How we performed against our strategy in 2019

We use KPIs and statistics to measure our progress against our strategy.

Growth

Geographical location and indicator	Year-on-year trend	2019	2018	2017
Life Healthcare Group
Net debt: normalised EBITDA (ratio), debt covenant is <3.5 (2018: 3.5)¹		1.96	2.73	2.55
Interest cover (ratio), debt covenant is >4 (2017: >5.0)¹		5.6	5.7	4.2¹
Capital expenditure as percentage of revenue (%)		8.0	9.6	8.0
Normalised earnings per share (EPS) (cps)		116.4	110.2	93.9
Normalised EPS excluding amortisation (cps)		148.1	139.3	120.6
Headline earnings per share (HEPS) (cps)		88.7	108.8	77.4
Operating profit		3 944	3 848	3 620
Free cash flow before transaction costs		2 342	2 237	1 928

Southern Africa
PPDs²		2 269 756	2 251 600	2 226 337
Occupancy (%)		69.7	69.7	70.0
Length of stay (LOS) (days)		3.76	3.72	3.71
Number of healthcare facilities		66	66	65
Number of registered beds		9 136	9 055	8 983
Number of acute facilities		49	50	50
Number of dedicated acute rehabilitation facilities		7	7	7
Number of dedicated mental health facilities		9	8	8
Number of specialised maternity units		1	1	1
Number of renal stations		329	318	303
Number of oncology units		5	5	4
Number of Life Esidimeni facilities		10	10	11
Number of Life Esidimeni registered beds		3 119	3 119	3 080
Number of Life Esidimeni PPDs		1 054 391	1 006 717	873 954
Number of Life EHS clinics (Life occupational health)		310	301	288
Number of lives covered through the Life EHS occupational health		210 589	211 086	222 895
Number of Life EHS (occupational health) on-site clinics (employee wellness)		81	80	78
Number of lives covered by Life EHS (employee wellness)		383 082	367 670	248 804

¹	Waiver consent letters were received from the relevant banks accepting the breach of covenants for a period of 13 months from the Alliance Medical acquisition date.
²	Indicator is externally assured.

Growth

Geographical location and indicator	Year-on-year trend	2019	2018	2017
Alliance Medical
UK
Diagnostic imaging static sites		33	33	37
PET national contract sites – wave 1 and 2		36	34	31
Mobile units		44	45	45
Radiopharmacy units		4	4	4
Diagnostic imaging static sites (scans)		298 186	281 020	323 744
Mobile (days)		11 070	10 051	10 089
PET-CT (scans)		96 956	83 639	72 807
Radiopharmacy (doses)		106 960	106 123	98 464
Mobile utilisation		82%	81%	81%
Italy
Owned clinics		34	34	25
Statics		8	9	13
Radiopharmacy units		1	1	1
MRI and CT scans – public and private		268 820	259 814	228 565
Other – public and private (scans and other)		2 391 727	2 292 657	2 120 972
Ireland
Operating sites		27	23	20
MRI and CT scans – public and private (scans)		201 029	189 070	160 678
Spain
Operating sites		11	11	11
Molecular imaging – PET-CT (scans)		783	3 406	1 431
Diagnostic imaging and other (scans)		97 068	102 541	101 192
Northern Europe
Mobile and relocatable buildings		18	22	21
Radiopharmacy units		4	4	4
Diagnostic imaging and other (scans)		27 843	25 259	29 799
Radiopharmacy (doses)		68 776	60 071	52 823
Scanmed
Occupancy (%)		69	69	69
Number of medical facilities		41	40	40
Number of registered beds¹		579	624	624
Number of cardiac facilities		12	12	12

¹	Decrease is mainly due to new regulation on increase in number of nurses required per bed introduced January 2019 resulting on deregistration of beds across the entire industry, and a temporary closure of a ward in Blachownia due to renovation.

Quality

Geographical location and indicator	Year-on-year trend	2019	2018	2017
Southern Africa
Quality metrics
Definitely recommend – inpatient (%)		70.70	70.70	70.00
Definitely recommend – emergency units (%)		66.50	67.30	67.20
Patient experience – inpatient (target >8.4)		8.4	8.4	8.1
Patient experience – emergency units (target >8.2)		8.0	8.1	8.1
Complaint rate (per 1 000 PPDs)		0.80	0.83	0.71
Clinical indicators
Patient safety adverse events^2,3 (per 1 000 PPDs)		2.44	2.68	2.69
Healthcare associated infections (HAIs)^3,4 (per 1 000 PPDs)		0.41	0.41	0.42
Ventilator associated pneumonia (VAP) (per 1 000 ventilator days)		0.90	1.09	1.48
Surgical site infections (SSI) (per 1 000 theatre cases)		1.05	0.99	0.96
Central line associated bloodstream infections (CLABSI) (per 1 000 central lines)		0.83	0.99	0.85
Catheter associated urinary tract infections (CAUTI) (per 1 000 catheter days on one line)		0.34	0.31	0.40
FIM^TM/FAM score⁵ (target >0.9)		0.84	0.90	1.00
MHQ14 efficiency⁶ (average gain/PPD) (target >2.25)		2.35	2.20	2.50
Employee adverse events (per 200 000 labour hours)		4.11	4.09	4.43
Alliance Medical⁹
Patient experience (satisfied and very satisfied)		95.30%	94.40%	95.4%
Friends and family score		94.90%	94.52%	94.2%
Written patient complaints per 10 000 scans		3.2	4.4	4.9
Escalated events per 10 000 scans⁸		0.9	0.7	n/a
CQC/IRMER incidents per 10 000 scans		0.1	0.1	0.02
RIDDOR reportable incidents per 10 000 scans		0	0.1	0.1
Clinical audit: level 1 and 2 discretionary scores		0.05%	0.02%	0.06%
Scanmed
HAI⁷ (%)		0.67	0.84	0.85
Surgical site infections (SSI) (%) (SSI)		0.09	0.16	0.17
Ventilator associated pneumonia (VAP) (%)		0.07	0.17	0.15
Central line associated bloodstream infections (CLABSI) (%)		0.03	0.02	0.05
Catheter associated urinary tract infections (CAUTI) (%)		0.12	0.08	0.12

²	Patient safety adverse events: Unintended or unexpected events which could have, or did, result in harm – this includes medication, falls, pressure ulcers, procedure-related incidents, behaviour, death due to unnatural causes, burns, other patient incidents, patients absconding and other patient information incidents.
³	Indicator is externally assured.
⁴	HAI: Combines all the healthcare associated infections determined according to the Centre for Disease Control (CDC) guidelines – VAP, SSI, CLABSI, CAUTI and other infections associated with the hospital stay.
⁵	FIM^TM/FAM: Weekly assessment of patients' function, while in an acute rehabilitation facility.
⁶	MHQ14 efficiency: Patient reported feedback in a mental health facility.
⁷	The calculations differ from the other areas – HAI: total number of HAI/total number of patients x 100%.
⁸	New category.
⁹	UK only.

Efficiency

Geographical location and indicator	Year-on-year trend	2019	2018	2017
Life Healthcare Group
Cash generated from operations as percentage of EBITDA, target is >95%		103.5	99.4	93.2
Normalised EBITDA margin (%)		22.3	23.6	24.0
Southern Africa
Normalised EBITDA margin (%)		23.8	24.9	25.5
Alliance Medical
Normalised EBITDA margin (%)		22.4	24.5	23.8
Scanmed
Normalised EBITDA margin (%)		7.2	6.7	4.0

Sustainability

Geographical location and indicator	Year-on-year trend	2019	2018	2017
Southern Africa
Number of permanent employees		15 385	14 725	14 466
Number of nurses enrolled in training		1 005	1 075	1 358
ACI employees (%)		75.82	74.0	72.6
Electricity usage¹ (kWh)		135 083 292	142 934 448	148 560 938
Water usage¹ (kℓ)		765 055	1 089 999	1 246 804
Healthcare risk waste^2,3 (HCRW) (kg/PPD)		1.96	1.88	1.81
Alliance Medical
Number of employees		2 040	2 003	1 715
Scanmed
Number of employees		3 646	3 523	3 345
Electricity usage¹ (kWh)		5 853 701	5 994 753	4 478 604
Water usage¹ (kℓ)		32 322	43 536	33 853

¹	These figures are based on best estimates using available information.
²	Indicator is externally assured.
³	Monitoring the amount of healthcare risk waste generated by hospital – including pharmaceutical waste, anatomical waste, sharps, cytotoxic, infectious non-anatomical waste and radioactive waste.