Spire Healthcare reported lower first-half earnings as reduced NHS activity and inflation across its largely fixed cost base outweighed continued growth in private medical insurance, self-pay and primary-care revenue.
Group revenue for the six months to 30 June was £792.7m, broadly unchanged from £796.7m a year earlier. Adjusted EBITDA fell by 16% to £112.4m, reducing the adjusted EBITDA margin from 16.8% to 14.2%.
The company recorded a statutory loss before tax of £14.8m, compared with a £10.8m profit in the corresponding period of 2025. Operating profit fell from £63m to £38.4m.
Pressure was concentrated in the hospital business, where NHS revenue declined by 14.3%. The fall was particularly pronounced during the first quarter, when NHS revenue was down 24.9%, before improving to a 3.2% year-on-year decline during the second quarter following a reset of commissioning plans.
Private activity moved in the opposite direction. Self-pay revenue increased by 4.5% and private medical insurance revenue rose by 3.1%. Total private revenue across the group increased by 3.6% to £535.2m.
The changing mix highlights the different economics facing independent healthcare providers. NHS work can provide substantial volumes but is influenced by public-sector commissioning and funding decisions, while private medical insurance and self-pay demand depend on households, employers and insurers funding treatment outside the public system.
Primary Care continued to expand. Revenue increased to £72.1m and adjusted EBITDA reached £5.5m. The division includes workplace health, talking therapies and services outside Spire’s traditional hospital estate.
Diversification beyond hospitals is becoming increasingly important to the group. Employer-funded health services and talking therapies also connect healthcare provision more directly with workforce absence, productivity and occupational health.
Spire said its transformation programme generated £5.5m of new savings during the half. Between 2022 and 2025, the business delivered about £80m of cumulative savings through transformation initiatives.
Cost control is particularly significant in hospitals because clinical staffing, buildings, equipment and regulatory requirements create a substantial fixed-cost base. A reduction in commissioned activity can therefore affect margins quickly when expenditure cannot be reduced at an equivalent pace.
The group expects full-year adjusted EBITDA to be broadly in line with 2025, maintaining previous guidance despite the weaker first-half comparison. More than 95% of revenue linked to NHS Indicative Activity Plans for the 2026/27 financial year has now been agreed, improving visibility for the remainder of the period.
The figures have also been published during an active takeover process. On 5 September, Tulip UK Bidco, a vehicle indirectly owned by a Toscafund-led consortium, announced a recommended final offer for Spire subject to shareholder and regulatory approval.
The transaction places the latest operating results in a different context from a routine interim reporting cycle. Potential owners are assessing a business in which private-pay demand is growing, primary care is expanding and NHS activity remains significant but more variable.
The wider independent-healthcare market continues to be shaped by NHS waiting lists, employer interest in health benefits, ageing demographics and insurer behaviour. Those trends can support demand without removing pressure from staffing costs, medical inflation and hospital utilisation.
Spire’s first-half results show that higher private revenue was insufficient to compensate for the combined impact of weaker NHS activity and cost inflation. Performance in the second half will depend on improved commissioning, continued private growth and further savings while the proposed takeover progresses through its approval process.
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