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Edited Transcript of NTC.J earnings conference call or presentation 18-Nov-19 8:00am GMT

Full Year 2019 Netcare Ltd Earnings Call

Benmore Dec 9, 2019 (Thomson StreetEvents) -- Edited Transcript of Netcare Ltd earnings conference call or presentation Monday, November 18, 2019 at 8:00:00am GMT

TEXT version of Transcript


Corporate Participants


* Keith N. Gibson

Netcare Limited - Group CFO & Executive Director

* Richard Harold Friedland

Netcare Limited - Group CEO & Executive Director


Conference Call Participants


* Kane Slutzkin

UBS Investment Bank, Research Division - Director and Research Analyst

* Steph Erasmus

Avior Capital Markets (Pty) Ltd. - Research Analyst

* Ian Cruickshanks;Institute of Race Relations;Chief Economist




Richard Harold Friedland, Netcare Limited - Group CEO & Executive Director [1]


Good morning, ladies and gentlemen, and welcome to this presentation of Netcare Limited's audited group results for the year ending September 30, 2019. And a warm welcome to the Chair of Netcare, Thevendrie Brewer; and members of the Netcare Board; and senior management that are present here this morning.

At our interim results, we announced the retirement of Azar Jammine. Azar was a Non-Executive Director of Netcare, who served Netcare for more than 20 years. And I want to reiterate our appreciation and gratitude to him for the valuable contribution he made.

At the time, we also announced the appointment of a new Non-Executive Director, Lezanne Human, to the Netcare Board. And I'm delighted to announce this morning the appointment of David Kneale as a new Non-Executive Director of Netcare. Now David requires little introduction. For the past 13 years, he was the Chief Executive of Clicks and was largely responsible for its phenomenal growth and transformation and is today the leader in its sector and one of the most successful companies in Africa. And I know that David will make an enormous contribution to Netcare. I also know that all of us are looking forward to benefiting from his wisdom, his experience in commercial analysis.

Present today are also our management teams from our different divisions, and I want to pay tribute to you for your extraordinary commitment and dedication over what has been a particularly difficult and challenging year for Netcare. The story we have to tell this morning is a powerful story, and it is really due to all your incredible efforts.

In terms of the format for today's presentation, I will take you through a brief overview of our results and then the operational review of our different divisions, before handing over to our Chief Financial Officer, Keith Norman Gibson, to take us through the financial results in more detail and give us guidance for the 2020 financial year. I will then return to give you an update on progress we've made in rolling out our new strategy.

Let's just take a look at some of the features of our performance. As I said, this was a very challenging environment, but I believe we've delivered a resilient operational and financial performance. This was assisted by a number of optimization and efficiency initiatives that we initiated at the beginning of the financial year.

And a standout feature of our results is our extremely strong cash generation. And as a result of that, the additional ZAR 1 billion paid out in terms of special dividends as well as share buybacks had a minimal impact on our overall gearing. And as I'll talk to you later, we've made important strides towards executing our strategic objectives.

A brief overview of our financial results. Revenue rose by 4.2% to ZAR 21.5 billion and EBITDA by 4.3% to ZAR 4.4 billion. And adjusted headline earnings from continuing operations rose by 3% to ZAR 1.712.

Cash conversion increased by 15.3%. And as I mentioned, we recorded a record cash conversion for Netcare of 111.4%. And largely as a result of that, we were able to achieve a net debt-to-EBITDA ratio of 1.2x versus 1.1x in 2018.

Now ladies and gentlemen, just to put that into some perspective for you, we had a cash outlay this year of ZAR 5.2 billion. And our net debt only increased by ZAR 300 million as a result of the superb cash conversion and cash generation. And really as a combination of all of this, the Board of Netcare was able to declare a final dividend of ZAR 0.64, some 6.7% higher than the comparable period last year.

Just a brief reminder of the extensive network of services that we have in Netcare and our unique health care delivery ecosystem, which really allows us to provide care across the continuum of care in South Africa, and to execute on our strategy of person-centered health care that will be fully digitally-enabled and data driven.

Let's take a look at some of the key health care sector trends and activity drivers that have impacted our results and performance for the year. Firstly, in terms of sector trends. We continue to see growth in restricted hospital networks, and 2019 was no different. Now more than 30% of our patient days are attributable to the so-called restricted networks. We're also seeing an increase in surgical day cases, and now more than 63% of the cases of elective procedures in our acute hospitals are day procedures, and that tracks very well or benchmarks very well compared to other international markets.

In terms of funder initiatives. Netcare was not selected as an anchor participant in a large restricted network in 2019. And yet despite this, we were able to retain 61% of this network's patient days. And last year, in July, we saw the application of stricter protocols regarding respiratory admissions, both by funders and then adopted by specialists. And this has had an impact on our admissions in this disease subset.

Pleasingly, we are still attracting a lot of specialists and health care providers to our network. And this year, we were able to grant admitting privileges to 112 specialists.

In terms of patient days, overall patient days increased by 3.7%, but this is largely because we included Akeso for the full 12 months of our results. Notwithstanding that, the growth in Akeso was very strong, given the underlying demand for mental health care. And patient days in our mental health care division increased by 17.9%. Now when you strip out new facilities within Akeso, the underlying organic growth was approximately 10%.

In our acute hospital, patient days fell by 1.4%. This was at the lower range of the guidance we gave of a decline of between 1.3% and 1.8%. And if you strip out the reduction in respiratory cases and our partial exclusion or inclusion in a large restricted network, our underlying growth was 0.8%.

All of this translated into an occupancy decline across full week in our acute hospitals on some 70 basis points to 65.9% and for weekday, 120 basis points decline to 71.4%. And as you can see, Akeso rose from 66.1% last year to an occupancy of 71.6% this year.

Translating this all into the financial performance. Revenue in the Hospital and Emergency Services rose by 4.1% to ZAR 20.8 billion, again due to the consolidation of Akeso in 2019 for the full 12 months versus only for 6 months in 2018. And if you strip out the impact of Akeso, the underlying growth in Hospitals and Emergency Services was 2.7%,largely driven by a 4.3% rise in revenue per patient day.

EBITDA rose 2.4% to ZAR 4.2 billion. At the EBITDA margin despite all of the challenges within the acute hospital sector, I'm pleased to say that it maintained its margin. We did incur some central costs, IT and digitization and data-driven costs. These costs are not related to CareOn project, which was well within budget. And as a result of that, our margin declined by 30 basis points to 20.5% versus 20.8% last year, again higher than the guidance we had given at the beginning of the year, where we forecast our margins to be between 20% and 20.3%.

And finally, looking at Primary Care. Revenue rose a healthy 10.9% to ZAR 795 million, largely as a result of the expansion of our occupational health care offering. EBITDA rose by 8.3% to ZAR 118 million, and the margin was slightly softer, approximately 40 basis points at 14.8%, largely due to the lower margin contribution of occupational health care, certain restructure costs and the ramping up of 2 new day clinics.

I'm going to hand over to Keith to take us through the financial results in more detail.


Keith N. Gibson, Netcare Limited - Group CFO & Executive Director [2]


Thanks, Dr. Friedland. Thanks. Good morning, ladies and gentlemen. It's my privilege this morning to step you through Netcare Limited's group results for the 2019 financial year.

So as has already been highlighted, the 2019 financial year presented certain challenges, both in terms of the broader economy and also in the overall health care landscape. But Netcare delivered a pleasing financial performance for the year despite these headwinds, which is built on a platform of basic business fundamentals. The

tight management of our cost base remains a key highlight of this year's performance. The group's balance sheet is strong, and our gearing levels are healthy. The business continues to generate strong cash flows, and we converted 111.4% of our EBITDA into cash during 2019. And we remain committed to the principles of disciplined capital management, both in terms of allocating capital to value-creating projects and in terms of distributing capital to our shareholders.

Now before we look at the financial results for 2019, I want to remind you that 2018 results contained a lot of noise, mostly related to our decision to exit from the U.K. operations, as you can see in this slide of exceptional items and discontinued operations. And I'm not going to revisit the 2018 transactions.

What I do want to draw to your attention is the fact that in the current year, we recognized a gain of ZAR 128 million, representing the realization of a foreign currency translation reserve. This noncash gain arose on the deregistration of a foreign subsidiary. And it's been recycled to retained earnings through the statement of profit or loss as required by the accounting standards. This transaction as well as all of last year's transactions have been stripped out, so that when we look at the group statement of profit or loss, the results from continuing operations are presented on a like-for-like basis.

So let's take a look at the group statement of profit or loss for the year ended September 2019. And we see that group revenues amounted to ZAR 21.6 billion as compared to ZAR 20.7 billion in the prior year, and they grew by 4.2%.

Group EBITDA amounted to just short of ZAR 4.4 billion and increased by 4.3%. Included in this number are HMI costs of ZAR 34 million as well as net nontrading income of ZAR 7 million in the current year versus non-trading costs of ZAR 63 million in the prior year. The group EBITDA margin remained stable at 20.3%.

Operating profit amounted to ZAR 3.6 billion and grew by 4.4%. Now we no longer hold any interest in BMI Healthcare's debt. But in the prior year before we announced our exit from the U.K., ZAR 104 million worth of interest income was recognized on this debt instrument.

Other net financial expenses have increased from ZAR 431 million to ZAR 486 million, and this is largely as a result of higher average debt levels due to both the payment of the consideration for the Akeso acquisition in the prior year, and also a focus on optimizing Netcare's capital structure.

Profit before taxation has remained flat at ZAR 3.2 billion, and the group taxation charge has decreased slightly from ZAR 904 million to ZAR 879 million, and this represents an effective tax rate of 27.2%. The group's profit after tax from continuing operations has, therefore, grown marginally by 0.9% to just under ZAR 2.4 billion, and we then need to take into account the effect of the exceptional items and the discontinued operations that we've already covered, which takes us down to a reported profit after tax for the year of just under ZAR 2.5 billion.

Next, we take a look at headline earnings per share, and this is presented on a continuing operations basis. And we have presented the headline earnings per share metric, which is being determined and calculated in accordance with the regulatory requirements. And as per usual, we also present an adjusted HEPS number, in which we strip out items of an exceptional or unsustainable nature.

So beginning with headline earnings per share. We can see that these have increased from ZAR 0.688 in the 2018 financial year to ZAR 1.659 per share for the 2019 financial year. This metric is not particularly meaningful because the 2018 headline earnings still includes the impact of a sizable noncash impairment of Netcare's interest in BMI Healthcare's debt, and therefore, it's not really a reliable indicator of underlying performance.

The group adjusted headline earnings per share from continuing operations amounted to ZAR 1.712 for the year and was almost flat on the prior year. However, as you can see, the prior year included ZAR 0.054 of adjusted HEPS arising from the interest income earned on BMI Healthcare's debt.

So if we adjust the base to exclude the prior year's nonrecurring interest income, we can see that the underlying growth in adjusted headline earnings per share equates to 3%. As Richard's already mentioned, a final ordinary dividend for the year of ZAR 0.64 has been declared, and that takes our total dividend for the year to ZAR 1.11.

Now Netcare's dividend policy is to pay a sustainable income to its investors, and we believe that we can distribute between 50% to 70% of our future earnings to shareholders while still maintaining a safe level of debt and an investment-grade credit rating. Given the strong cash conversion and our conservative level of gearing, the total dividend for the 2019 financial year equates to 64.8% of adjusted headline earnings per share, which is towards the top end of this range.

Moving along now to the statement of financial position. We can see the total assets of the group amounted to ZAR 21.4 billion at September 30, 2019, and this has grown from ZAR 20.8 billion, 1 year earlier at September 2018.

The group has invested a total of ZAR 1.4 billion in terms of CapEx, of which ZAR 512 million was invested in expansionary projects. And the major expansionary approach during the course of 2019 would include the expansion of Netcare Milpark Hospital to accommodate the transfer of 100 bed licenses from Rand Hospital; continuation of our multiyear refurbishment and expansion at Netcare Saint Augustine's Hospital; ongoing construction on the new 427-bed Alberton Hospital; the opening of a new day clinic, the Foreshore Day Clinic, which is adjacent to our Netcare CBMH Hospital in Capetown; and also the addition of 57 mental health care beds in Akeso, which includes the reopening of the expanded and refurbished Akeso George facility.

Assets classified as held for sale represents Netcare's 56.9% interest in GHG PropCo 2 at a carrying value of ZAR 226 million. These investments consist of 6 hospitals in the U.K., and our plans to dispose of these assets are progressing well.

Total shareholders' equity has decreased from ZAR 10.4 billion to ZAR 10.2 billion, and this has really been influenced by the utilization of ZAR 458 million for the repurchase and cancellation of shares and the payment of a special dividend of ZAR 542 million.

As we usually do, let's take a closer look at our debt balances. And we can see that the gross debt balances of the group amounted to ZAR 6.8 billion at the year-end, and that has grown by just under ZAR 700 million from gross debt balances at September 2018. We've seen an increase in our cash holdings of around -- to ZAR 1.7 billion as compared to just under ZAR 1.4 billion at September 2018.

Therefore, the group's net debt levels amounted to ZAR 5.1 billion at the year-end, and these have increased by ZAR 309 million over the course of the year, and I'll unpack that in a little bit more detail shortly.

The leverage of the group remains comfortable with net debt-to-EBITDA coverage of 1.2x. We see that the cost of debt has reduced marginally from 8.8% to 8.6%. Net interest paid has increased from ZAR 326 million to ZAR 484 million for reasons which we've already covered. And the interest cover the group, remains healthy at 7.5x.

Now Netcare's overarching approach to its capital structure is to maintain a strong balance sheet and to retain an investment-grade credit rating whilst utilizing a safe level of debt to reduce our cost of capital. And in this regard, I'm pleased to announce that GCR has revised Netcare's long-term credit rating from A+ to AA- and has retained our short-term credit rating intact at A1+.

In terms of available resources. Netcare has cash and undrawn facilities totaling ZAR 6.8 billion available to it. And as you can see, our debt maturity profile is appropriately staggered, which reduces refinancing risk to manageable tranches. Therefore, we have sufficient capacity to manage our future capital requirements.

I'd like to spend a few moments stepping you through an analysis of the group's cash flows. The group generated ZAR 4.5 billion from its operations during the course of 2019. Sound management of our working capital balances generated a further ZAR 400 million worth of cash. Then after paying out our net interest expenses and our taxes, and investing to maintain our facilities, the group generated ZAR 2.6 billion of free cash flow for the year.

In terms of our capital allocation approach. We invested in value-creating projects, net of amounts received on the disposal of assets, to the amount of ZAR 300 million. As mentioned, our policy is to pay a sustainable income to our investors, and we distributed ordinary dividends of ZAR 1.6 billion during the year.

Netcare remains committed to optimizing its capital structure, and our preferred method of returning excess cash to shareholders is share buybacks. And in this regard, we utilized ZAR 0.5 billion for the repurchase and cancellation of 19 million shares during the year. And over and above that, we utilized another ZAR 0.5 billion to pay a special dividend.

So as Richard mentioned, during the course of the year, Netcare distributed ZAR 5.2 billion, of which ZAR 2.6 billion or 50% thereof was distributed to its shareholders. And the net impact of all of this is an increase of only ZAR 300 million in terms of Netcare's overall net debt levels.

Last year, we communicated to the market our disciplined approach to capital management, and we also set out some medium-term targets and some internally-generated policy limits that we use within the business to guide and to measure our capital management decisions. And a year later, it's appropriate that we give an accounting of how we fared.

And we set ourselves a medium-term target of achieving a ROIC in excess of 20% over the next 3 to 5 years. And I'm pleased to advise that we got there in 2019 with our ROIC increasing from 19.9% to 20.1%.

We also set a goal of achieving a group EBITDA margin of 20.5% within the next 3 to 5 years. Given the pressures prevalent in the health care market, we did not achieve that this year. But group EBITDA margins did remain stable at 20.3%.

Now although our banking covenants are set at less strict parameters, we have set a more conservative internal policy limits of maintaining our net debt-to-EBITDA coverage below 2x. And we've achieved this with comfortable headroom with a coverage of 1.2x.

Similarly, we also seek to keep our EBITDA-to-net interest coverage above 5x cover, and we outperformed that target, achieving a metric of 9.1%.

As I mentioned in the earlier slide, total dividends for the year amounted to approximately 65% of total adjusted headline earnings per share for the year, and that remains within the guided range of 50% to 70%. And we've seen an improvement in our long-term credit rating and our maintenance of our short-term credit rating.

So in short, I think this slide reveals that we have stuck to our guidelines in terms of managing our capital resources. Let's turn our attention now to our guidance for the 2020 financial year.

Netcare expects total patient day growth, that is acute hospitals and mental health facilities combined in 2020, within a range of between 0.8% to 1.2%. H1 will remain under pressure in the first quarter as a result of the hospital network arrangements, which took effect in January of 2019. However, Netcare has secured participation as an anchor provider in new hospital network arrangements, which will take effect from January of 2020. And we expect this to positively benefit activity. We also expect demand for mental health services to remain strong.

Turning to our guidance for EBITDA margin, which is exclusive of the impact of IFRS 16, which I'm going to cover on the next slide. We expect our core acute hospital margins to remain intact after absorbing ZAR 38 million worth of CareOn costs. And this will be supported by our ongoing cost efficiency and nursing optimization and initiatives, which are going to remain a key focus area for us in 2020.

Another key focus area is going to be the continuation of our digitization rollout across our businesses, including building up our capabilities with respect to artificial intelligence and data analytics. And in this regard, we expect to spend approximately ZAR 50 million in central costs in the 2020 financial year as we build out these platforms and these capabilities, and as we roll out our digitization of electronic patient medical records to our Akeso, Medicross and Cancer Care services.

Obviously, as a trusted health care provider, we are always focused on further improving our quality outcomes and patient safety. With regard to CapEx. We anticipate investing ZAR 1.4 billion in CapEx 2020 financial year, of which approximately ZAR 500 million will be on expansionary projects. And these will include the completion of the Netcare Milpark Hospital expansion. We already have 48 beds, which were brought into use late in September 2019, and the remaining 52 beds are due to be commissioned in February of 2020.

There will be the continuation of the multiyear expansion and refurbishment at Netcare Saint Augustine's Hospital, and the construction at Netcare Alberton Hospital will continue. And this is due to replace our Union and Clinton Hospitals upon completion.

On the Akeso side, we will be opening up a new 36-bed facility in Richards Bay towards the end of the 2020 financial year. And this year, we'll commence construction of a new 72-bed Akeso Hospital in Port Elizabeth.

And of course, we're going to continue the rollout of our CareOn program, and that will utilize approximately ZAR 50 million of CapEx during the 2020 financial year.

As part of Netcare's commitment to transformation, on the 15th of October 2019, so post year-end date, a further allocation of 61 million previously unallocated net cash shares was approved. These shares were available under our Health Partners for Life Broad-Based Black Economic Empowerment scheme, which was originally concluded in 2005. We're going to provide more details of this later in the presentation. But from an accounting guidance point of view, this allocation is going to result in a once-off noncash IFRS 2 charge to the income statement in 2020 of ZAR 347 million. The trickle dividend, which flows as a result of this transaction, is not expected to have any major impact on future earnings per share.

And then finally, I do need to draw to your attention that Netcare will be adopting the new accounting standard on leases, IFRS 16, with effect from October 1, 2019. And this accounting standard brings leases on to the statement of financial position. Although IFRS 16 is going to significantly change the way that we account for leases, it's important to highlight that it does not alter in any way the underlying economic principles or the cash flows under our leases. Netcare's elected to adopt the modified approach, and that means that we will not be restating our historical financial information.

I'd like to just spend a few minutes talking you through the accounting impact on Netcare's accounts that arise from adopting this new standard. So beginning with the statement of financial position. Leases are going to be capitalized as a right-of-use asset. Now each lease has a bespoke capitalization rates, and that depends on various factors such as the length of the lease, credit risk factors, the location of the assets, et cetera. And the capitalization rates that will be applied to our leases range from between 8.3% to 12.9%.

The recognition of the right-of-use asset is offset by the raising of a related lease liability. And therefore, under IFRS 16, Netcare's statement of financial position will reflect both a right-of-use asset and a lease liability of between ZAR 4.1 billion and ZAR 4.5 billion.

The effects on the statement of profit or loss are as follows. A rent charge is no longer recognized, and that means that EBITDA is going to increase by between ZAR 450 million to ZAR 500 million. And as a result, EBITDA margins will improve. The right-of-use asset is depreciated over the lease period, and this is going to increase our depreciation charges by between ZAR 350 million and ZAR 410 million. And then the lease liability attracts an interest charge, and that is going to increase our interest paid from ZAR 375 million to ZAR 435 million.

After adjusting for the tax consequences of the above, the group's profit after tax under IFRS 16 is expected to reduce by between ZAR 200 million and ZAR 250 million. And that equates to a range of between ZAR 0.149 and ZAR 0.186 per share of earnings. As already mentioned, there is no impact on the cash flows.

And then finally, in the bottom right-hand corner here, I've set out a couple of pro forma indicative numbers, which are intended to show the impact of IFRS 16 on certain performance metrics. This has been determined as if IFRS 16 had been adopted on the first day of the 2019 financial year and at the midpoint of these ranges indicated here.

And I have to stress very clearly that this should not be seen as a restatement of our 2019 results under IFRS 16. It's merely an illustrative tool. And what it reflects is that our net debt-to-EBITDA coverage under IFRS 16 decreases from 1.2x to 1.9x. This is still very comfortably within our current covenant limits. And our banks have confirmed to us that we will continue to report covenants under the existing pre-IFRS methodology. So the relevant metric still remains the 1.2%.

You'll also notice that there's a marginal improvement in our RONA and our ROIC, arising from the adoption of IFRS 16.

At this point in time, I'm going to hand back to Richard to continue the presentation.


Richard Harold Friedland, Netcare Limited - Group CEO & Executive Director [3]


Thank you very much, Keith. I'd now like to update you on the progress we've made in executing on our strategy, which mercifully, ladies and gentlemen, is slightly less complicated than IFRS 16. I'm also going to be taking you through, for the very first time, a live demonstration that will link us to Milpark [Met Kimmel] Park Hospital, to demonstrate this very powerful mobile digital and electronic patient record that we are currently rolling out across our network.

So we are driving innovation in health care and anchoring our strategy based on these 3 key global trends in health care. One is consumer centricity, the other is digitization and data. And in terms of customer centricity. We're putting patients at the absolute center of everything we do, and encouraging patients to participate in their health care and take co-responsibility. We think this is fundamental to improving outcomes and improving compliance.

In terms of digitization, we've said before that it's our stated intention to digitize our entire ecosystem and network and thereby, enable patients to have lifelong records of their engagements with health care providers. This, we believe, will lead to a far more coordinated approach to health care, improve outcomes and safety and ultimately, improve and remove efficient wastage in the system.

And then leveraging off this digitization, we are investing heavily in data and data analytics to improve outcomes, our predictability of these outcomes and safety of patients as well as financial and administrative efficiencies within our organization.

So turning first to person-centered health and care. I think I've already alluded to the fact that we have an ideal ecosystem to roll out care across the continuum of care. But I think we all recognize in South Africa and globally that health care is fragmented. It's siloed and it's uncoordinated. And it results in poor health care, ultimately, poor outcomes and a lot of wasted expenditure.

And central to our strategy is trying to streamline this and improve the seamless interface between providers and providers as well as providers and patients. Now let me just step back and share with you some of the initiatives that we have begun this year.

This year, we focused on trying to understand how patients access our various services and how do we improve upon that ease of access. Let me give you a couple of examples.

Many of our patients complain that it's difficult to find an appropriate doctor or specialist. And once they found an appropriate doctor or specialist, it's even more difficult to ascertain whether they charge the scale of benefits or medical aid rates or whether there's a copayment required or whether they're going to have to pay cash for the first consult.

As a result of that, we've developed a central booking platform called Appointmed, where patients can phone in, and we can inform them of the appropriate specialist, we can find the appropriate doctor and inform them as to what the potential charges are. And most importantly, we can make that appointment for them. Currently, that's a telephonic service. It will be fully digitized by the end of December. We've rolled that out in the south team, and we are now rolling that out in the coastal regions early next year.

Now ladies and gentlemen, that's all well and good when you are wanting to seek a health care provider in the comfort of your working environment or home. But what happens in an emergency? When you're traumatized, where perhaps you yourself have been injured and are semiconscious, and you can't remember exactly where you are, where the accident has taken place. And often, we find that valuable time is lost in trying to ascertain and locate where people are in a crisis.

Netcare 911 has now developed a system that can immediately and automatically, through your mobile phone, geo-locate you. An incredible example of this occurred earlier this year when a group of experienced mountain climbers went climbing in the Drakensberg. They got lost and as night fell and clouds descended, they became more and more disorientated, and by 9:00 in the evening, were completely lost. But a single call to Netcare 911 was able to immediately geo-locate them and rescue them the same evening. Many of our patients also visit our emergency departments after hours because their GP services are not available. In other words, they are noncritical patients, and many of them complain that they have to wait long periods of time because there are more serious and critical patients being looked after.

Through data analytics and machine learning, we're now able to predict waiting times and inform patients of what these waiting times might be. And therefore or thereby, redirect them to other emergency departments that are less busy. We're busy piloting this at one of our emergency departments. Again, we'll roll this out during the course of next year.

Throughout our network, we are trying to encourage patients to prebook, electronically preadmit themselves, to avoid queuing at our reception stations. And lastly, we're in pilot with one of the largest medical aid providers in the country to develop an express check-in system that will ultimately use voice -- sorry, will ultimately use face recognition, in order to improve the speed of access into our facilities.

As part of person-centered health and care, we're also focused on excellent outcomes and patient experience. And this year, in our annual integrated report, we'll be publishing an entire plethora of significant clinical outcomes.

I'm delighted also to announce that last week, we were awarded the Ask Africa Orange Index Award for Service Excellence in the private hospital sector.

This is the fourth time in a row that Netcare has been awarded this, and it places us in the top 5% of 188 companies that were surveyed.

We're using cutting-edge technology to drive our digitization strategy. And in partnership with global IT giants such as Deutsche Telekom, SAP, Apple, IBM Watson, Healthcare and Capsule, we're rolling out a unique digital and mobile electronic health record for our patients across our entire hospital sector.

I just want to show you the progress we've made in digitization. We are certainly well on our way. We are in a pilot phase at Milpark and have met all of our milestones, all within budget and plan to roll out to additional hospitals from midyear 2020. Netcare 911 is already fully digitized, is the only digitized emergency service on the African continent and indeed one of a handful globally.

And together, in partnership with Altron, we are implementing a South African-developed primary health care electronic patient record that has passed a successful pilot and will be rolled out in the 2020 calendar year. And then plans to digitize National Renal Care, Akeso and Netcare Cancer Services are progressing very well.

I'm now going to be taking you through a live demonstration of this mobile digital service. I want to apologize to those who are on the webcam, you'll be able to hear my voice, you won't be able to see the screen shots.

I want to also assure you, ladies and gentlemen, because I am showing you live data, patients' names have been anonymized, but you will actually see the live data as I use my iPad to go into one of our ICUs within Milpark Hospital.

So this is the iPad. As you can see it, it's an Apple iPad. And the reason we've used Apple, and there'll be about 9,000 of these iPads distributed across Netcare to all of our doctors and staff. But the reason we are using such an iPad is because Apple is at the cutting-edge of health care development and also it is water resistant. It allows us to disinfect this iPad. This is the protective casing that all our nurses and doctors have. So that if they accidentally drop it, it doesn't damage it.

What's important is that we are allowing access by our clinicians to data offsite. And this is exactly what I'm showing you here, is I'm about to go into an ICU. And that means that doctors can now gain access to their patient information at home, at dinner at a restaurant, in theater or in their consulting rooms and see live accurate data of what's transpiring. And this will have a huge impact on a patient's safety.

Importantly, the way this has been developed, thanks to Deutsche Telekom, it's the latest mirror imaging technology, is that everything has to be transmitted via 3G and instantly. And given how early we are in the development of IT infrastructure in South Africa, we have to be data-light. And you will see, as I move through this, how quickly the data is transmitted.

So this is what a doctor would be confronted with. This is my own iPad of patients. I would come in and want to do a history and examination and assessment here. I've obviously done that already. This is the patient who's anonymized. It's a real patient in one of our units. And you can see up on the right-hand side what the risk factors are and potential diagnoses. And unfortunately, this patient also has a number of others.

I may want to just click on this to understand more about the patient, and this tells you there are no drug allergies, what the risk factors are, length of stay, what the insurance plan is, what is the working diagnosis. This is a patient who came in with a CVA or stroke, who are the treating doctors. And if I scroll up on the iPad, I can see more history, again live on the patient. And importantly, who are the nurses and allied health care professionals who are treating this patient at the moment, and exactly when, all of this is date stamped from a data perspective, they last saw the patient.

Probably the most important thing I want you to see having spoken to a patient, I can do this in my rooms or away from the bedside, is to understand what's happened to the patient over the last few hours, who's treated the patient, what orders have been carried out and what procedures. And so I can go quickly into notes here and go look at the journal, again live into Milpark. And you can see here at 9:36 this morning was last seen. There was some physiotherapy done, and these are the various different engagements that have occurred.

Now an outstanding feature of this clinical record developed by Deutsche Telekom, and you can see it by that asterisk is that any orders that are given or carried out are automatically transcribed as journal notes. And you can see that within the trail of this patient.

I can then go in and filter it, say, for instance, I only want to see the doctor and progress notes or perhaps allied health professionals. And I can see all the notes that are now being written on this patient since that admission.

I just want to spend 2 or 3 minutes showing you 1 or 2 other features. One of the unique features on this is medication. We are the first in Africa to provide fully fledged and total escripting. Doctors are able to prescribe medicine. This goes digitally to the pharmacy and is then prescribed to the patient, and you have a very accurate record of what's been prescribed.

Here, you can see the number of days that the patient has been on a variety of medicines, the dosage, the frequency, because it has to be authorized by a doctor, telephonic order can be given by -- from home or from theater, but it ultimately has to be authorized. And when it's authorized, you see this yellow release sign coming up.

And importantly, something we've never had before, that we now have in partnership with IBM Watson Micromedex, is the ability to see whether there are any drug interactions and to check the dosage, particularly of pediatric drugs, critical in providing safe health care. And IBM Micromedex, Watson Micromedex has the largest pharmaceutical database in the world, which we have crossmatched to every available drug in South Africa.

Let me show you what that looks like. I push on drug alerts over here. And this is a live system. You can see how quickly it connects. We can see there are 16 drug interactions, and you can see the drugs that are contraindicated in this case, major side effects or major contraindications. And it gives the ability of both doctors and pharmacists to input comments on this to ensure patient safety.

Finally, we'll just -- almost finally, let's have a look at orders. Let's take a look at lab results. Again, we can order digitally results from -- tests from the laboratory, and all of those results will come back in this patient, the ones that are abnormal are in yellow. And in order to show the patient or to be able to demonstrate to other clinicians, we can graph those results. And let me show you one of those results. For instance, here is creatinine. You can see these are the normal levels, lower and upper levels, and you can see this patient clearly has abnormally high levels. I may want to find out more about that specific indication. Let's just press on one of these. And again, I can find out exactly what is more detail on the specific lab result.

And then lastly, a unique feature that we have invested in, is that we are connecting all of our monitors, all of our anesthetic machines, our cath labs, all of our machinery, over 13,000 devices in Netcare to this electronic medical record. So no longer do nurses have to spend lots and lots of time copying down what the monitors tell you.

And here is an example of the live monitoring on this patient. This is non-invasive blood pressure. And as I scroll down, pulse, temperature, respiratory and general vitals. And all of this is automatically captured on the patient.

Why is this important? In a normal ICU, we capture about 422 data points in a day. And actually, we capture 422 data points. If we're recording that every 15 minutes, that's more than 12,000 data points a day, humanly impossible to analyze or to record. Yet this does this completely digitally. And ultimately, we'll be able with data analytics to drive a lot of analysis and predictability behind it.

Here's an example of the drugs that have been given and their dosages. And here, you can see 2 drugs that weren't given by that X marker. I'm going to stop over there, but just an example of the sophisticated and, hopefully, easy-to-use digital and first-of-its-kind mobile electronic health record that we are rolling out in partnership with some IT global giants.

And in particular, I want to thank Deutsche Telekom, who've been extraordinary in meeting all of our very onerous and demanding objectives in this project. We're in the early days, but it has exceeded our expectations. We are within budget, and we do hope we can roll this out across South Africa and be able ultimately to give patients their own discharge summary and access to all of their hospital records.

Now in case you didn't find that impressive, take a listen to what 2 of our doctors who are currently using the system at Milpark have to say about it.



Richard Harold Friedland, Netcare Limited - Group CEO & Executive Director [4]


Now I did mention and certainly, Keith alluded to the fact that we are investing significant amounts into building out our data analytics and artificial intelligent capability within Netcare. We are currently rolling out Microsoft Azure data analytics platform that will help us assimilate the vast amounts of data we have in our organization, not just clinical but administrative and financial and be able to make far more intelligent decisions around patient care and coordination and outcome.

And I want to give you, ladies and gentlemen, just 3 examples of how we've used data analytics to save lives. The first is from Netcare 911. We all know that time matters and time save lives -- saves lives, particularly in an emergency situation. And over the past few years, mainly from 2011, we've been able to reduce our response time. In other words, the time taken from receipt of a call to arriving on scene of an accident or an emergency from 40 minutes to 22 minutes. That's largely been achieved by technological advances in our call center and operational efficiencies, but mainly by increasing the number of resources in terms of paramedics, ambulances and response cars on the road.

And we never imagined we would be able to break the 20-minute barrier without having to substantially increase the number of paramedics, ambulances and response cars. But we have developed now a predictive model, an algorithm using a lot of data analytics that can predict on a daily basis and guide the placement of our resources, so that we can arrive on scene as quickly as possible.

And now as a result of that, without increasing a single resource, we've been able to bring our resource -- our response time, down to 15.5 minutes. And in a critical -- critically injured patient, that's the difference between -- often the difference between life and death.

The second example I want to give you is this concept that expertise matters. And there are many international studies that show the correlation between improved survival of critically ill patients and appropriate trauma expertise and levels of expertise in trauma centers. And so what we did with the aid of significant data analytics was to analyze all of our data over the last 5 years, some 138 different variables, and we were able to conclusively and statistically demonstrate the correlation between improved survival rate and the level of expertise and accreditation of trauma centers.

And we came to this extraordinary staggering conclusion that if you are a polytrauma patient, critical multisystem injured individual and you are taken to a level 1 accredited trauma center, your probability and chances of improved survival rise by 76%.

We have 27 accredited trauma facilities in South Africa, and we are the only network in Africa that has 3 level 1 accredited trauma facilities. We've also been using machine learning to stop the scourge of superbug infections. We know this is a threat to global health care, and we've been leading the way in antibiotic stewardship of trying to prevent the maverick use or the overuse of antibiotics within our facilities. Now with the use of data analytics and algorithms, we're able to understand exactly what the appropriate use of antibiotics should be in all of our facilities.

Now that's no easy task taking into account different disease entities, patients with many complications and thousands upon thousands of patients. And this is a fundamental development for us because it will allow us now to predict potential outbreaks of superbugs in our hospitals and prevent them occurring and ultimately, as we digitize, ultimately predict any form of sepsis.

Part of our strategy in terms of rolling out data and digitization is improving the access to health care across the African continent. And I'm very proud to say that together with Standard Bank, we've invested in Founders Factory Africa. It's a corporate debt incubator and accelerator. It's led by a highly experienced team of experts who have a proven track record in developing and establishing start-up businesses. It began as Founders Factory in United Kingdom, who are in partnership with the likes of L'Oreal, Marks & Spencer, Aviva, easyJet and The Guardian. And only last week, Founders Factory was formed in United States in partnership with Johnson & Johnson.

We've committed to investing up to ZAR 180 million over the next 5 years in developing 35 health tech start-ups across the continent. And Standard Bank was similarly [driving] 35 new fintech companies and businesses across the continent. And together, we think there are significant synergistic benefits.

And finally, ladies and gentlemen, in terms of our updates on our strategy, we're also applying our innovative thinking to be a force for social good: firstly, in our overall custodianship of our environment, in terms of sustainability; secondly, in terms of transforming our own company and economy; and thirdly and most importantly, in making active efforts to improve accessibility to affordable health care and improving inclusion in our own society.

Let me just take you through briefly on what we've been doing. We set out to achieve a reduction in energy intensity of 30% over 10 years. We're 2/3 of the way there having achieved 20%. And I'm pleased to say we've achieved international and national recognition for this. This year, the Association of Energy Engineers, this is a global association spanning 84 countries based in the United States, awarded us the Sub-Saharan Corporate Company of the Year award, the first for a health care company across the African continent. We also came second in the world by -- accredited by the Global Green and Healthy Hospitals Association. This is an association of more than 1,200 members, spanning 48 countries and 36,000 hospitals. And here locally in South Africa, the Southern African Energy Efficiency Confederation awarded us the Corporate Company and the Corporate Project of the Year award.

In terms of transforming our own business, we're absolutely committed to building a transformed company in South Africa, characterized by values of social and economic inclusion and equality for all. Keith alluded to our share ownership scheme and the number of shares we are issuing. They benefit the majority of Netcare employees, 80% of which are black and 65% of which are black women. These are issued at a 10% discount. There are no forfeiture conditions, and there'll be a 20% trickle dividend. And we are hoping to achieve a level 4 BBB accreditation at the end of this year.

Now in terms of transforming our own company and society, allow me just to show you some metrics that I think demonstrate how far in the progress we've made this year. We've improved our employee profile quite significantly, as you can see from that. We're also a leading employer of people with disabilities. Now some 3.6% of our staff are people living with disability. Of our skills development, we spend a staggering ZAR 338 million a year, 80% on black employees. We're one of the anchors in the youth employment service. We've been committed to train 1,000 unemployed youth, and I'm pleased to say we've been able to offer jobs to 81% of them.

We've made big strides in procurement as you can see there, and we remain a very strong force for good. Given the focus on gender violence and sexual abuse in our society, I thought I'd put this up and demonstrate for the past 20 years, we've been running 36 rape crisis centers across our emergency departments. It's a service that's offered free of charge. In fact, more than 90% of the survivors who access it have no medical aid and are indigent. Tragically, unfortunately, of the 13,400, 40% are under the age of 18. And finally, we spent ZAR 65 million on enterprise and supply development, created 188 jobs. Our incubation hub, which will see the start of 3 new businesses, was slightly delayed this year. And we will launch that, hopefully, during the course of 2020.

And then I'm very pleased to announce the launch of a very special shoes project in Netcare, which we will launch as a back-to-school project in Katlehong in February of next year. Many of you would have read in the newspapers last week of school boys who were sent home and expelled because they didn't have school shoes.

In partnership with Adcock Ingram Critical Care, we are recycling all of the drips in our various hospitals. And 20 drips, ladies and gentlemen, produces a pair of school shoes. Within the Netcare network, we'll be able to produce 80,000 shoes. Our target, of course, is a lot higher. And we believe in collaboration with the public sector and other hospitals, we can produce 0.5 million free pairs of shoes for children that need it in South Africa.

We're also using enterprise supply developers companies to recycle and to produce these pairs of shoes for us.

And finally, as I conclude, where -- there's been a lot of noise, debate, perhaps controversy and discussion around the draft amendment, the second amendment of the National Health Insurance bill. And I want to clarify once and for all our position as Netcare. Firstly, we recognize that there is a huge inequality and inequity in the provision of health care in our country. And we cannot build a healthy and a sustainable society until we've provided for the health care of all. And so we unequivocally embrace the principles of universal health care.

We think that the private sector can be leveraged to constructively engage in providing support to achieving that. And we are hard at work behind the scenes to develop affordable health care services and products that will improve access, inclusion and affordability for those that are currently uninsured. We hope to share some of those exciting developments with you early next year.

Thank you, ladies and gentlemen. That concludes our presentation for the day.

Apologies that that's gone on for a while. We are going to open up for any questions that Keith and the rest of the team will gladly answer.


Questions and Answers


Kane Slutzkin, UBS Investment Bank, Research Division - Director and Research Analyst [1]


It's Kane Slutzkin, UBS. Guys, you obviously had a sort of a poorish second half in volume, you've done well to do sort of maintain margins. And I guess, some our -- can be quite baffled how you're able to do that. You've obviously spoken about a lot of the cost efficiencies. And this year, you've got increased investment, the ZAR 50 million you sort of spoke about on central cost fund [related] initiatives, yet you are sort of aiming to maintain margin. Can you just maybe just share with us maybe how much legs does the sort of cost efficiency initiative program have? How much legs that has?

And then just on the restricted network comments you guys made, that you've secured participation, can you give us any more info on that? And then just last question, if I may, is just on the continuum of care. You've obviously got primary health care day clinics. What's your sort of current thinking on sort of diagnostics? And we've obviously heard one of your peers, who are quite vocal around the opportunity in radiology. So maybe just some comments on that?


Richard Harold Friedland, Netcare Limited - Group CEO & Executive Director [2]


So if I hear you correctly, and I'll start from the last question, which I'll deal with and then move on to the efficiencies. Firstly, in terms of other services, we are always looking at improving that continuum of care. And when we're in a position to talk about that or have something material, we'll certainly share that with the market.

Secondly, in terms of us, the anchor provider in a new network. This is the new GEMS efficiency network of which we are now an anchor participant. And there are 1 or 2 other smaller networks, which we've also gained access to and are the anchor provider in those smaller networks. I think that answers those last 2 questions. You want to talk to the first one, Keith?


Keith N. Gibson, Netcare Limited - Group CFO & Executive Director [3]


Sure. Thanks, Richard. So the question relates to our cost savings and efficiency initiatives. And I think it's fair to say that going back in the year, around about January, we were facing the situation where we had been excluded from a major network. And we were very focused on implementing cost savings initiatives so that we could respond to the change in the activity that has gone through the business. It certainly did take some months to bed that down and particularly, gain traction across the second half of the year and more strongly in the last quarter of the year.

So the point I'm trying to make is that those initiatives are not in the base for a full year, and we'll continue to drive these initiatives strongly into 2020.


Steph Erasmus, Avior Capital Markets (Pty) Ltd. - Research Analyst [4]


This is Steph Erasmus from Avior Capital Markets. Just a question regarding occupancies. So occupancies have come off a little bit from where they were last year. I suppose it talks to Kane's question regarding the preferred network provider list. Can you sort of just articulate exactly how you see your digitization strategy playing out in terms of your, let's say, position as a preferred provider going forward compared to some of your competitors?


Richard Harold Friedland, Netcare Limited - Group CEO & Executive Director [5]


Yes. Thank you very much. I think that's a very important question to answer. What you would have seen throughout this presentation and probably in previous presentations is our shift from a strategy based on pure bricks and mortar to one of building out a strategy based on more systems and processes. And we believe that our digitization strategy will give us significant competitor advantage and bode what Warren Buffett refers to as a moat around the business.

I think we've spent many years. This is 2.5 years in development to get to this point. And when we are able to give patients access to their own records on their mobile phones and doctors ease of access, and we're able to show and demonstrate as we have with data analytics better and superior outcomes, I don't think there'll be a choice in the market other than Netcare. I know it sounds arrogant. It's not meant to be. We're purely following the trends that we've seen globally. And so if I can give you an example. You have a knee operation today. It's done very well. But in 3 years' time, you've got a problem with your knee, it's worrying you, you go back to your surgeon and you say to him or he's not available, you see someone else, you say, "Well, I had a knee operation." "I can see you've got a scar, but what actually happened?" "Well, I don't really know?" Well wouldn't you like to be in a position to say, "Well, here's my record. I had an anterior cruciate ligament repair. There's the MRI. And by the way, you can see I was allergic to morphine, so don't give me that again. And there are all of my clinical records." That's what we're aiming for in Netcare. That's honest medicine. That's efficient medicine, and that's medicine that drives a totally different paradigm in this fragmented, siloed and uncoordinated health care that we know today. And I think the health care of tomorrow is less about bricks and mortar. It's about providing this coordinated care and making patients responsible and compliant through their own health care.


Ian Cruickshanks;Institute of Race Relations;Chief Economist, [6]


Ian Cruickshanks, Institute of Race Relations. Just thinking what you just said, you don't see how anybody else would be able to compete. The proposed National Health Insurance, which government is -- hopes to be offering, is that not the major competitor? And is it possible to compete with them if they do what they say they're going to, which, of course, there's a question mark at the end. But nevertheless, how do you feel about that?


Richard Harold Friedland, Netcare Limited - Group CEO & Executive Director [7]


Well, as I've said earlier, we think -- we embrace the principles of universal health care and we do not see National Health Insurance as a competitor at all. We want to work with government in providing solutions and being a trusted partner in improving access to affordable health care. We are working hard in developing solutions for what we believe can be implemented in our country across the employed but uninsured base of South Africans. And we're talking 15 million to 20 million South Africans.

We see that as a responsibility of corporate South Africa. In the United States, they refer to this as the Walmartification of health care. You've seen Walmart already coming out with affordable solutions for their own employee base, and we think in combination and collaboration with like-minded corporates in South Africa, we can develop very meaningful solutions and products and health care services for those that are currently employed but uninsured. So we certainly don't see NHI as a competitor, we want to work in collaboration with government on this.


Ian Cruickshanks;Institute of Race Relations;Chief Economist, [8]


If I can make a comment on that. Government has not shown much inclination to public-private partnerships. They really haven't got going at all. Can you change that? Obviously, you must believe you can.


Richard Harold Friedland, Netcare Limited - Group CEO & Executive Director [9]


Well, I do believe that we can demonstrate our bona fides with corporate South Africa and with this very large population of South Africans who are employed but uninsured. And of course, our doors remain open and willing to cooperate with government at any stage.

We spent 5 years cooperating with the NHS very successfully in the United Kingdom. And when we first -- I first began that operation in 2001, people said there was absolutely no legs to it, and we became a very credible provider to the NHS.


Unidentified Company Representative, [10]


A couple of questions that came through from the webcast. From Prudential, the company has guided to growth in patient days for 2020. Can you please highlight the longer-term potential should the company not invest in further capacity? Should it be no on a like-for-like basis, particularly in acute cases?


Keith N. Gibson, Netcare Limited - Group CFO & Executive Director [11]


Okay. Thank you. I think as Richard's already alluded to, we foresee the future in terms of utilizing better the infrastructure and the capacity that we have. At our current levels of occupancy, we are able to take on more patients and to service patients. And I think the focus is on improving access. And through that, we believe that we can grow patient base into the future without having to add substantial new beds.

This doesn't mean necessarily that we are absolutely close to that. Where areas exist, where the investment case is compelling, we certainly are open to investing in value-creating new projects. And as I've already alluded to, we are opening a new Akeso facility in Richards Bay and building a new hospital in Port Elizabeth to meet the demand for mental health care services.


Richard Harold Friedland, Netcare Limited - Group CEO & Executive Director [12]


Yes. And I think just to Keith's point, growing one's occupancy is not about doing more of the same. And more of the same is simply opening up more wards and more beds and buying more equipment. Health care is changing globally. We need to be part of that trend, and we need to be at the forefront of it. And that's exactly where our strategy is aligning towards. Many of our patients in the future won't be treated within facilities. And to invest in bricks and mortar and this old type of model simply is not one we believe is sustainable into the future.


Unidentified Company Representative, [13]


Are you able to disclose which restricted hospital network you have secured anchor stages in?


Richard Harold Friedland, Netcare Limited - Group CEO & Executive Director [14]


Yes. We did mention earlier to the first question, that's the GEMS efficiency network. And there are 1 or 2 other smaller, Nedbank and the Hosmed and 1 or 2 others that I can't recall exactly, but these are the ones that we are now anchor providers to.


Unidentified Company Representative, [15]


Next question. It appears the share buyback was done at a share price of approximately ZAR 24 a share. Could you provide some color as to the management's thinking behind this decision and future share buyback considerations?


Keith N. Gibson, Netcare Limited - Group CFO & Executive Director [16]


Thank you. So as I've indicated, we are focused on optimizing our capital structure. And our approach is that if we feel that we have excess cash, our preferred method of distributing that to shareholders would be through share buybacks. And we do remain focused on that in the next 12 months going forward. We certainly believe that where opportunities present themselves that we would be very much open to that.


Unidentified Company Representative, [17]


Next question. Keith, will your share buyback program in the year ahead include considering buying back preference shares?


Keith N. Gibson, Netcare Limited - Group CFO & Executive Director [18]


Yes. We will certainly give consideration to that. We have to recognize that the preference shares are not very liquid, not a huge volume of them trade, but we would be open to buying back prefs as well as ords.


Unidentified Company Representative, [19]


Next question. What is the impact on margins from the GEMS network inclusion?


Keith N. Gibson, Netcare Limited - Group CFO & Executive Director [20]


I think in terms of future margins, we've already given our guidance, and that's to hold firm our acute core hospital business margin in 2020.


Unidentified Company Representative, [21]


Last question. A follow-on question from Kane and Stephen's questions around occupancies. Can you please give us a sense around which therapeutic disciplines you are transferring beds to? Are there any additional opportunities for you to review your hospital portfolio and, as a result, potential for further disposals?


Richard Harold Friedland, Netcare Limited - Group CEO & Executive Director [22]


So there are 2 questions there. We are continuously evaluating our network. At the moment, we don't have any further assets for disposal at this stage, but we will update the market in the interims if that should change. And we're continuously looking to move beds into higher demand disciplines. Again, we'll update the market at our interims if we're able to be successful. Clearly, there's a long tail to this -- or long period in terms of getting permission from the respective health departments to do that.


Unidentified Company Representative, [23]


That's all the questions.


Richard Harold Friedland, Netcare Limited - Group CEO & Executive Director [24]


Well, thank you very, very much, ladies and gentlemen, and please join us for some refreshments outside.