Fresenius Medical Care AG American Depositary Shares (Each representing 1/2 of an Ordinary Share)

Ladies and gentlemen, thank you for standing by. I'm Natalie, your chorus call operator. Welcome and thank you for joining the Fresenius Medical Care Earnings Call Report on the first quarter 2022. Throughout today's recorded presentation, all participants will be in a listen-only mode. The presentation will be followed by a question and answer session. If you would like to ask a question, you may press star followed by one on your touchdown telephone. Please press the star key followed by zero for operator assistance. I would now like to turn the conference over to Dominic, Head of Investor Relations. Please go ahead.

Thank you, Natalie. As mentioned by Natalie, we would like to welcome you to our earnings call for the first quarter in 2022. We appreciate you joining today to discuss the performance of the first quarter and, of course, of the outlook. I will, as always, start out the call by mentioning our cautionary language that is in our safe harbor statement as well as in our presentation. and in all the materials that we have distributed earlier today. For further details concerning risks and uncertainties, please refer to these documents as well as to our SEC filings. We are aware that today is a busy reporting day with three German companies in the sector reporting. Therefore, we will try to keep the presentation short and leave time for questions. As always, we would like to limit the number of questions again to two. in order to give everyone the chance to ask questions. Should there be further questions and time left, we can go a second round. It would be great if we could make this work. Unfortunately, we are limited to 60 minutes for the call. With us today, unfortunately for the last time, is Reece Powell, our CEO and Chairman of the Management Board. Reece will give you some more color around the strategy and business development, and of course, also with us is Helen, our Chief Financial Officer, Chief Transformation Officer, and Deputy CEO, who will give you an update on the financials and the outlook. Before I hand over, I want to make sure that you all have in your diaries our next expert call on June 28th with Frank Maddox, our Chief Medical Officer, and Joe Turk, who has our home activities and is former president of Next Stage Medical. They will provide an update on how we are accelerating home growth. Further information is available on our website.

Rhys, the floor is yours. Thank you, Dominic. Welcome, everyone. Thank you for joining our presentation today. You will have seen the announcement yesterday, and Dominic has already mentioned that this will be my last earnings call, as I will now shift my focus to the handover for the remainder of this year. I think now I'm looking at somewhere around 41 or 42 earnings calls for me in the role as CEO and Chairman. I have thoroughly enjoyed my time discussing FMC with you, trying to answer your questions and guide you as best that we could as we took the journey through these 10 years together. Before I start with the quarter, I'd like to say a few words on the war in Ukraine. I am both touched and proud of our team there. Our colleagues are relentlessly continuing to provide for our patients, even risking their lives to continue to administer dialysis treatments under the most difficult of circumstances. It is admirable and it's heroic, and I'm very proud of these people. Although it has less focus in the media, the pandemic continues to be present, and the highly infectious Omicron variant has put a great deal of strain on our organization. I continue to be grateful to our entire team and our frontline workers in the clinics, our production sites and distribution centers for their continued, tireless work in what is an extraordinary situation for more than two years now. As flagged in our last earnings call in February, we were expecting a weak start into the year, driven by high excess mortality, as well as inflationary pressures in all spending categories for the company. January excess mortality was even higher than expected, and while we did see very significant declines in February and March, overall first quarter excess mortality was higher than we had assumed. Omicron affected us in multiple ways, particularly in our health care services business in North America. I will show you later Omicron caused infection rates to spike high in our patient population, and so we once again had to increase the number of isolation clinics, which led to additional labor costs in the forms of extra shifts, overtime, and hazardous pay. Due to its highly infectious nature, we had record absenteeism and sick leave as our employees either had to isolate for themselves or take care of their family members. Therefore, we had to employ more temporary and traveling nurses and other temporary staff in our services business. Additionally, we were short of employees in some of our manufacturing sites, as well as our delivery drivers, resulting in increased supply chain costs for distribution and logistics, in particular, in the products business. Additionally, we all see higher oil and energy prices leading to increased raw materials and logistics costs. We have a sizable negative effect, particularly on our product margins, which are already under inflationary pressures. Despite these significant adverse developments, we continue to progress in our FME25 transformation. We are also encouraged by the strong decline in COVID-19 infection rates that we have recently observed in February and March of the quarter. Consequently, we confirm our financial targets for 2022. We also continue to make good progress in several important strategic areas. The announced merger between Fresenius Health Partners, Interwell Health, and Cricket Health in March is an example of how we are executing on our 2025 growth strategy while also leading the market in value-based care. The new company, which will be fully consolidated by FMC and operate under the Interwell Health brand, will manage 100,000 lives. With the merger, we now target for 2025 to engage and manage the care of more than 270,000 people with kidney disease and manage roughly 11 billion US dollars of medical costs. We expect the transaction to close in the second half of this year. Despite the unprecedented and not improving labor shortage situation, and the resulting lack of training capacity for our home dialysis business, I'm glad to say that we've managed to keep our share of U.S. treatments in a home setting at a high level of slightly more than 15% through the first quarter. And as you know, when we need nurses out of our training facilities to go into clinics to provide treatments, we will do that, and that does put pressure on our training capabilities. We are making good progress on our sustainability journeys. As you know, we began the year by setting our global climate targets. We are now working on continuously implementing our target roadmap, and we will regularly report on our progress. We have also increased transparency on our sustainability activities. Our recently published non-financial report outlines the progress of our global sustainability program and highlights focus areas and measures we are taking to support our patients, our people, and the environment. This annual sustainability update includes more than 200 sustainability performance indicators. Turning to slide five. As you well know, we are very mission-focused at Fresenius Medical Care, and our number one priority is delivering quality outcomes for our patients. During the first quarter, we delivered approximately 13 million life-sustaining dialysis treatments to more than 343,000 patients. The absence of growth in the number of patients and treatments directly reflect the impact of the COVID-19 pandemic. While the number of clinics increased by 1% year over year, mainly due to acquisitions, it is important for you to note that sequentially the number of clinics has declined from Q4 2021 through the first quarter. Turning to slide six. This slide highlights our key quality indicators, which show the stability of clinical results in our patients receiving their treatments, as there is no visible COVID-19 impact on the quality that we are delivering. We continue to see stable anemia as well as bone and mineral metabolism control, demonstrating that our patients are receiving consistent, high-quality dialysis care even throughout the pandemic. I would ask you to note on the bottom of the chart, you can see we have now moved to days in hospital per patient year on a global basis. This is new. It's something I promised to do for you before I retired, and so let it be made known we got this done. And you can see the first quarter of 21, and then we've made some progress in the first quarter of 22. Moving on to slide seven. This slide compares the development of COVID-19. Match the emergence and spread of the highly contagious Omicron variant. We are extremely relieved to see that the infection rates have since come down almost as fast as they had previously spiked. We're back to the levels seen before the Omicron-related surge. With the substantial spike in confirmed infections in the month of January, we once again had to increase the number of isolation clinics, leading to additional labor costs in the form of extra shifts, overtime, hazardous pay. With 800 clinics, we had more than three times as many isolation shifts at the peak of Omicron in January than we had at the end of March when we were at 250 some odd isolation clinics. tremendous impact in that period of time with the infection. Turning to slide eight, COVID-19 related excess mortality significantly increased in January. Even though excess deaths came down strongly in February and March, excess mortality among our patient population increased to around 2,300 during the quarter. And thus, it did exceed the assumptions we had. However, The assumed full-year excess mortality range of 5,000 to 6,000 seems realistic to us at this point in time. Globally, since the start of the pandemic, excess deaths have accumulated to approximately 22,600. We expect that excess mortality in the second quarter will reflect a recently observed significant drop in our patient population's infection rates. Turning to slide nine, during the first quarter, we realized revenue growth was 3% in constant currency, supported by positive growth in both health care services and products. Unfortunately, that growth did not fall through to the bottom line, mainly due to significant increases in labor costs, further compounded by Omicron-related costs, as well as the significant costs we incurred in our supply chain in the first quarter. In addition, increased energy, raw material, and logistics costs are weighing on our product margins during the quarter. These substantial adverse developments were partially offset by an earlier than planned partial reversal of an accrual related to a revenue recognition adjustment for accounts receivables and legal dispute. So with that, we were able to deliver the quarter in line with our original expectations. We had assumed in our guidance support from the U.S. Provider Relief Fund for our wholly owned entities would help with the compounded labor costs, but those funds have not yet been distributed, and therefore they did not offer us any opportunity in the first quarter. On a net income, excluding special items, declined by 23% on a constant currency basis. During the quarter, we had 33 million euros in FME25-related costs and a €22 million negative impact related to the war in Ukraine. Both numbers relate to operating income and are reported as special items. And now it's my pleasure to turn it over to Helen. She'll walk you through the financials and the outlook.

Thank you, Lee. And hi, everybody. I'll pick up with the regional developments on slide 11. First of all, with organic growth of 2%, it is good that we are seeing a sequential slight improvement in same-store growth. In North America, revenue increased by 9%. Constant currency growth of 2% was supported by the earlier-than-planned reversal of an accrual of around €20 million on the net income level that Rhys has just mentioned. The adverse COVID-19 impact on the healthcare services business clearly had a negative impact on the development in the quarter. Therefore, organic growth was flat. Revenue in the EMEA region increased by 1%. At constant currency, this 3% growth was mainly due to organic growth in the healthcare services business, which was achieved despite the negative impact of COVID-19. In Asia Pacific, revenue increased by 8% in the first quarter, At constant currency, the 4% growth was mainly driven by organic growth in the healthcare products business. And Latin America revenue increased by 15% in the first quarter, mainly driven by strong organic growth in both the healthcare services and healthcare products business. Moving to slide 12, healthcare services delivered revenue growth of 3% in constant currency, mainly driven by organic growth, which was achieved despite the adverse impact of COVID-19, the already mentioned partial reversal of an accrual, and contributions from acquisitions. While same market treatment growth is still negative, it has improved a bit compared with the fourth quarter. Once again, Asia Pacific stood out as a positive regional contributor, delivering positive same market treatment growth of around 2%. In healthcare services, the adverse impact from COVID-19 related excess mortality on organic growth amounted to approximately 290 basis points. Turning to slide 13, revenue for our healthcare products business also increased by 3% in constant currency, driven by higher sales of incentive disposables and pharmaceuticals. This was somewhat offset by lower sales of machines for chronic treatment. Turning to slide 14, Here we show the operating margin development for the first quarter. With 180 basis points, the largest impact on margins year over year relates to adverse developments in business growth, driven by the already mentioned negative effects of COVID-19 on the utilization of our clinics and downstream assets. The difficult inflationary environment impacted the margin with 80 basis points year over year, the continued high labor costs were further increased by the negative effects from Omicron, which required the operation of more isolation shifts and clinics. Increased supply chain costs and the general macroeconomic inflationary cost increases in areas such as raw materials and freight are only examples of cost increases every company is currently experiencing, and this added to the unfavorable margin development in the quarter. Unfortunately, these headwinds more than offset the positive impact from higher average reimbursement rates, increased treatment volumes, as well as the first contributions from our FME25 transformation program, consisting of initial savings from our reorganization towards the new operating model. Turning to special items, we incurred 33 million Euro in costs related to FME25, resulting from the reorganization towards our new operating model. And of this amount, approximately 19 million euro was recorded in corporate and around 13 million euro in North America. In the first quarter of this year, we also had negative impacts of 22 million euro related to the war in Ukraine, consisting mainly of bad debt expense in Ukraine and Russia. These costs have been treated as special items. And over the next few months, we will have to observe and assess, excuse me, in more detail how our future business operations in both of these countries will develop and what scenarios may arise. The sequential 210 basis point deterioration of the operating margin compared to the fourth quarter of 2021 was impacted by COVID-19 related excess mortality that has continued to accumulate. This development shows the magnitude COVID-19 continues to have on our business. Turning to slide 15, you will recall the list of tails and headwinds and related assumptions for the impacts that were provided to you in February so that you could understand what went into our 2022 outlook. I would now like to give you some color on where we stand with the most important assumptions. As Rhys described in detail, this has been a tough quarter for us. Another way of explaining the quarterly development to you is to explain how most of our tailwinds and headwinds already impacted the quarter. As mentioned on the previous slide, business growth was negatively impacted by a number of reasons, with excess mortality being a sizable negative driver. In the further course of this year, we continue to expect a material tailwind from business growth based on organic growth and leveraging up our infrastructure. further penetration of home treatments, and the expansion of our value-based care arrangements. FME25 savings already amounted to approximately €9 million. We expect the quarterly savings to step up in the next quarters as we proceed further with the implementation of FME25, and we are well on track to reach the guided range. Turning to the outlined headwinds, we continue to expect COVID-19-related excess mortality of 5,000 to 6,000, we assume that the first quarter will have had the biggest impact. Accordingly, of the roughly 100 million euro negative impact we anticipate for the full year, approximately one-third of this headwind was affecting the first quarter. The number of patient-facing open positions in the U.S. has increased by around 1,000 further openings. While this has helped us to counterbalance and reduce the impacts from significant wage inflation, Omicron-related additional overtime and hazardous pay, this is not the way we plan to continue in the next quarters. We clearly target to reduce the number of open positions significantly over the course of the year. To mitigate the impact on the future cost base, we focus on one-time measures like retention payments, but also have to accept that new hires might come in at higher compensation levels. Our full-year assumption, which includes provider relief funding remains that we will have 100 million Euro higher costs beyond the typical 3% wage inflation. Should we receive provider relief funding in excess of our assumptions for our wholly owned subsidiaries, we will apply this to ease at least some of the pressure in our labour market situation with measures like the mentioned retention payments. This will be neutral to our guidance. As we did not have costs related to a ballot initiative in 2021, the potential ballot initiative in California could translate to a 20 to 30 million euro headwind. So far this year, an amount of approximately $1 million has been spent on efforts to defeat the ballot initiative. For the unfavorable macroeconomic inflationary environment and the elevated costs in the supply chain, we had put in a headwind assumption of 50 million euro. This was prior to the war in Ukraine accelerating the macroeconomic inflationary environment. In the first quarter, we've experienced a headwind of 16 million euro. This is likely to be an increasing challenge for us, as for all other companies, and we are looking to accelerate some of our savings initiatives to compensate for the resulting effects. Moving to slide 16. During the first quarter, we generated operating cash flows of 159 million euro. which equates to 3.5% of revenue. The decrease was mainly driven by the continued recoupment of the U.S. government's advance payments, initially received in 2020 under the CARES Act, and a decrease in net income, partially offset by a favorable impact from trade accounts and other receivables from unrelated parties. €170 million was recouped in the first quarter of 2022. With the recoupment of funds in our lower EBITDA our net leverage ratio of 3.5 is within our target range. I'd like to continue with slide 18. Despite the significant Omicron related adverse developments, we were able to deliver a quarter that was in line with our original expectations. Given the significant drop in excess mortality in February and March, we reiterate our guidance and continue to expect low to mid single digit revenue and net income growth on a constant currency basis and before special items. I would like to flag to you that based on our current discussions with our auditors, we are likely to adopt hyperinflation accounting at our Turkish subsidiary from the second quarter onwards. From today's point of view, we expect this to have a low to mid double-digit million euro impact on operating income in the second quarter and would be treated as a special item. That concludes my prepared remarks, and I will now turn back over to Dominic to begin the Q&A.

Thank you, Rhys. Thank you, Helen, for your presentation. I will now turn back to Natalie to open the Q&A. I look forward to your questions.

Ladies and gentlemen, at this time we will begin the question and answer session. Anyone who wishes to ask a question may press star followed by one on the touchdown telephone. If you wish to remove yourself from the question queue, you may press star followed by two. If you're using speaker equipment today, please lift the handset before making your selections. In the interest of time, please limit yourself to two questions only. Anyone who has a question may press star followed by one at this time. One moment for the first question, please. And the first question is from the line of Patrick Wood from Bank of America. Please go ahead.

Perfect. Thank you very much for taking my questions. I'll give it to you, please. First one is just, you know, obviously with input cost inflation and wage inflation being challenging, how do you think, you know, mid-term, I know it's always tricky to answer this question, but whether CMS or, you know, the exchange plans or the private providers and the managed care side of things will look at compensating the dialysis industry and I guess the others as well for that? And I guess some of that is connected to their ability to then pass pricing themselves on to keep MLRs in a good place to their customers. So just trying to think about how much can also ultimately in the following years be passed back up the chain by you guys. I'm just curious how you're thinking about that midterm. So that's the first one. And then the second one, apologies if I missed this, but it's the first sort of quarter where we've seen a little bit more of a reversal in the clinic base, at least sequentially, obviously not year on year. Just curious, you know, is that connected to FME25? Is that looking at the base in general and just thinking there's some efficiencies you can take out? Just any kind of color around that would be really helpful.

Thank you.

Hey, Patrick, it's Rhys. I guess I'll take both of those. On the cost inflation and midterm, what might we see or hear from payers? I think we'll have to kind of separate the payers out. You know, there's the mechanism for the government payers on, you know, Medicare fee for service. The cost reports are going to drive at a two-year lag what reimbursement we'll look at as we go through time. And I do believe that, you know, the rates are going to – I think they have to go up given the inflationary things that we're dealing with. Now, I think it gets a little trickier when we think about commercial payers and where that may go. I think that's going to come down to negotiations and how we approach – the impact that inflation is having on us, and then what impacts do they see, and we'll have to work our way through that. But I think there's got to be a reality factor here that people understand that we're going through the highest inflation, particularly in the U.S. at the moment, but really worldwide, that we've had in years, and we can't just sit there and act like it's not happening, and we don't intend to do that. So I think there will be some outcome of this for sure. And then as far as the reversal of the clinics, I think we – are simply signaling that we are looking at our clinic base, we're analyzing what we're doing. There'll be some of that, I think, Helen, that goes into FME25, and some of it is just the situations that we're in right now. If we don't need clinics, you know, if we just don't have a reason for them, given the pandemic and what we're seeing and the impacts there, we can easily kind of cut back on some of those, and obviously home plays into that as well. So, I wouldn't read a big, big trend into it, but I would just say it's kind of reality setting in, if you will, and how we're going to manage it.

I appreciate the answers. And sorry to see you go, but hopefully you can reset after a very intense sort of seven, eight years. Thanks. Thanks.

The next question is from Oliver Metzger from AutoBHF. Please go ahead.

Hi, good afternoon or good morning. Two questions regarding the three-way merger. So value-based care is currently structured by 80,000 end-stage renal disease and 20,000 chronic kidney disease if the merger is done. You want to plan to go from this 100,000 patients now to 270,000 in 2025. So could you elaborate about the underlying assumptions and how the split between CKD and ESRD is assumed still in this 80 to 20 mix, or what's your assumption? Second question, in your last call, you specified the compensation for value-based care as 100 basis points of medical customer management. The amount is expected to increase also with, for example, a merger from 6 billion in 2022 to 11 billion in 2025 with this merger. So as Crickthouse's focus primarily is on CKD, while your focus is on E3D, can you elaborate on the respective margin potential? Do you still regard the 100 basis points target as realistic for the new entity?

Oliver, I'll take a shot at your first question, and Helen will pick up your second question. So if you think about that growth of 100,000 to 275,000, remember that the opportunity in the CKD space is about two to three times larger in terms of the lives of patients that you could impact versus the stage five patients. So a lot of that growth. from 100,000 covered lives to 275 is going to revolve around the CKD population and the fact that there's just so many more opportunities there. I think it's too hard to try to give you a complete split CKD to ESRD at this particular point in time since that's a little bit out in time, but we can work on that. But that's what's really driving it. It's just the size of the opportunity when you think about stage 3 and 4 patients versus stage 5 and then none. I'll turn it over to you on the medical cost under management, please.

Yeah. Hi, Oliver. Hope you're well. As we think about the medical cost under management, yes, we see that as, you know, kind of around that 1%. We still think that makes sense to us in FIX, and obviously over time we would be looking to see how we could improve that. But I think 1% for modeling purposes is a good number to use.

Okay, great. Thank you very much and wish to you all the best for your future. Thank you, Oliver. Thank you very much.

The next question is from the line of Tom Jones from Berenberg. Please go ahead.

Good afternoon. Thank you for taking my two questions, one hopefully for each of you. The first one, for Helen maybe, at Q4 you very helpfully gave us some idea of the percentage of net income you thought you were going to generate in Q1. I was wondering if you could give us some colour on how you expect the phasing of net income to pan out in the coming quarters. I think that steer you gave us at Q1 was pretty helpful and wondered if you might do the same for Q2. And then the second one is... Maybe it's... a big picture question, really, for Rhys. But, you know, we're all very much focused on mortality in your clinics and cost inflation that you're having to deal with. But you're the sort of 500-pound gorilla in the industry, not you personally, obviously. So, you know, you are much more capable of dealing with these pressures than a lot of the smaller operators and smaller product manufacturers in the industry. So I'm just kind of wondering... how you think the whole thing shakes out long term. Are there any kind of changes you think that will come in the industry that over the medium and longer term, once we get over the current challenges, will actually fall out in FMC's favour? It would be interesting just to feel how you're thinking about the longer term for the industry as we move forward.

Hi, Tom. I'll take the first question, as you expected. I won't give you the percentage for Q2, but I think what you can expect is half two will be better than half one, and obviously we expect to improve on that profitability by quarter as we go through the year, ramping up as we get to the back half of the year. It's probably the best I can provide color to on that for now.

Fair enough. Tom, nobody's ever called me a 500-pound gorilla before. Just for the record, I've lost about 20 pounds there. Look, I think it is going to be an interesting time for the industry as we come out of COVID. And I think, you know, how synergistic might it be that we're coming out of COVID and inflation stays up? If those separate and, let's say, people get, you know, get really focused on inflation, bringing it down to Fed, ECB, or whatever, it might not be – as tough as I kind of think it is going to be. I think we're going to see some dropout of the smaller providers. I think it's going to be really hard. And the biggest thing is just simply burnout. I mean, I just think two and a half years into this, there are physicians and, you know, caregivers that are just really going to struggle with, you know, now what are we doing if inflationary pressures stay as large as they are? I still think home is going to be hot, hot, hot. I think it's really going to be something that's going to grow and take off. And I think we're probably going to see some creative deal structures. We're going to see some movement in people trying to band together where they can cover their weaknesses by who they might partner with. Now, that's not a read across to why we did our merger, if you will, but it's People have got to get out of this idea that they can buy everything they need and it's all going to be okay. Sometimes, and I've learned this the hard way, Tom, you've got to partner with somebody that knows more about something than you do, and you've got to bring your value to the party, and they've got to bring their value to the party. And I think that situation we're in right now is going to drive some of that as we go out through time on this. But it interests me greatly, and it's probably something I'll sit around and think about when – walking around as a 500-pound gorilla, Tom. Good.

And all the best for the future, Rhys, and well done over the last years. It's been a challenging 10-year period for the company, but we'll miss you.

Thanks, Tom. I appreciate that.

The next question is from the line of Graham Doyle from UBS. Please go ahead.

Thanks for taking my questions, guys. Just two from me. So, firstly, just on the cost-saving side of things, so It looks like you've, as you said in the presentation there, delivered something like a 20 basis points improvement, which is clearly at the bottom end already of your guidance for the full year. So it would be good to get a sense of what you've done thus far to deliver that. And maybe, you know, should we be thinking at the upper end of the range for this year? And then just a second question. So obviously we've seen we're basically a change at the top of the business. but we've got targets set for 2025 and a strategy set for that. So would you be able to maybe comment on the sort of continuity around that and how the market should be looking at that as well? Thanks a lot, guys.

Go ahead with your question on the cost improvement specifically around FME25.

Exactly, yes. Obviously, it looks like it's off to quite a good start in Q1, and it doesn't leave much work to get to the middle of the range for the full year of 2022. So I suppose, should we be looking at the top end of the range for 2022 in terms of cost savings?

Yeah, thank you for clarifying. Yes, we are off to a good start. I think we've seen some early savings from some of the initiatives that we had already started, particularly in some of the GNA functions, like, you know, kind of technology and procurement areas. But we're also starting to see some savings come through from, you know, the kind of the clinic operations, as an example, and the restructuring around the operating model. Clearly, we are, you know, Looking to see what we can accelerate all the time. You know, some of the labor situations, obviously with consultation with workers' councils and things like that, make sure that we can only move at a certain pace. But nothing that we're overly concerned about. We are looking to lever, you know, we have a lot of initiatives and we are looking to lever them all as quickly as possible. Our expectation right now is that that will ramp up over the year. And clearly, as you see, the inflationary measures that we're dealing with are going in the wrong direction. We would hope that if we can accelerate, it would at least countermeasure some of the challenges that we are seeing there. But I do think we are encouraged with how the transformation is going and our ability to you know, to be able to book savings into one, but truly in line with our expectations on the phasing that we had.

Yeah, Graham, it's Reece. So let me see if I can walk a fine line here. Look, I would say this. The business is going to do just fine with me not being around. So I think the targets that we've set and the way we vetted these targets among the management board and we presented them, to our employee base, and to the supervisory board. I can truly sit here right now at this moment in time and tell you that, you know, 23, 24, and 25 will be over in the blink of an eye. It goes really quick. And so I think that, you know, Carla's going to come in and take her read. She's going to work with this great management board, and they're going to figure out what they want to do. But I tend to think it may be a little far-reaching, more like five years, seven years out, because we have a lot of work to do to get to where we wanted to be in 25, and I think we will stay that course to try to get there. But make no doubt about it, there will be, I'm sure, some shifts in strategy and some different thinking. We'll have to react to the world that we're in as we look a little further out, you know, five, seven years or whatever. But that's what my experience would tell me might be the way this plays out. But we also have to leave that open for, for crawlers to come in and get their feet on the ground and start thinking about this as well.

Okay, thanks a lot. I really appreciate that, and best of luck, Rhys.

Thank you.

The next question is from a line of David Edlington from JP Morgan. Please go ahead.

Thanks very much, and heads up. First up, Rhys, thanks for all your help over the last 10 years. It's been a pleasure, and I hope you get some time to catch a lot more fish. Just in terms of on the questions on the wage inflation, I just wondered what you're seeing at the moment in terms of percentage wage increases and how that compares with your original expectations and what you assumed in your guide. And then secondly, in terms of one thing you've given this last few quarters, not in this quarter slide, is where your vaccination rates have got to, please.

Helen, you want to take one and I'll speak to two.

Yeah, happy to do so. Hi, David. Yeah, the whole topic of labor inflation, as we know, is quite complex and a lot of moving parts. And why, when we gave guidance, we talked about a net increase of, I think, around about 5% at that time, kind of net to the three. As you can appreciate with what we experienced in Q1, we have favorability from open positions, which has been offset by, the higher infection rates with Omicron and the isolation clinics and covering employee absenteeism and so on. And then higher costs from temporary labor, shift premiums and overtime, for example. I think for us, obviously what we're keeping a mindful eye on is what measures do we need to put in place that are helping to overcome the challenges but that are more temporary in nature for 2022. which is things like retention measures, for example, or one-time sign-on payments, versus permanent measures, which are more the things that we're seeing on wage compression as we fill those positions. So I think we'll see the labor pressure ramp up over the course of the year, but it is in line with our guidance expectations. as we rethink about that, obviously with some offset from relief that we still expect to get. So, yeah, quite a complex story on labor, but I think we have our arms around it as we see it today and kind of still holding to that percentage that we had given last quarter.

Hey, David, thank you for your best wishes, and I'll send you some pictures, okay, some big fish pictures down the road. Vaccination rates, so on the patient side of this, we're at about 81%, up just a little bit from the other quarter slightly. But I'm happy to report on the employee side, we're at 96%. So we've had significant improvement there. And as we all know, the multi-million dollar question will be, is there going to be another surge in the fourth quarter? And so we're going to continue to push. We are still trying to get patients vaccinated. We're in a good place with employees, but... We never say never, so we're just going to keep pushing it as best we can. But there's an awful lot of fatigue out there, as you can imagine, on getting vaccinated.

Sure, thank you. Maybe just to have a quick follow-up on the open positions, Helen. I think you mentioned an extra 1,000 this quarter, so that takes you up to about 7,000, is that right? That's right. And are you seeing, that's obviously a net figure in terms of people lost and people gained. Are you seeing a higher level of turnover currently than you would normally see, and What impact does that have on training the new people that are coming in?

Yeah, I appreciate the challenges that you're putting out there. That's exactly what we're seeing. However, I would say that we are starting to make a dent into the filling of the positions. We have some best-in-class employee referral programs, our recruitment, going to campuses. recruiting directly. So I do feel that we're making an impact. And, you know, hopefully next quarter we'll be talking about, you know, the positions that we – we would hope that we're at the peak at this point. It would start to come down from here.

We have some people coming back. Some people come back. We're actually rehiring some people. I think they've had a chance to clear their head and you know, rethink about what they want to do. So that is beginning to happen for us as well. And that's great if we can do that.

Thanks so much, guys.

Thank you.

Thank you.

So there are no further questions at this time. And I hand back to Dominique for closing comments.

So that's great. That was fast. Thank you. Sticking to two. That was, I think, one of our last reports. Thank you very much. And As it was Reese's last call, I don't say goodbye. I'll hand over to Reese.

Thanks, Dominic. Listen, it's been a pleasure. Some quarters more than others, I might say. But I just want to wish you all well, and I appreciate the interest you've had in the company. And when you supported us, I appreciate it. And when you disagreed with us, I understood it. But I wish you all very well. Stay healthy. And you guys just enjoy what you're doing. Thank you.

Ladies and gentlemen, the conference has now concluded near my disconnected telephone. Thank you for joining and have a pleasant day. Goodbye.