35drive operating efficiencies, particularly within labour and procurement through local monitoring of KPIs and active contract management. This allowed us to continue to manage a reduction in corporate overheads as a percentage of revenue . Capital investment for the year was £50.6 million, including acquisitions totalling £6.1 million. Cash generated for the year was £170.3 million. Cash at bank and in hand at 2010 year end was £59.6 million The financial statements on pages 39 to 73 report the results of the business. The table below includes highlights of these statements.Spire Healthcare produced another year of strong revenue and profit growth with total revenue of £643 million, an increase of 3.7% over 2009. This converted into a 10.5% improvement in EBITDAR (pre-exceptional items), up from £153.6 million in 2009 to £169.8 million in 2010.Key financial highlights for the full year. Revenue grew by £23 million. This was partly a result of continued growth in out-patient and diagnostic activities through further investment in our diagnostic capability and an increase in the average revenue per discharge. This increased Spire's EBITDAR (pre-exceptional items) margin from 24.8% in 2009 to 26.4%. Other factors contributed to this improvement; for example, we continued to Group results2010 full year£m2009 full year£mGrowth%Revenue643.0620.03.7%EBITDAR (pre-exceptional items)169.8153.610.5%EBITDAR margin %26.4%24.8%To improve year-on-year comparability in measuring operating performance, our primary measure is EBITDAR (earnings before interest, tax, depreciation, amortisation and hospital property rentals).Group revenue and profit before interest and tax2010*£m2009£mGrowth%Revenue643.0620.03.7Group EBITDAR (pre-exceptional items)169.8153.610.5Rent(1.4)(3.2)Group EBITDA (pre-exceptional items)168.4150.412.0Integration and rebranding(0.4)(1.0)Reorganisation and set-up costs(1.1)(3.5)Corporate restructuring and refinancing1.6(0.5)Depreciation(45.8)(41.0)Profit/(loss) on disposal assets(0.0)(0.4)Profit before interest and tax122.7104.018.0*Full income statement is presented on page 43.

36Spire Healthcare Annual Review 2010Chief Financial Officer's statement continuedBorrowingsAt the end of 31 December 2010, net bank debt was £1,245.1 million (2009: £1,276.7 million). This comprised senior bank debt of £1,304.7 million (2009: £1,315.8 million), partially offset by cash in hand of £59.6 million (2009: £39.1 million). In addition, Spire has investor-funded loan notes of £601.8 million (2009: £537.2 million) and obligations under finance leases of £74 million (2009: £nil).Spire's borrowings are available under a number of term loan facilities, including operating company facilities of £293 million (2009: £310 million) and property company facilities of £1,078 million (2009: £1,075 million), repayable over the years 2014 to 2018. During the year £23.1 million of bank debt was repaid and £24.3 million was raised from finance leases and bank loan facilities. Further detail on borrowings is set out in note 15 of the financial statements.Loan facilities referred to above also include: . revolving credit facilities totalling £55 million (2009: £55 million), which are available to finance working capital requirements and for general corporate purposes . acquisition/capital investment facilities of £56 million (2009: £56 million) As at 31 December 2010, £17.7 million of the revolving credit facility had been utilised in the form of guarantees and letters of credit, leaving a balance available of £37.3 million (2009: £36.8 million), and £44.9 million drawn from the acquisition/capital investment facilities, leaving a balance available of £11.1 million (2009: £15.6 million).Profit before interest and tax for the year was £122.7 million, compared with £104.0 million in 2009. Integration and rebranding costs were £0.4 million, which related to activities associated with acquisitions.Reorganisation and set-up costs in 2010 were £1.1 million. These comprise costs associated with the new hospitals at Shawfair (Edinburgh) and Brighton and the cost of acquisitions in the year relating to The London Cognitive Behaviour Therapy Centres and London Fertility Centre.Corporate restructuring and refinancing of £1.6 million net, related to accounting adjustments following changes to lease terms, after charging £1.6 million costs incurred in respect of corporate financing.Cash flowThe business remains highly cash generative and cash flow from operations during the year was £170.3 million (2009: £146.8 million). Of this cash flow, £98.7 million (2009: £92.1 million) was used to meet the cash interest and other financing costs of Spire's borrowings. Capital projectsSpire's targeted capital expenditure programme is aimed at investing in new equipment that will enable us to increase capacity, improve service and drive additional growth through carrying out more complex procedures. In addition, we have spent capital on maintaining the infrastructure of our existing hospitals. All proposed capital projects are separately appraised, both operationally and financially, and Spire sets clear targets to help in assessing the viability and prioritisation of capital projects.