedeliverybutalsoonitscontributionto

thegrowthanddevelopmentofahighqualityhealthsystem

intheUK.Throughacommitmenttoaprogrammeofclinical

governance,BMIHealthcareremainsaccountabletopatients,

theirdoctors,otherhealthcareagenciesanditselfforthescope

andstandardofthecareitdelivers.

EveryBMIhospital/facilityhasalocalframeworkthroughwhich

clinicaleffectiveness,clinicalincidentsandclinicalqualityare

monitoredandanalysed.Whereappropriate,actionistakento

improvecontinuouslythequalityofcare.Thisisthroughthework

ofamultidisciplinarygroupandtheMedicalAdvisoryCommittee

ineachhospital.Atcorporateleveltheclinicalgovernanceboard

hasanoverviewandensuresthatthereiscorporatelearningand

qualityimprovement.

GeneralHealthcareGroupinitiatedaclinicalindicatorproject

in2007.Thisisnowajointdevelopmentinconjunctionwithall

otherindependentsectorproviders,theDepartmentofHealth,the

CareQualityCommissionandtheNHSInformationCentre.

Range of infections in NHS vs. BMI Healthcare*

Clostridiumdifficilecasesper1,000beddays

MRSAbacteraemias(bloodinfection)casesper10,000beddays

* BMI - Reported via corporate surveillance reporting mechanism (Oct 2008 to Sept 2009)

NHS - Health Protection Agency (May 2008 to April 2009)

0.9

0.8

0.7

0.6

0.5

0.4

0.3

0.2

0.1

0

Clostridium difficile per1,000beddays

MRSA bacteraemiasper10,000beddays

NHS 0.79cases

BMI 0cases

NHS 0.52cases

BMI 0.09cases

Low High Low High


Magnet for the best: our people

9,200 dedicatedpermanenthealthcareandsupportstafflookingafterpatients

acrossthecountry

Quality of care and attention to patients is a key differentiator between us, the NHS, and our competitors.

“ “

Care


Everymonthnearly14,000peopleare

engagedinemploymentwithGHG.

Thesearemainlylongtermpermanent

staffand‘bank’staffonpart-timeadhoc

hours,whomayhavealong-standing

relationshipwiththecompany.Justover

halfofouremployeeshaveaclinicalrole,

asnurses,pharmacists,physiotherapistsor

radiographers,andthemajorityoftheothers

areinrolesdirectlyassistingourpatients,

forexampleinreceptionorhousekeeping.

Ourstaffarethereforeatthecentreofthe

patientexperienceand,assuch,shapethe

waythecompanyisperceived.Theyprovide

thecare,commitment,professionalismand

servicethatunderpinourpositionasthe

leadingprivatehealthcareproviderinthe

UK.

AtGHG,wearecommittedtocreating

aworkingenvironmentthatattractsand

retainstalentedindividuals,engages

andmotivatesthemtodelivertheirbest,

providesrecognitionforcontribution,

providesexcellentandongoing

developmentopportunitiesandensuresthis

isachievedwithahealthyregardforwork-

lifebalanceandindividualwellbeing.

GHGiscommittedtopromotingequalityof

opportunityforallitsemployeesandaims

tocreateaculturewherestaffrespectand

valueeachother’sdifferences.Weseekto

removeanybarriers,biasordiscrimination

thatpreventindividualsfromrealising

theirpotentialandcontributingfullytothe

company’sperformance.

Ourcurrentmanagementtraining

programmesincludesessionsonfair

selectionandmanagingdiversity.Inthe

autumnof2009,wewillbelaunching

specifictrainingondiversityinconjunction

withenhancedtrackingofequal

opportunitydata.Wehavealwaysprovided

flexibleworkingarrangementstoenable

ustoappealtopeopleinaswidearange

ofpersonalcircumstancesaspossible,

andthisremainsakeystrengthwithinour

employmentproposition.

Oursuccessisinextricablylinkedwiththe

knowledgeandexpertiseofouremployees,

anddespitethecurrenteconomicpressures,

weincreasedourlevelofinvestmentin

traininganddevelopmentlastyear.

Wecreatedanddeliveredaground-

breakingprogrammeforourHealthCare

Assistants(HCAs),whichblendsclassroom

andpracticaltrainingforallnewand

recentrecruits.Thisprogrammeensures

thatourHCAsareequippedtoprovidea

consistentlyhighstandardofpatientcare,

whileenablingRegisteredNursestofocus

onclinicalsupport.

Inlatesummer2009,wecommenced

deliveryofaportfolioofnationalnursing

trainingprogrammes.Theseincludecross-

trainingintheatreskillstoprovidethe

opportunityforwardnursestodevelopin

thisarea,returntopracticeprogrammes,

andongoingprofessionaldevelopment

seminars.

During2008/09,wedeliveredover2,000

daysofmanagement,leadershipand

commercialdevelopmentprogrammesfor

middlemanagement.Theseprogrammes

aredesignedtosupportthesignificant

organisationalchangeunderwayand

tofacilitateasharedcultureacrossthe

UKbusiness.Thiscontinuesandwillbe

expandedfurthertoprovidearelated

programmeforsupervisors.

Atseniorlevels,wewillbelaunchinga

leadershipdevelopmentprogrammewithin

twoyearstosupportouraimoffilling

themajorityofseniorvacanciesthough

successionanddevelopment.

Wehavebeguntoimplementonline

mandatoryclinicaltraining,whichprovides

therequiredtheorycomponentthrough

aseriesofonlinemodules,togetherwith

classroom-basedpracticaltraining.This

givesemployeesflexibilityoverwhenthey

completetraining,andensuresconsistency

ofstandardsandautomatedmonitoringof

compliance.

Qualityofcareandattentiontopatients

isakeydifferentiatorbetweenus,the

NHS,andourcompetitors.Customercare

willthereforebeamajorareaoffocus

in2009/10.Intheautumnof2009we

willlaunchanintegratedprogrammeof

initiativeswhichbringstogethertrainingin

customercareskills,operatingstandards

andcarepathwaysforallhospital-based

staff.Thiswillbecomplementedbya

nationalawardprogrammeforteamsand

individualsthatrecognisesexceptional

deliveryofcustomerserviceorpatientcare.

“ Our staff are at the centre of the patient experience and, as such, shape the way the company is perceived.”


Corporate social responsibility

GeneralHealthcareiscommittedtocorporatesocialresponsibility

andthisiscarriedthroughinallouremploymentpolicies,

environmentalpoliciesandourinteractionswiththelocal

communitiesaroundourhospitals.

Health & SafetyHealthandsafetypoliciesareintegratedintoallGroupoperations

toensurethesafetyandwellbeingofouremployees,patientsand

theirvisitors.Healthandsafetycommitteesoperateinallbusiness

unitswiththefollowingtermsofreference:

nInstigate,developandimplementmeasuresdesignedtoensure

workplacehealthandsafety

nMonitorcompliancewithOccupationalHealthandSafety

legislation,regulationsandcodesofpractice

nFormulate,reviewanddisseminatepoliciesandprocedures

relatingtohealthandsafety,whicharetobecarriedoutor

compliedwithwithintheworkplace

nMonitorincidentstatisticsandspecificreportsasnecessary

nProvideriskassessmentsofmajorsafetyhazardsanddevelop

appropriatemitigationofexposuretorisks

nEnsurereadinessforfireandalliedperilexposures.

Sponsorship

Charities and fundraising TheGroupsupportedmanycharitableorganisationsthrough

sponsorshipandfundraisingefforts,includingwalks,marathons,

golftournaments,coffeemorningsandfancydressdays.Toensure

thatourhospitalsmaintainstrongtieswiththeirlocalcommunities,

manyofourcharityeventsarelocallyfocused,andweencourage

ourstafftobeactivelyinvolved.

Corporate sponsorshipAtacorporatelevel,ouroperatingcompany,BMIHealthcare,

supportedthefollowingorganisationsandcampaigns:

The Royal College of Surgeons (RCS)isEngland’sleadingsurgicaland

educationalorganisationandreceivesworldwiderecognition.

BMIHealthcarehasagreedtoprovidesponsorshipoverthreeyears

tosupporttraininganddevelopmentprogrammesofferedbythe

Collegetothenextgenerationofconsultantsurgeons.

Royal College of General Practitioners (RCGP)isanacademic

organisationforgeneralpractitionersintheUK.

In2008/09,BMIHealthcaresponsoredtheannualNationalPrimary

CareConference,anationalshowcaseforthecollege,general

practiceandprimarycareandworkedwiththeRCGPstodevelopa

seriesofeducationalseminarsdeliveredbyourconsultants.

Wellbeing of Women (WoW)raisesmoneytoinvestinmedical

researchandtosupportthedevelopmentofspecialistdoctorsand

nursesworkinginthefieldofreproductiveandgynaecological

health.WoWwasBMIHealthcare’sofficialcharitypartnerthisyear.


Our UK business supported charitable organisations through sponsorship and fundraising efforts, including walks, marathons, golf tournaments, coffee mornings and fancy dress days.

“ Support

Other sponsorship and fundraising eventsInaddition,hospitalsprovidedongoing,

adhocsupporttoschools,children’shospices

andassociationsforthedisabled.

Thecharitiessupportedduringtheyearincluded:

n ActionMedicalResearch

n BritishArtsFoundation

n ChildreninNeed

n Delta,thenationalcharityfordeafchildren

n KentAirAmbulance

n LemonTreeFoundation,Africa

n NationalBlindChildren’sSociety

n NorthLondonHospice

n SaintLuke’sCheshireHospice

n SportRelief

n WarwickshireandNorthamptonshireAir

Ambulanceservice

n WhiteLodgeCentreinChertsey

Hospital initiativesBMIHealthcarehospitalssupporteventsonthenationalhealthcarecalendar

thatraiseawarenessofspecificillnessesorhealthconditionsandoftenprovide

earlydiagnosisscreeningopportunities.Theseincludedhypertension,hip

replacementtherapy,stress,allergies,prostatecancer,cervicalandbreast

cancers,coronaryarterycalcium,molesandotherskinblemishes.

Patient support groupsBMIHealthcarehospitalshostedandorganisedsupportgroupsforpatientswho

haveundergonecancertreatmentsaswellascosmeticandobesitysurgery.

UpFront,abreastcancersupportgroupbasedatBMITheChilternHospital,

wasestablishedinJanuary2005bytwospecialistbreastcarenursesandfive

womenwhohadbreastcancer.Currentlytherearewellover200membersfrom

thesurroundingareawhoattendgroupsupportsessions.

Aspecialeventwasheldthisyeartomarkthefirstanniversaryoftheweight

losssurgerypatientsupportgroupsatBMIChelsfieldParkHospitaland

BMITheAlexandraHospital.Thesewereamongthefirsthospitalstolaunch

patientsupportgroupsinconjunctionwiththeUK’sleadingpatientassociation

forweightloss,theBritishObesitySurgeryPatientAssociation(BOSPA).

“


Environmental initiatives

Environmental initiatives Duringthelastyear,GHGincreaseditsfocusonthedirectandindirectimpactour

businesshasontheenvironment.In2008/09,welaunchedagroup-wideinitiative

todeliverexcellenceacrossprocurementandsupplychainmanagement,facilities

management,propertydevelopment,cateringandhousekeeping.Centraltothis,

isourcarbonmanagementprogramme,EcoNomics,whichinvolveschanging

businesspracticesacrossourhospitalsandoffices,affectingallstaff,toreduceour

impactontheenvironment.


Ourinitialfocushasbeenonenergyinitiatives,howeverthe

programmewillcover:

n Energy

n Waste

n Water

n PurchasingandLogistics

n AssetManagement&CapitalInvestment

TheCarbonTrust,commissionedlastyeartoreviewthecarbon

emissionsofourbusiness,estimatedourtotalcarbonfootprintat

42,419tonnes.Thiswasprimarilycomposedofenergyusedinour

hospitals.Thisworkhasprovidedaclearfocusintheshorttermto

reduceourenergyconsumptionthroughTheBigTurnOffinitiative,

whichhasbeenthemainfocusofactivitythisyear.Inthemeantime,

furtherplanningandresearchcontinuestoshapeabroaderstrategy

for2009/10andbeyond.

Corporate Asset Management and Capital Investment Strategy

GHGownsandoperatesmorethan67privatehospitalsand

treatmentcentres,aswellasancillaryofficesandbuildings.

Maintenancestandardsofthesepropertiesarebeing

improvedtoincorporatecarbonmanagement,inparticular

withregardtoenergyandwater.Wearedevelopinglong-

termplanstoreviewthewayinwhichheatingandcooling

systemsareoperated,aspartofastrategytoreplacethem

progressivelywithmoreenergyefficientsystemsand

renewableenergysources.

Ouroverridingaimistoincorporatecarbonreduction

measuresintoourcorporateassetmanagementandcapital

strategy,withthefollowingkeyobjectives:

n Buildcarbonassessmentintolifecyclecostsfor

replacementoradditionalcapitalplantorequipment

n Ensurebuildingsoperatetominimumcarbonefficiency

standards

n Developcapitalreplacementprogrammetosupportthe

objectivesofthecarbonmanagementprogramme

n Providesufficientfundingforspecificinvestments

intechnologyinsupportofthecarbonmanagement

programmeunderthecontroloftheGreenPolicyProject

Manager

n Ensureourbuildingsmeetcurrentenvironmental

legislativerequirements

n Ensurenewbuildingsandrefurbishmentsarecarriedout

toBREEAM‘excellent’criteriatominimisetheircarbon

impact.*

*BREEAM(BREEnvironmentalAssessmentMethod)istheleadingandmost

widelyusedenvironmentalassessmentmethodforbuildings.Itsetsthe

standardforbestpracticeinsustainabledesignandhasbecomethedefacto

measureusedtodescribeabuilding’senvironmentalperformance.

Our overriding aim is to incorporate carbon reduction measures into our corporate asset management and capital strategy.

“ “

CarbonThe‘BigTurnOff’hascreatedinitialfocusandactionacrosstheestate.

Inorder,however,toreduceourimpactontheenvironmentsignificantly,

andmeetourtargetsandfuturelegislation,ourfocusin2009/10willbe

ondeliveringthewiderstrategy.Changingstaffbehaviourwillcontinue

tobefundamentaltoourcarbonmanagementsuccess.


Corporate governance

Corporate governance philosophy TheGroupacknowledgesthat,inreturnforitslicencetooperate,itis

subjecttotherulesandconstraintsofsocietyandstakeholderimperatives.

Incombiningthetwinrequirementsofconformanceandperformance,

theGroupstrivestomaintainthehigheststandardsofdiscipline,integrity

andtransparencyinsupportinganappropriatelegal,regulatoryand

institutionalfoundation.


Overall StructureThecorporategovernanceoftheGroupisledbytheBoardof

GeneralHealthcareGroup.

Thisgovernanceencompassesboththebusinessaspectsandthe

serviceandsafetyaspectsoftheGroup’sactivities,andcommittees

oftheBoardhavebeenestablishedtodealwiththespecific

componentsofthis.

TheBoardcomprisesexecutiveandnon-executiveDirectors.The

16non-executivesaregenerallyappointedbyanddrawnfromthe

Group’sinvestors,althoughthenon-executiveChairman,SirPeter

Gershon,isindependentoftheshareholders.

ThethreeexecutiveDirectorscomprisetheChiefExecutive,

theChiefFinancialOfficer,andtheGeneralCounsel.TheChief

Executiveisresponsiblefortheday-to-dayoperationsofthe

Groupanditsstrategicdevelopment.TheChiefFinancialOfficer

isresponsibleforthefinancialmanagementoftheGroupandthe

GeneralCounselisresponsibleforadvicetotheBoardandthe

executive,andfortheGroup’scompliancewithitsresponsibilities

andrelationswithexternalagencies.

TheconstitutionandfunctionoftheBoardCommitteesis

asfollows:

Audit CommitteeTheAuditCommitteeischairedbySirPeterGershon(Group

Chairman)andhasthreemembers,allnon-executivedirectors.

TheCommittee’sresponsibilitiesinclude:overallresponsibilityfor

internalandexternalauditoftheGroup’sfinancialactivitiesand

financialreporting,theappointmentandremunerationofexternal

auditors,thecompany’sinternalcontrols,andotherfinancialand

businessriskissues,includingcertaincompliancefunctions.

Executive CommitteeTheExecutiveCommitteeischairedbyAdrianFawcett(GroupChief

Executive)andcomprisestheGroup’sseniorexecutivefunctional

anddivisionalheads.ItsroleistoaddressallGroupoperational

mattersanditistheprincipleexecutivedecision-makingbody

withintheGroup.

Finance and Investment CommitteeTheFinanceandInvestmentCommitteeischairedby

VaughanFirman(ChiefFinancialOfficerofNetcareinSouth

Africa).Itsroleistoreviewpotentialcapitalinvestmentsandcapital

projects,andundertakefollow-onpostacquisitionreviews.

Remuneration CommitteeTheRemunerationCommitteeischairedbySirPeterGershon

(GroupChairman).TheCommitteereviewsandsetstheGroup’s

remunerationstrategyandsalaryandbenefitlevelsacrossthe

Group,toensurecompetitivenessofremuneration.Italsomonitors

themanagementequityarrangementsinplace.

Quality and Risk CommitteeTheQualityandRiskCommitteeischairedbySirPeterGershon

(GroupChairman)anditsroleistomonitorthesafety,effectiveness

andqualityoftheGroup’soperationalactivities.Italsomonitorsthe

Group’sregulatorycompliance,operationalconformitytointernal

policy,andthelevelofriskretainedbytheGroup.

GroupBoard

AuditCommittee

ExecutiveCommittee

Finance&InvestmentCommittee

Quality&RiskCommittee

RemunerationCommittee


ThegrowthinEBITDAhasfallendirectlytothebottomline,representedbya£16mincreaseinprofitbeforetax.Interest

andfinancechargeshaveremainedstableduetoswappingoutthevariableloaninterestrateforafixedinterestrate.The

marginalincreaseinfinancechargesisduetothefullyeareffectofthePropCodebtraisedontheprioryearacquisitionof

theex-Nuffieldhospitals.

TheGroupisdelightedtohaveproducedastrongfinancialperformanceinaclimateofeconomicuncertaintyasaresult

oftheglobaleconomicdownturn.TheGroup’sfocusfor2010andbeyondremainsoninvestmentinitsassetbaseand

serviceprovision,andonmaintainingandfurtherimprovingitsfirst-classfacilities.Thisinvestment,coupledwiththe

highestlevelsofclinicalstandards,willensurethatGeneralHealthcareGroupbuildsonitspositionasthemarket’s

leadingprivatehealthcaregroup.

Group profit and loss

2009£’m

2008£’m %

Revenue 832 773 7.6%

Group EBITDA 221 204 8.3%

Non-recurringitems (7) (6) 16.7%

Depreciation (65) (67) 3.0%

Profitonsaleofassets - 2

Interestandotherfinancecharges (132) (129) (2.3%)

Swapcosts 2 (1)

Profit before tax 19 3 533.3%

Tax (3) 8

Profit after tax 16 11 45.5%


Group cash flow

TheGroupgenerated£130millionofoperatingcashflow.Thiswasnegativelyaffectedbytheworkingcapitaloutflow

experiencedduringtheyear.Thisisprimarilyduetothechangeincasemixfromselfpay(paymentupfront)toNHS

(prolongedpaymentdays).Workingcapitalwasalsoadverselyaffectedduringtheyearbythecatch-upinpayments

tocreditors,whichbuiltupduringtheintroductionoftheSharedServiceCentrein2008.Thisisnotexpectedtorecur

goingforward.

BorrowingsAttheendofSeptember2009,grossbankdebtwas£1,925.1m,withunamortisedfinancecostsof£26.7mandcashof

£40.6m–givinganetdebtpositionof£1,857.8m.Nonewdebtfacilitieswereenteredintoduring2009.

TheGrouphasundrawnloanfacilitiesof£72.7m,ofwhich£3.7misheldundrawnasguaranteesandlettersofcredit,

leavingfacilitiesof£69.0mavailabletofinanceworkingcapitalandforgeneralcorporatepurposes.

ThebankloanfacilitiesrequiretheGrouptocomplywithcertainfinancialcovenants.Thedirectors’forecastsshowthat

theGroupwillbeabletooperatewithinthelevelofitscurrentfacilitiesandwillcomplywithitsfinancialcovenants

throughouttheforecastperiod.

2009£’m

2008£’m %

EBITDA (after non-recurring items) 214 198 8.1%

Capitalexpenditure (45) (48) 6.3%

Changesinworkingcapital (39) (17) (129.4%)

Operating cash flow 130 133 (2.3%)

Nuffieldacquisition(net) (118)

Netinterestpaid (125) (124) (0.8%)

Taxpaid (3) (2) (50.0%)

Movement in net debt 2 (111)

Debtraised - 120

Debtrepaid (20) (28) 28.6%

Movement in cash (18) (19) 5.3%

Cashatbeginningoftheyear 59 78

Cash at end of the year 41 59


General Healthcare Group executive committee

Top row (L to R): PhilWieland,StephenCollier,GuyBlomfield

Middle row (L to R): JohnvonKlemperer,CatherineWard,AdrianFawcett,ProfessorDuncanEmpey

Bottom row (L to R): PhilPegler,BelindaMoore


Adrian FawcettChiefExecutiveOfficer

AdrianFawcettisChiefExecutiveOfficerofGeneralHealthcareGroup.

HealsositsontheBoardoftheDepartmentofWork&Pensions.Previously,AdrianwastheChiefOperatingOfficerforPunchTavernsplc.HejoinedPunchfromInterbrewwherehewasCorporateVicePresidentoftheBelgianbrewer.

Phil WielandChiefFinancialOfficer

PhilWielandjoinedtheGeneralHealthcareGroupasGroupFinancialControllerinApril2006andwassubsequentlypromotedtoChiefFinancialOfficerinJanuary2007.

HehadpreviouslybeenemployedbyBSkyB,holdingnumerousseniorfinancepositionsincludingSupplyChainFinanceDirectorandGroupFinancialController.PhilqualifiedasaCharteredAccountantwithPwCin1998andholdsanhonoursdegreefromLeedsUniversity.

Stephen CollierGeneralCounsel

StephenCollierisabarristeremployedinthefieldofhealthcareandhasworkedwithGHGsincethe1980’s,havingpreviouslybeeninpracticeattheBar.

StephenhasagraduatedegreeinlawfromUniversityCollegeLondon,andaMastersgainedattheLSE.

Professor Duncan Empey FRCP,GroupMedicalDirector

DuncanEmpeyisaFellowoftheRoyalCollegeofPhysiciansandjoinedGeneralHealthcareGroupasGroupMedicalDirectorin2008.Priortothat,hewasMedicalDirectoratCapioHealthcarefrom2005to2007.

DuncanisHonoraryConsultantPhysiciantoBartsandTheLondonNHSTrust.He

hasheldthepostofHonoraryConsultantPhysiciantoKingEdwardVII’sHospital,SisterAgnes,inLondonsince1995.HeisalsoFoundationProfessorandDeanoftheBedfordshireandHertfordshirePostgraduateMedicalSchool.

Guy BlomfieldGroupStrategy&CommercialDirector

GuyBlomfieldjoinedGHGinOctober2007,comingfromOasisHealthcareplc.

BeforejoiningOasis,Guyheldanumberofmanagementconsultancyroles,ultimatelyasownerandManagingDirectorofImcisLtd,aspecialiststrategyconsultancywithexpertiseinpubs,franchiseoperations,apparelandfoodretailing,withMarksandSpencerplcasakeyclient.HehasanHonoursdegreeinAccountingandFinanceandanMScinCorporateFinance.

Catherine WardGroupHumanResourcesDirector

CatherineWardhasextensiveexperiencewithinHRmanagementandconsultancy.PreviousHRDirectorpositionsincluderolesatBAA,whereshewasHRDirectorforHeathrowAirport,andtheBBC,whereshemanagedmajorrestructuringinitiatives.

AsaconsultantshehasworkedforKPMGandforSHLasConsultancyDirector.

CatherinehasaBScinBiologyandanMScinOrganisationBehaviour,bothfromtheUniversityofLondon,andqualifiedasaCIPD.

Belinda MooreGroupMarketingDirector

BelindaMoorejoinedGHGinMay2007fromBritvicplcwhereshewasHeadofMarketingandOperationsfortheInternationaldivision.

BeforejoiningBritvic,BelindaheldaseriesofseniormarketingrolesinanumberofleadingFMCGandbluechip

organisationsincludingWhitbreadplc,ThomsonTravelGroup,GilletteCompanyandInternationalDistillers&Vintners.

ShealsospentsixyearsinpharmaceuticalsalesandmarketingfortheWellcomeFoundation.BelindahasanHonoursDegreeinRussianandSovietPolitics.

Phil PeglerManagingDirectorHospitalDevelopment

PhilPeglerjoinedGeneralHealthcareGroupinOctober2007.Inhiscurrentrole,ManagingDirector-HospitalDevelopment,heisresponsibleforcommercialdeliveryofnewinitiativesacrossthegroup.

PhilhadpreviouslybeenemployedbyPunchTavernsPlc,holdingnumeroussenioroperationalroles.

PhilholdsanhonoursdegreeinBusinessStudiesfromManchesterandanMBAfromBirmingham.

John von KlempererManagingDirectorHospitalOperations

JohnvonKlempererjoinedGeneralHealthcareGroupinSeptember2006asRegionalDirectorandwaspromotedtoManagingDirector-SouthDivisioninOctober2008.InJuly2009hewasappointedtohiscurrentroleasManagingDirector-HospitalOperationsfortheBMIGroup.

PriortojoiningGHG,JohnservedinasimilarpositionforNetcareHospitalGroupinSouthAfricawherehewasemployedfor16years.

JohncompletedtheExecutiveDevelopmentProgrammeattheUniversityoftheWitwatersrand,Johannesburg,in1981.

General Healthcare Group executive committee


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