Spire Healthcare Group (LON:SPI) reported full-year 2025 results that management described as resilient despite employment cost inflation and a late-year slowdown in NHS commissioning. Group Chief Executive Justin Ash and Chief Financial Officer Harbant Samra said the company delivered its planned transformation savings, increased free cash flow, and saw improving momentum in self-pay demand into early 2026, while flagging significant uncertainty around NHS activity levels for the year ahead.
Market backdrop: mixed private demand and a late-year NHS slowdown
Ash said the private market saw “low single-digit” volume declines for much of 2025, but he highlighted improving demand momentum in the second half, “especially self-pay,” alongside continued growth in primary care. The company also faced “significant labor inflation” during 2025, driven by the increase in employer National Insurance contributions and, as the CFO later noted, National Minimum Wage increases from the second quarter onward.
Full-year financial performance and cash flow
Samra reported group revenue grew 4.5% in 2025, with hospital revenue up 4.3%. Adjusted EBITDA rose 3.2% to GBP 268.6 million, supported by transformation savings and price and mix management, partially offsetting higher employment costs. Adjusted profit before tax was GBP 46.5 million, down 7.4% year-on-year, with depreciation and finance charges described as in line with guidance.
Capital expenditure was reduced by 30% year-on-year to GBP 78.5 million while still funding “growth projects and transformation,” according to the CFO. Adjusted free cash flow increased 64.9% to GBP 64.3 million. Return on capital employed (ROCE) was 8% versus 8.2% in 2024; excluding the impact of National Insurance and National Minimum Wage uplifts, ROCE would have been 8.5%, Samra said.
The company recorded GBP 27.9 million of adjusting items, including roughly GBP 13 million in one-off transformation delivery costs (such as redundancy and establishing patient support centers) and around GBP 7 million of fees linked to the ongoing strategic review. Statutory profit after tax declined to GBP 17.2 million, with Samra also noting a reduction in taxation following a review of qualifying capital investment deductions covering multiple years.
Operational highlights: transformation, self-pay funnel, and primary care expansion
Management emphasized 2025 as the company’s “biggest year of change yet,” delivering a GBP 30 million savings plan. A central initiative was moving administration for inquiries, bookings, pre-operative assessments, and self-pay sales into three patient support centers. Ash said the shift is already improving experience and creating a platform for growth. He also said Spire’s well-invested estate enabled lower CapEx in 2025 “without compromising on quality.”
Ash outlined several initiatives aimed at improving self-pay acquisition and conversion:
- Brand measures: unprompted awareness reached 35% and prompted awareness 80%, which Ash said were the highest levels to date; consideration rose 6% to 61%, driving record inquiries.
- Call handling: after centralizing self-pay sales and bookings, call answer rates were “around 95%” versus 60% previously, enabling more same-day bookings.
- AI-enabled pricing: the company continued applying AI to optimize local pricing while protecting margin.
- Diagnostics: AI tools were applied to MRI scanners at 21 hospitals, halving scan times and contributing “over two and a half million GBP” of EBITDA in 2025 through activity growth.
In primary care, Ash said Spire opened five clinics in 2025, including in Kingston, Wimbledon, and King’s Lynn. Samra reported primary care revenue increased 7.4% to GBP 133.7 million, driven by organic and new contract growth in talking therapies and occupational health. Including acquisitions (Acorn and Physiolistic), revenue growth was 10.5%, and the acquired businesses performed in line with plan. Primary care adjusted EBITDA was GBP 9.8 million; Samra said the “core business” grew more than 5% year-on-year and two of the three larger new clinics were already profitable. Both executives highlighted that outpatient clinics generated downstream hospital referrals worth GBP 3 million of EBITDA.
On clinical capability, Ash said Spire ended the year with 29 surgical robots across its estate after adding seven in 2025, citing improved outcomes, capacity for higher-value private care, and faster recovery times. He also cited work to reduce average length of stay across procedures, saving “just over GBP 1 million” while improving access and recovery.
NHS uncertainty shapes 2026 planning; private growth expected to improve
Management said NHS commissioning uncertainty is the key variable for 2026. Ash said the company expects NHS revenue to be down about 25% in the first quarter of 2026 due to activity management plans. In contrast, Spire expects approximately 4% growth in private revenue in Q1, with self-pay up around 6%.
For the full year 2026, Samra said private patient momentum has improved in the early months and the company expects mid- to high-single-digit private revenue growth year-on-year. However, NHS volumes “remain a material uncertainty,” and commissioning activity from April has yet to be agreed. As a result, Spire is targeting adjusted EBITDA for 2026 “broadly in line with 2025.” The base planning assumption is that NHS revenue for Q2 to Q4 will be down 5% to 10% year-on-year, a significant improvement versus Q1.
On cost actions, management said it expects to deliver at least the existing GBP 30 million savings target in 2026 and is planning to deliver ahead of it to at least offset the impact of the Q1 NHS shortfall. Samra said more than half of the savings are underpinned by annualization of 2025 actions and head office restructuring in January, with additional savings expected from ongoing transformation (including digitization) and bringing forward operational efficiencies.
Strategic review and care quality update
Ash reiterated that the board’s strategic review, announced in September 2025, is ongoing and is evaluating actions to drive long-term sustainable shareholder value. He said options under consideration may include a potential sale of the company, value generation from the hospital property estate, and adjustments to operational and strategic plans, while emphasizing there is no certainty that any offer will be made. Ash also noted Takeover Panel rules limit what the company can say regarding the review and forecasts.
On quality, Ash said 98% of sites were rated “good or outstanding” (or equivalent) by regulators in 2025. He added that 97% of hospital patients rated care as good or very good, and 84% of consultants rated care very good or excellent.
During Q&A, management said it views the environment with private medical insurers as “pretty constructive,” with insurers showing interest in broader offerings, including primary care. On NHS volumes, Ash said the company expects activity to increase after the April reset, but warned the year could include a mix of indicative plans and “spot” work to address local waiting-list pressures. He also said Spire had multiple suppliers for bone cement and was “unaffected” by the U.K. shortage. Samra said the company has fixed-price arrangements for energy needs through the end of Q1 2027, with coverage tapering thereafter.
About Spire Healthcare Group (LON:SPI)
Spire Healthcare Group plc, together with its subsidiaries, owns and operates private hospitals and clinics. It offers various treatments in the areas of allergy and infectious diseases, blood tests, bones and joints, bowel treatments, breast screening and surgery, cancer investigations and treatments, cosmetic surgery, cyst removal, and dental surgery, as well as ear, nose, and throat treatments. The company also provides eye surgery and treatments, family planning, gastroenterology, general medicine, general surgery, haematology, hand surgery, hip and knee treatment, and heart and kidney treatments.
