Our operating environment

Healthcare is a heavily regulated sector world-wide. These regulations, from national governments or from professional or other regulatory bodies, define what we can and can't do from a healthcare provision perspective. As a consequence of regulations, different healthcare models are employed around the world. In South Africa, competition regulations limit our ability to grow by acquisition in the acute hospital space due to our relative market share. In addition, we are largely not allowed to employ medical specialists, and there are restrictions on our ability to provide fully accredited undergraduate training for nurses and doctors despite shortages of these skills in South Africa.

• Complexity of regulatory environment and compliance risk
• Reputational risk
• Skilled healthcare professional shortages

Governments, and their regulations, are essentially a reflection of the values, beliefs and aspirations of society. Society plays a role in holding governments and businesses accountable for their actions. We are serious about corporate responsibility, which is embodied by our commitment to ethical and sustainable behaviour. We discuss these commitments within our governance overview and Social, Ethics and Transformation section.

• Changing business environment and innovation risk
• Reputational risk

Our employees are critical to the delivery of our services. Our ability to employ and retain talented and passionate employees is a key component of delivering consistent high-quality care. Shortages of nurses globally have led us to invest in training in SA nurses through our own nursing college (Life College of Learning). However, regulatory restrictions related to accreditation of independent training colleges hampers our ability to train fully registered nursing employees.

• Human capital (people) risk
• Complexity of regulatory environment and compliance risk
• Clinical and patient safety risk

Doctors and specialists are critical to our healthcare services delivery. In many countries we operate in we either do not, or are not allowed to, employ doctors and specialists. They act as consulting partners with access to our facilities and have rights to carry out procedures and admit patients within our facilities.

Shortages of doctors globally, our inability to do accredited medical school training of doctors, and our inability to employ them directly within South Africa, present challenges in terms of the sustainability of our operations, our ability to expand across the continuum of care, and our aspirations to implement value-based care across our business.

• Skilled healthcare professional shortages
• Complexity of regulatory environment and compliance risk
• Clinical and patient safety risk

Healthcare funders are important stakeholders as we receive much of our remuneration directly from them. In southern Africa our services are mostly funded through private medical insurance coverage and occasionally through direct out-of-pocket payments or publicly funded schemes (such as the Road Accident Fund). In the United Kingdom and Europe most of our services are funded by national healthcare services and a small component from private sector funding.

• Funder risk

Shareholders, investors and financiers provide the equity and debt capital we rely on to fund our businesses and growth aspirations.

• Macroeconomic and political risk
• Changing business environment and innovation risk
• Business resilience and continuity risk
• Complexity of regulatory environment and compliance risk
• Clinical and patient safety risk
• Reputational risk

Our suppliers deliver the consumables, drugs, equipment and food we utilise during the provision of our services. We also rely on utilities to supply us with water, electricity and other municipal services. Reliability of our supply chain and utilities is crucial to the sustainability of our services.

• Business resilience and continuity risk