Spire Healthcare Posts Resilient 2025 Results Amid Strategic Review and NHS Headwinds

FY25 at a glance: steady progress in a tougher backdrop

Spire Healthcare delivered a resilient set of 2025 results while navigating cost inflation and a sharp slowdown in NHS commissioning late in the year. Revenue rose 4.5% year on year to £1,579.8m and adjusted EBITDA (earnings before interest, tax, depreciation and amortisation) increased 3.2% to £268.6m, supported by £30m of transformation savings.

Reported profit before tax fell to £18.6m, down 51.4%, driven by higher adjusting items of £27.9m, including £13.1m of restructuring and £7.4m tied to the ongoing Strategic Review. Adjusted profit before tax was £46.5m, down 7.4%.

Key metric	FY25	FY24	Change
Revenue	£1,579.8m	£1,511.2m	+4.5%
Adjusted EBITDA	£268.6m	£260.0m	+3.2%
Adjusted EBIT	£150.5m	£149.4m	+0.7%
Adjusted PBT	£46.5m	£50.2m	-7.4%
Reported PBT	£18.6m	£38.3m	-51.4%
Adjusted EPS	9.6p	8.8p	+9.6%
Basic EPS	4.1p	6.3p	-34.9%
Adjusted free cash flow	£64.3m	£39.0m	+64.9%
Net bank debt	£332.4m	£325.9m	+2.0%

What drove the numbers in 2025

Hospitals: growth and margin discipline

Hospital revenue rose 4.3% to £1,446.1m with admissions and outpatient procedures up 1.4% and average revenue per case higher across all payors. Adjusted EBITDA in Hospitals increased 3.9% to £258.8m with margin held at 17.9% (FY24: 18.0%) despite National Insurance and National Minimum Wage increases and an energy hedge rolling off.

• Private payors: revenue up 1.7% to £1,010.1m, with growth accelerating to 2.8% in H2. Self-pay volumes returned to positive growth by year end, while PMI (private medical insurance) revenue increased 3.1%.
• NHS: revenue up 11.4% to £407.9m, strong in H1 before moderation late in the year as Integrated Care Boards tightened budgets. Over 60% of NHS admissions were in higher-acuity orthopaedics, supporting case mix and pricing discipline.

Primary Care: top-line growth, investment drag

Primary Care revenue grew 7.4% to £133.7m on contract wins in Talking Therapies and Occupational Health and two bolt-ons (Acorn and Physiolistic) acquired at around 5.5x EBITDA. Adjusted EBITDA declined 13.6% to £9.8m, reflecting planned losses from new outpatient-led clinics that are already feeding referrals into the hospital network. Excluding loss-making clinics and NI/NMW effects, adjusted EBITDA rose 5%.

Cost take-out and centralisation

Spire completed the centralisation of administration and bookings into three Patient Support Centres and reduced around 400 mainly clinical permanent roles as it shifted to a more flexible staffing model. These moves, plus procurement standardisation, delivered £30m of new savings in the year and £80m since FY22.

Cash, capex and leverage: the balance sheet picture

Adjusted free cash flow jumped 64.9% to £64.3m, helped by tighter capex and working capital. Capex fell to £78.5m (FY24: £112.1m) after years of estate investment, freeing up cash while still funding robotics expansion, AI-enabled MRI upgrades and digital improvements.

Net bank debt ended at £332.4m with covenant leverage steady at 2.0x and interest cover at 7.5x. Facilities were extended to August 2028, and the group maintains an undrawn £60.0m RCF. Lease liabilities stood at £948.7m, a reminder that IFRS 16 puts hospital leases on balance sheet and inflates finance costs (£104.0m in the year). Return on capital employed was 8.0% (8.5% excluding NI/NMW rises).

The Board recommended a final dividend of 1.5p per share (FY24: 2.3p). Income seekers will note the step down, though it aligns with the focus on cash generation and headroom during the NHS wobble.

Quality, brand and tech: still differentiating

• 98% of inspected hospitals retained ratings equivalent to Good or Outstanding.
• 97% of patients rated their experience Good or Very good and 84% of consultants rated care Very good or Excellent.
• 29 robotic surgery platforms now installed and 21 MRIs running AI software to lift throughput and diagnostic quality.
• Prompted brand awareness up 7% to 80%, with Spire leading the market on awareness and consideration.

FY26 outlook: NHS reset vs private momentum

Q1 2026 trading

• Private revenue up around 4% year on year, with self-pay up around 6%.
• NHS revenue expected to decline about 25% due to Activity Management Plans through to the end of March.
• Incremental transformation savings in FY26 will be ahead of the previously flagged £30m and are expected to at least offset the Q1 NHS impact.

Q2-Q4 and full-year target

NHS commissioning plans reset from April and demand remains high via the e-Referral System, but funding terms are not yet agreed and the provisional 2026/27 tariff uplift is around 0%, well below inflation. Spire is targeting FY26 EBITDA broadly in line with FY25 while pushing harder on private revenue and efficiency. This constitutes a formal profit forecast under the Takeover Code, with assumptions set out in the RNS.

Strategic Review: potential catalysts to watch

The Strategic Review remains live. Options include a potential sale of the company, value generation from the hospital property estate, and adjustments to operational and strategic plans. There is no certainty an offer will be made or its terms. You can track updates on Spire’s investor site and the dedicated review page:

• Investors home
• Review of strategic options

My take: where this leaves investors

The good news

• Private pay momentum improved into H2 and early FY26, which matters if NHS volumes remain choppy.
• Cost execution is credible. £30m of FY25 savings, more to come in FY26, and capex discipline drove a 64.9% jump in adjusted free cash flow.
• Balance sheet looks sensible with 2.0x net bank debt to EBITDA and facilities extended to 2028, giving time to execute.
• Operational quality and brand strength remain clear differentiators.

The watch-outs

• NHS visibility is poor and the provisional tariff uplift of around 0% for 2026/27 is unhelpful against sticky cost inflation.
• Reported profit is pressured by adjusting items and high lease-related finance costs, which dilute bottom-line growth.
• The final dividend of 1.5p is lower year on year, reflecting a cautious cash stance.

Why it matters

Spire is leaning into the more resilient part of the UK healthcare demand story – private self-pay and PMI – while ringfencing margins through transformation and active case-mix management. If the Strategic Review unlocks value from the property estate or a corporate transaction, that could be a material catalyst. In the meantime, management’s FY26 target of EBITDA broadly in line with FY25 reads pragmatic given a tough NHS backdrop.

For me, this is a story of steady execution and optionality. If private pay continues to firm and the efficiency programme does what it says on the tin, free cash flow should keep improving. The big swing factor is what, if anything, emerges from the review. Until then, think of FY26 as a hold-the-line year with upside from private growth and self-help.