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Mon 24 Nov 2008, 7:05 NTC - Netcare - Audited group results for the year ended 30 September 2008
NTC
NTC                                                                             
NTC - Netcare - Audited group results for the year ended 30 September 2008      
Netcare Limited                                                                 
Registration number: 1996/008242/06                                             
(Incorporated in the Republic of SouthAfrica)                                   
JSE share code:  NTC     ISIN code: ZAE000011953                                
("Netcare", "the Company" or "the Group")                                       
Audited group results for the year ended 30 September 2008                      
+17% increase in Group revenue                                                  
+13% increase in Group operating profit                                         
+101% of Group EBITDA converted to cash                                         
Group balance sheet                                                             
at 30 September                                                                 
                                         Note       2008       2007             
                                                    Rm         Rm               
ASSETS                                                                          
Non-current assets                                                              
Property, plant and equipment                        29 732     26 683          
Goodwill                                             17 555     16 091          
Intangible assets                                    355        289             
Associated companies and loans            3          104        298             
Financial assets                                     558        1 453           
Deferred taxation                                    907        514             
Total non-current assets                             49 211     45 328          
Current assets                                                                  
Loans and receivables                     3          75         56              
Inventories                                          638        600             
Trade and other receivables                          3 500      2 875           
Cash and cash equivalents                            1 202      1 361           
                                                    5 415      4 892            
Assets held for sale                      4          304        319             
Total current assets                                 5 719      5 211           
Total assets                                         54 930      50 539         
EQUITY AND LIABILITIES                                                          
Capital and reserves                                                            
Ordinary share capital and premium                   1 601      1 819           
Treasury shares                                      (5 555)    (5 555)         
Option premium on convertible bond                   172        172             
Other reserves                                       1 685      1 863           
Retained earnings                                    6 590      5 833           
Ordinary shareholders` equity                        4 493      4 132           
Preference share capital and premium                 644        644             
Minority interest                                    3 714      3 806           
Total shareholders` equity                           8 851      8 582           
Non-current liabilities                                                         
Long-term debt                                       31 530     28 944          
Financial liability - Derivative                     1 654      1 156           
financial instruments                                                           
Post-retirement benefit obligations                  126        115             
Deferred lease liability                             91         63              
Deferred taxation                                    6 681      6 073           
Total non-current liabilities                        40 082     36 351          
Current liabilities                                                             
Trade and other payables                             3 387      2 570           
Short-term debt                                      2 021      2 086           
Taxation payable                                     268        410             
Bank overdrafts                                      240        461             
                                                    5 916      5 527            
Liabilities in disposal group held for    4          81         79              
sale                                                                            
Total current liabilities                            5 997      5 606           
Total equity and liabilities                         54 930     50 539          
Group income statement                                                          
for the year ended 30 September                                                 
Note       2008       2007       %               
                                        Rm         Rm         change            
CONTINUING OPERATIONS                                                           
Revenue                                    21 735     18 607     16,8           
Cost of sales                              (12 842)   (10 856)                  
Gross profit                               8 893      7 751                     
Other income                               256        204                       
Administrative and other                   (5 779)    (4 965)                   
expenses                                                                        
Operating profit                5          3 370      2 990      12,7           
Financial income                6          279        328                       
Financial expenses              7          (2 706)    (2 463)                   
Attributable earnings of                   2          32                        
associates                                                                      
Profit before taxation                     945        887        6,5            
Taxation                                   (68)       99                        
Profit for the year from                   877        986        (11,1)         
continuing operations                                                           
DISCONTINUED OPERATION                                                          
Profit for the year from        4          105        109        (3,7)          
discontinued operation                                                          
Profit for the year                        982        1 095      (10,3)         
Attributable to:                                                                
Ordinary shareholders                      801        927                       
Preference shareholders                    67         30                        
Profit attributable to                     868        957                       
shareholders                                                                    
Minority interest                          114        138                       
982        1 095                      
Earnings per share (cents)                                                      
Basic                                      63,5       75,4       (15,8)         
Continuing operations                      55,2       66,5       (17,0)         
Discontinued operation                     8,3        8,9        (6,7)          
Diluted                                    62,6       71,7       (12,7)         
Continuing operations                      54,4       63,3       (14,1)         
Discontinued operation                     8,2        8,4        (2,4)          
Reductions of capital per share            32,0        31,0                     
(cents)                                                                         
Group cash flow statement                                                       
for the year ended 30 September                                                 
2008       2007              
                                                  Rm         Rm                 
Cash flows from operating activities                                            
Cash received from customers                        21 099     18 869           
Cash paid to suppliers and employees                (16 436)   (14 895)         
Cash generated from operations                      4 663      3 974            
Interest paid                                       (2 558)    (2 355)          
Continuing operations                               (2 550)    (2 348)          
Discontinued operation                              (8)        (7)              
Taxation paid                                       (290)      (286)            
Continuing operations                               (268)      (269)            
Discontinued operation                              (22)       (17)             
Preference dividends paid                           (67)       (30)             
Reductions of capital paid                          (407)      (347)            
Net cash from operating activities                  1 341      956              
Continuing operations                               1 352      882              
Discontinued operation                              (11)       74               
Cash flows from investing activities                                            
Purchase of property, plant and equipment           (1 268)    (1 389)          
Continuing operations                               (1 240)    (1 291)          
Discontinued operation                              (28)       (98)             
Proceeds on disposal of property, plant and         708        40               
equipment                                                                       
Additions to intangible assets                      (148)      (103)            
Post-retirement obligation                                     (151)            
Decrease/(increase) in investments and loans        171        (52)             
Proceeds on disposal of businesses                  15         1                
Interest received                                   134        158              
Realised gain on cross-currency swap                324                         
Dividends received                                  1          1                
Acquisition of subsidiaries and businesses, net of  (2 112)    (169)            
cash acquired                                                                   
Net cash from investing activities                  (2 175)    (1 664)          
Continuing operations                               (2 147)    (1 632)          
Discontinued operation                              (28)       (32)             
Cash flows from financing activities                                            
Proceeds from issue of ordinary shares              48         669              
Long-term liabilities raised                        974        262              
Short-term liabilities repaid                       (133)      (317)            
Net cash from financing activities                  889        614              
Continuing operations                               889        617              
Discontinued operation                                         (3)              
Net increase/(decrease) in cash and cash            55         (94)             
equivalents                                                                     
Translation effects on cash and cash equivalents of (32)       39               
foreign entities                                                                
Cash and cash equivalents at beginning of the year  900        1 009            
Effects of cash in disposal group held for sale     39         (54)             
Cash and cash equivalents at end of year            962        900              
Group statement of recognised income and expense                                
for the year ended 30 September                                                 
                                                   2008       2007              
Rm         Rm                 
Effect of translation of foreign entities           130        (93)             
Fair value gains/(losses) on investments            93         (24)             
Effect of cash flow hedge accounting                (427)      600              
Actuarial (losses)/gains on defined benefit plans   (24)       1                
Movement in contingency reserve                     (9)        6                
Disposal of shares in subsidiary                               (36)             
Fair value deficit on disposal of shares                       (7)              
Movements in employee share trust reserve           30                          
Other reserve movements                             (20)                        
Net (loss)/income recognised directly in equity     (227)      447              
Profit for the year                                 982        1 095            
Total recognised income for the year                755        1 542            
Attributable to:                                                                
Ordinary shareholders                               780        1 062            
Preference shareholders                             67         30               
Minority interest                                   (92)       450              
                                                   755        1 542             
Headline earnings                                                               
for the year ended 30 September                                                 
2008       2007       %                
                                        Rm         Rm         change            
Reconciliation of headline earnings                                             
Profit for the period from continuing     877        986        (11,1)          
operations                                                                      
Less:                                                                           
Preference shareholders                   (67)       (30)                       
Minority interest                         (114)      (138)                      
Earnings used in the calculation of basic 696        818        (14,9)          
earnings per share from continuing                                              
operations                                                                      
Adjusted for:                                                                   
Impairment of goodwill                    1          16                         
Impairment of intangible assets                      40                         
Impairment of investments                 1          1                          
Impairment of land and buildings          1                                     
Reversal of impairment of land and        (17)       (11)                       
buildings                                                                       
Profit on disposal of property, plant and (28)       (1)                        
equipment                                                                       
Loss/(profit) on disposal of              2          (1)                        
subsidiaries/investments                                                        
Tax effect of headline adjusting items    6                                     
Minority share of headline adjusting      10         (16)                       
items                                                                           
Headline earnings from continuing         672        846        (20,6)          
operations                                                                      
Earnings from discontinued operation      105        109                        
Adjusted for:                                                                   
Profit on disposal of property, plant and (2)                                   
equipment                                                                       
Headline earnings from discontinued       103        109                        
operation                                                                       
Headline earnings                         775        955        (18,8)          
Headline earnings per share (cents)                                             
Basic                                     61,5       77,6       (20,7)          
Continuing operations                     53,3       68,8       (22,5)          
Discontinued operation                    8,2        8,8        (6,8)           
Diluted                                   60,5       73,8       (18,0)          
Continuing operations                     52,5       65,4       (19,7)          
Discontinued operation                    8,0        8,4        (4,8)           
Notes                                                                           
for the year ended 30 September                                                 
1. Basis of preparation and accounting policies                                 
The condensed financial statements have been extracted from the Group financial 
statements which have been prepared in accordance with International Financial  
Reporting Standards (IFRS), the Listing Requirements of the JSE Limited and the 
South African Companies Act, 1973, as amended.                                  
The accounting policies applied are consistent with those of the prior year,    
except for the following:                                                       
- IFRS 7 Financial Instruments: Disclosures                                     
- Amendment to IAS 1 Presentation of Financial Statements: Capital Disclosures  
- IFRS 2 Share-based payment: Amendments to vesting conditions and cancellations
2. Acquisition of businesses                                                    
The following significant business combinations took effect during the year:    
2.1 With effect from 2 October 2007, the Group acquired the remaining 56,25%    
interest in Community Hospital Group (Proprietary) Limited (Community) for a    
consideration of R169 million. The acquisition consideration was settled through
the issuance of 14,2 million Netcare shares on 5 October 2007 at the closing    
Netcare share price of R11,89 at the acquisition date. In addition, the Group   
assumed debt of R171 million and capital commitments of R53 million for the     
projects in progress. The Group increased their shareholding in Bougainville    
Hospital which forms part of Community for an additional consideration of R6    
million. The results of Community have previously been equity accounted.        
2.2 Effective 12 November 2007, the Group acquired 100% of the shares in        
Linkwood Clinic (Proprietary) Limited.                                          
2.3 On 1 February 2008, the Group acquired nine hospitals in the United Kingdom 
from Nuffield Hospitals for a total consideration of R2 076 million (GBP140     
million) excluding transaction costs of R80 million (GBP5 million). This was an 
asset acquisition only whereby the Group acquired property, inventory and       
tangible fixed assets. Subsequently, Nottingham Hospital was disposed of in     
March 2008 and Gerrards Cross Hospital was disposed of in April 2008.           
2.4 With effect from 18 August 2008, the Group acquired 61% of Oxford           
Musculoskeletal Clinic LLP in the United Kingdom for a nominal consideration.   
From the dates of acquisition to 30 September 2008, the following amounts have  
been included in the Group`s income statement:                                  
Community    Linkwood     Nuffield    Oxford      Rm             
              Rm           Rm           Rm          Musculo-                    
                                                 skeletal                       
                                                 Clinic                         
Rm                             
Revenue         597          33           501         8           1 139         
Operating       50           2            37          (1)         88            
profit                                                                          
The results of the group for the period if the acquisition dates had            
been at the beginning of the period are as follows:                             
                                                                 Total          
                                                            Rm                  
Revenue                                                           22 033        
Operating profit                                                  3 381         
The following table reflects the fair values at acquisition:                    
                           Community    Linkwood    Nuffield    Oxford          
Musculo-            
                                                            skeletal            
                                                            Clinic              
                           Rm           Rm          Rm          Rm              
Property, plant and         534          8           1 799       24             
equipment                                                                       
Investments                 4                                                   
Inventories                 2                        24          2              
Trade and other receivables 80           3                       6              
Cash and cash equivalents   44           5                       1              
Long-term debt              (104)                                (17)           
Deferred taxation           (81)                     (237)                      
Trade and other payables    (309)        (27)                    (16)           
including short-term debt                                                       
Taxation payable            (8)                                                 
                           162          (11)        1 586                       
Minority interest           (4)                                                 
Fair value of net assets    158          (11)        1 586                      
acquired                                                                        
Investment in associate     (102)                                               
56           (11)        1 586                       
Goodwill                    119          11          570                        
Purchase consideration      175                      2 156                      
Less amounts settled by     (169)                                               
issue of shares                                                                 
Cash and cash equivalents   (44)         (5)                     (1)            
in acquiree                                                                     
Cash (inflow)/outflow on    (38)         (5)         2 156       (1)            
acquisition                                                                     
The fair values reflected above are equal to the carrying values at             
acquisition except for:                                                         
Property plant and equipment                       Carrying    Fair             
value       value              
                                                 Rm          Rm                 
Community                                          234         534              
Nuffield                                           1 458       1 799            
30          30               
                                                 September   September          
                                                 2008        2007               
                                                 Rm          Rm                 
3.  Associated companies and loans                                              
   Non-current                                                                  
   Associated companies*                           89          282              
   Other loans and receivables                     15          16               
104         298              
   Current                                                                      
   Loans and receivables                           75          56               
                                                   179         354              
*Directors` valuation of associated companies   282         466              
4.  Disposal group and assets held for sale                                     
   Assets held for sale                                                         
   Assets in disposal group - Ampath Holdings      295         275              
Trust                                                                         
   Land and buildings held for sale                9           44               
                                                   304         319              
   Liabilities in disposal group held for sale                                  
Liabilities in disposal group - Ampath Holdings (81)        (79)             
  Trust                                                                         
   Discontinued operation - Ampath Holdings Trust                               
   The Ampath Holdings Trust has been classified                                
as a disposal group held for sale. Our 50%                                    
  share of the discontinued operation was as                                    
  follows:                                                                      
   Revenue                                         563         507              
Other income                                    2                            
   Administrative and other expenses               (426)       (380)            
   Operating profit                                139         127              
   Financial expenses                              (8)         (7)              
Profit before taxation                          131         120              
   Taxation                                        (26)        (11)             
   Profit for the year                             105         109              
   The assets and liabilities of the disposal                                   
group are as follows:                                                         
   Property, plant and equipment                   71          54               
   Goodwill                                        72          72               
   Investments and loans                           11          5                
Inventories                                     10          8                
   Trade and other receivables                     116         76               
   Taxation receivable                                         6                
   Cash and cash equivalents                       15          54               
Long-term debt                                  (8)         (6)              
   Post-retirement benefit obligation              (9)         (10)             
   Trade and other payables                        (56)        (57)             
   Taxation payable                                (4)                          
Short-term debt                                 (4)         (6)              
   The cash flows are as follows:                                               
   Net cash from operating activities              (11)        74               
   Net cash from investing activities              (28)        (32)             
Net cash from financing activities                          (3)              
5.  Operating profit                                                            
   After charging:                                                              
   Depreciation and amortisation                   1 244       1 044            
Operating lease charges                         345         190              
6.  Financial income                                                            
   Dividends received                              1           1                
   Fair value gain on cross-currency swap          136                          
contracts                                                                     
   Fair value gain on interest rate swaps          8           65               
   Foreign exchange gains (net)                                104              
   Interest received                               134         158              
279         328              
7.  Financial expenses                                                          
   Fair value loss on cross-currency swap                      115              
  contracts                                                                     
Foreign exchange losses (net)                   156                          
   Interest paid                                   2 550       2 348            
                                                   2 706       2 463            
8.  Commitments                                                                 
Capital commitments                             753         1 031            
   South Africa                                    258         492              
   United Kingdom                                  495         539              
   Operating lease commitments                     4 496       5 413            
South Africa                                    1 460       395              
   United Kingdom                                  3 036       5 018            
9.  Contingent liabilities (guarantees and                                      
  suretyships)                                                                  
South Africa                                    253         236              
   United Kingdom                                  118         112              
                                                   371         348              
Segment report                                                                  
for the year ended 30 September                                                 
                                      2008         2007        %                
                                     Rm           Rm          change            
INCOME STATEMENT                                                                
Revenue                                21 735       18 607      16,8            
South Africa                           10 385       8 869       17,1            
Hospitals and Emergency Services       9 020        7 782       15,9            
Primary care                           1 365        1 087       25,6            
United Kingdom                         11 350       9 738       16,6            
EBITDA                                 4 614        4 034       14,4            
South Africa                           1 739        1 685       3,2             
Hospitals and Emergency Services       1 735        1 584       9,5             
Primary care                           4            101         (96,0)          
United Kingdom                         2 885        2 411       19,7            
Capital items                          (10)         (62)                        
South Africa                           20           (29)                        
United Kingdom                         (30)         (33)                        
Operating profit                       3 370        2 990       12,7            
South Africa                           1 401        1 406       (0,4)           
Hospitals and Emergency Services       1 414        1 328       6,5             
Primary care                           (13)         78          (116,7)         
United Kingdom                         1 979        1 646       20,2            
Capital items                          (10)         (62)                        
South Africa                           20           (29)                        
United Kingdom                         (30)         (33)                        
Net interest paid                      2 416        2 190       10,3            
South Africa                           518          456         13,6            
United Kingdom                         1 898        1 734       9,5             
BALANCE SHEET                                                                   
Total assets                           54 626       50 220      8,8             
South Africa                           10 956       7 387       48,3            
United Kingdom                         43 670       42 833      2,0             
Debt net of cash                       32 589       30 130      8,2             
South Africa                           4 837        5 246       (7,8)           
United Kingdom                         27 752       24 884      11,5            
The segment report excludes the disposal group and assets held for              
sale                                                                            
Salient features                                                                
for the year ended 30 September                                                 
                                                  2008        2007              
Share statistics                                                                
Ordinary shares                                                                 
Total shares in issue (million)                    1 262       1 245            
Weighted average number of shares (million)        1 261       1 230            
Diluted weighted average number of shares          1 280       1 293            
(million)                                                                       
Market price per share (cents)                     825         1 193            
Currency conversion guide (R:GBP)                                               
Closing exchange rate                              14,76       14,03            
Average exchange rate for the year                 14,65       14,13            
Commentary                                                                      
Netcare Limited, an investment holding company listed on the JSE Limited, which 
operates through its subsidiaries the largest private hospital networks in South
Africa (SA) and the United Kingdom (UK), announces audited group results for the
year ended 30 September 2008. The financial information in this announcement has
been prepared in accordance with International Financial Reporting Standards    
(IFRS), the Listings Requirements of the JSE Limited and the South African      
Companies Act, 1973, as amended.                                                
Group financial highlights                                                      
- Group revenue up 17% to R21 735 million                                       
- Group operating profit up 13% to R3 370 million                               
- Group cash conversion to EBITDA ratio of 101%                                 
- Cash generated from operations up 17% to R4 663 million                       
-?2008 reductions of capital of 32 cents per share                              
Group business highlights                                                       
-?Treated over four million patients in SA and UK                               
-?Acquired 14 hospitals (eight in the UK and six in SA)                         
-?UK delivered strong operating performance                                     
-?Achieved Level 3 B-BBEE accreditation (dti), and Empowerdex AA rating         
-?Netcare 911 recognised as SA`s top healthcare brand                           
-?Awarded R1,1 billion healthcare PPP in Lesotho post year end                  
Group financial performance                                                     
Group revenue increased by 16,8% to R21 735 million with the SA business        
contributing 48% and the UK business contributing 52%. Performance was driven by
organic and acquisitive growth in both countries and the impact of the increased
average ZAR/GBP exchange rate during the year.                                  
Group operating profit increased by 12,7% to R3 370 million while the Group     
operating profit margin declined from 16,1% to 15,5% as a result of sub-optimal 
tariff levels in SA, underwriting costs in Primary Care and non-recurring costs 
in both SA and UK amounting to R132 million. Included in operating profit are   
restructuring costs of R135 million and transaction costs of R53 million on the 
acquisition of seven Nuffield hospitals (Nuffield acquisition), all of these    
offset by a profit on the curtailment of the UK defined benefit pension fund of 
R76 million.                                                                    
Group net financial expenses increased by 13,7% to R2 427 million, due to       
marginally higher prevailing interest rates and increased debt associated with  
the consolidation and acquisition of Community Hospital Group (Community) and   
Nuffield hospitals. The prior year had included a R58 million gain on the UK    
interest rate swaps.                                                            
Group taxation at R68 million, representing an effective tax rate of 8%, was    
favourably affected by the restructuring of previously trapped UK tax losses and
accounting for deferred tax credits in the UK. Notably, the prior year credit of
R99 million had been favourably impacted by a R372 million deferred tax release 
following a 2% reduction in the UK statutory tax rate to 28%.                   
The abovementioned deferred tax release boosted prior year headline earnings per
share (HEPS) by 15,9 cents and distorts any year on year comparisons. Adjusting 
the prior year to exclude this release, results in adjusted HEPS of 61,7 cents  
in line with the 61,5 cents reported for 2008. Reported HEPS for 2007 was 77,6  
cents.                                                                          
Net debt rose by 8,2% to R32 589 million mainly as a result of the ZAR/GBP      
exchange rate movements and the Nuffield acquisition. The debt relating to the  
UK is without recourse to the SA operations, with financing secured for a       
further five years.                                                             
Capital expenditure of R1 240 million was incurred for additions and upgrading  
of existing facilities.                                                         
Cash generated from operations increased by 17,3% to R4 663 million. The Group  
converted 101,1% (2007: 98,5%) of its EBITDA into cash.                         
South African operations                                                        
Netcare acquired the balance of the shareholding in Community in October 2007,  
adding five hospitals and 667 beds and Linkwood Clinic, a natural-birth         
maternity unit with 33 beds, in November 2007. During the financial year        
Netcare`s SA businesses were restructured into three focused divisions:         
Hospitals, Primary Care and Emergency Services.                                 
Employing 19 651 people, Netcare was again ranked as one of the top 10 large    
companies to work for in South Africa in a survey conducted by Deloitte. We also
achieved an AA-rating from Empowerdex, equivalent to Level 3 compliance in terms
of the Department of Trade and Industry (dti) Codes of Good Practice for Broad- 
Based Black Economic Empowerment. This represents excellent progress from the   
Level 5 attained last year and demonstrates Netcare`s commitment to             
transformation.                                                                 
Netcare`s hospital management expertise was recognised by the Lesotho government
and the International Finance Corporation in the award to Netcare of the largest
healthcare Public Private Partnership (PPP) yet in Africa. With our consortium  
partners we will construct a 390-bed referral hospital in Maseru and refurbish  
three primary care referral clinics, as well as delivering all clinical         
services. The agreement was signed on 27 October 2008.                          
Financial performance                                                           
Netcare SA grew revenue by 17,1% to R10 385 million, boosted by the acquisition 
of Community and Linkwood Clinic, the increased revenue contribution from       
Primary Care and the incorporation of our two newly built hospitals, Alberlito  
and Blaauwberg. Organic revenue growth in SA was 13,2%.                         
EBITDA increased by 3,2% to R1 739 million. SA`s operating performance was      
adversely impacted by sub-optimal tariff levels across all divisions,           
inflationary cost pressures, higher underwriting costs (including approximately 
R20 million relating to the prior year) in Primary Care, together with          
restructuring costs of R12 million. This resulted in an operating margin of     
13,5%. Adjusting for non-recurring items of R32 million, operating profit rose  
1,9% to R1 433 million at an operating profit margin of 13,8%.                  
Capital expenditure for the year amounted to R687 million, which included       
investments in hospital infrastructure, new medical equipment, and plant and    
equipment.                                                                      
Working capital management improved significantly, particularly in the last six 
months, achieving a cash conversion of 167% (113% for the full year).           
Divisional review                                                               
Hospitals                                                                       
Total patient bed days grew by 13% of which 3% was organic, and 10% as a result 
of the Community and Linkwood acquisitions as well as Alberlito and Blaauwberg. 
The average length of stay remained unchanged. Average weekday occupancy        
increased to 73%, including Alberlito and Blaauwberg.                           
Average revenue per patient day was up a modest 6,2%. Revenue was impacted by   
Netcare`s decision to honour the request by the former Minister of Health to    
hold tariff increases for several months of the calendar year despite the higher
inflationary environment.                                                       
In January 2008, a new policy on tariff structures was implemented; namely the  
Actual Acquisition Price model (AAP). The AAP model ensures that all surgical   
consumables are charged at cost. All pharmaceuticals are charged according to   
Single Exit Price (SEP).                                                        
Hospital revenue comprises 40% alternative reimbursement fees and 60% fee-for-  
service. We continue to develop protocols and guidelines to ensure quality      
outcomes at the lowest possible cost.                                           
Retail scripts dispensed from hospital pharmacies rose by 3% in part due to     
extended hours and increased customer focus. Netcare continues to pilot in-store
retail pharmacies in partnership with Woolworths.                               
A significant cost driver remains the shortage of skilled nurses and            
pharmacists. Netcare now trains 25% of all nurses in the country although we    
manage only 7% of total private and public beds in the country.                 
Significant progress has been made on the construction of the Eastern Cape PPP`s
- Settlers Hospital in Grahamstown and the Port Alfred Hospital. Both of these  
are expected to be fully operational during the 2009 financial year.            
Primary Care                                                                    
The Primary Care division comprises two primary clinic networks (Medicross and  
Prime Cure) and the managed healthcare division within Prime Cure.              
The clinic services provider platform offers national coverage through 101      
Medicross Health Centres and Prime Cure Clinics, hosting 684 independent doctors
and dentists. These facilities recorded 3,7 million patient visits in the       
period, up 8% on the prior year.                                                
The managed healthcare division continued to expand its managed care and risk   
management services into the previously uninsured section of the healthcare     
market in South Africa. The number of managed lives increased by 32,5% to 235   
039. Prime Cure experienced an unprecedented migration of clients from primary  
healthcare cover to full risk cover, including hospitalisation. The change in   
the nature of the business resulted in higher underwriting and servicing costs. 
In addition, the contracted network of designated and accredited doctors and    
dentists was extended by 19,3% to over 3 700 providers nationally, thereby      
improving healthcare access for all our insured members.                        
Emergency Services (Netcare 911)                                                
Netcare 911 is South Africa`s largest private emergency service providing a     
broad range of pre-hospital services on a national basis, comprehensive         
international assistance to travellers in Africa and worldwide emergency medical
assistance to several industrial and mining clients. It also operates the       
largest private training facility for Emergency Medical Services in Africa.     
The division attended to over 214 000 calls during the year and has             
approximately 7,5 million members. The increased number of indigent patients    
served, compounded by high fuel prices and other cost pressures have            
necessitated a review of the business model to mitigate these operational costs.
Health sector developments                                                      
In the past year there has been significant regulatory focus on the private     
healthcare sector, culminating in the release of the draft National Health      
Amendment Bill and Medicines and Related Substances Amendment Bill. Regulations 
will be reviewed in 2009 in light of the renewed impetus towards National Health
Insurance for all South Africans.                                               
Netcare welcomes the appointment of Ms Barbara Hogan as Minister of Health. Her 
constructive and open approach to healthcare issues heralds an opportunity for  
the health sector, both public and private, to collectively confront the        
challenges to national health, specifically those posed by the HIV/AIDS and TB  
epidemics and the problems in healthcare delivery.                              
Netcare stands ready to assist government and the Department of Health in       
initiatives to broaden access to quality healthcare and ensure better clinical  
outcomes. Our commitment is demonstrated in our training of nurses and          
paramedics, active involvement in PPPs, servicing of indigent patients by       
Netcare 911 and increasing private healthcare access to lower-income families   
through Prime Cure.                                                             
United Kingdom operations                                                       
Netcare`s UK business consists of a 50,1% stake in the General Healthcare Group 
(GHG). GHG has 58 hospitals operating under the BMI brand and a National Health 
Services (NHS) outsourcing division, Netcare UK. The UK operations have 8 473   
full time equivalent employees.                                                 
GHG acquired seven of Nuffield`s private charitable hospitals in February 2008, 
the Oxford Clinic, a specialist musculoskeletal hospital in August 2008 and the 
Woodlands Hospital in Darlington in October 2008. GHG`s substantial organic     
growth coupled with an effective acquisition strategy is serving to extend the  
Group`s geographic footprint in the UK, enabling it to deliver further cost and 
revenue efficiencies with a corresponding improvement in profitability.         
Financial performance                                                           
Revenue from the UK business increased by 16,6% to R11 350 million (GBP772,6    
million), with organic revenue growth of 7,4%. The seven acquired Nuffield      
hospitals contributed 4,8% to the revenue increase and the higher average       
exchange rates during the year resulted in an additional 4,4% in ZAR denominated
revenue.                                                                        
EBITDA in Rand increased by 19,7% to R2 885 million and in GBP increased by     
14,6% to GBP195,7 million and includes non-recurring items amounting to net     
GBP6,6 million (2007: GBP5,6 million). Adjusting for these, EBITDA for the year 
was GBP202,3 million (2007: GBP176,4 million).                                  
Operating profit in Rand increased by 20,2% to R1 979 million and in GBP        
increased by 12,5% to GBP128,7 million and includes non-recurring items set out 
above plus an at-acquisition goodwill adjustment of GBP3,7 million (set off by a
corresponding credit in deferred tax). Adjusting for these items operating      
profit for the year was GBP139,0 million (2007: GBP120,0 million).              
Capital expenditure for the year was R553 million (GBP41,9 million). This       
capital investment includes the upgrade of ward and theatre facilities, the     
purchase of new diagnostics imaging equipment, the roll-out of network-wide     
radiology systems (PACS/RIS) and the addition of new operating theatres and     
equipment.                                                                      
Divisional review                                                               
Hospitals (BMI)                                                                 
Overall admissions in the UK grew by 6,1% with patient visits rising 10%. The   
increase is attributable to increased general practitioner (GP) engagement,     
incremental business development support for consultants and rebranding BMI as  
"The Consultants` Choice", as well as the addition of new sites. Private Medical
Insurance (PMI) volumes remained static with an increase in NHS volumes         
offsetting a decline in self-pay volume. Significant progress has been made in  
transforming the UK business and in improving efficiencies and synergies.       
In August BMI opened the Nottingham Primary Care Centre, providing access to    
primary care services including diagnostics, outpatient services and specialist 
(consultants) services. A joint partnership with Nottingham Emergency Medical   
Services will allow the centre to also offer a walk-in service and NHS GP       
services, and potentially, after hours emergency primary care services.         
Netcare UK (NHS division)                                                       
Netcare UK continues to service existing Independent Sector Treatment Centre    
(ISTC) contracts successfully. Some of these are the mobile ophthalmic project, 
the Greater Manchester Surgical Centre, the Commuter Walk in Centre in Leeds,   
which treated 30 000 patients during the year, and the surgical initiative with 
the Scottish NHS in Stracathro. The five-year ophthalmic contract to provide 44 
000 cataract operations is nearing its successful completion in April 2009.     
Regulatory overview                                                             
The principal regulator in England is the Healthcare Commission (HCC) which is  
to be merged with the Commission for Social Care Inspection, to form a super-   
regulator to be known as the Care Quality Commission (CQC). The regulatory      
framework is expected to change and the standards applicable to GHG`s hospitals 
in England will, with effect from 2011, converge with those applicable to the   
state`s NHS units. Furthermore the private (independent) sector is moving to a  
more self-inspection oriented regime, with a reduced frequency of on-site       
inspection visits from the HCC and the CQC. We believe this reflects the        
maturity and credibility of management and systems in place in the independent  
sector.                                                                         
GHG has introduced a specific compliance focus in its quality and risk function 
activities to ensure continued improvement in compliance levels across the      
business units. GHG participates in a sector-wide project (actively supported by
the HCC and the Department of Health) to establish a clinical outcomes          
programme, which will assess effectiveness at an individual patient level. Data 
from this project will come on stream in early 2009. Comparatives will be drawn 
from across the independent sector and, in time, the NHS.                       
Outlook                                                                         
Given ever-changing global economic uncertainties, it is difficult to predict   
the impact of the prevailing conditions on the economies of both SA and the UK. 
However, the requirement for healthcare continues despite changes in economic   
cycles.                                                                         
However, Netcare remains confident that the demand for private healthcare will  
be sustained in SA. This is underpinned by a financially sound and growing      
medical scheme market. We are hopeful that real opportunities to partner and    
assist government in the improvement of access to healthcare may also be        
forthcoming.                                                                    
In the UK, the recessionary environment is expected to impact out-of-pocket     
spend on private healthcare in the short term. GHG is confident that this will  
be somewhat offset by the NHS activity which provides much opportunity for      
growth as the UK public starts to participate in the Free Choice Programme and  
Primary Care Trusts rationalise around purchasing quality. GHG is increasingly  
relevant and well positioned to capture the opportunities that exist in the UK  
market in the years ahead with a continued focus on outstanding quality and     
unrivalled national hospital coverage.                                          
Board and management changes                                                    
Mr Motty Sacks retired as non-executive chairman on 31 March 2008 and remains as
a non-executive director. Mr Jerry Vilakazi was appointed independent non-      
executive chairman with effect from 1 June 2008. Professor Taole Mokoena        
resigned on 4 June 2008, Mr Martin Kuscus was appointed as an independent non-  
executive director with effect from 1 July 2008, and Dr Jan van Rooyen resigned 
as a non-executive director with effect from 11 August 2008.                    
On 5 November 2008, Peter Nelson, the Chief Financial Officer gave notice of his
resignation from the company to take up employment outside of the Netcare Group 
with effect from 5 December. Vaughan Firman, Financial Director of Netcare`s    
South African operations, has assumed the role of Acting Chief Financial Officer
of the Netcare Group with immediate effect.                                     
The Board wishes to express it sincere appreciation to Mr Sacks for his         
exceptional contribution to the Group and looks forward to his ongoing          
participation. The Board also wishes to thank Professor Taole Mokoena, Dr Jan   
van Rooyen and Peter Nelson for their excellent contributions.                  
Audit opinion of the independent auditors                                       
The Group`s annual financial statements have been audited by Grant Thornton and 
their unqualified audit report is available for inspection at the Company`s     
registered office.                                                              
Declaration of reduction of capital number 19                                   
In accordance with the authority given to the directors by way of an ordinary   
resolution passed on 25 January 2008, the Board of Directors declared on 20     
November 2008 a reduction of capital (number 19) out of share premium of 18     
cents per ordinary share (2007: 18 cents per ordinary share), payable on 26     
January 2009, to shareholders recorded in the register of the Company as at 23  
January 2009.                                                                   
In compliance with the requirements of Strate, the following dates are          
applicable:                                                                     
Last date to trade "cum" the reduction                                          
of capital (LDT)                               Friday, 16 January 2009          
Date trading commences "ex" the reduction                                       
of capital                                     Monday, 19 January 2009          
Record date                                    Friday, 23 January 2009          
Date of payment                                Monday, 26 January 2009          
Share certificates may not be dematerialised nor rematerialised between Monday, 
19 January 2009 and Friday, 23 January 2009, both dates inclusive.              
On behalf of the board                                                          
Jerry Vilakazi                                                                  
Chairman                                                                        
Dr Richard Friedland                                                            
Chief Executive Officer                                                         
Peter Nelson                                                                    
Chief Financial Officer                                                         
Sandton                                                                         
21 November 2008                                                                
Note regarding forward-looking statements                                       
The Company advises investors that any forward looking statements or projections
made by the Company, including those made in this announcement, are subject to  
risk and uncertainties that may cause actual results to differ materially from  
those projected. Factors that may affect the Group`s operations are described   
under "Risk factors" on the investor relations website                          
www.netcareinvestor.co.za.                                                      
Executive directors: Dr RH Friedland (Chief Executive Officer);                 
PG Nelson (Chief Financial Officer); IM Davis; Dr VLJ Litlhakanyane?Non-        
executive directors: SJ Vilakazi (Chairman); Dr APH Jammine; JM Kahn; MJ Kuscus;
HR Levin; Adv KD Moroka SC; Dr AA Ngcaba; MI Sacks; N Weltman                   
Company secretary: J Wolpert?                                                   
Registered office: 76 Maude Street (corner West Street), Sandton 2196; Private  
Bag X34, Benmore 2010?                                                          
Transfer secretaries: Link Market Services South Africa (Proprietary) Limited;  
11 Diagonal Street, Johannesburg 2001; PO Box 4844, Johannesburg 2000           
Sponsors: Merrill Lynch South Africa (Proprietary) Limited; (Registration number
1995/001805/07); 138 West Street, Sandown, Sandton 2196?                        
Investor relations: +27 11 301 0212; ir@netcare.co.za,www.netcareinvestor.co.za 
Registration number: 1996/008242/06?                                            
(Incorporated in the Republic of SouthAfrica)?                                  
JSE share code:  NTC?ISIN code: ZAE000011953?                                   
("Netcare", "the Company" or "the Group")                                       
Date: 24/11/2008 07:05:09 Produced by the JSE SENS Department.                  
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