Assura : Annual Report 2024 F

Enabling better health outcomes

Assura plc Annual Report and

Accounts 2024

Assura plc

Annual Report and Accounts 2024

Highlights

Operational

5%

uplift in rent roll from activities completed

5

new development completions

10.8 yrs

WAULT maintained through portfolio activities

8

asset enhancement capital projects completed

A-

investment grade credit rating reaffirmed by Fitch Ratings Ltd

Strategic report

Governance

Financial

3.4p

EPRA EPS

3.2p

dividends paid in the year

2.3%

average cost of debt

13.2%

EPRA Cost Ratio - amongst the lowest in listed UK real estate

49.3p

diluted EPRA NTA

Financial statements

Additional information

ESG: The Bigger Picture

1.9m

annual kWh saved from 45 energy efficient upgrade projects in our portfolio

£3.40/£

social value generated from community activities

728

volunteering hours, with 90% of employees participating

Top 10

performer in FTSE 250 Women Leaders 2023 review

AA

MSCI ESG rating maintained, and EPRA Gold award received for sustainability disclosures

Assura plc

Strategic report

Governance

Annual Report and Accounts 2024

Contents

Strategic report	Governance
1	Introduction	72	Chair's introduction
2	Assura's role in the future		to governance
	of healthcare	75	Our governance framework
3	Enabling better health outcomes	76	Board of Directors
7	A balanced portfolio	80	Key Board activities
8	Chair's statement	82	Q&A with Louise Fowler
10	CEO statement	83	Nominations Committee Report
13	Spotlight: The Bigger Picture	86	Audit Committee Report
14	Our market	88	ESG Committee Report
18	Investment case	90	Directors' Remuneration Report
19	Our strategy	107 Directors' Report
25	Spotlight: Private asset in Guilford	109Directors' Responsibility
26	Our business model		Statement
28	Our key performance indicators
35	CFO review	Financial statements
39	Stakeholder engagement	110	Independent Auditor's Report
	and impact	118	Consolidated income statement
52	Our environmental impact	118	Consolidated balance sheet
59	Principal risks and uncertainties	119	Consolidated statement of
67	Compliance statements		changes in equity
		119	Consolidated cash flow
			statement
		120 Notes to the accounts
		133 Company financial statements

Additional information 136 Appendices

139 Glossary

142 Corporate information

More information

This report forms part of our year-end reporting suite.

Our website includes our year-end results presentation, sustainability disclosures and investor fact sheet.

We have also published our Net Zero Carbon Pathway.

Financial statements

Additional information

1

Enabling better health outcomes

As the specialist healthcare property investor and developer, Assura play a vital role in helping our customers deliver essential health services across the UK and Ireland.

We leverage our unique understanding of the challenges facing the healthcare sector, and our two decades of experience, to deliver modern, high-quality spaces that support a healthy population.

WE DO THIS THROUGH:
Sharing our expertise	Partnering to deliver
and knowledge	innovative solutions
READ MORE ON PAGE 3	READ MORE ON PAGE 5
Improving access to	Focusing on social impact
local health services	and sustainability
READ MORE ON PAGE 4	READ MORE ON PAGE 6

Assura plc	Strategic report	Governance	Financial statements
Annual Report and Accounts 2024

Assura's role in the future of healthcare

There is a critical need for investment in infrastructure in the healthcare system. As the largest developer of GP surgeries, healthcare, diagnostic and treatment buildings in a community setting, and a trusted partner in providing the right estate solutions for private healthcare providers, Assura has a vital role to ease the pressures faced by the system.

READ MORE ABOUT HOW ASSURA ENABLES BETTER

HEALTH OUTCOMES ON PAGES 14 TO 17

Additional information

2

How healthcare estates support better health outcomes
01	02	03
Demand for care	Meeting the need	A lever to help reduce
	for investment	health inequalities

04

A net zero carbon future

With an ageing population and increasingly complex health conditions, pressure on the health system and waiting lists is growing. Community healthcare buildings can enable a greater range of health providers and services, creating extra capacity in the system.

A significant proportion of the NHS estate is not fit for purpose, and the maintenance backlog continues to grow. Significant investment is needed now to facilitate better health services.

Areas of greatest health deprivation have more patients per GPs, shorter appointment times and slower recovery times. Investment in the health estate in these areas can improve GP recruitment and allow a greater range of health practitioners to operate.

Investment in energy efficient building upgrades can reduce operating costs for occupiers, as well as reducing the carbon footprint of operations.

READ MORE ON PAGE 15

READ MORE ON PAGE 15

READ MORE ON PAGE 16

READ MORE ON PAGE 17

Assura plc

Annual Report and Accounts 2024

Strategic report

Governance

Financial statements

Additional information

3

Enabling better health outcomes

Sharing our expertise and knowledge

Our market expertise, longstanding relationships and proven track record - combined with our development and asset enhancement capabilities - make us an attractive partner to the healthcare market.

READ MORE ON PAGE 46

Assura plc

Annual Report and Accounts 2024

Strategic report

Governance

Financial statements

Additional information

4

Enabling better health outcomes

Improving access to local health services

We work together with customers to deliver bespoke health centres that meet the evolving needs of local communities. Assura is best placed to respond to these healthcare needs, taking the pressure off the healthcare system and ensuring our customers can do what they do best - deliver essential healthcare services.

READ MORE ON PAGE 40

Assura plc	Strategic report	Governance	Financial statements
Annual Report and Accounts 2024

Enabling better health outcomes

Partnering to deliver innovative solutions

We unlock the power of design and innovation to provide customers with state-of-the-art spaces to deliver diagnostic, specialist treatment and mental health services. We are continually evolving our offer, leveraging our expertise to meet changing healthcare needs and tackling the challenges of access to local services and health inequalities.

Additional information

5

READ MORE ON PAGE 25

Assura plc

Annual Report and Accounts 2024

Strategic report

Governance

Financial statements

Additional information

6

Enabling better health outcomes

Focusing on social impact and sustainability

Our goal is to become the number one listed property business for long-term social impact and sustainability and to have a net zero carbon portfolio by 2040.

Our ESG strategy 'The Bigger Picture' sets out our ambition for a Healthy Environment, Healthy Communities and Healthy Business.

READ MORE ON PAGE 52

Assura plc

Strategic report

Annual Report and Accounts 2024

Governance

Financial statements

Additional information

7

1. balanced portfolio

HEALTH FACILITY, KETTERING

Facts and figures

614

properties

6.4m

patients served by our buildings

2040

net zero carbon target date

£542m

total development pipeline

Regional portfolio

1

2 9

3

10

4

8

6

7

5

Value of properties by region

		>£10m	£5-10m	£1-5m	<£1m
1	Scotland	50	20	23	-
2	North East	167	141	247	8
3	North West	198	58	62	3
4	Midlands	127	164	200	4
5	South West	78	39	88	5
6	London	116	82	146	2
7	South East	73	155	208	9
8	Wales	-	47	81	1
9	Northern Ireland	-	14	5	-
10 Ireland	23	-	9	-

GO TO OUR WEBSITE FOR THE LATEST

INFORMATION ABOUT ASSURA

Assura plc

Annual Report and Accounts 2024

Strategic report

Governance

Financial statements

Additional information

8

Chair's statement

Delivering growth for our shareholders

Dear shareholder

I am pleased to be reporting to you on another year in which we have delivered for all of our stakeholders - delivering new buildings for health services, delivering building upgrades and sustainability improvements, delivering social value through our community initiatives and delivering growth for our shareholders.

The delivery of health services in the UK is

a subject which is so often front and centre of the political agenda and is incredibly important to the population of the UK. The NHS faces many challenges: long waiting lists, an ageing population with increasingly complex health needs, budgetary pressures, ageing infrastructure and a wave of medical and technological innovations. All of these will need to be addressed in the coming years.

Whilst the NHS continues to be a system of which we, in the UK, are rightly proud, it is also a system that needs help to continue to adapt and deliver the changes a fit-for-purpose health service requires.

There are many improvements that can be made to achieve this. Moving services out of hospital into a community-setting. Shifting the focus to prevention from treatment. Investing in an estate which has a growing maintenance backlog. Training the staff needed to deliver the healthcare of the future. Harnessing the power of digital delivery and access. Thinking about sustainability as an investment for improved long-term cost efficiency. All areas that can be enabled through Assura's expertise and experience.

Increasingly, the NHS is supported by, or patients choose to be seen by, the private sector. Embracing the help of the private sector from capacity to expertise can enable the health system as a whole to become more efficient. Jonathan's CEO Statement covers why we consider private assets, and those in broader healthcare markets, as attractive investments. What is most important is that patients get early diagnoses and then are treated promptly and efficiently - something that Assura enables by creating standout quality facilities that provide capacity to support high quality patient care and improved patient outcomes.