Spire Healthcare

2007

Private hospitals. Spire Healthcare is the second largest private healthcare hospital group in the UK with 38 hospitals (including the recently completed Montefiore Hospital, Brighton.) Spire undertakes a wide variety of treatments, but major areas of business are fertility, obesity treatment, cosmetic surgery and cancer treatment. (1,2,3)

Spire was formed through the buy-out of 25 BUPA hospitals in 2007 by the UK private equity firm Cinven. The hospitals were rebranded as Spire Healthcare and a further 11 hospitals were added in 2008. Shire also owns the London Fertility Centre, a stand-alone private chemotherapy and radiotherapy centre (in partnership with CancerPartners UK), and The Insight Network providing mental health services. (1,2)

In January 2017 Spire announced that it will be moving into the private GP market. The company will set up a network of GP clinics in its hospitals around the country. Spire is not the first private company to do this, HCA, Nuffield and BUPA all have private GP services within thier clinics.

Spire has great hopes of gaining business due to the underfunding of the NHS. In an article in the Financial Times in August 2016, the company was reported to be investing £190m in new hospitals, wards, and operating theatres as it bets that an NHS funding squeeze will push more British patients into its private facilities. Although in the short-term the company's business from NHS referrals is likely to suffer as NHS budgets are constrained.

Spire is opening two new hospitals in Manchester and Nottingham early in 2017, as well as seven additional operating theatres at existing facilities. The company also reported in mid-2016 that it is negotiating the purchase of a site in London.

Work carried out for the NHS is the company's biggest growth area and accounted for 30% of sales in the 2015 financial year. The vast majority of this is from GP referrals rather than block contracts from local commissioning groups.

Spire Healthcare was floated on the stock exchange in July 2014 and valued at £850 million. 

In 2015, Spire Healthcare reported revenue of £884.8 million, up from 856 million on 2014, and a net profit of £60 million (£6 million in 2014). The company reports net debt of £419.5 million (£424.3 million in 2014). NHS patients accounted for 29.6% of revenue.

Prior to the flotation in July 2014, the parent company of Spire Healthcare is Spire Healthcare Co-Invest Limited Partnership, a limited partnership registered in Guernsey. Rozier (Guernsey) Limited, a subsidiary of Cinven Limited, has a significant interest in the partnership. The ultimate parent undertakings of Spire Healthcare Limited Partnership are funds managed or advised by Cinven Limited. Cinven is keen to sell Spire and in January 2013 completed a partial refinancing in order to reduce Spire's heavy debt burden and make it more attractive to buyers. This saw 12 of the company's 38 hospitals sold and then leased back. The sale, which netted £700 million, was to a group of investors including Malaysia's Employees Provident Fund (EPF), Och-Ziff Capital Management Group and Moor Park Capital. Cinven is expected to now sell Spire by the end of 2013. (2, 18) In 2014 Cinven indicated its desire to sell on Spire, with a consortium fronted by CVC Capital Partners - a London based private equity firm - and also backed by the Abu Dhabi Investment Authority (ADIA) in the running to purchase the company. (19)

Spire Healthcare is part of the e-referral system (formerly Choose and Book) for NHS patients and in 2015 almost 30% of its income came from NHS work, up from 20% in 2011. 

Dan Toner, the company’s General Counsel and Group Company Secretary was previously at the Department of Health and Patricia Hewitt ex-Health Secretary is an advisor to Cinven. (9,10)

Spire Healthcare is a member of the PHA (Private Hospitals Alliance), a lobbying group set up by the five biggest private hospital companies in the UK to lobby the Government on policy. The other members are HCA, Nuffield, Ramsay Health, and GHG.

Care Quality

In February 2011 MP Ian Duncan Smith called for an inquiry into the death of a patient with bowel cancer at Spire’s Roding Hospital in Essex in 2009. The patient died of a heart attack and questions have been raised over the hospital’s resuscitation procedure. Furthermore, the patient’s death was recorded as carcinoma of the colon rather than heart attack, and it was only due to information from a nurse who had worked at the hospital that the true nature of the patient’s death came to light. (16)

Financial

According to Spire’s 2012 results the company is a profitable business with an operating profit of £129.7 million, despite this it posted a loss of £130.5 million. The loss is due to the company’s heavy debt burden in part due to loans that Cinven used to buy the company in 2007. In the company’s 2012 report its debt burden is reported to be around £1.4 billion, with the majority maturing in 2014 (£1.2 billion). Media reports that Spire's owner Cinven planned to sell Spire began in mid-2011. However, the scale of Spire's debt was reported to make the company unattractive to buyers. To reduce the company's debt, in 2011 Spire appointed Banc of America Merrill Lynch to ‘explore options for the real estate portfolio’. In April 2012 Spire began an auction looking to generate funds through the sale of a possible 10 hospitals, approximately one third of its property portfolio. In August 2012 Spire finalised the sale of its Edinburgh Shawfair hospital for £20 million to LaSalle Investment Management, a global real estate investment company. Spire now leases back the hospital. In January 2013 Spire completed the sale of a further 12 hospitals to a consortium of investors, including Malaysia's Employees Provident Fund, Och-Ziff Capital Management Group and Moor Park Group. Spire has now leased back these hospitals. The sale has halved Spire's debt burden from £1.4 billion to £700 million. Selling the company’s property may well be a way to ease its debt, but also means the company has less control over its rent costs. (2,11,12,13)

An investigation carried out by Corporate Watch reported in March 2012 that Spire had paid roughly £3 million in taxes in the three year period 2008-2010 despite making an operational profit in 2010 alone of £123 million. Profits reduced in 2010 by the £108 million in interest Spire had to pay on £1.3 billion worth of bank loans, leaving £15 million of taxable profit. The investigation, however, also found that Spire's accounts show how it paid a nominal £65 million in interest on loans it owes to Rozier, a Luxembourg-based subsidiary of its parent company, Cinven, meaning that it was able to declare a £53 million loss for tax purposes in 2010. In 2011, Spire paid Rozier £71.9 million in interest on loans, which once again pushed the company into a net loss. In 2011 Spire actually received a tax credit of £26.4 million, which also reduced its net loss. (2,4,14,15)

 

  1. http://www.spirehealthcare.com/ImageFiles/--%20CORPORATE/Annual%20reports/Spire%202012%20Annual%20Review%20final.pdf 
  2. http://www.ft.com/cms/s/0/e5b17e7a-ae55-11e2-bdfd-00144feabdc0.html#axzz2YXYRLmDW
  3. http://www.spirehealthcare.com/corporate-news/spire-healthcare-refinancing/
  4. http://news.sky.com/story/1242920/abu-dhabi-fund-and-cvc-in-1-5bn-spire-race
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