Optima Health PLC Acquires PAM Healthcare in £100 Million Transformational Deal

Optima snaps up PAM Healthcare for £100 million: what the deal really means

Optima Health has agreed to buy PAM Healthcare for approximately £100 million in cash, in a move the company calls “transformational”. Only one condition stands between signing and completion: clearance under Ireland’s foreign direct investment regime, which Optima expects within 90 days. Once over the line, this will mark an exit for PAM’s private equity backer, LDC.

The pitch is simple: bigger scale, broader services, and faster progress towards Optima’s stated medium-term targets of £200 million revenue and £40 million adjusted EBITDA. Management also expects the deal to be accretive to adjusted earnings per share after the first full year, rising to over 25% accretion by year three.

Deal terms, funding, and the moving parts

The acquisition is on a debt-free, cash-free, normalised working capital basis. Funding is a blend of new bank debt and a short-term bridge from a related party, with a plan to refinance the bridge through an equity raise:

• New secured debt facilities: £70 million from HSBC and Barclays, initial margin 2.5% over SONIA, stepping down to 1.7% as leverage falls.
• Bridge facility: £30 million from Deacon Street Partners (an entity controlled by Lord Ashcroft KCMG PC), unsecured, interest-free if repaid within three months; 10% per annum thereafter.
• Intended repayment: a fully underwritten £35 million Open Offer at 175 pence per share, a 17.8% discount to the 213 pence close on 13 February 2026.

Assuming the bridge is repaid via the Open Offer, Optima guides to pro forma net debt to EBITDA of 2.7x on the trailing 12 months, with a plan to deleverage rapidly to below 1x by year three. The only completion condition is Irish FDI clearance.

Why PAM? Financial profile, growth drivers, and fit

PAM is a top-tier provider of outsourced occupational health and wellbeing services across the UK and Ireland, supporting over 1.5 million employees and more than 1,500 organisations. It brings a long-standing customer base (average 7.8 years among its top ten), a proprietary platform (OHIO), and a substantial in-house clinical workforce.

On the numbers, PAM delivered unaudited 2025 revenue of £66.6 million and adjusted EBITDA of £8.2 million, with margin improvement to 12.3%. Over 90% of budgeted FY26 revenue is underpinned by existing contracts, and free cash conversion is over 60%.

Key item	Figure
Purchase price	~£100 million (cash-free, debt-free, normalised working capital)
Completion condition	Irish FDI clearance (expected within 90 days)
Funding mix	£70 million secured debt + £30 million bridge
Open Offer (intended)	£35 million at 175p, 17.8% discount to 213p; underwritten
Pro forma EBITDA (pre-synergies)	>£26 million
Synergies	>£5 million p.a. by end of year 3; ~£1.5 million in year 1
Pro forma leverage	2.7x net debt/EBITDA (assuming bridge repaid)
Target leverage	<1x by year 3
PAM 2025 (unaudited)	Revenue £66.6m; adj. EBITDA £8.2m; margin 12.3%
PAM net assets (Dec-25, unaudited)	£21.3 million
Market share	~15% pro forma; target 25%

Synergies, scale, and market leadership

Optima sees cost and revenue upsides from combining the businesses. The plan includes aligning central functions, rationalising the estate, and leveraging prior technology investment. On the top line, cross-selling and lower churn are expected to support growth. Management guides to more than £5 million per annum of synergies by the end of year three, with around £1.5 million in the first year.

Importantly, the deal pushes Optima to an estimated 15% market share in a £1.6 billion UK and Ireland market that’s forecast to grow by up to 9% per year. With only about 45% of UK workers currently covered by occupational health services versus over 80% in peer European markets, there’s headroom for expansion – and room for further consolidation.

Debt package and covenants: sensible, but watch the clock

The new bank facilities are committed for three years, with options to extend by up to two more. Margins step down as leverage improves, which aligns incentives. Covenants include:

• Net debt (excluding the bridge) to underlying EBITDA capped at 3.5x initially, stepping down to 3.25x and then 3.00x.
• Adjusted EBITDA to interest of at least 3.5x.
• Cash flow to debt service not less than 1x.

The bridge is the time-critical piece: three months to repay it interest-free, or 10% per annum thereafter. The intention is to clear it with the underwritten Open Offer.

Open Offer at 175p: what retail holders should know

The company plans to raise £35 million at 175 pence per share. That’s a 17.8% discount to the most recent reference price disclosed. The offer will be underwritten by Deacon Street. Because the underwriter is a related party and could surpass 30% of voting rights if it had to pick up the shares, Optima will seek a Rule 9 waiver (Rule 9 of the Takeover Code requires a mandatory bid at 30%+). Independent shareholders will be asked to approve this on a poll via a circular after completion.

Translation: existing shareholders get a chance to participate at a discount. If they don’t, there’s potential dilution – but the underwrite gives certainty that the bridge can be repaid.

The positives and the pressure points

What looks good

• Strategic fit: PAM strengthens Optima’s leadership and broadens its clinical and tech-enabled offer in core markets, including Ireland.
• Earnings accretion: management expects adjusted EPS uplift in year one, rising to over 25% by year three.
• Visibility and cash generation: over 90% of PAM’s FY26 budgeted revenue underpinned by existing contracts; free cash conversion over 60%.
• Credible synergies: >£5 million per year by year three, with early benefits signposted.
• Clear path to deleveraging: start at 2.7x net debt/EBITDA, targeting below 1x by year three.

What to watch

• Equity dilution: the Open Offer is at 175p. Non-participants will be diluted.
• Related party optics: the £30 million bridge and £2.5 million fee (plus VAT) to Deacon Street are related party transactions. The board, advised by Panmure Liberum, says terms are fair and reasonable.
• Execution risk: integration and synergy delivery, always the hard yards.
• Regulatory step: Irish FDI clearance is the sole condition – expected within 90 days, but it remains a gate.
• Timing risk: the bridge turns expensive if not repaid within three months.

Quick jargon buster

• Accretive to EPS: earnings per share go up after the deal, all else equal.
• Debt-free, cash-free: the price assumes no net debt or cash in the target at completion.
• Open Offer: existing shareholders can buy new shares, often at a discount, typically in proportion to their holding.
• Rule 9 waiver: avoids a mandatory takeover bid if an underwriter crosses 30% ownership due to picking up shares.
• SONIA: the overnight risk-free rate used to price sterling loans.

My take: a decisive step up in scale with manageable risks

This is a bold, well-signalled move that accelerates Optima’s strategy. The financial profile of PAM is solid, the market tailwinds are real, and the synergy plan looks grounded in operational levers Optima already knows how to pull. The debt terms are sensible, and the underwritten equity backstop reduces funding risk.

The trade-offs are clear: near-term dilution for those who don’t participate in the Open Offer, related party sensitivities, and the usual integration execution risk. On balance, though, the combination should enhance Optima’s growth, margin potential, and market leadership. If management delivers the >£5 million synergy run-rate and the deleveraging plan, the deal should earn its “transformational” label.

What to look for next

• Confirmation of Irish FDI clearance and completion timing.
• Open Offer circular with Rule 9 waiver details and timetable.
• Initial integration update and synergy milestones.
• Any refreshed guidance on combined revenue and adjusted EBITDA trajectory.