17Spire Healthcare's customer proposition and strategyWith three years of strong growth across all areas of the business, our strategy has proven to be successful.We continue to expand the volume and range of services offered by our hospitals, focusing on working collaboratively with consultants, with the goal of delivering the highest clinical standards and premium patient services, supported by investment in our staff and facilities. Consultants are our most important stakeholders. Our aim is to provide them with the best service in every region where there is a Spire hospital and, in so doing, to deliver the best private healthcare experience for patients.Growth and innovationOur focus on investing in innovative treatments and services in areas of high demand continues to stimulate revenue growth. Pathology is a particularly strong area, delivering a solid return on our two years of capital investment in advanced facilities and equipment to develop a high-quality, efficient network of laboratories that offer a range of electronic reporting systems. This includes a web-based results service that reduces turnaround times and enhances customer service. In 2010 we secured external contracts with a wide range of third parties and this success has continued into 2011, with a number of large and smaller opportunities in development. 26.4%20102008200921.6%24.8%Key performance indicatorsImprovements in EBITDAR (pre-exceptional items)2008£127.4m2010£169.8m2009£153.6mIncreasing EBITDAR margin (pre-exceptional items)

18Spire Healthcare Annual Review 2010Business review continuedThe restructure has resulted in consultant satisfaction increasing, the hospital taking on more complex work and there is now a waiting list to join our team.""