05The main focus for Spire in 2010 has been in expanding our facilities and range of services and our growth in this area is impressive. During the year we added a range of new services and increased capacity. This included opening our new £24 million hospital in Edinburgh (Spire Shawfair Park Hospital), acquiring London Fertility Centre and the majority share of The London Cognitive Behaviour Therapy Centres, creating four out-patient clinics and one theatre, and launching additional paediatric, cardiac, spinal surgery and fertility services.Engagement with doctors and our staff is always a high priority. Our bi-annual national Medical Advisory Committee Chairman's meetings were held in February and June 2010. They provide a valuable forum in which consultant representatives from our hospital teams across the UK can present their views and assist management in formulating clinical strategy. 2010£643m2009£620m2008£589m* Based on results presented on page 35.Revenue*I am pleased to report that 2010 was another successful year for Spire Healthcare. We were able to increase revenue by £23 million by continuing to focus on investments in our staff, clinical services and equipment. This revenue growth, aligned with our Group buying and purchasing power, enabled us to continue to improve profitability. As a result, Spire was able to record a £169.8 million EBITDAR (pre-exceptional items) with an improvement of 10.5% over 2009. This represents an improvement over the 2007 baseline results of 114.8%.Improved financial performance - despite the challenge of a global downturn - is testament to the management skills within the company and the hard work and dedication of everyone at Spire. These results have been achieved through our strategy of continuous improvement and investment in equipment, operating theatres, staff and new services, plus a true commitment to managing the performance of key components of the business: service quality, reputation, people and shareholder value, which are all monitored via a balanced scorecard.The private sector has an important role in the UK healthcare system and, within it, Spire is the second largest private provider of acute care hospital services. We have continued to stay focused upon our core business of private patients, while providing complementary services to the NHS. We believe the private sector will continue to expand in the UK, fuelled by uncertainty around NHS cuts in services, increased waiting times and an increasing desire from patients and doctors for advanced techniques and treatments. We also continue to work very closely with private health insurance companies and assist where we can in helping them to expand their product range and sales in the current environment.

06Spire Healthcare Annual Review 2010Chairman's statement continuedOver the last three years we have also worked to empower local management and give them autonomy. We believe this has led to higher levels of staff engagement and determination in hospitals to achieve set business goals. We are pleased to say that, during the year, we successfully increased our employees' level of engagement while improving once again on our financial results.I have announced my resignation as Chairman of Spire Healthcare and I am pleased to inform you that I will be handing over the reins of Chairman to Garry Watts, who has extensive experience in the private health sector. Garry was Chief Executive Officer (CEO) of SSL International, a consumer healthcare company, for six years and was previously its Chief Financial Officer (CFO). He has also been a director of Protherics plc and Celltech plc and was a member of the Medicines and Healthcare products Regulatory Agency supervisory Board for 17 years. I am confident that Garry will provide great support and guidance to the company as it drives forward in the years ahead. Robert Wise has stepped aside as CEO after more than three very successful years at Spire Healthcare. I would like to thank Rob for all his hard work and the success he has brought to the company, and am delighted that he has agreed to stay on with Spire as a Non-Executive Director. Rob Roger, who has been our CFO since the formation of Spire, stepped into the CEO role on 1 May 2011. Rob played a significant role in transforming the business into the strong organisation it is today and together he and Garry will provide the experience and stability needed to expand the company in the future. 2010£169.8m2009£153.6m2008£127.4m* Based on results presented on page 35 (pre-exceptional items).EBITDAR* (pre-exceptional items)* NHS acute Trust data; April 2009 - March 2010.Service qualityMRSA bacteraemia cases per 10,000 bed daysSpire HealthcareSpire Healthcare0.45C. difficile infection cases per 10,000 bed days NHS average3.6*NHS average0.5*0.17