Narayana Hrudayalaya Ltd — Q3 FY26

Narayana Hrudayalaya Ltd Q3 FY2025-26 Earnings Conference Call https://www.youtube.com/watch?v=QywvNXW07hs Published: 2 months ago

0:01 1 second Uh good afternoon everyone. Uh my name is Nishan Singh and I welcome you all to the quarter 3 FI26 earnings call of Narana Limited. Uh to discuss our 0:08 8 seconds performance and address all your queries today. We also have with us Mr. Viretti our vice chairman. Dr. Manuel Rupert our CEO and MD, Mr. Syraman our group CFO, Mr. Venitesh our group COO, Dr. 0:20 20 seconds Anishetti MD of our overseas businesses, Mr. Rabi Vishnad CEO of NHIC and Mr. 0:25 25 seconds Vive Advar senior manager in the IR function. Uh before we pro proceed with this call, we would like to remind everyone that the call is being recorded and the transcript of the same shall be 0:34 34 seconds made available on a website as well as on this stock exchange at a later date. 0:37 37 seconds We would also like to remind you that everything that is being said on this call that requests any outlook for the future or which can be considered as a forwarding statement uh must be viewed 0:45 45 seconds in conjunction with the answered entities and risk that we face. uh as a special request for this time as we now have multiple business streams across 0:52 52 seconds the globe we suggest we spend first 30 minutes Q&A on India and the rest is 30 minutes on the UK and KMP peace. Uh with that now we would like to start the Q&A. 1:01 1 minute, 1 second I would request everyone to now use a raise hand feature to start posing their questions. 1:11 1 minute, 11 seconds Yes, please go ahead. 1:14 1 minute, 14 seconds Uh hi you know congrats for good set of numbers. Uh let me start with India first because you know you mentioned that uh this is the second consecutive 1:22 1 minute, 22 seconds quarter where we have seen a very high profit growth for India business. I mean looks like finally we're benefiting from 1:30 1 minute, 30 seconds the initiatives that we have been taking over the last few years. The margin expansion that we saw in India business over the last two quarters which is almost 150 200 basis points on y basis. 1:43 1 minute, 43 seconds Do we expect the same trend to continue for few more quarters? You think still there are levers for margin expansion in India business? 1:54 1 minute, 54 seconds Uh I'll take this uh see uh we've been putting a lot of efforts over the last couple of years on our transformation programs 2:02 2 minutes, 2 seconds our mix optimization initiatives. So the effect of a transformation program has 2:09 2 minutes, 9 seconds seen results now where patients opting for higher weight configuration of course keeping our 2:15 2 minutes, 15 seconds volumes stocky intact also with a lot of technology infusions and increased volume of robotic cardic surgeries and other procedures. the realizations have 2:24 2 minutes, 24 seconds increased substantially uh resulting in higher revenue and better margin and uh as I said pair mix optimization 2:32 2 minutes, 32 seconds uh initiatives consistently helping in building upon the margin and increase in realization uh though we can't have a specific 2:41 2 minutes, 41 seconds indication or guidance but our efforts will always be to maintain these margins utilized in the last couple of quarters except uh for unknown short-term impacts. 2:53 2 minutes, 53 seconds Uh got it. Yeah. A follow up on this. 2:56 2 minutes, 56 seconds The losses that the company has been making on insurance and clinics has been coming down in the last few quarters. So 3:04 3 minutes, 4 seconds when shall we expect break even for this particular business segment? 3:10 3 minutes, 10 seconds I'll ask to answer and then I'll follow up at the end. 3:14 3 minutes, 14 seconds Yeah. Um so you know we are still in building stage uh in these businesses. 3:18 3 minutes, 18 seconds So right now our focus is on making sure that we are attracting customers and taking care of them and building out the various uh propositions uh for them. So 3:28 3 minutes, 28 seconds that's our focus right now. I think it's a little bit early for us to talk about break even on this but I'll ask I'll request Vin to add any further comments. 3:37 3 minutes, 37 seconds Yeah, we are uh balancing out the scope of expansion of our clinic program across the country and merging it into 3:44 3 minutes, 44 seconds NHL. So we're better able to manage the synergies and cost between two entities. 3:50 3 minutes, 50 seconds So the diluted impact should minimize over the coming quarters. Having said that, this is a business that still we want to invest in and build out across 3:59 3 minutes, 59 seconds all our core geographies. So there will be somewhat of margin dilution going forward. We will call it out in the 4:06 4 minutes, 6 seconds investor deex and you'll get a sense of how much we are spending on this but uh too early at this point to tell when the break even will be achieved. 4:16 4 minutes, 16 seconds Fine. So looks like you know at least we are behind the peak losses. Uh okay I have a couple of questions on Kayman and UK but you know I'll join back in the queue. 4:25 4 minutes, 25 seconds Thanks just to repeat first 30 minutes will be for India questions. Uh those with India questions please uh raise hand. 4:47 4 minutes, 47 seconds right until the question get populated. Priti, you want to move on to K? Yeah, we have Rajat with his questions. 4:57 4 minutes, 57 seconds Okay. 4:58 4 minutes, 58 seconds Yeah, can I add a question please? 5:00 5 minutes Yeah. uh just a small request and if it's possible to uh you know present the financials of each of the three entities 5:08 5 minutes, 8 seconds in a proform way the way you you know uh file your financials with the with the with the exchange and you can have I 5:17 5 minutes, 17 seconds mean they they could be unreed or unawited as well. Will that be possible going forward? 5:27 5 minutes, 27 seconds uh we are presenting relevant information uh different uh segments. 5:33 5 minutes, 33 seconds I think uh this is the model supposed to continue with however if you have any specific questions on how to understand 5:42 5 minutes, 42 seconds the numbers from our investor deck, you can set up time with our IR team and they'll be very happy to uh help you construct your uh entity wise P&L. 5:53 5 minutes, 53 seconds All right. Thanks a lot. And just a quick quick question on uh an announcement that was made some time back on setting up a subsidiary to look 6:01 6 minutes, 1 second after uh some initiatives in north. I think you you announced a subsidiary being set up uh for the specific purpose. Am I right? 6:12 6 minutes, 12 seconds Yeah. 6:12 6 minutes, 12 seconds Uh could you elaborate on that? What are we looking at? You've been present in North for quite a some quite a long time. 6:18 6 minutes, 18 seconds Is there anything specific that you're looking at? nothing that uh we can disclose as of now, but the north is an area of interest for us and it's 6:26 6 minutes, 26 seconds something that we're looking to see what we can do there. Okay, thank you. 6:33 6 minutes, 33 seconds Thanks. Nan, can I have a question please? 6:37 6 minutes, 37 seconds Hi. Uh thanks for taking my question. Uh on you know this quarter we've had a pretty strong growth in uh in the Bangalore cluster. Uh so anything which 6:46 6 minutes, 46 seconds sort of stands out in terms of what has gone differently in Bangalore this quarter? 6:53 6 minutes, 53 seconds I have a request for you guys to take this up. 6:55 6 minutes, 55 seconds Yeah. Yeah. So I have already uh mentioned in the previous question about how the transformation has given the 7:02 7 minutes, 2 seconds results for us in mainly our fractures where uh higher realizations have come out from the higher level of beds. Of 7:10 7 minutes, 10 seconds course uh we done that uh again I'm repeating the payix optimization which has consistently helped our uh flagships 7:18 7 minutes, 18 seconds and including Bangalore cluster to uh work constantly on increasing realization plus the most important thing is the high-end uh robotic work 7:27 7 minutes, 27 seconds aided with technology across all these specialtities including cardiac surgeries which have really improved our margins and also on the volumes. So uh 7:36 7 minutes, 36 seconds plus a lot of emphasis have have been put in along around Bangalore urban rural and also in 7:44 7 minutes, 44 seconds the northern parts of Karnataka to have more footfalls coming in from domestic as uh we've specifically mentioned our whole emphasis going forward will be to 7:54 7 minutes, 54 seconds consolidate on the domestic volumes and uh revenues and that's exactly what we've been doing over the last six quarters and uh all these together have 8:02 8 minutes, 2 seconds improved our volumes margins izations and revenues uh in this quarter if you compare on a year-on-year basis for the 8:10 8 minutes, 10 seconds Bangalore cluster and wingesh does it become a template for the other clusters or this is more of a Bangalore phenomena that we've seen 8:18 8 minutes, 18 seconds you know this some of these initiatives you're talking about so uh this is the same template we're going to follow for all our clusters including the eastern cluster they're 8:26 8 minutes, 26 seconds also following suit in terms of uh how the margins and the realizations are working because these are the two major clusters where our flagships are 8:35 8 minutes, 35 seconds And uh we will continue to work towards the same type of an objective in the north cluster as well. There is a little 8:43 8 minutes, 43 seconds bit of a gap which we have to cover up there. But uh with the way things have set up for the north, this is going to be the template for all our regions going forward. 8:53 8 minutes, 53 seconds And on that point you know on the on the northern cluster you know there has been a little bit of again it's sort of quite contrary to way Bangalore played out. 9:01 9 minutes, 1 second anything that you want to call out on what you know how the you know what sort of kept the growth a little soft on the northern cluster this quarter? 9:09 9 minutes, 9 seconds Yeah. Uh we have been a bit cognizant on the receivable problems in uh some of the scheme payers and also on the 9:17 9 minutes, 17 seconds capping on reimbursement of certain drugs uh which has actually uh resulted in a conscious call in controlling 9:24 9 minutes, 24 seconds volumes on the schemes plus uh a little bit I mean constant efforts towards optimizing the pair mix uh uh has resulted in volume reduction in schemes. 9:34 9 minutes, 34 seconds We have yet to catch up on the preferred pair. But of course uh uh the volumes will catch up soon. But having said that 9:41 9 minutes, 41 seconds this optimization actually has led to an increased realization and revenue in spite of slight dip in volumes. Uh plus 9:48 9 minutes, 48 seconds uh increased competition from new hospitals in the region around north has also contributed to a bit of a shortfall. But we are confident of overcoming this because it's going to be 9:56 9 minutes, 56 seconds short-term measures confident of overcoming this through our active marketing and operation strategies over the short period of time because it's just time bound and I don't think this 10:05 10 minutes, 5 seconds problem will persist beyond a quarter or a couple of quarters. 10:12 10 minutes, 12 seconds Okay. Thank you so much. Can we have the next question please? 10:22 10 minutes, 22 seconds [clears throat] 10:39 10 minutes, 39 seconds Nishant uh someone Alanka has a hand up. 10:42 10 minutes, 42 seconds Alanka. Yes, please go ahead with the question. 10:44 10 minutes, 44 seconds Yeah. Hi, good afternoon everyone. Uh one question uh yeah one question on uh Bangalore and contrasting it with some 10:53 10 minutes, 53 seconds of the other clusters. Uh so firstly you spoke about following the same template in the other clusters. Now if I look at 11:00 11 minutes the ARP in Bangalore, it's significantly higher than other clusters including Kolkata as well as uh the two hospitals 11:08 11 minutes, 8 seconds in Delhi and I just wanted to understand even once you try and bridge that gap and follow 11:15 11 minutes, 15 seconds the same template in say Kolkata the east cluster as well as uh Delhi NCR uh structurally uh is there anything 11:24 11 minutes, 24 seconds different which uh which is happening in Bangalore on case makes or which is likely to keep the realizations 11:32 11 minutes, 32 seconds in Bangalore significantly higher than these two other clusters going ahead. Uh assuming those uh uh changes which you 11:41 11 minutes, 41 seconds mentioned are incorporated over the next few years in these other clusters. 11:49 11 minutes, 49 seconds Yeah. uh to answer system 11:59 11 minutes, 59 seconds compared to the Kolkata cluster. So you are going to see uh these kinds of numbers especially in robotic cardiac surgery, 12:08 12 minutes, 8 seconds bone marrow transplants all these are very large numbers here. 12:14 12 minutes, 14 seconds in the last quarter and in fact past few quarters we have done the largest uh robotic cardiac surgery in the country 12:21 12 minutes, 21 seconds uh from our largely from our Bangalore unit. Similarly, we continue to do the largest volumes in terms of bone marrow 12:30 12 minutes, 30 seconds transplant in terms of uh uh several advanced procedures. So that comes in at a higher 12:42 12 minutes, 42 seconds Yeah. Uh hello, can you hear me? Yes. 12:48 12 minutes, 48 seconds Okay. Uh uh okay. So my question was not specifically for uh the the the third quarter but yeah I mean structurally 12:56 12 minutes, 56 seconds also I think some of the points which you mentioned uh are are fine. Uh okay the second 13:02 13 minutes, 2 seconds question was uh if I just uh look at uh uh Bombay the the Mumbai hospital you you had spoken about uh trying multispy 13:11 13 minutes, 11 seconds there or adult multispy there earlier any update on those plans yeah we're still working with the 13:19 13 minutes, 19 seconds trustees and the charity commission on getting the licensing shipped okay by broadly when can we expect uh 13:27 13 minutes, 27 seconds any progress uh there vin Uh we don't have a timeline on this as 13:34 13 minutes, 34 seconds will all okay fair enough. Uh that's it from my side. Thank you. Thanks. 13:43 13 minutes, 43 seconds Can we have the next question please? 13:56 13 minutes, 56 seconds There is a question. 13:59 13 minutes, 59 seconds Yeah. Uh there was a chat question which is does the OP consultation doctor revenue count as part of the overall OPD 14:08 14 minutes, 8 seconds revenue? Do we track it? Uh the quick question is we track it internally but OP consultations are a very small part 14:15 14 minutes, 15 seconds of the overall OPD revenue and all of that uh payout goes towards the doctor. 14:29 14 minutes, 29 seconds If we have no other questions on India we'll uh probably move to Cayman. 14:35 14 minutes, 35 seconds So could you raise uh anyone raise their hands for questions on Cayman for Q3? 14:40 14 minutes, 40 seconds We have a question from Damanti. Damanti please go ahead. 14:45 14 minutes, 45 seconds Hi uh thank you for the opportunity. Uh I just have one question on your India business uh regarding the competition 14:51 14 minutes, 51 seconds scenario in Bangalore market. So we have uh we are seeing a couple of competitors expanding their presence there. So from 14:59 14 minutes, 59 seconds your perspective, how do you see this dynamics to play out for your business? Thank you. 15:06 15 minutes, 6 seconds There is enhanced competition. A lot of new hospitals are coming up in uh Sajjapur area and in North Bangalore. We currently don't have hospitals there. So 15:14 15 minutes, 14 seconds it's not easy for us to comment on the impact it has. But just broadly if you were saying that Bangalore is a large market, it is well served. Uh more 15:23 15 minutes, 23 seconds hospitals would serve the community even more. There may be a lag between any new hospital that comes up and the time it 15:31 15 minutes, 31 seconds would take to break even. and the business practices that have to be followed to uh fill up those beds. We 15:38 15 minutes, 38 seconds would say like all competition has definitely short-term impact in terms of enhanced cost and time to break even but 15:46 15 minutes, 46 seconds long-term it evens out because still all the organized corporate hospitals put together are barely able to service the 15:54 15 minutes, 54 seconds true demand that exists. But the lag exists because not everyone gets treated for the procedure that they require and not everyone is aware that they may be 16:02 16 minutes, 2 seconds suffering from underlying chronic or any sort of life-threatening condition. 16:08 16 minutes, 8 seconds Sure. And in your flagship hospital uh the majority of volume will be the local uh population volume or you see uh 16:17 16 minutes, 17 seconds mostly the out stations for high-end procedures etc. 16:22 16 minutes, 22 seconds Most of the business we get comes from within a 15 km radius. 16:28 16 minutes, 28 seconds Uh even the high-end transplant uh bone marrow uh surgeries etc. that is uh within this 15 kilome catchment. 16:37 16 minutes, 37 seconds Uh that's two different. So bone marrow transplant yes that comes from across the country. So that will have a very high representation from eastern India. 16:47 16 minutes, 47 seconds uh but for very high-end cardiac procedures they are more represented by people traveling locally. Okay. Thank you. 16:57 16 minutes, 57 seconds We have some questions in the chat. 16:59 16 minutes, 59 seconds All right. Uh how do you see the oncology fair and mix going forward? The oncology started from a very very low 17:07 17 minutes, 7 seconds base to becoming a second highest specialty. It is the fastest growing department. We believe going forward oncology and cardiac will account for 17:16 17 minutes, 16 seconds more than half of our revenue going forward. But as to what a percentage share it will constitute going forward we would it will be hard for us because 17:24 17 minutes, 24 seconds with the newer hospitals the case mix may skew slightly differently. So cardiac at a third will continue to remain our largest department and 17:32 17 minutes, 32 seconds oncology could go up possibly another 20% depending on the uh years going forward. 17:41 17 minutes, 41 seconds Uh question is on the vision objective question what do you want to be in the next 5 years we will take that last 17:49 17 minutes, 49 seconds uh our pop in oncology we don't break out departmentwise our pop 18:00 18 minutes yeah do you have any questions India specific yeah just wanted to 18:06 18 minutes, 6 seconds gross return premium has really gone up quite significantly this water. Uh is 18:13 18 minutes, 13 seconds there any I mean how many new policies have we done or what exactly has led to this expansion? 18:21 18 minutes, 21 seconds Could I take that? Uh V. Yeah. All right. Please. 18:26 18 minutes, 26 seconds Yeah. Um it's a combination of things. I mean so uh you know our retail uh business which is where we started um you know that's the productivity there 18:34 18 minutes, 34 seconds and the acceptance of that in the market has been increasing. uh as we told you last time we've also uh started uh offering business in uh outside of 18:43 18 minutes, 43 seconds Bangalore. So we've got Kolkata and Rayur and Mysore also available. We've also uh uh entered the theme market uh 18:52 18 minutes, 52 seconds where we are looking at small and medium um enterprises uh and providing them with an integrated approach uh for not 19:00 19 minutes just hospitalization but also comprehensive care which also includes uh outpatient care, consultation, uh 19:08 19 minutes, 8 seconds medicines etc. Uh and that's uh been appreciated quite well uh by by our by our customers. Um and you know those 19:17 19 minutes, 17 seconds those are some of the things that have been driving our our performance this quarter and uh yeah we continue to work hard to keep that trajectory going. 19:25 19 minutes, 25 seconds Uh any any numbers that you could share if you have plans for F27 in uh insurance? 19:33 19 minutes, 33 seconds Um we no we're working through those things now. I mean uh but uh you know we continue to be optimistic about uh the 19:39 19 minutes, 39 seconds pace of growth uh in insurance uh and uh you know we think there's there's quite a quite a large market for it especially for an integrated approach which 19:48 19 minutes, 48 seconds combines u hospitalization and primary care at our clinics uh as well as at our hospitals. Uh we think there's there's 19:57 19 minutes, 57 seconds um that's a proposition that is a unique uh and b that is relevant and resing resonating with the market. So we're 20:04 20 minutes, 4 seconds quite excited about uh about the future growth. 20:08 20 minutes, 8 seconds We don't not don't wish to comment right now on next year's numbers. 20:12 20 minutes, 12 seconds Okay. You you are now looking at delinking it from the NHIC. So therefore going forward NHL will be reported as independent of the business of the care. 20:24 20 minutes, 24 seconds Correct. 20:27 20 minutes, 27 seconds Yes. Correct. the the insurance business even otherwise we are reporting out separately only in our uh investor day 20:35 20 minutes, 35 seconds and integrated care we are reporting separately integrated care will merge into NHL the insurance business we'll 20:42 20 minutes, 42 seconds continue to report out separately uh would we get some uh color on the the profitability of that business the 20:50 20 minutes, 50 seconds insurance business or is it too early to comment on that yeah we have given the integrated care 20:57 20 minutes, 57 seconds losses is at the moment we are giving that out as part of our investor deck. 21:02 21 minutes, 2 seconds We will report once the merger happens we will report out the profitability of the insurance business separately. Okay. Thank you very much. Thanks. 21:10 21 minutes, 10 seconds It's not very substantial right now. I understand. Yeah, that is understood. Yeah. Thanks a lot. 21:23 21 minutes, 23 seconds Okay. While we wait for ants to populate for the India uh questions uh any plans of diluting stake to offset debt. No. 21:33 21 minutes, 33 seconds Uh our view on Gura Delhi Hospital profitably aspects and ability to fill the beds from a competition viewpoint 21:41 21 minutes, 41 seconds giving multiple large players are expanding already and have an existing presence. That has been our biggest challenge. Golga there are much larger 21:49 21 minutes, 49 seconds hospitals that our existing Gulga hospital has had to doctor acquisition as well as patients coming in. It's been quite challenging 21:59 21 minutes, 59 seconds for us as no doubt all of you have been aware. Uh we have done a lot of things to improve profitability. We've done a 22:06 22 minutes, 6 seconds lot of cost optimization and we run a lot of efficiencies within the overall network to make the hospital break even and run in a sustainable manner that 22:15 22 minutes, 15 seconds delivers very high quality of clinical care. Uh its path going forward could not get more challenging if more 22:24 22 minutes, 24 seconds hospitals come in. Uh it would continue on its current path. But yes, this is uh something that is a challenge faced even 22:32 22 minutes, 32 seconds by the largest hospital which is every incremental bed does have a short-term dilutive impact but over the long enough 22:40 22 minutes, 40 seconds time frame there is still sufficient demand to fill up these beds. 22:47 22 minutes, 47 seconds There was a question on a reason for such a high increase in salaries and doctor fees. Um I'm guessing the person 22:54 22 minutes, 54 seconds who brought this question up would have been looking at the consolidated numbers which adds the UK to that but from an India mix we've actually improved the 23:03 23 minutes, 3 seconds doctor cost as a percentage of the overall payouts. 23:08 23 minutes, 8 seconds The question on sharing occupancy rate for the current quarter. This is a number we are moving away. We have moved away from uh we are not in the hotel 23:16 23 minutes, 16 seconds business and occupancy matters less to us as the overall patient volumes that come in. 23:24 23 minutes, 24 seconds Are there any other one more on the insurance just wanted to know whether we operate only in Bangalore and my markets for insurance segment which other markets do we look to tap for insurance segment 23:33 23 minutes, 33 seconds I've expanded to uh Kolkata and we will be slowly expanding to Raipur as well over time we want to operate our 23:40 23 minutes, 40 seconds insurance plan in all the markets where we have a significant physical presence but we will be opening it up phase wise 23:50 23 minutes, 50 seconds question is are we looking at growing the pharmacy business the pharmacy is an integral part of the NHIC clinics. So 23:57 23 minutes, 57 seconds pharmacy as a proportion of business within NHIC is quite high and that's how we will be growing it. We would not be 24:04 24 minutes, 4 seconds running a standalone uh pharmacy business in a big way. 24:14 24 minutes, 14 seconds I think we should come back on the online questions. Priti, can you please have a question? 24:21 24 minutes, 21 seconds Yeah, thanks. Before getting into Kayman, I just have one question on India business. 24:27 24 minutes, 27 seconds Given that you mentioned you will implement the similar template even in Kolkata cluster. Uh how many years it 24:33 24 minutes, 33 seconds will take for Kolkata clustered ARP to reach closer to Bangalore? Uh just to get a sense you know how many years it 24:41 24 minutes, 41 seconds will take for you to implement all these measures. Yeah, I can answer that very quickly. 24:46 24 minutes, 46 seconds Kolkata will the hospitals in Kolkata given the payer mix and uh sort of patient where will always be at a discount to the Bangalore hospitals. 24:57 24 minutes, 57 seconds Uh I mean yeah I understand there will be a discount but I'm just trying to understand the extent of discount because the way the Bangalore has risen in the last few years. 25:08 25 minutes, 8 seconds Do we expect similar trend to happen even in Kolkata? 25:11 25 minutes, 11 seconds Not in the near term. The Rajar Hospital which we are planning as a flagship health city built along the same lines as the health city in Bangalore with 25:19 25 minutes, 19 seconds modern construction and the best equipment and getting very good infrastructure should serve to fill up that gap a little bit but it will still 25:28 25 minutes, 28 seconds be diluted a lot by the impact of our older hospitals there. 25:32 25 minutes, 32 seconds Understood. Pan just one final question on India business. You think before the new hospitals get commissioned uh can you sustain this double digit 25:41 25 minutes, 41 seconds revenue growth momentum or you think the great might moderate by FI29 before you commission a new hospital? 25:50 25 minutes, 50 seconds The like to like hospital growth we believe definitely should be able to sustain. There will be quarterly 25:58 25 minutes, 58 seconds variations barring any kind of major adverse events. Say for example, should a hospital poach an entire clinical department or anything of that nature? 26:11 26 minutes, 11 seconds Uh there's no reason that the same hospital growth should not be sustainable till the new hospitals come online. 26:21 26 minutes, 21 seconds Okay. Thanks. Uh can I move to Cayman now? 26:25 26 minutes, 25 seconds Just have couple of more questions on the chat and then we can start the Cayman and Yeah. 26:29 26 minutes, 29 seconds Yeah. So there's a very quick question on thousand cr capex uh to be funded. It will be internal acroals and debt. Uh the number is actually closer to 3,000 but the answer is still the same. 26:40 26 minutes, 40 seconds Any other chat question? 26:41 26 minutes, 41 seconds One more on the expansion plan. What's the question? 26:44 26 minutes, 44 seconds Was there right? We move on to Cayman. 26:52 26 minutes, 52 seconds Uh Anish on the Cayman revenue. I mean especially for the hospitals right now we are at $45 million. I know occupancy 26:59 26 minutes, 59 seconds is not a right metric uh to look at it but can you give some data or some number that will help us to understand 27:07 27 minutes, 7 seconds how are we with respect to the percentage of full potential for Cayman hospital business. 27:15 27 minutes, 15 seconds So there are two aspects to that Priti uh one is the local market one is the international uh market. The international market obviously we have 27:22 27 minutes, 22 seconds no way of uh quantifying uh how big it is. We just know the progress we are making uh locally in in in Cayman. We 27:29 27 minutes, 29 seconds know that uh the government hospital is uh is still larger than us in terms of of revenue. So of course there are certain structural reasons uh for that. 27:38 27 minutes, 38 seconds They have an exclusive right over a entire payer class that that we don't have. Uh there is another private hospital that that also does well. So we 27:46 27 minutes, 46 seconds we know that there is room to grow. Uh bit uh tricky to put an exact number to it. uh but uh you know that there is still market share to to be had. 27:56 27 minutes, 56 seconds Got it. And on the insurance side I mean despite having higher revenue for Cayman insurance this quarter we saw even losses widening on sequential basis. 28:06 28 minutes, 6 seconds I mean what explains that and also I think a last quarter or a quarter back you mentioned by Q4 or Q1 you might 28:15 28 minutes, 15 seconds reach break even for the Cayman insurance. We just update on that. 28:20 28 minutes, 20 seconds Sure. uh I think even when we spoke last quarter uh like we said it is quite uh challenging to have a quarteronquarter 28:26 28 minutes, 26 seconds predictability in in in insurance loss ratio there will be you know large claims and and things like that there'll be quite a bit of volatility uh if we 28:35 28 minutes, 35 seconds take a rolling couple of quarters that should give a better better picture having said that uh up until now our focus has been on aggressively expanding 28:44 28 minutes, 44 seconds the size of the book uh which we have been uh successfully able to do u or from coming quarter onwards we the focus 28:51 28 minutes, 51 seconds will be more on uh improving our underwriting performance and under improving the underlying uh processes as 28:58 28 minutes, 58 seconds well as the clinical decision-m better uh but we've achieved where we wanted to get fairly quickly uh ahead of schedule in terms of the size of the book that 29:07 29 minutes, 7 seconds that we have we have most of the the marquee clients now the focus will be on on optimizing the book that that that we do have uh 29:15 29 minutes, 15 seconds is it possible to give market share number for the insurance business uh it's actually publicly available on the monetary authority uh website. One 29:24 29 minutes, 24 seconds can derive it with a lag of a few quarters because it's not up to date. So even we would wouldn't have the most up to up to date figures but with a couple 29:31 29 minutes, 31 seconds of quarters lag uh one one can understand the size of the market. 29:35 29 minutes, 35 seconds Okay fine we'll take from that. Thank you. Uh I have one more question on UK I'll join back in the queue. 29:45 29 minutes, 45 seconds Any other questions on Cayman? 30:03 30 minutes, 3 seconds We can move on. Min. 30:05 30 minutes, 5 seconds Okay. So, there was a question on uh this is more group level. There's some previous question in the chat. Are there targets for uh net debt to equity? 30:15 30 minutes, 15 seconds Just Nishan. Yes. So we we we track the ratio of net to beta on the console basis and our end endeavor is to maintain the number below 2.5. 30:27 30 minutes, 27 seconds Um another point that came up is I mentioned poaching of entire departments. This is anecdotal. Uh it's 30:34 30 minutes, 34 seconds has not happened to us. Um there are doctors who leave for various reasons such as relocating to cities where they would like to move to be with their families. 30:44 30 minutes, 44 seconds uh I was just using this to illustrate um 30:51 30 minutes, 51 seconds but our doctor attrition at the senior level is high single digits it's quite low 31:01 31 minutes, 1 second okay this question has come up the vision objective goal in Narayana what do you want to be in the next 5 years and where you'd like to be 31:10 31 minutes, 10 seconds uh the vision is as Dr. Dr. Shetty had always defined for us which is building a world-class healthcare institution 31:17 31 minutes, 17 seconds that provides accessible affordable care for everyone who comes in. The objectives are to build a healthcare institution that's able to deliver on 31:26 31 minutes, 26 seconds that. The goals are how we achieve those objectives. The goals used to be beddriven which is chasing after having 31:35 31 minutes, 35 seconds the largest presence and the largest number of beds all over the country. We found out that using that as a route to getting to our objective was diluting it 31:44 31 minutes, 44 seconds a lot because we entered into markets where we had very little presence and recognition and we were not able to execute well. As of today what we are 31:53 31 minutes, 53 seconds working on is consolidating our presence in our core markets starting with Bangalore and Delhi and from there the other markets where we have success such 32:02 32 minutes, 2 seconds as Parlay, Ahmedabad, Jaipur, Delhi, Bombay etc. 32:06 32 minutes, 6 seconds We are growing there with a combination of hospitals, clinics and insurance. And we will also be offering our integrated 32:15 32 minutes, 15 seconds care offerings to patients so that we can offer healthcare services to them throughout the year rather than them coming in for cancer and cardiac services. 32:27 32 minutes, 27 seconds What we would like to be in 5 years in our core markets is a significant operator with a presence so that 32:36 32 minutes, 36 seconds wherever you are in at least in Bangalore or Kolkata, you're never more than 25 minutes away from an NH center, 32:43 32 minutes, 43 seconds be it a hospital or a clinic. With those points of presence, we would then work towards earning the trust of our patients and increasing our market share 32:51 32 minutes, 51 seconds in total overall health spent which is money spent in clinics, pharmacy, uh procedure level and health insurance. 33:00 33 minutes The steps we will take to do it will be the combination of all the offerings that we have invested in. 33:08 33 minutes, 8 seconds Dundi has a question. Yeah, please go ahead. 33:12 33 minutes, 12 seconds Hi. Uh I have question on the UK operation. Uh shall I go ahead? Yeah, please please. 33:18 33 minutes, 18 seconds Okay. So uh we have some uh data available in the presentation uh for the UK operations and when we look at the 33:26 33 minutes, 26 seconds profitability uh that obviously is uh significantly below your India operation or Yemen operations and we understand 33:34 33 minutes, 34 seconds the market is different there. uh but from your uh perspective or strategies what are the key points uh which you'll 33:42 33 minutes, 42 seconds focus on to improve uh margins from here on and uh uh reducing the gap between what UK operation has in terms of margins versus the console numbers. 33:54 33 minutes, 54 seconds Yeah. 33:56 33 minutes, 56 seconds Yeah. Thanks Danti. So um as you uh identified in the beginning you know every market will have its uh potential. 34:02 34 minutes, 2 seconds uh we don't think that uh the profitability of what we the operations in the UK will ever reach where we are in in Cayman because they're very different markets, very different risk 34:10 34 minutes, 10 seconds profile. Um secondly, in terms of uh you know what what are we going to do? So we it's been about a little over a few 34:17 34 minutes, 17 seconds months since we acquired uh the company and there are quite a few um opportunities to implement essentially our entire technology platform and uh 34:26 34 minutes, 26 seconds what we've done with Cayman from India which is a lot of operational process level efficiencies related to both 34:34 34 minutes, 34 seconds clinical and nonclinical functions. uh as well as the company has a very very uh small revenue composition from non- 34:42 34 minutes, 42 seconds NHS sources that is private uh insurance and self-pay those tend to yield higher realizations on a like to-like basis 34:50 34 minutes, 50 seconds compared to NHS there are some initiatives related uh to growing that market share the private market share those will also help meaningfully 34:57 34 minutes, 57 seconds contribute to the margins along with uh revenue growth but in in a summary uh the broad idea would be uh a much larger 35:06 35 minutes, 6 seconds scaled version of what we've been able to do in Cayman which is essentially implement our technology platform and 35:13 35 minutes, 13 seconds other operational efficiencies uh but at a larger scale. 35:18 35 minutes, 18 seconds Sure. And uh these majors uh will take say how much time before we start seeing 35:25 35 minutes, 25 seconds some uh notable changes happening in the UK numbers. You do have avenues but uh 35:32 35 minutes, 32 seconds in general uh shall we assume two to three years or even higher time uh timeline to see these uh initiative to bring fruits? 35:41 35 minutes, 41 seconds Yeah, I don't think we'll have to wait two to three years to start seeing results but obviously to to get the entire you know to do a lot of what we 35:49 35 minutes, 49 seconds can do will take uh you know some time but we should start seeing uh early results trickle in. um no no guide no 35:57 35 minutes, 57 seconds guidance on exactly how long that will that will take but uh we don't I don't think we will we'll be waiting 2 to 3 years to see benefits uh start flowing in. 36:07 36 minutes, 7 seconds Okay. And my last question is in these uh uh UK setup it's all local teams right in terms of doctors as well as non 36:16 36 minutes, 16 seconds uh medical teams is the local absolutely yeah okay yes okay thank you 36:27 36 minutes, 27 seconds yes please go ahead yeah just wanted to check out on your uh you have been mentioning this Birmingham 36:34 36 minutes, 34 seconds unit of uh the UK operations uh how big is it and how long will it take to come out of the losses there but 36:42 36 minutes, 42 seconds how long will it take to get completed and completely operational? 36:46 36 minutes, 46 seconds Sure. So the hospital is operational uh but recently so uh in terms of it is a hospital that the earthw owners had 36:55 36 minutes, 55 seconds acquired uh from another health system as part of a divestment. Um so it it it has been a hospital for for decades but it was largely neglected for a long 37:04 37 minutes, 4 seconds time. So under our ownership, sorry, under practice plus ownership, it's it's been about a year, year and a half and NH for the past few months. Uh so the 37:13 37 minutes, 13 seconds hospital is fully operational. Uh to your question about how long it will take to come out of our losses, we've always hoped that you know these such an 37:21 37 minutes, 21 seconds operation would take about four quarters or one year. It's been half that time. 37:26 37 minutes, 26 seconds Uh we will continue to monitor it. uh you know there are some positive changes on on the ground but it is still a new market for us and a new asset for the 37:33 37 minutes, 33 seconds company that we are uh still getting our hands around. 37:36 37 minutes, 36 seconds In size is it bigger than the average PPG hospital? 37:41 37 minutes, 41 seconds No no the the all the hospitals are more or less the same uh in terms of template there are minor variations here and 37:48 37 minutes, 48 seconds there uh but in terms of number of square feet or number of operation theaters or beds etc they there very little variation between them. Yeah. 37:56 37 minutes, 56 seconds Okay. Okay. And lastly, would you be required to put in some money on capex in Birmingham or is that all done already? 38:03 38 minutes, 3 seconds No, that's done. There are some minor uh equipment that will be uh coming online in the next few weeks, but the bulk of the investment was done uh before. 38:11 38 minutes, 11 seconds Nothing nothing major. Uh there are some you know some sterilization units etc. uh but nothing that was left for us. 38:19 38 minutes, 19 seconds Okay. Just just one last question on the total it is net 183 million GBP right 38:28 38 minutes, 28 seconds how much of it is equity and how much of it debt I may have you may have mentioned that in the past maybe if you can just let let us know repeat it 38:36 38 minutes, 36 seconds I'll take this we have taken a debt 150 million on this uh I also want to take another question here which is on the 38:44 38 minutes, 44 seconds repayment of the debt we have a 2 + 5 years repayment scheduled over the period of which uh we aspire to repay this debt. 38:54 38 minutes, 54 seconds So it is 33 million uh equity and 150 million debt is it? 38:59 38 minutes, 59 seconds We had put in 45 million equity because there were also deal costs which we had to spend on uh so 39:07 39 minutes, 7 seconds 150 million debt and 45 million equity is what we put in. But what we paid was uh 39:14 39 minutes, 14 seconds 183 net in after netting of the cash which was there in the entity. Yeah. Thank you. Thank you. 39:24 39 minutes, 24 seconds Do you have any follow on questions on UK? 39:27 39 minutes, 27 seconds Yeah, I just have one question. Uh Anish, this is again on UK setting it would have been couple of months for you taking over the business. Uh are there 39:35 39 minutes, 35 seconds any shocks that you're facing because it's a new geography etc. or is it fairly 39:42 39 minutes, 42 seconds uh I mean relatively easy for you to implement whatever you wanted to implement it? 39:49 39 minutes, 49 seconds Uh it's still too early to to say pr so no you know fortunately no bad shocks um but it's been about 3 months we have a 39:58 39 minutes, 58 seconds good idea of essentially we've scoped out a lot of the process changes we're going to be making a lot of the digital uh applications and the rollout of 40:06 40 minutes, 6 seconds certain transformations that we're going to be doing uh in in in terms of how hard it is to uh you know to to roll these out. We we know in a few quarters 40:15 40 minutes, 15 seconds but so far uh you know we're fairly optimistic. I don't think there's any uh negative surprise thankfully yet. 40:23 40 minutes, 23 seconds And you think there are many lowhanging fruits for you to uh implement in the first few quarters? 40:34 40 minutes, 34 seconds Uh we definitely will get started. Um there are obviously uh you know some initiatives that are easier than others. 40:40 40 minutes, 40 seconds Some that will be quicker, some that will take a longer time. uh but I think you know in a few quarters we we will get a better sense of uh the timelines 40:49 40 minutes, 49 seconds as well as uh you know a better quantification of these things. We have a broad sense of where we're going and internally you know obviously we do have 40:56 40 minutes, 56 seconds uh a road map for what we'll do when and when we expect these synergies to start kicking in but nothing to to share as of now. Okay thanks and it's all the best. 41:07 41 minutes, 7 seconds Thank you. Yeah, Vin. Uh I think you have a hand. 41:19 41 minutes, 19 seconds Yeah. Just one more question on UK. Uh you mentioned about uh there being a 4 to 6 weeks 41:27 41 minutes, 27 seconds waiting time for surgeries in UK. uh was that because of uh operational constraints or is that uh just the sheer 41:36 41 minutes, 36 seconds number of people and the capacity to occupy them? Is there a chance of reducing this uh backlog? 41:45 41 minutes, 45 seconds Uh when I when you say four to six weeks I assume are you referring to our waiting time within our hospital or in the NHS? Uh I I mean I'm I'm looking at 41:56 41 minutes, 56 seconds your uh deck that you had circulated in November where it says latent demand 4 to 6 weeks wait in time for surgeries. 42:03 42 minutes, 3 seconds So I was just trying to see how quickly can we uh increase our IITA there. So is that one of the options to go about is it a problem or is it a opportunity? 42:15 42 minutes, 15 seconds Sure. Uh I'll I'll try and answer the question because I'm I'm not very sure. 42:19 42 minutes, 19 seconds Uh I'll look back at the slide you're you're referring to later. 42:22 42 minutes, 22 seconds That's what the background information 4 to 6 weeks is NHS waiting list. Yes. 42:27 42 minutes, 27 seconds Yeah. So that's much larger. So it's not 4 to say it's actually I mean the national waiting time for depending on which elective procedure is more than 18 42:35 42 minutes, 35 seconds weeks to 20 weeks and there are some that are that are quicker. But essentially the concept that we shared was that uh there is a waiting time for elective surgeries more than which is 42:44 42 minutes, 44 seconds more than ideal uh in the public health system. Thus the opportunity that that exists for all private operators. So uh 42:51 42 minutes, 51 seconds the motivation for patients to pay out of pocket rather than get good healthcare free is the waiting time and the quicker access in the private 42:58 42 minutes, 58 seconds sector. So this is something that uh all private operators are looking to to capitalize on and this is particularly related to certain procedures such as 43:07 43 minutes, 7 seconds joint replacements, catact uh you know other orthopedic procedures, general surgery etc. 43:13 43 minutes, 13 seconds Okay. So it it makes sense to keep with that uh long waiting list. 43:21 43 minutes, 21 seconds No, it's not up to us. Uh that's the that's the restriction that the government the public NHS trust hospitals have with regards to their 43:28 43 minutes, 28 seconds resources available. Um and you know that that's been a a multi-deade problem and it doesn't appear that it's going to go away anytime anytime soon. 43:38 43 minutes, 38 seconds Okay. Thanks a lot. Uh Rajit do you have any questions? 43:46 43 minutes, 46 seconds Uh yes uh on the UK financials just wanted a a few clarifications on the numbers. So the depreciation for UK as 43:56 43 minutes, 56 seconds per the slide 14 comes to around 40 kores. 44:00 44 minutes Now the balance sheet of the annual report of practice plus gives a very different number. So how do we understand this and is this the number 44:08 44 minutes, 8 seconds which we should take going forward as well 40 crores for 2 months kind of a number? 44:14 44 minutes, 14 seconds Yes, you should take this number going forward. Um so the practice plus balance sheet was three legal entities uh which 44:23 44 minutes, 23 seconds were there and this is now after the carve out. There is also a uh the most of the depreciation is also coming from 44:31 44 minutes, 31 seconds the leases and as we consolidated uh there was a uh reacounting that we do with the statutory auditors in terms of 44:39 44 minutes, 39 seconds some of the lease charges. So that's why you're seeing a slight uh uh was not a very material deviation from the number. 44:46 44 minutes, 46 seconds So this number you can take going forward. I would just recommend that you wait for Q4 where we get the full effect 44:53 44 minutes, 53 seconds of all the numbers in our P&L. I think that's a good uh um Q4 or Q Q2 of 45:00 45 minutes practice plus that'll be a good representative of a full quarter number for us. 45:06 45 minutes, 6 seconds Okay. Okay. Understood. Okay. So, similar would be the case for interest cost as well I guess. 45:12 45 minutes, 12 seconds Yes. Interest cost has gone up because we have borrowed right. No entire borrowing has come on 45:19 45 minutes, 19 seconds the and I think we've given a small schedule on that for clarity. Yeah. Yeah. 45:24 45 minutes, 24 seconds Yeah. That's fine. Uh and and just a subjective question on the doctor's expenses and other employee expenses 45:33 45 minutes, 33 seconds compared to the rest of your uh I mean XUK UK obviously has uh these expenses as much higher expenses percentage of 45:41 45 minutes, 41 seconds sales. So is there anything which can be done or which you think can be done to uh bring them lower by any margin? 45:51 45 minutes, 51 seconds You would see our doctor costs, doctor and employee costs whether you take it year on year versus last quarter or you 46:00 46 minutes take it quarter on quarter. Quarter on quarter is almost flat slight increases there mainly because of the lower revenue uh in quarter 3 and it has 46:08 46 minutes, 8 seconds improved year on year. No, what I meant is a percentage of sales is it's much higher compared to x UK 46:18 46 minutes, 18 seconds including UK right including UK will be higher yes because UK or doctor cost profile is very 46:26 46 minutes, 26 seconds different I think for India you could look at the India slide that where we call out the doctor cost separately you know there is a table that we give 46:33 46 minutes, 33 seconds which is fine so my question is whe do you think the these expenses in UK can be brought down to certain extent 46:40 46 minutes, 40 seconds Oh, in UK. Okay. I'll let Okay. Okay. 46:44 46 minutes, 44 seconds Yeah. No, no, Raj. So, I mean essentially um anything we do around improving the payer profile will lead to 46:52 46 minutes, 52 seconds a reduction in the doctor cost as a percentage of revenue. Uh and of course any other uh savings we have with regards to clinical efficiency uh would 47:00 47 minutes would also help. It's that is definitely in the bucket of what we are targeting but it's more a mid-to- long-term uh ambition. 47:08 47 minutes, 8 seconds Okay. and other employee expenses as well will be similar. 47:11 47 minutes, 11 seconds Other employees there is definitely much more scope. To put it in perspective, compared to peers, the doctor cost as a percentage of revenue is by far the 47:19 47 minutes, 19 seconds lowest uh compared to peers. But in the non-d doctor bucket, you know, there are a lot of operational efficiencies as our software is implemented that that we hope to realize. 47:29 47 minutes, 29 seconds Okay. Thank you. Thanks a lot. 47:32 47 minutes, 32 seconds Um should should we take some questions from the chat? Uh Nishant. 47:36 47 minutes, 36 seconds Yeah. Anesh on UK hospitals are the expected timelines around payer mix improvements away from NHS. 47:43 47 minutes, 43 seconds Yeah, I'll I'll read these through and answer them as we go. Again, you know, that's that's an ongoing u I mean directionally we obviously want to uh 47:51 47 minutes, 51 seconds improve the private payer mix. Uh no no expected timelines and uh you know to quantify that but hopefully in one direction which is upwards. Uh the next 47:59 47 minutes, 59 seconds question is uh in over five years would NH uh significantly scale up international presence blah blah blah. 48:06 48 minutes, 6 seconds Uh are you open for another international acquisition opportunity? 48:09 48 minutes, 9 seconds Uh definitely not for the foreseeable future. I think we have our hands full with uh with this large uh operation in in the UK and what we already have 48:17 48 minutes, 17 seconds happening in in Cayman. uh and as we've said several times before the right of first refusal so to say for our uh 48:24 48 minutes, 24 seconds capital will always be at home uh country in India where we are most familiar and where we have the most uh opportunities to grow and where we are deploying the bulk of our capital 48:33 48 minutes, 33 seconds presently and over the next 5 years as well. Uh the next question is uh from an ROC perspective why UK isn't this ROC 48:41 48 minutes, 41 seconds dilutive move in case there is a cap on profitability compared to your Indian operation as NHS share can't reduce 48:48 48 minutes, 48 seconds substantially uh the entire private sector compared to the NHS is a very very very uh tiny percentage of the market far lower than it is in 48:57 48 minutes, 57 seconds surrounding European countries or other uh first world countries as well. uh we don't our thesis wasn't counting on the 49:06 49 minutes, 6 seconds NHS share uh reducing materially. It's there is far more than enough to go around for the size of uh where where practice plus fits in in the private 49:14 49 minutes, 14 seconds market hierarchy as well. And even a tiny tiny shift from the massive elephant that is the NHS has very very significant positive ramifications for 49:23 49 minutes, 23 seconds all private players. U so we aren't counting on any drastic moves in in the NHS uh market share. The next question 49:32 49 minutes, 32 seconds is for adjusted IBITA numbers for UK should we look at post IFRS or pre-IFRS as the one that gets into the console 49:40 49 minutes, 40 seconds IBITA in NH books I can take that yeah yeah correct it will be post IFRS only 49:48 49 minutes, 48 seconds the reason we are calling out pre IFRS at least for some time we will call out is because it's a substantial number the lease charges so just to give that uh 49:57 49 minutes, 57 seconds transparency we are calling it out separately There's a question Anish on revenue seasonality of UK hospitals across each quarter. 50:07 50 minutes, 7 seconds Yeah. No, not much seasonality because ours is elective work. There is seasonality depending on contracting with the NHS trust. But that's subjective for each location and each 50:16 50 minutes, 16 seconds hospital because the work we do is not is different from India. We're not a full spectrum hospital. Uh we only do 50:23 50 minutes, 23 seconds elective uh secondary care surgeries. So there isn't uh much uh seasonality here. 50:29 50 minutes, 29 seconds The variation quarter on quarter would depend on contracting relationships with with the trust. 50:36 50 minutes, 36 seconds Um okay the next one could you uh early observations on how the disease burden there differs from 50:44 50 minutes, 44 seconds India across key specialties uh evolving UK demographics age migration etc. No, I don't think this is um the uh the 50:52 50 minutes, 52 seconds correct way to think about it because uh our UK hospitals and all private hospitals in the UK are not general tertiary or secondary care hospitals 51:00 51 minutes like you see in India. The NHS is the primary place where people would go to for uh for for what this question seems to be asking about. Private sector 51:09 51 minutes, 9 seconds providers only do a very narrow spectrum of elective cold uh surgeries. So we don't have any uh specific insights uh 51:17 51 minutes, 17 seconds about uh uh the the the question that the gentleman is asking. Uh the next one uh we mentioned last quarter that the UK 51:26 51 minutes, 26 seconds acquisition is expected to be EPS neutral to slightly positive even in the near term based on the disclosed proform financials after the interest and 51:33 51 minutes, 33 seconds amotization costs. It seems that we will have losses for full year. There are elements of one-timers but SA you want to uh take that question. 51:44 51 minutes, 44 seconds Now the question is on EPS neutrality. 51:47 51 minutes, 47 seconds Yeah. So this quarter has been uh slightly distorted because we had the one-time of the deal cost also coming in 51:54 51 minutes, 54 seconds into the UK PNLN. We do expect that the PAT will be uh flat or mildly positive 52:01 52 minutes, 1 second like we' indicated earlier. Uh so therefore uh we do continue to hold our position that this acquisition will be 52:08 52 minutes, 8 seconds EPS new for the group. Of course we're just 2 months into the business. We are still getting our hands around it and you have to give us some time to be able 52:16 52 minutes, 16 seconds to give a more uh confirmed view on this. 52:25 52 minutes, 25 seconds Um I think where Mina do you have your your hand is up? Sorry. No, no, I you have answered my question. 52:34 52 minutes, 34 seconds Thanks a lot. Okay. Thank you. 52:36 52 minutes, 36 seconds So the other question from the chat on the direction of the doctor related costs over the next couple of years. Uh Dr. Rupert if you could just address. 52:46 52 minutes, 46 seconds Uh it is on on track. We don't see a major change in what is happenings and uh even with the new hospitals I think 52:54 52 minutes, 54 seconds there will be some minor fluctuations here and there but uh we have it well covered as far as uh that is concerned. 53:03 53 minutes, 3 seconds Your question is what is the core competency of NH compared to its peers? 53:08 53 minutes, 8 seconds I think that uh we do a lot of work on improving the 53:15 53 minutes, 15 seconds inhosp efficiencies both by using operational expertise by 53:22 53 minutes, 22 seconds doing streamlining cost cutting and using digitization to be able to provide a like forlike experience 53:31 53 minutes, 31 seconds uh and world-class life the clinical service at a price that few institutions can match. 53:39 53 minutes, 39 seconds without compromising on the clinical quality that it's not core comp every hospital is supposed to do that but we'd like to 53:47 53 minutes, 47 seconds believe that we do it far better than most and how it manifests itself is in 53:55 53 minutes, 55 seconds the almost close to what the industry is able to get on the India levels of dup at a realization that average 54:03 54 minutes, 3 seconds realization that is far far lower The expansion plans that's another question from the chat for India are as 54:12 54 minutes, 12 seconds we had mentioned earlier it's in the slide um in the investor presentation the core focus is in Bangalore and 54:19 54 minutes, 19 seconds Kolkata that's where the bulk of our spend is going to be there is some expansion happening in Raipur as well with an expansion to the existing 54:27 54 minutes, 27 seconds hospital and we will be adding uh a lot of medical equipment next year we planned for four uh Dainci robots so 54:35 54 minutes, 35 seconds that all our hospital become robotic surgery equipped. Uh we'll be adding a lot more oncology services in all the 54:42 54 minutes, 42 seconds hospitals. So these are minor investments. 54:47 54 minutes, 47 seconds Uh Anish, how does PPG compare on average revenue per patient compared with peers in the UK? 54:57 54 minutes, 57 seconds Yeah. So, uh, private peers in the UK have anywhere from, uh, 30 to 50 60% of, uh, NHS work, whereas we are almost 90% 55:06 55 minutes, 6 seconds or more NHS work. So, on an average revenue per patient, those numbers would be quite quite different given the payer mix change. 55:17 55 minutes, 17 seconds The next question is around uh what kind of PAT growth should we expect in next financial year. Um Sandy can take it but we usually don't uh give guidance. 55:28 55 minutes, 28 seconds Yeah I I think we have given a reasonable view of where uh where looking at India Cayman. India will grow 55:36 55 minutes, 36 seconds Cayman will sustain and UK we are looking to grow. So that gives you a direction of where our raita is headed. Uh PAT will follow the same direction. 55:45 55 minutes, 45 seconds We will have interest costs coming on and we have given our capex plan for India. There is no significant capex in 55:53 55 minutes, 53 seconds Cayman that we anticipate and UK it will be largely the borrowing costs that we will service for the acquisition. 56:01 56 minutes, 1 second So uh this will give you a fair idea of how you could calculate our PAT uh for the next financial year. 56:10 56 minutes, 10 seconds Gorov has his hands up. 56:12 56 minutes, 12 seconds Sorry go ahead Nishant. No no we can we can come back on the chat questions. We'll take Gorov's question first. 56:19 56 minutes, 19 seconds Yeah, please go ahead. Yeah. Hi, thank you and good evening. 56:23 56 minutes, 23 seconds Uh, so firstly on uh practice pluses margins, if I recall correctly, you 56:30 56 minutes, 30 seconds know, this business was at a bit margin of 12% x of the Birmingham asset and this quarter we've done close to 10%. 56:39 56 minutes, 39 seconds So, uh, anything that's changed in the business post the acquisition uh, where costs have gone up and do we expect this 56:47 56 minutes, 47 seconds 10% to stay here or improve again back to you know 12% going forward 56:55 56 minutes, 55 seconds the business was always in that 8 and a half to 9% range and it continues to be in that range uh over a period of time 57:03 57 minutes, 3 seconds Birmingham losses will come down uh it has come down also it'll come down further as well and as far as the base 57:12 57 minutes, 12 seconds core business is concerned I think it's just too early for us we still getting a handle of the business so we'll need some time to comment on but broadly we 57:21 57 minutes, 21 seconds have not seen any dilution in the business performance in the two months that we have seen or we have taken over the business. 57:28 57 minutes, 28 seconds If the number was from the practice plus disclosures just know that it accounts for three separate businesses with 57:35 57 minutes, 35 seconds corporate costs allocated across three different business units. So there would be a distortion once you set only the hospital then we are fully responsible for that. 57:45 57 minutes, 45 seconds Yeah, we had done that. But you're saying that 8 and a half 9% is the uh normaliz of Birmingham for now that this 57:54 57 minutes, 54 seconds business that was always what it was, Garov. Uh I'm actually not sure where you got that. Yeah. Yeah. 57:58 57 minutes, 58 seconds Got it. Got it. And uh you know uh you've taken 115 million of pounds of 58:05 58 minutes, 5 seconds debt. Uh and if you've spelled out the interest cost, so if I back calculated the cost of debt, is it 4.5%. 58:13 58 minutes, 13 seconds Is that assumption correct? Is the cost of debt for us at 4 and a half%. 58:18 58 minutes, 18 seconds It's not a number that we've kind of made available public but broadly we have taken so far plus 200 bits is the 58:26 58 minutes, 26 seconds broad range we have taken. Uh obviously there are lot of plus minus in that number and that's the reason you're not 58:33 58 minutes, 33 seconds able to see it clearly. Uh but it's 200 blips plus of Okay. Got it. 58:39 58 minutes, 39 seconds Yeah. Yeah. Sonia plus 200. Yeah. 58:43 58 minutes, 43 seconds And uh what was the 2 + 5? If you can just help me understand that 2 + 5 a little better in terms of 58:50 58 minutes, 50 seconds 2 year of moratorum in which we are only servicing the interest for the debt and then we have a uh principle and in 58:59 58 minutes, 59 seconds servicing for the next five years and is that uh equally over the next five years or is it you know again 59:06 59 minutes, 6 seconds skewed towards the end of the five years? It is equally over the next five years after the first two years is finished. 59:17 59 minutes, 17 seconds Got it. Got it. Uh separately on your you know joint venture where you're looking at healthcare centers for the 59:24 59 minutes, 24 seconds treatment of cancer patients and specifically provide chemo services. 59:30 59 minutes, 30 seconds Uh you know which geographies would that be and you know how many centers you plan to come through with this JV? Any 59:37 59 minutes, 37 seconds color please? Yeah, this is an investment we made in uh Ever 59:45 59 minutes, 45 seconds Hope Oncology. Their focus areas are creating chemo centers in Delhi. The first center has come up in Gura. 59:52 59 minutes, 52 seconds They're scouting for more partners to open up more centers with. The next investment they made is in SSO oncology, 59:59 59 minutes, 59 seconds surgical service oncology in Mumbai and they have three centers and they're looking to expand more. 1:00:09 1 hour, 9 seconds So any investment that we've earmarked you know for this uh particular venture over the next 3 years no we've just made the initial 1:00:17 1 hour, 17 seconds investment the rest we'll take a call once you see the trajectory of the existing uh business and how they're able to scale 1:00:25 1 hour, 25 seconds perfect thank you all the best thanks if we can go to your question please 1:00:33 1 hour, 33 seconds yeah sir in Bangalore market as seen presentation there are for the next four years you're doing a additional bed of 1:00:41 1 hour, 41 seconds around 900 bets also if you see other peers listed peers they're also doing aggressive tapets towards the Bangalore 1:00:50 1 hour, 50 seconds market do you see do you think there would be enough room for growth in this market 1:00:57 1 hour, 57 seconds yes any color on that sir 1:01:05 1 hour, 1 minute, 5 seconds there is room for growth in these markets. 1:01:14 1 hour, 1 minute, 14 seconds There was a question in the chat on the ROCE uh dilution impact because of UK. 1:01:20 1 hour, 1 minute, 20 seconds What we'd like to say is that uh initially because of the size and scale I think we are seeing that dilution but a it's a leveraged buyout b it's a 1:01:29 1 hour, 1 minute, 29 seconds assetike model. uh so we do believe that the UK acquisition will deliver reasonably strong ROC's for us. Our 1:01:37 1 hour, 1 minute, 37 seconds current ROC is very high because of the uh assets in India coming up uh uh you 1:01:45 1 hour, 1 minute, 45 seconds know long back and therefore the cost of acquisition is lower there is a normalization that is happening on ROCE 1:01:52 1 hour, 1 minute, 52 seconds uh at the excluding UK also at a group level we will still be healthy we won't be at that very high levels we were till 1:02:00 1 hour, 2 minutes last year and UK will in the medium term not be dilutive to the group ROC 1:02:10 1 hour, 2 minutes, 10 seconds There's a question on the expansion plans for Cayman and UK. Uh over 5 years would NH would significantly scale up 1:02:18 1 hour, 2 minutes, 18 seconds international presence based on Kman UK experience or remain nation. 1:02:21 1 hour, 2 minutes, 21 seconds We answer that Nishant happy to sorry do we need Yeah. We have our hands full right now. Until we are able to improve 1:02:30 1 hour, 2 minutes, 30 seconds the performance of the UK, there is no scope for us to expand internationally. 1:02:34 1 hour, 2 minutes, 34 seconds India, we've already spelled out what our expansion plans are. 1:02:39 1 hour, 2 minutes, 39 seconds Uh the question is uh when you look at the payer profile, our government schemes is the highest in the industry. Uh this has always been the case for NH. 1:02:46 1 hour, 2 minutes, 46 seconds We cater to the mass market and the government payers are a very large portion of that. We try to balance out our commitments to society and 1:02:54 1 hour, 2 minutes, 54 seconds maintaining a healthy mix of different uh patient base against our cash flow requirements. So the government numbers will effective on that. 1:03:06 1 hour, 3 minutes, 6 seconds Uh question is are there plans to raise equity capital? Not right now. We don't see a need for it. 1:03:13 1 hour, 3 minutes, 13 seconds Anish the question on sourcing elective treatment from the NHS board. you'll be able to answer that if you need 1:03:20 1 hour, 3 minutes, 20 seconds uh when you refer to sourcing elective treatments could you clarify the types of disease and procedure involved. So for the most part they are joint uh orthopedics uh would be joint 1:03:29 1 hour, 3 minutes, 29 seconds replacement arthoscopy some amount of general surgery gastroenterology and of opthalmology as well. So this is the the bulk of what we source from the NHS pool 1:03:38 1 hour, 3 minutes, 38 seconds which is uh elective secondary care surgeries. Uh that's also the answer to the treatment mix. Uh the last part of 1:03:46 1 hour, 3 minutes, 46 seconds the question are you primarily focusing on building cardiology in the UK or are you opening to scaling other specialties as well? Uh we will not be building 1:03:54 1 hour, 3 minutes, 54 seconds starting cardiology services immediately. There there are very very few private cardiology services in in the country and um especially outside of 1:04:02 1 hour, 4 minutes, 2 seconds London. So this isn't a a first uh step forward. there are uh diversification and enhancements of the existing specialties that we will be doing such 1:04:11 1 hour, 4 minutes, 11 seconds as getting into uh back and spine surgery more complex orthopedics etc. So those would be the first uh topics we'll 1:04:19 1 hour, 4 minutes, 19 seconds be taking up the first new services we'll be starting with. 1:04:26 1 hour, 4 minutes, 26 seconds SA uh I think the next question is why does NH come out with its results towards the end of the period? Is there any particular reason? 1:04:34 1 hour, 4 minutes, 34 seconds Yeah. So I think this is something that we'll have to work on. uh this quarter especially was because we had to go through the consolidation with UK and uh 1:04:43 1 hour, 4 minutes, 43 seconds we are still getting the uh systems in place but in even otherwise in general I think we come out a little late in terms of how we are able to release our 1:04:51 1 hour, 4 minutes, 51 seconds results. This is work in progress for us and uh we take your feedback and we'll work on this. 1:04:58 1 hour, 4 minutes, 58 seconds The next question on the chat was on India business. What is the impact of the increase in CDHS rates? I think we had given this number last quarter. 1:05:06 1 hour, 5 minutes, 6 seconds Nishan do you recall what the impact of enhanced CDHS relates to will be it was a non-material amount for us given our 1:05:13 1 hour, 5 minutes, 13 seconds limited presence in Delhi and that we have limited exposure to CHS but the exact number we can come back to your 1:05:19 1 hour, 5 minutes, 19 seconds own data all right if there are no other questions 1:05:27 1 hour, 5 minutes, 27 seconds there was just one small clarification I wanted to give uh see what I'm not sure who it was you pointed out this 12% 1:05:34 1 hour, 5 minutes, 34 seconds versus 8 and a half to 9%. I think one small thing is we were tracking the prefrs number which is 8 and a half to 9. You're right post ifs is 12%. So um 1:05:44 1 hour, 5 minutes, 44 seconds that has you've seen a slight moderation in Q3 because uh Q3 is also like a partial quarter for us and we are still 1:05:51 1 hour, 5 minutes, 51 seconds getting complete handle of how the numbers are rolling up. We do uh aspire to be at that 8 and a half to 9% prefrs. 1:06:01 1 hour, 6 minutes, 1 second Next time onwards we will start giving the same ambition post IFRS. I think that will clear the confusion uh which got created in that answer. 1:06:11 1 hour, 6 minutes, 11 seconds Sure. Thank you. 1:06:14 1 hour, 6 minutes, 14 seconds Raise of hands. So, so we with this we'd like to conclude the session and thank you everyone for the active participation as usual. Thank you.