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Ramsay Healthcare

050307-N-8796S-070Banda Aceh Indonesia (Mar 07 2005)-- A patients X-ray hangs over the bed as Dr Elizabeth Mclarney, an orthopedic surgeon from the non-governmental organization "Project HOPE", performs surgery on an Indonesian patient alongside Indonesian medical professionals at the Tentera Nasional Indonesia Military Hospital in Banda Aceh, Indonesia. The surgery was successful in removing metal plates and screws from the patients leg as well as a piece of wire from the patients jaw, following reconstructive surgery eight years ago. The hospital ship USNS Mercy (T-AH 19) and its crew of medical and support personnel, civilian mariners, Uniformed Public Health Service and the NGO, ìProject HOPEî have been operating off the coast of Sumatra, Indonesia providing assistance to international relief organizations and host nation medical teams ashore in tsunami affected areas. US Navy Photo By Photographer's Mate Second Class Timothy Smith

Ramsay Healthcare operates 220 hospitals and day surgery facilities in Australia, Indonesia, France and the UK, with over 8000 beds and nearly 25,000 staff. In the UK Ramsay Health has a network of 30 hospitals and 3 neurological units, delivering both private treatment and care under contract to the NHS. Ramsay Health Care UK employs over 3500 staff. In early 2021, Ramsay began a bid to acquire Spire Healthcare. If successful, Ramsay would become the UK's largest private hospital company.

Ramsay Health Care UK is a subsidiary of Ramsay Healthcare (Australia). It was established 1964 in Australia by Paul J Ramsay.

 

Strategy

Through a process of acquisition in its home market Ramsay Health has become Australia’s largest private hospital operator. Acquisitions have included other private hospital groups, with the largest being of Affinity Healthcare in 2005, which increased Ramsay’s hospitals from 35 to 69. Ramsay also has a history in Australia of moving into the public hospital sector. In 1994/1995 Ramsay Health Care won bids to privatise two government-owned repatriation hospitals (also known as veterans hospitals) – Hollywood Hospital in Perth and Greenslopes Hospital in Brisbane. This strategy has continued and in 2012 two private/public hospitals were in development.

Ramsay Healthcare’s first foray outside Australia was to Indonesia where it now runs three private hospitals; these were acquired with the acquisition of Affinity Health in 2005. Then in 2007 the company acquired Capio, at the time the fourth largest operator of private hospitals in the UK. The company’s focus for expansion switched to France in 2010, with the March 2010 acquisition of 57% of the French hospital company Group Proclif SAS, now known as Ramsay Santé. Ramsay’s expansion in France has continued, with the May 2011 acquisition of the Clinique Convert hospital, which Ramsay notes is a first step in expanding the Ramsay Santé business, with plans for further expansion. The company currently operates nine hospitals in France.

In the UK Ramsay’s growth had been driven by increasing volumes of NHS patients - in 2019 they accounted for 79% of admissions, up from from 75.5% in 2015.  Self-pay customers are also integral and Ramsay puts focus onto its “premium care” advertising to private patients.

Recent years have been tough for Ramsay in the UK: in June 2018 Ramsay wrote down the value of six sites in the UK by £70m. The company welcomed the Government's June 2018 promise of more money for the NHS, but it does "not anticipate immediate benefits for us and expect operating conditions in the UK to remain challenging in the medium term.”

In late 2020, Ramsay opened a new £7.5m Beacon Park day surgery hospital in Stourbridge. The site comprises an operating theatre, seven consulting rooms, six day case bays and a physiotherapy suite.  Earlier in 2020, the company began work on a new daycase facility in Chorley, due to open in July 2021. The company has become increasingly focused on daycase activity. In July 2020, the Stourside Hospital in Stourbridge opened.

Ramsay Healthcare UK benefited from the contract at the beginning of the Covid-19 pandemic, which allowed the NHS use of its facilities and staff, with payment covering full operating costs (see below).

In early 2021 Ramsay Healthcare began bid to acquire the UK company Spire Healthcare. However, several of Spire's leading shareholders opposed the takeover, including Fidelity and Toscafund Asset Management, and in June 2021 urged other investors to reject Ramsay's offer of 240p per share that valued the company at around £1 bn. Ramsay was forced to increase its offer to 250p per share or £1.2 bn. The reason for the opposition to the original bid notes Toscafund was that "operating conditions in the private healthcare market [in the UK] are set to be strong for some years to come" and so £1 bn was undervaluing the company. Toscafund also opposed the increased bid, but more investors backed this bid. The board of Spire recommended that the offer be accepted.

If the merger goes ahead, which looks likely, Ramsay will become the largest private hospital company in the UK, overtaking Circle/BMI. The competition and mergers authority is likely to look at the deal, however, and Ramsay may have to sell some facilities.

Financials

In the UK Ramsay’s business is conducted through Ramsay Health Care UK Operations Ltd. The most recent accounts available from Companies House are for the financial year ending 30 June 2020.

Total revenue for the year stood at almost £480 million (2019: £502.5 million) with a loss of £19.4 million (2019: profit £7.8 million).

NHS work is a major source of revenue, in the year to June 2019, 79% of admissions to Ramsay Hospitals were NHS patients. Figures for the year to June 2020 were affected by the Covid pandemic and the contract with the UK government which began in March 2020 and are not directly comparable to previous years.

Full accounts are published by the Australian parent company, Ramsay Health Care. Accounts are available for the financial year ending June 2020.

Contracts

In March 2020, Ramsay Healthcare was part of the deal with the government for using all its premises and staff for NHS patients during the Covid-19 pandemic. NHS England block-booked almost the entirety of England's private hospital sector’s services, facilities and nearly 20,000 clinical staff for the foreseeable future to help cope with the surge of covid-19 patients. The agreement only covers England and added around 8,000 hospital beds, nearly 1,200 more ventilators, more than 10,000 nurses, 700 doctors and 8,000 other clinical staff. This deal, which means the NHS is paying all operating costs for the hospitals, has been a lifeline for the company, as the lockdown meant that no private work was possible.

In June 2020, a £5 billion deal to extend the March deal to help the NHS clear the backlog of work was agreed by NHS England and the private hospital companies, however this was blocked by the Treasury.  The Treasury did not believe the deal represented good value for money and that the evidence was not substantial. The block-contract basis of contracts with private providers continued, however on a rolling-basis, as NHS England prepared a new four-year framework contract for increasing capacity. In November 2020, ContractFinder, the government tendering database, reported that Ramsay was one of 67 suppliers awarded a place on the NHS framework contract NHS Increasing Capacity worth in total £10 billion. The framework runs until November 2024.

In October 2020, the HSJ reported that Ramsay was the recipient of the third largest contract for staff and capacity from NHS England, according to a series of contract award notices, however the time period of 2020 this covered is unclear. The contract with Ramsay amounted to £271.1 million.

These block contracts have been criticised after leaks revealed that the capacity paid for by NHS England at companies, such as Ramsay and Spire, was very under-utilised. HSJ reported that two-thirds of the private sector capacity that was block-purchased by the NHS at a cost of an estimated £400 million a month went unused by the NHS over the summer, despite long waits for operations.

According to the HSJ, of all the private providers delivering publicly-funded work, Ramsay is the most dependent on NHS outsourcing and the choose-and-book system.

Ramsay Healthcare performs surgery at nearly all of its hospitals and clinics for the NHS.

Dorset Spinal Surgery Service

In August 2017, Ramsay was awarded a seven year contract for spinal surgery in Dorset, worth £30,800,000.

Concerns

In October 2017, Ramsay was fined £550,000 at Southwark Crown Court following a prosecution by the HSE. The HSE was alerted by a whistleblower in 2014 to deficiencies in the company's occupational health team and it subsequently found a string of problems, including failing to risk assess hazardous substances, including carcinogenic chemotherapy drugs, and failing to provide workers with adequate health surveillance.

In 2007, Ramsay Health agreed a 10-year deal with Bromley Hospitals Trust (now South London Hospitals Trust) for the Princess Royal University Hospital in Orpington to build a £4.2 million, 25-bed unit, which the trust would then rent to Ramsay Health UK for £500,000 a year. But in June 2009, just two years into the contract, Ramsay closed the unit saying it was no longer commercially viable. This has left the already deeply in debt South London Hospitals Trust having to pay back eight years rent that was paid upfront by Ramsay Health, and with no money to pay the running costs of the unit without impacting on its budget or to offset the £4.2 million the unit cost to build.

In March 2011 Jill Watts CEO of Ramsay Health UK was called to give evidence before the Public Accounts Committee. Although Watts was at ­first evasive on the issue of failure, eventually she admitted that should a business be failing then the company would close it. When questioned on what would then happen to the patients she noted that that would depend “on what the marketplace is”.

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