News & Views

5th May 2015

UK private healthcare sector poised for wave of M&A

A common feature of any large, developed market is the dominance of its largest participants. Grocery sales in the UK are dominated by the ‘big four’ supermarkets that, in the 12 weeks ending 4th January 2015, had a combined market share of over 74%. The publicly owned ‘big oil’ super majors, big tobacco and telcos are similarly structured.

The conglomeration visible in these sectors came about during intense periods of M&A, in which smaller players were absorbed and larger entities brought together. This consolidation sought to combine companies with synergistic components and create efficiencies.

The mere prospect of a publically traded company being taken over drives share prices up on the expectation of higher revenues based on the increased efficiency. Royal Dutch Shell’s acquisition of BG Group is a clear example of this. Precedent shows us such deals are incredibly lucrative for principals and spark a flurry of amalgamation within a sector.

Identifying a market where such event driven value creation can be found is a sensible investment strategy. However, most markets of significant scale are largely consolidated and will remain so until regulatory ‘trust busting’ or significant macroeconomic pressures engender change.

One area noticeably overlooked by investors, until recently, is the UK specialist care market. US, European, Middle Eastern, Asian and UK investors are beginning to recognise the sector’s strong long term fundamentals as well as the scope for M&A driven returns.

Specialist care is the provision of support for those with learning disabilities, mental health needs and acquired brain injuries. It is a market of considerable size and growth prospects – with the latest Laing & Buisson figures estimating the total market to be worth in the region of £7bn.

Laing & Buisson anticipates the market will appreciate at a rate of about 1% per annum, due to population growth and better diagnosis of mental illnesses. The market is supported by strong, inflation protected fee yields charged for care, paid for by Local Authorities.

Highly fragmented

Despite its size and potential, the UK specialist care sector is highly fragmented, in which the top 10 providers control more than 15% of the market and in excess of 81% of assets lie outside of the top 16 operators.

This presents a huge opportunity for larger participants to purchase some of the many smaller care groups at low p/e multiples, ratioalise their processes and bolt on existing platforms and resources. Such actions will fashion earnings growth through cost savings and increase the scope for revenue

Transactional activity in the space shows smaller assets are currently being bought at 6x earnings by larger assets trading at 10x, some as much as 13x earnings. It is easy to see how this process is lucrative for investors.

Activity accelerating

Transactional activity has accelerated over the last year, driven primarily by private equity and REIT buyers.

When looking at the size of the market, current M&A activity and the scope for further deals, we believe the investment opportunity will peak within two to three years before the market’s largest participants have captured the majority of the market.

The main reason this has not already happened is that healthcare provision in the UK is a staunchly regulated space, with high fiscal and care driven barriers to entry. However, there are ways for investors to participate.

Private equity, REITs and open-ended funds – such as the Montreux Healthcare Fund – have gained traction in the institutional market and are ideally poised to fuel M&A activity in private healthcare.

The investment rewards for such vehicles could be considerable. Montreux Capital Management, for example, recently acquired The Regard Partnership and ACH Care Homes, measurably improving the companies’ earnings with ACH’s run rate EBITDA moving from £4.49m to £5.46m and its investment increasing 99.1% in ten months*.

The UK care market is a compelling investment case underpinned by irrefutable demographic trends providing strong natural returns and a high inflation-linked level of income. The private healthcare sector will continue to grow unabated on the back of these inherent fundamentals, however, the ‘window of opportunity’ for M&A driven value uplifts will be largely over in two to three years as the larger participants attain greater market share.

*Taken from Fund NAV & ACH actuals April 2014 & January 2015




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