Underlying non-IFRS financial measures

The Group uses underlying income statement reporting as non-IFRS measures in evaluating performance and as a method to provide shareholders with clear and consistent reporting. The underlying measures are intended to remove volatility associated with certain types of one-off income and charges from reported earnings. Historically EBITDA and underlying EBITDA were disclosed as supplemental non-IFRS financial performance measures because they are regarded as useful metrics to analyse the performance of the business from period to period. Measures like underlying EBITDA are used by analysts and investors in assessing performance.

The rationale for using non-IFRS measures:

  • it tracks the underlying operational performance of the Group and its operating segments by separating out one-off and exceptional items;
  • non-IFRS measures are used by management for budgeting, planning and monthly financial reporting; and
  • non-IFRS measures are used by management in presentations and discussions with investment analysts.

The Group’s policy is to adjust, inter alia, the following types of income and charges from the reported IFRS measures to present underlying results:

  • restructuring costs;
  • profit/loss on sale of significant assets;
  • past service cost charges/credits in relation to pension fund conversion rate changes;
  • significant prior year tax and deferred tax adjustments;
  • accelerated IFRS 2 charges;
  • accelerated amortisation charges;
  • mark-to-market fair value gains/losses, relating to ineffective interest rate swaps;
  • significant impairment charges;
  • significant insurance proceeds; and
  • significant transaction costs incurred during acquisitions.

EBITDA is defined as operating profit before depreciation and amortisation, excluding other gains and losses.

Non-IFRS financial measures should not be considered in isolation from, or as a substitute for, financial information presented in compliance with IFRS. The underlying measures used by the Group are not necessarily comparable with those used by other entities.

The Group has consistently applied this definition of underlying measures as it has reported on its financial performance in the past as the Directors believe this additional information is important to allow shareholders to better understand the Group’s trading performance for the reporting period. It is the Group’s intention to continue to consistently apply this definition in the future.

Group financial performance

Group revenue increased by 30% to £2 749m (2016: £2 107m) for the reporting period.

Underlying operating profit before interest, tax, depreciation and amortisation (“underlying EBITDA”) was 17% higher at £501m (2016: £428m), underlying margins declined from 20.4% to 18.2%, and basic underlying earnings per share were 19% lower at 29.8 pence (2016: 36.7 pence).

During the reporting period, the following exceptional and one-off items were adjusted for in determining underlying earnings:

  • £13m (£10m after tax) mark-to-market fair value gain, relating to the ineffective Swiss interest rate swaps. The Group uses floating-to-fixed interest rate swaps on certain loan agreements to hedge against interest movements which have the economic effect of converting floating rate borrowings to fixed rate borrowings. The Group applies hedge accounting and therefore fair value adjustments are booked to the consolidated statement of comprehensive income.
    With the removal of the Swiss franc/euro peg during January 2015 and the advent of negative interest rates in Switzerland, the Swiss interest rate hedges became ineffective once Libor moved below zero as bank funding at Libor plus relevant margins is subject to a zero rate Libor floor. Effective from 1 October 2014, the mark-to-market movements are charged to the income statement. As these are non-cash flow items and to provide balanced operational reporting, the Group excluded the charge in the measurement of underlying performance in the 2015 financial year and consistently excludes the gain arising this year. The swaps expire in 2017 and 2018.
  • A past-service cost credit of £13m (£10m after tax) arising in the main Hirslanden pension fund. This relates to a change in the pension fund conversion rate advised by an independent professional. The underlying income statement has been adjusted as the credit is not related to the current year underlying performance of the Swiss hospital operations.
  • Accelerated amortisation of £7m relating to the Al Noor trade name.
  • Restructuring costs of £5m relating to the integration of the Al Noor operations. Consistent with last year’s treatment, the underlying income statement has been adjusted for these costs following the combination in 2016. Currently, no further restructuring costs associated with this transaction are expected to be adjusted beyond 31 March 2017.
  • £1m gain on the mark-to-market of a put option.

Spire Healthcare Group

Mediclinic has a 29.9% investment in Spire. The investment in Spire is accounted for on an equity basis recognising the reported profit of £53.6m for the 12 months to 31 December 2016 (“Spire’s FY16”). The equity accounted share of profit from Spire recognised by Mediclinic during the period under review was £12m (2016: £6m) after adjusting for the amortisation of intangible assets recognised in the notional purchase price allocation for the Group’s acquisition of its equity investment.

Spire’s FY16 saw solid growth with adjusted revenue up 5.8%, adjusted EBITDA up 5.4% and comparable EPS (excluding exceptionals and tax one-offs) up 4.9%. Total patient admissions grew 2.3% driven by self-pay and NHS volume growth. After adjusting for St Anthony’s and prior year disposals, Spire’s adjusted EBITDA margin remained stable at 18.2%, while EBITDA conversion to operating cash flow increased to 115% before exceptional items and tax.

Foreign exchange rates

Although the Group reports its results in British pound, the operating segments profits are generated in Swiss franc, UAE dirham and the South African rand. Consequently, movement in exchange rates affected the reported earnings and reported balances in the statement of financial position.

Foreign exchange rate sensitivity:

  • The impact of a 10% change in the GBP/CHF exchange rate for a sustained period of one year is that profit for the year would increase/decrease by £14m (2016: increase/decrease by £11m) due to exposure to the GBP/CHF exchange rate.
  • The impact of a 10% change in the GBP/ZAR exchange rate for a sustained period of one year is that profit for the year would increase/decrease by £8m (2016: increase/decrease by £7m) due to exposure to the GBP/ZAR exchange rate.
  • The impact of a 10% change in the GBP/AED exchange rate for a sustained period of one year is that profit for the year would increase/decrease by £2m (2016: increase/decrease by £6m) due to exposure to the GBP/AED exchange rate.

During the period under review, the average and closing exchange rates were the following:

Cash flow

The Group continued to deliver strong cash flow converting 101% (2016: 96%) of underlying EBITDA into cash generated from operations. Cash and cash equivalents increased from £305m to £361m.

Interest-bearing borrowings

Interest-bearing borrowings increased from £1 841m at 31 March 2016 to £2 030m at 31 March 2017. This increase is mainly as a result of the change in the closing exchange rates, offset by a loan amortisation payment. During the reporting period, the bridge facility was repaid using additional financing facilities in South Africa and the Middle East.


Property, equipment and vehicles increased from £3 199m at 31 March 2016 to £3 703m at 31 March 2017. This increase is mainly as a result of additions as well as the change in closing exchange rates.

Intangible assets increased from £1 941m at 31 March 2016 to £2 156m mainly because of the change in closing exchange rates.

Income tax

The Group’s effective tax rate decreased from 22.4% in the prior year to 20.8% for period under review predominantly due to the following:

  • the tax rate decreased by 4.2% in respect of prior year one-off non-deductible expenses which were not incurred in the period under review. This was related to Al Noor transaction costs as well as an accelerated IFRS 2 charge; and
  • the tax rate increased by 3.0% due to a reduced contribution by Middle East to earnings.


* Profit attributable to equity holders in Switzerland is shown after the elimination of inter-company loan interest of £16m.
* Profit attributable to equity holders in Switzerland is shown after the elimination of inter-company loan interest of £17m.

Tax strategy

The Group is committed to conduct its tax affairs consistent with the following objectives:

  • comply with relevant laws, rules, regulations, and reporting and disclosure requirements in whichever jurisdiction it operates; and
  • maintain mutual trust and respect in dealings with all tax authorities in the jurisdictions the Group does business.

Whilst the Group aims to maximise the tax efficiency of its business transactions, it does not use structures in its tax planning that are contrary to the intentions of the relevant legislature. The Group interprets relevant tax laws in a reasonable way and ensures that transactions are structured in a way that is consistent with a relationship of co-operative compliance with tax authorities. It also actively considers the implications of any planning for the Group’s wider corporate reputation.

In order to meet these objectives, various procedures are implemented. The Audit and Risk Committee has reviewed the Group’s tax strategy and related corporate tax matters.


The Group’s main strategic focus remains to ensure high-quality care and optimal patient experience. To this end, Mediclinic continues to invest in its people, patient facilities and the technology within the facilities. The Group’s growing international scale also enables it to unlock further value through promoting collaboration and best practice between its operating platforms and to extract further synergies and cost-efficiencies. The Group is well-positioned to deliver long-term value to its shareholders with a well-balanced portfolio of global operations, a leading position across all four attractive healthcare markets and a platform for future growth.

Demand for Mediclinic’s services across its platforms remains robust, underpinned by an ageing population, growing disease burden and technological innovation. However, the increase in demand across the platforms is impacted by lower economic growth and greater competition. In addition, there is an increased focus on the affordability of delivering healthcare which is resulting in changing care delivery models and greater regulatory oversight.

The Group provides the following guidance for the financial year ending 31 March 2018 (“FY18”):

  • Hirslanden: Given the already high occupancy rates and stable bed numbers the Group anticipates modest revenue growth. The underlying EBITDA margin is expected to be lower. This is due to the tariff and regulatory environment including the impact from the proposed national TARMED adjustment and outmigration framework coming in the fourth quarter FY18, increasing costs relating to several major projects including Hirslanden 2020 and assumes no further tariff provision releases that benefited FY17. The impacts of these will partially be offset by ongoing efficiency gains.
  • Mediclinic Southern Africa: The Group expects revenue growth in line with inflation despite the challenging macro-economic environment, greater competition and funder constraints. Despite cost inflation running above tariff increases, the underlying EBITDA margin is expected to remain broadly stable through increased efficiencies.
  • Mediclinic Southern Africa and Hirslanden business days will be impacted by two Easter holiday periods in the current year.
  • Mediclinic Middle East: The Dubai operating performance is expected to remain stable despite the competitive landscape. A gradual improvement is expected in the Abu Dhabi business over the next couple of years. As a result, the Group expects only a marginal improvement in Middle East revenues for the full year and a more gradual improvement in underlying EBITDA margins over time, including the impact associated with the opening of new facilities. First half FY18 Middle East performance versus the prior year comparator is expected to be lower largely due to the higher patient volumes and revenues in Abu Dhabi prior to the regulatory changes, asset sales and business and operational alignment initiatives during FY17.
  • The Group’s budgeted capital expenditure is £281m in constant currency. This comprises £118m in Hirslanden, £71m in Mediclinic Southern Africa and £92m in Mediclinic Middle East.


The Group’s dividend policy is to target a pay-out ratio of between 25% and 30% of underlying earnings. The Board may revise the policy at its discretion.

The Board proposes a final dividend of 4.70 pence per ordinary share for the year ended 31 March 2017 for approval by the Company’s shareholders at the annual general meeting on Tuesday, 25 July 2017. Together with the interim dividend of 3.20 pence per ordinary share for the six months ended 30 September 2016 (paid on 12 December 2016), the total final proposed dividend reflects a 27% distribution of underlying Group earnings attributable to ordinary shareholders.

Shareholders on the South African register will be paid the ZAR cash equivalent of 80.60500 cents (64.48400 cents net of dividend withholding tax) per share. A dividend withholding tax of 20% will be applicable to all shareholders on the South African register who are not exempt therefrom. The ZAR cash equivalent has been calculated using the following exchange rate: £1:ZAR17.15, being the five-day average ZAR/GBP exchange rate on Friday, 19 May 2017 at 3:00pm GMT Bloomberg.