Smith & Nephew plc
Q4 2011 Earnings Call Transcript

Published: 2 Feb 2012

[Olivier Bohuon:]

Good morning, everybody. So as you know, I'm Olivier Bohuon. I'm the Chief Executive Officer of Smith & Nephew, and I welcome you to our fourth quarter and my first full year result presentations. I will speak about our results for the fourth quarter and then hand over to Adrian to take you through the numbers. When Adrian is finished, I will come back and update you on the progress we're making against our new strategic priorities and some thoughts for 2012. As usual, we'll take questions at the end of the formal presentation. So we finished 2011 well. For the year, our revenues were up 8% reported and 4% underlying to nearly $4.3 billion. All our business units contributed to this growth. In Orthopaedics, we led the market in knee growth and delivered a solid performance from our traditional hip portfolio. Trauma had a more mixed performance. I will talk more about what we're doing to change this in a few slides. Our Endoscopy business performance reinforced my belief that minimally invasive joint repair is a good market to be in and a great market to lead. It offers scope for more innovation and obvious benefits to patients and payers. For the third year in a row, Advanced Wound Management is our fastest-growing business, exceeding this year $1 billion in revenues for the first time. Our successful entry into negative pressure market is a major driver, but we should not forget that our larger advanced wound care business contributes also significantly. We finished the year with a good margin of 22.5%, and we're now well into our action plan to increase this. The generation of cash is a clear sign of a healthy business and we generated free cash flow of over $0.5 billion. I joined Smith & Nephew in April last year. As its full year results demonstrate, the company has strong foundations. In August, I set out our strategic priorities. These are necessary to ensure we are growing faster, better balanced and are fit and effective for the future. 2011 was the start of this journey. 2012 would be a year of balancing the delivery of these priorities while managing our more immediate operational challenges and opportunities. Later in the presentation, I will provide an update on our actions against these priorities. Our Q4 revenue were up 4% to $1.1 billion, an underlying improvement of 3%. The overall trading environment in Q4 was roughly similar to what we have seen in Q4 -- in Q3, I'm sorry. Our trading product margin was 25.2%, exceeding the 24% commitment we made last quarter. As I said then, we'll take the actions necessary to ensure all areas of our business maximize their growth in margin. Adjusted earning per share were $0.219, an increase of 1% on last year's $0.216. We have proposed a final dividend of $0.108 per share, up 10% on prior year. Adrian will give you a detailed analysis of our revenue and margin performance in Q4. I was just picking out the most relevant points. On the first slide, on the Orthopaedic business. Ortho revenue in the quarter were flat on Q4 last year. This is a solid performance against a background of a challenging market and a tough comparative period. Market conditions, including pricing trends, are broadly consistent with those we saw in the previous period. Overall, we think the global reconstruction packet growth was, again, only marginally positive. Global knee growth was at plus 2%. This continues to be a market-leading performance, however, at a slower pace. The very strong full launches of our market-leading VERILAST and VISIONAIRE products are now annualizing. Trauma growth declined 2%, and would have been flat excluding the U.S. royalty payment expiring. Some of this performance reflects a strong comparable. However, we believe we should do better, and during the quarter we appointed new management team charged with achieving this. Turning to our Endoscopy business. Sales in Endo grew strongly as Europe delivered again another good performance. Growth in sports medicine repair sales was double digit. During Q3, we widened the launch of FAST-FIX 360, the next generation of our leading meniscal repair system. As anticipated, this received a positive response from surgeons and our knee franchise improved materially. Resection of blades also had a good quarter. Our new range of DYONICS PLATINUM blades are now making a valuable contribution to the growth. Turning now to the Advanced Wound Management. Our Advanced Wound Management business grew revenue by 8% in the quarter, more than double the market rate at around 3%. One of the most pleasing things for me about the quarter has been the continuation of our rate of product lunches, 10 in the quarter after 11 launches in Q3 for a total of 35 new launches in 2011. This rate of new product introduction and line extensions will continue into 2012. Of the launches in Q3, DURAFIBER and PICO, in particular, contributed to the European performance as well as a weak comparative. Our negative wound therapy franchise achieved strong revenue growth across all regions. In the U.S., we saw significant conversion activity at hospitals, such as Cleveland Clinic, Kaiser, and UAB. PICO gained the 510(k) approval in December and has been commercially launched in the U.S. in January this year. So I'm going to give the floor to Adrian. I will come back then to talk about the strategic priorities.

[Adrian Hennah:]

Well, thank you, Olivier, and good morning, ladies and gentlemen. We turn firstly to Slide, I think it’s 10, the income statement. Slide 10, yes, it’s Slide 10 and the income statement. Revenue in the quarter was $1.106 billion. As Olivier mentioned, this represents 3% underlying sales growth after adjusting for exchange rates on quarter 4 last year. Trading profit in the quarter was $279 million, an underlying decline of 1%. The reported trading margin of 25.2% was in line with the commitment that we gave last quarter and 80 basis points lower than quarter 4 last year. Restructuring cost charge in the quarter was $33 million. $26 million relate to the efficiency program announced with our last results -- with our results last -- our last results in October. Olivier will explain the goals, main content and shape of this overall program in a moment. The legal charge of $23 million relates to the creation of the provision in connection with the previously disclosed investigation by the U.S. Securities and Exchange Commission and Department of Justice into potential violations of the U.S. Foreign Corrupt Practices Act in the medical devices industry. Based on information currently available, the group believes that it is possible to make a reasonable estimate of the losses expected. The group has not reached final agreement on a settlement on these matters, but believes that any additional material loss is unlikely. We cannot say more on these legacy issues as there is no final agreement. We can say that we believe that we have, today, an excellent compliance program across the business and we have enhanced -- which we have enhanced since these investigations began in 2007. Interest costs are down on last year, reflecting our lower debt. Moving to Slide 11 and moving down the -- moving further down the income statement. The tax rate for the full year on trading profit was 29.9%. This is a slight reduction on the 30.2% rate we had been expecting and had provided for at quarter 3. Accordingly, the rate in quarter 4 is slightly lower at 29.3%. EPSA in the quarter 4 were 29 -- $0.219, an increase of 1.4% on last year. This is slightly stronger than the small underlying trading profit decline, due principally to the lower interest charge and a small exchange gain. EPSA for the full year also increased 1.2% on last year, stronger than the underlying trading profit decline and also principally due to the lower interest charge and the relative weakness of the dollar. Unadjusted earnings per share were 5.8% lower in the full year, impacted by the estimated cost of the FCPA settlement and by the restructuring costs. There is no impact of the recently announced Bioventus transaction in these P&L numbers. In line with accounting requirements, we are treating the assets involved in the transaction as assets held for sale in the balance sheet. The impact on the P&L will commence on the closing of the transaction. I will touch on the details of this impact in a moment. Turning to the next slide, Slide 12, and an analysis of revenue by business segment. This slide shows the reported growth rates by division and the impact of currency movements on those growth rates. The impact of currency was small, a small net gain as you can see in the quarter. And turning straight onto the next page, Page 13, which provides an analysis of revenue growth rates by business and by geography. Olivier has talked to the shape of our revenue and I'll have a few more -- I will add a few more detailed points. Market conditions remained as we expected

[Olivier Bohuon:]

Thank you, Adrian. Thanks. So I’d like to remind you of the strategic priorities to drive the growth priorities I set out for Smith & Nephew and I would like to update you on the progress we have made so far. I'd like to start with a reminder of these priorities. We have set out 5 priorities in August. The first one is to win in established market. What does it mean winning in established market? It means that we want to gain market share in established market because we cannot serve on the growth of the market, which is almost flat. So what does it mean to win in emerging markets, in the established market? Well, it means to launch innovations. As an example I give to you, was the Wound Management that we won. The second one is to optimize the sales and services to help to gain market share. The third one is to improve the sales force effectiveness. And those are absolutely critical. And actually, there is a fourth one, which is also maximize the price and the premium prices linked to the innovative product that we launched. So those are really the main things that we want to achieve and we have now set up a number of things to be able to handle all these programs. The second priority I was mentioning in August is develop the emerging markets. As you know, we have -- when I talk about emerging market here, I am talking about the BRIC countries, okay? We have been pretty strong in China and we are strong in China. Big growth, big base now, almost $100 million of sales in China. And we want to develop our sales in Brazil, in India and in Russia pretty strongly. So to do that, what do we do? We have, so far, now a top management in place. We have named, January 1, the president of the emerging market, of the BRIC market. We have also named a head of R&D who is a very strong person, I mean very competent. And this gentleman will be in charge of proposing the programs of development to develop the portfolio, specifically dedicated to the emerging markets. Innovation remains core. And as I said to you, we are reinventing R&D. We have done our homework on this one

[Olivier Bohuon:]

Yes, first row.

[Navid Malik:]

Navid Malik from Cenkos. Three questions. On the PICO, I know you tend not to want to break out your market share, for example, in Europe, but can you give us some idea of the quantum of sales, approximately of what you're seeing in Europe? Because obviously KCI has been taken private. PICO offers advantage in terms of austerity and convenience, et cetera. What impact is it happening -- is that having on market share? Trends perhaps would be a better metric. And in terms of hips, on BHR, obviously a big debate on metal-on-metal and iron toxicity, et cetera, and then the recalls of ASR. How are you differentiating clinically? What evidence are you able to produce to drive that catch-up, which we hope will occur over time that the procedures are obviously being offset? And on the M&A -- on the acquisitions column on Slide 23. It was conspicuously empty. What sort of acquisitions are you looking at potentially? What type of acquisitions, which will help drive your strategic objectives?

[Olivier Bohuon:]

The first question was what? PICO, okay? Look, quickly on this one. The last one, acquisition, to make it quick. I've said in Q2, in Q3 and now again in Q4 that we are looking for a bunch of potential acquisitions. We have done a number of bolt-on acquisitions, first off. We are working hard now on emerging markets. My new President of Emerging Market has a very strong agenda, so we are moving fast on this one. So we look for mainly in Brazil and in India at this stage. In the rest, I reinforce what I've said to you previously, which is we're looking hard in Advance Wound Management and in minimally invasive surgery and in extremities because that's what we do. There's nothing else I can tell you at that at this stage. Regarding metal-on-metal, we are actually pretty disappointed that some commentators do not differentiate BHR than the global metal-on-metal. And I think it's for patient, I mean this could be a potential distress, which is not necessary. When I see the article I read on Sunday, when it said poisoning patient, it's a big anxiety. Actually, we know that BHR is a good product. We have been following this product for 10 years in a row. We do not see any problem. Actually, all the data we have received recently, independent data, one is the English and Welsh joint register is showing that BHR has the best survival rate after 8 years, which is roughly 98.5%. So we do not have any concern about the product. The problem that we have in face of us, these adverse winds, actually of metal-on-metal, which are a handicap for us. But we do not believe that there's any issue with BHR. On the contrary, we believe, for a number of patients, this the best product to implant. Now the BHR represent roughly 12% of our hip business. The adverse wind we see is regular. Actually, it's roughly minus 25%. So we are suffering about this, but not at a level which is crazy. And again, we don't think there is any issue here. Regarding PICO, I'm not going to tell you anything about the market share, as you can guess. But what I can tell you, I've been following this product very deeply because I love it. And I've been in Europe talking with physicians, talking with all our teams and it has a very good start, actually a very strong start. I was in the U.S. last week in our wound operations and so we have an extremely good feedback of the first days of launch, I would say, week. I mean good adoption. Again, the PICO -- the beauty of PICO, it is not supposed to replace the RENASYS. It is supposed to extend the market. So we don't foresee any type of cannibalization of the RENASYS, but we expect to really have a number of wound, not treated before by negative pressure, were now treated by negative pressure. So it's very encouraging, that's what I can tell you.

[Navid Malik:]

Second question. Obviously, on the...

[Olivier Bohuon:]

Last one.

[Navid Malik:]

Yes, last one. So on venous leg ulcers and similar wounds, obviously, Shire has better Dermagraft now. What sort of -- what innovation can you bring into that part of the market to attack that because it's a very -- it's a large market opportunity, which Dermagraft has a small market share in currently, but has a lot of potential to grow in. It seems to be very complementary to, obviously, NPWT?

[Olivier Bohuon:]

Are you going to AOS next week, no? You would have seen everything. So okay, next question.

[Martin Brunninger:]

Martin Brunninger from Nomura. Just a question on margin improvement for this year. It seems like what you said on the cost savings and on the costs for restructuring, seems like almost margin-neutral this year, $80 million and $75 million. So where are the margin improvement coming from for this year? And how much is there from product mix and how much from geographical mix? And the other question I had on Spain. You said there was -- obviously, we've seen a margin contraction on the Orthopaedic side on Q4. Is Spain included there or is not?

[Olivier Bohuon:]

Spain is included there.

[Martin Brunninger:]

In the adjustment?

[Olivier Bohuon:]

Yes.

[Martin Brunninger:]

So what was the margin contraction driven by exactly?

[Adrian Hennah:]

Well, I understand the second one. I'm sorry, I didn't catch the first question, maybe you...

[Martin Brunninger:]

Well, the first question was, you gave -- on your outlook, you gave a margin improvement. For this year, how much is it and where does it come from? Because what you said on the cost savings and the cost for the restructuring program, it seems like it's neutral for this year. So where do the margin improvements come from?

[Adrian Hennah:]

What about margin improvements? Going forward in 2012?

[Martin Brunninger:]

Yes, just for this year.

[Adrian Hennah:]

Okay, this year, 2012, okay. Well, in terms of Ortho, what's happening to the margin, I mean we went into some detail at quarter 3 as you may recall through what was impacting the Ortho margin and we identified there was a bunching of one-off costs in quarter 3, which hit us. But there were 2 more longer-term stuff that was hitting us in quarter 3. One was gross margin pressure because the products that were growing fastest had lower gross margins, and you've seen that actually happening all the way through the year. And we showed that, that has abated in quarter 4 because, as you know, VERILAST growth rates have come down. So therefore, the gross margin pressure from those growth rates have come down. But the most important thing we've been doing in quarter 4 is starting on this restructuring program. Now the actual -- the restructuring benefits, as in headcounts leaving and the associated process changes, frankly, only began to take -- to impacted earnings towards the end of the quarter. So those 150 positions that were eliminated in Orthopaedics and Endo during quarter 4 mostly happened at the end of the quarter. So most of the improvement you're seeing in Endo and Ortho in the quarter is not that. What it is, is a tough cost environment that we put in place coinciding with the start of that. Now some of that was cost reductions, which frankly are not sustainable. There are things that we have absolutely started again doing in January. But they were important to do at the start, if only to -- not if only. One of their benefits was to sort of accelerate the psychology that goes behind the structural changes. So that very tight control of discretionary costs is one of the elements you're seeing improving the margin, both in Endo and in Ortho in quarter 4. That, however, is not the core of what would improve the margins going forward in 2012, which is structural. And maybe to answer your second question, what are the sources of that, well, what it is not is sales force. We are -- the absolute focus of this program is to sustain and improve customer service, but lower the cost to serve and lower the cost to serve not by taking -- not by dealing the sales hits but by dealing everything that works behind that. So it certainly includes the platforms, which serve sales people, all the operational stuff that deals with getting the kit to the sales guy at the front and everything going backwards from that. Roughly, roughly, we see about 1/4 of the total benefiting cost of sales and about 3/4 in G&A in that stuff sitting between the front line sales force and the factory gate. The latter -- the G&A will be quicker because it's much more directly headcount-related and you can get after it quicker. The next wave of factory stuff will take a bit longer, but we're starting on it. We’re starting on it immediately, in fact. And Olivier mentioned we just got board approval for an extension to our Suzhou factory. Well, that kicks it off, but it will long for that to achieve flow-through into benefits. But that's what we're mapping in. That's the nature of the stuff we expect over the next couple of years, the flow-through as a result of the program.

[Martin Brunninger:]

And you expect the price declines at the same pace as you've seen last year? That's part of your assumption then?

[Adrian Hennah:]

Well, I don't know it's part of our assumption. It's a core scenario. It's been a core scenario for some time, that the environment will stay pretty much as it is for some significant time to come. We don't predict those sort of things. That's what people and economists think today [ph].

[Olivier Bohuon:]

We have not seen any degradation of the price in Q4 versus Q3. They've been roughly the same trend, so we don't see anything worse actually in 2012.

[Unknown Analyst:]

Great. I have 3 questions. Firstly, on restructuring. Who determines whether the $200 million really are restructuring charges or normal costs? Is it really the finance department or is it also the auditors who have to sign off on those charges? And question number two on -- also on restructuring, where is the main hit taking place? Are you -- is it more the Orthopaedic side or is it more the Endo side?

[Olivier Bohuon:]

It's -- on this one, I will leave Adrian answering. I mean, on this for -- actually it's everywhere. It has been everywhere. But the 220 job that I was mentioning, 40 of them are in wound, for example. So it's not only Ortho or Endo. It's just all across. Most of the savings in accounts are coming from -- actually, they come from everywhere. I mean I think that's what we should say. It's a mix.

[Unknown Analyst:]

And then the third question is if you look at your hip, your knee and your Trauma growth rates constant-currency, adjusted for comps, you've seen a very sharp slowdown in the fourth quarter compared to the previous 3 quarters.

[Olivier Bohuon:]

In revenue you mean?

[Unknown Analyst:]

Well, organic costs compared [ph] to sales growth. Does this sort of coincide with your restructuring efforts, meaning are your efforts affecting your growth rates?

[Olivier Bohuon:]

I was expecting this one, that's a good one. But no, it's obvious. No, actually, the answer is no. And I give you 2 examples why no. Actually dynamic has been not so good in Ortho, and I'm going to come back on this one. It has been extremely good on Endo, extremely good on Wound. So if this would have been a problem, you would have seen an issue everywhere, actually not only in the Ortho business. Actually, the Ortho revenue, the first thing that you have to think about when you think Q4 is annualization of VERILAST and VISIONAIRE. They have been launched in the last quarter, so you obviously see a growth which is not as strong as this one. You had a very strong 2010 comparator, just 2 figures, it was 5% up in 2010 Q4 for the Recon business. It was 10% up for Trauma business. So you compare a Q4 with a very, very strong Q4 in 2010. Then the hip is constantly going down and I was mentioning the BHR impact is still here. So these are things which show you why -- I mean if you exclude this stuff actually, we'll do -- it's not -- we're not worried about that, so I don't think that's an issue. And do we have any issue with the restructuring program touching the dynamic of this? Not at all, not at all. And you know what, I was, last week again, when I was in the U.S., I’ve attended the big ASD sales force yearly meeting. 1,200 reps were here. And so I was talking to a guy, explaining what we're doing and obviously had many interactions. None of them have said to me, by the way, we have problem with your program because these can kill the sales dynamic. None of them. So I haven't heard any question, telling me, oh by the way, there's a problem. So they even don't feel it. So that's why it's not the point. Here, we talk about all the G&As. It’s been not S, it’s G&As and another thing is duplications that we have had with Ortho, Endo or a change of structure, business model, that we are looking for in wound, for example, where you have more tendering as well. That's...

[Adrian Hennah:]

And on your first question, Michael, are we using these restructuring charges to prop up the trading profit line? Certainly not. I mean, it's -- we are very, very rigorous about -- I mean we’re very, very rigorous internally, but obviously it's subject to audit, too. And we have been 110% transparent with EY [ph] on it. I mean that's the cardinal principle of transparent accounting, which I stand fully behind absolutely. And we are going to be as transparent as we possibly we can on accounting.

[Olivier Bohuon:]

So we'll have one question on the phone, I think, Phil, and then we'll come back to you, guys.

[Operator:]

We'll now take our first question from Matt Miksic from Piper Jaffray.

[Matthew S. Miksic:]

I just -- if I could follow up on the question just asked just now on the Orthopaedic growth. I can see the modestly tempered comps in the prior year quarter. I guess I would drill down a little further into the hip and knee or the knee growth, specifically. To what degree would you attribute the slower sequential growth to an easing of any of the DTC campaigns that you have been running for VERILAST? And had you eased off on that? And then to what degree is that more VISIONAIRE, which -- and if VISIONAIRE, is it slowing due to competitive pressure or simply a slowdown in penetration or pricing in that sector? And then I have one follow-up.

[Olivier Bohuon:]

Okay, on VISIONAIRE, yes, we have competition coming in that impact us potentially in market share, but you know what? Not much. And the boost given to the market growth linked to the arrival of new competitors is really pushing us, so I don't see any issue at VISIONAIRE level. Regarding the VERILAST DTC campaign, that's true, we have not done very active DTC campaign in Q4. We have done a number of -- and actually we don't know if we'll do or not next year. But we have done a number of exercises in DTC to see the value of DTC. Yes, you have a correlation between the DTC campaign and the revenue growth. Is it a good return on investment? I'm not so sure. So before starting any campaign, I want to know if it's just a fire and then coming down or it means something more structural and the value in terms of profit is good enough to follow up. So that's what I believe was in the second page. You want to take the other one, Adrian?

[Adrian Hennah:]

That was -- that was it. I'd only heard the second question.

[Olivier Bohuon:]

And you have a follow-up question, you said?

[Matthew S. Miksic:]

Yes, a follow-up question on you had talked a little bit about looking at acquisitions in emerging markets. And I'm wondering if you could be -- is it more specific around perhaps the lines of business that you're looking at, expanding lines of business in the emerging markets that you're in or is it more of a product line additions or distributor-type additions?

[Olivier Bohuon:]

Yes, it's actually both. It's -- it could be products and we have some targets, it could be distributors, it could be manufacturing platforms or it could be companies. So we are looking at this on a pretty wide basis. So regarding the line of products, it's almost everywhere, actually Ortho, Endo and wound, yes, I think. So that's what I can tell you, but it's pretty general, yes.

[Veronika Dubajova:]

That's great. Veronika Dubajova here from Goldman Sachs. Three questions, if I can. First of all, on the margin guidance, midterm, I think you've put in the sentence in the presentation thing, it excludes the impact of the excise tax, which of course, brings me to the question we tackled last results, which is when you do think about the excise tax impact, do you think you can absorb it? And if so, how quickly? The second question I had was Negative Pressure Wound Therapy sales. If I remember correctly, a year ago you said the run rate was around $100 million. I was wondering if we can get an update on that? And the last one was in terms of product launches, AOS or otherwise. I think normally you include a slide in terms of the plan for the full year and I didn't see one in the presentation this year. So if you can run us through some highlights that you're planning for 2012, that would be really helpful.

[Olivier Bohuon:]

On the Negative Pressure, did we really say $100 million?

[Adrian Hennah:]

The run rate in quarter 4 last year was $100 million, significantly above $100 million now, I can tell you now.

[Olivier Bohuon:]

Exactly. So it's much more than that actually. And so that's good, first question. Second question -- and actually we're very active with this Negative Pressure Wound Therapy, so that's what I can tell you. You take the rest, Adrian.

[Adrian Hennah:]

Yes, I mean on the excise tax, I mean I guess there's 2 ways of absorbing it as you described, Veronika. One is what is going to happen to pricing. And one is what can you do about the costs to compensate. And pricing, who knows? I mean we're just going to see what happens. It's a marketplace issue. It's not a company-specific issue. And who knows? We're just going to have to wait and see. And as regards the cost absorption, well, you've heard our intent. But we're also not putting a date to that intent because there's a lot of variables that can happen, including this one. So we expect to have to fight hard to deal with this one. How much will be left after the price issue? We don't know, which is why we’re deliberately carving it out as an uncertainty framing. Not very helpful, Veronika, but it is what it is.

[Olivier Bohuon:]

Nobody knows on this tax increase, that's -- it's very...

[Adrian Hennah:]

Yes. And then lastly, on AOS, we do normally put in, as you say, a pipeline except for our quarter 1 numbers because it's usually just before AOS and then we say we won't do that. We'll do it when we get to AOS. So that's why there isn't one this time, Veronika, but there will be one next quarter after the AOS.

[Veronika Dubajova:]

[Indiscernible]

[Adrian Hennah:]

No. Go to AOS.

[Olivier Bohuon:]

Go there.

[Unknown Analyst:]

Two questions relating to emerging markets. Firstly, on the costs, it looks like in the cost-saving program, there's relatively little of that coming from the cost of goods sold line, and you're also sourcing relatively little in low-cost countries and manufacturing and all that. Should we expect a sort of second part or another program starting later where you're addressing more the cost of goods sold line in addition to this $150 million savings? And what of timescale should we be thinking about here? The second question is on your target for sales in emerging markets to increase fivefold over 5 years, I think it was. How back-end loaded should we expect that to be?

[Olivier Bohuon:]

On the sales, all will depend -- again, we sell $150 million in the emerging markets, in the BRIC countries, okay? Out of the $430 million, I think, that we have between international markets and emerging markets. So if I just keep the BRICs, we have a growth here, which is -- I mean the organic growth of the business is around 40%. Actually, a little bit less than that, but it's in China. India was almost 50%. So it is -- you can make a calculation out of the pace of growth of this. On top of this, everything which will be acquired will help mechanically to help that. So I'm very confident that things would move very quickly on this field. I don't think there is any risk, I tell you, at least fivefold, something which is a pretty easy to wait, actually.

[Adrian Hennah:]

And in terms of the costs to emerging markets, it's not a question of another phase, it's in this phase. I mean, we -- around the quarter of the -- we expected the benefit of $150 million will be cost of sales and that is largely local sourcing, and we have -- I think we referred in the announcement to a recent approval of an extension to our Suzhou factory. The Suzhou factory had been tremendously successful in the wound business and we plan to build on it and build on it quickly.

[Unknown Analyst:]

Just one quick follow-up there. So what percentage from low-cost countries would you then be sourcing and manufacturing at the end of this?

[Adrian Hennah:]

We don't have a specific target for that now. But it'll be -- it'll go north. There are constraints on it. I mean there are practical constraints, things like – it’s a lot of [indiscernible] as you well know from other companies you follow. So we haven't got a -- we don't have a goal to get to. That doesn't seem like a sensible thing to have but it will clearly be north of where we are now, materially north of where we are.

[Olivier Bohuon:]

We're at 10%, 11% -- 10% to 15% now, so I guess it will be much more than that, yes.

[Unknown Analyst:]

I have 2 questions. First of all, on the manufacturing side again. Can you give us a sense of does it -- whether it makes sense for you to relocate some of the manufacturing for Ortho and Endo to lower-cost countries? And then for Wound Care, based on what you have at the moment, is there further scope to move that? And then the second question is you've provided your guidance relative to market for the different businesses. Can you give us your assumptions for the market?

[Olivier Bohuon:]

No, we can't and we don't do that, actually. We don't give assumption for the markets, unfortunately. That's what we do. Regarding the changes in manufacturing, yes, potentially. But again, we believe at this stage that we have very strong and good facilities in Andover, in Memphis. There is a lot of things to improve there in terms of cost of good management, in terms of manufacturing productivity before thinking about moving these factories. However, when I'm talking about the emerging market development, we obviously have 2 ways of looking at it. A, the existing portfolio of products that we sell in the emerging markets and here we have to improve the cost of good, and we're not going to move these manufacturing at this stage, okay? We manage cost of good and we have a pricing policy in the emerging market for the high tier, which will change. B, for the new portfolio of emerging markets. Here, definitely we will [indiscernible] manufacturing of Ortho, Endo change the manufacturing footprint and manufacture much more locally as we do actually in China, in Beijing for the Ortho business, for example.

[Unknown Analyst:]

A couple of questions. Firstly, just on the wound stocking, you put out the revenue impact. I just wondered what the impact on margins was from that stocking? Secondly, you saw a big increase in margin, particularly in Endo and wound in the fourth quarter. I just wondered how much of that was just early delivery of the cost-savings program that you were perhaps anticipating previously? And then finally, in terms of -- it looks like you're going to be reporting international revenues going forward. I just wondered what the margins, relative margins, were in those emerging markets compared to the rest of your business and whether you'd be reporting those going forward as well?

[Adrian Hennah:]

Yes. Sorry, the first one was wound margin?

[Unknown Analyst:]

Yes, the impact from the stocking. Is there any positive impact?

[Adrian Hennah:]

Marginal, but not significant. I mean, yes, when you have a slightly extra sales that can sit one side or other appear depending on the customer wants is going to slightly affect the figures, but not materially, frankly. And then your second question was the margin improvement in Endo and Ortho in the quarter was that bringing forward the...

[Unknown Analyst:]

Yes, was it actually early [indiscernible]. Did you manage to let go of more people than you were anticipating originally and therefore it's just a timing issue rather than...

[Adrian Hennah:]

The people -- the positions that were eliminated in Endo and Ortho in quarter 4 absolutely are part of the program. There's no question about that. Most of those did not happen until towards the end of the quarter. So the movement you have seen in the quarter was only in small part attributed to that. It is simply because it was a phasing, which didn't happen till the end of the quarter. So actually, in the quarter, more of the benefit was around tough cost management, not all of which is sustainable. I mean some of it is just stopping things that you don't stop forever. You need to get back to it. They will not continue. We’re back to those now. But the stuff that was started towards the end of the quarter will continue to yield benefit and there'll be more of that, if that answers your question. And then the emerging markets, what are the margins? The -- I mean it’s -- we're very clear. Olivier mentioned 2 or 3 times in different context already that there are different types of product for emerging markets. And our goal, over time, is to very much tailor what we have to the different parts of the emerging markets in that seek to bring up the margin to a much more level closer to where it is for the corporation as a whole. Today, that is not the case. Today, both because we still mainly sell top-end product, both at top end in the emerging markets but also in the middle end, it drags down your margin. But also we are at a phase of investing in SG&A really quite heavily in the BRICs, which also brings down your margin. So today, in the BRIC countries, no, the margins are very low indeed. When you take together rest of the investment in SG&A and the fact that we do not have a complete range of mid-tier products, which will be designed to be -- will be designed for the price points that are in the mid-tier. Actually, in the other international markets, those parts of EM and IM, which we call without the BRICs, the margins are pretty good actually, but there we’re not as investing as strongly in SG&A. Does that make sense?

[Operator:]

We’ll now take our next question from Jason Wittes from Caris.

[Jason Wittes:]

Just another question on emerging markets. You're obviously spending -- refocusing a lot of effort there. What's a realistic outlook in terms of the percentage of your revenues that you would -- could expect to cover emerging markets in the mid and long term?

[Olivier Bohuon:]

Well, I said that it will be more than $500 million in the next 5 years. What is the percentage? I leave you to make the calculation of what it means. It will be significantly higher actually than what we have now. And again, emerging markets here I'm mentioning -- when I say emerging market, it's BRIC. Don't be -- we still have a very high-growth expectation for the international markets, led by South Africa. We, by the way, we have a rich -- for the first time in South Africa, more than $100 million. That's a big operation for us, with very strong margin and 30% market share. So that's what – so we expect to do on this everywhere we can. So yes, but again it will be a good part of revenue. Again, I'm not pushing too strongly the pace of growth in the emerging market until I have the right basis to make a profitable growth. So it means manufacturing footprint and it means revisiting the price policy that we have for the high-tier products.

[Jason Wittes:]

Okay. And also obviously, there's continued pressure on metal-on-metal. Did you guys provide what percentage of your hip revenues, U.S. and worldwide, are metal-on-metal at this point? Any idea of what your exposure is – where your exposure lies at the moment?

[Adrian Hennah:]

It's 12% across the globe. We haven't split it between the U.S. and non-U.S. But global, it's 12%, or thereabouts, so that our hip revenue is in BHR and it's declining at, as Olivier mentioned, 20%, and has been for some time, sadly. But we see it as a great product.

[Unknown Analyst:]

Yes, on the wound business, the durable medical equipment program has been expended this year in the U.S., and the bidding process we believe is going forward in the next couple of quarters. Can you give us an idea about how much the wound market in the U.S., the negative pressure wound market in the U.S. is going to be effectively up for tender? And how much an opportunity you believe there can be for you as you obviously tender against KCI?

[Olivier Bohuon:]

It's a -- we have a few figures here. The negative pressure in the U.S. is $1.7 billion market, which is a big market. It's the biggest in the world, which mean that we in Europe and the rest of the world are very underdeveloped in negative pressure, which is a good sign, which means that we will have a huge number of opportunities here. The growth of our business in Wound in the U.S. has been roughly, I think, 6% and global with about -- market growing at about, I think, plus 3%, correct me, in the U.S. And when I was telling you that I think that we do great, and actually the negative pressure was very, very high growth within this part, we gained market share in negative pressure. We have about 60 people promoting negative pressure versus about 800, 900 with KCI. So this shows you gaining market share within this concept means how good is a product and how good we are in providing these products. So that's why when I'm telling you I want to reinforce our share of voice and our strength in the U.S. either through acquisitions or through reinforcement of our sales force, that's what I mean here. There is a huge potential. So I'm very optimistic about the future growth in the Negative Pressure Wound Therapy in the U.S. and the rest of the world.

[Unknown Analyst:]

And just a quick follow-up. I mean, do you have a feeling of how much of the – of say, KCI's current business is effectively going to be up for tender? And what proportion of the U.S. market?

[Adrian Hennah:]

No, we do not have a good feel of how that's going to place. It's still pretty fluid. And I would say compared to 18 months ago when we saw those tenders, there's definitely a good way to get in there. They still are, but actually as our offering has got much more complete and we've demonstrated our capabilities so much more effectively to customers, it's no longer as important a tool for getting KCI out as it used to be. If it happens, well, obviously, we'll be in there and using every ability which we can, obviously.

[Unknown Analyst:]

I've got 3 questions but 2 of them are quite quick. Just on the repair business, you've turned in yet another quarter of very, very solid growth. It'd help if you'd give us a little bit color as to where the growth is coming from in terms of price mix and volume. And on the volume side, I mean how much share you're taking and how much is underlying market growth? I suppose what I'm really trying to drive at is how long can you continue to drive that business along with a double-digit rate? The second question is just a follow-up on Veronika's wound question. I think for – back to that 4% coming from NPWT out I get to a run rate of about $140 million and just a vague comment as to whether that's in the right ballpark or not would be helpful. And then the third question, a follow-up on Marcus' question about restructuring charges. Irrespective of where the bean counters telling you, you have to put it on your P&L. This will be the sixth, I think, consecutive year of restructuring charges, the eighth year in '11. Do you think it's about time as shareholders and investors we started to think of these as an ongoing cost for your business and start to factor that into how we think about the business and maybe we should think about some of these costs being more sustainable going forward?

[Adrian Hennah:]

Good question. Well, first, in the first 2 -- well, no, the first one I think is a very positive answer. We absolutely see this business as sustainable. And that's why we're very keen to focus on the minimally invasive part of Orthopaedics. We’re very pleased that, that's the part of the broader orthopaedic market where we're most, in market share terms, strong. There is lots of innovation happening in that field. And there’s a second important driver, which we've talked and that is the Arthroscopy, minimally invasive approaches to the joint, they are the newest form of orthopaedics and the specialty has had its deepest roots and it's most established in the United States. That tends to happen with these things. In other parts of the world, it's less established. So you've actually got another driver as you get outside of the U.S.A. that more people are training in it. And I always find it interesting, if you look at young orthopaedic surgeons being trained generically as orthopaedic surgs now and ask where do they want to go? Well, more and more of them want to go the arthroscopic route. They see that as the route for the future. So for all those reasons, we are very comfortable that there is sustainable growth with technological advancement and a spread outside the U.S. of the specialty as it is today in the U.S. So we are very comfortable with that. We are -- to your narrow part of your question, we are seeing much less price pressure in the arthroscopic field than we are in implants for obvious reasons. And I wouldn't say we're seeing price increases, but we're not -- certainly not seeing the same price pressure. And the growth is coming very helpfully from volume and somewhat from mix. Your calculations in NPWT aren't too bad.

[Olivier Bohuon:]

One day we'll disclose it. We'll make a...

[Adrian Hennah:]

Yes. And your point about restructuring charges is a good one. And clearly, at the end of the day, this is shareholders’ money that's coming out wherever you put it in the books. We -- transparency's very important to us. So doing these programs, being very clear what the costs are, where they come from so the shareholders can make their judgment is very important. Clearly, as we look forward, we see this as a 3-year program. It is important, it will be important as you get to the end of this program well, where are we? What is the environment? Can one sustain that in the total environment without having to need more fuel like that. It's hard to predict precisely 3 years now. But that has -- that would be the -- that will clearly be the goal in the best functioning companies, wouldn't it? So you wouldn't have to do these things. But now isn't a question that makes sense. We have to do this that will be a significant benefit for shareholders from doing this. Good, I think we're done.

[Olivier Bohuon:]

Done? Thank you.