‘We de-risked the business, and we take away more people’s pain’

Every other Saturday, on average, over the last seven years, a bus has left the southwest corner of the island at an ungodly hour of the morning bound for the Kingsbridge Hospital in Belfast.
With a number of pick-ups along the way, passengers arrive at the private hospital for a consultation in the afternoon followed by an overnight stay at the five-star Hastings Grand Central hotel in the city centre, and surgery the next day.
The bus heads back southwards on Sunday afternoon. The vast majority of travellers will have had cataract surgery. Those who have had surgery on their right eyes, and have patches on that side, sit on the left of the bus going home, and vice versa, says Mark Regan, chief executive of Kingsbridge, “so they can still have a view out the window”. That’s attention to detail.
“We had one chap who celebrated his 100th birthday while he got off the bus into Kingsbridge,” he says. “We had the cake ready.”
The Blind Bus, as it became known, was conceived by the independent TDs Michael Collins and Michael Healy Rae, and exploits the EU’s cross-border health directive. The centenarian was one of 60,000 patients from the Republic of Ireland who have travelled to Kingsbridge for surgeries in the past three years, under the cross-border directive and the HSE’s national treatment purchase fund (NTPF).
Kingsbridge is Northern Ireland’s biggest private healthcare group. It is also, Regan says, the only all-island private healthcare company. It is the biggest provider of services to the NTPF, providing more care than any of the private hospitals in the Republic to public patients.
Kingsbridge has two hospitals in Belfast, one in Co Derry and one in Sligo. It is the only private hospital group of any scale north of “the line between Dublin airport and Galway”, Regan, 49, says. In the last three months, Kingsbridge has treated a patient from every single county on the island at one of its hospitals. “Health needs do not recognise the border,” Regan says.
This only partly explains why Exponent, a private equity firm, bought a large majority stake in Kingsbridge last month. The deal valued the group at £300 million and crystallised a nine-figure payday for each of the founders, Suresh Tharma, a consultant obstetrician born in Malaysia, and Ashok Songra, a maxillo-facial surgeon.
Since setting up the group up in 2002, the doctors have ploughed profits back into the business. Both are staying on as minority shareholders, reinvesting again in a business that is growing at a tremendous pace.
In 2021, Kingsbridge made roughly £3 million in earnings before interest, tax, depreciation and amortisation (ebitda). This year it expects to announce earnings of £30 million.
The surge includes contributions from new hospitals, the Kingsbridge Diagnostic and Treatment Centre near the former King’s Hall on the Balmoral showgrounds in Belfast, and Kingsbridge Northwest in Ballykelly, Derry. But above all, it reflects a surging demand for private healthcare, north and south of the border, largely in response to two public healthcare systems groaning under the strain of their waiting lists.
Regan, a radiologist, worked in public hospitals on both sides of the border before jumping into the commercial sector, first with Bracco, an Italian drug company , and then with the medical equipment division of Philips Ireland.
In 2007, he sold a CT scanning machine to Tharma and Songra, who had set up a private consulting practice at 352 Lisburn Road — the group was known as the 3fiveTwo Healthcare up to 2021. Regan says he had “no notion” at the time that this would lead him to ditch secure multinational employment to join 3fiveTwo. At the time, he says, private healthcare in Northern Ireland was reserved for what was called in a nod to the sole provider the Bupa club, senior executives or wealthy business owners living in BT9, the Belfast equivalent of D4. At best, it included 5 per cent of the population.
Regan found the two doctors persuasive, entrepreneurial and dynamic — and different to the typical hospital consultant. “They had a passion for improving access to healthcare, for all. They wanted to improve services, equipment, and facilities. That has been the cornerstone of what we’ve been doing for the last 20 years.”
Tharma and Songra developed an ingenious business plan. It involved leasing NHS facilities at weekends. At 5pm on a Friday evening, the company “took the keys from NHS”, Regan says, and staffed the hospitals and operating theatres with nurses, radiographers and consultants, mostly from the NHS. “We handed the keys back on a Sunday night or a Monday morning, and the idea was that they wouldn’t know we’d have ever been there.”
At its peak, the company was running 15 NHS theatres every weekend. It was the largest provider, public or private, of weekend surgery in Northern Ireland. “We had no assets, no overhead, no worries,” Regan says. “We were, I suppose, the Uber of healthcare. It was a fantastic model.”
The service catered for public patients. “They were outsourced to us, which we then re-insourced [into the NHS].” As the service grew, however, the virtual hospital was at the mercy of NHS planners for access to facilities. “We really needed our own facility to drive our own ship forward.”
The company acquired a former private eye clinic on the Lisburn Road in Belfast, an “empty shell”, Regan says, that took six months to get re-registered.
“The big advantage was, because we were already up and running as a company, and doing so much surgery, we were able to simply redirect patients to the new facility,” he says. “We were busy on day one. Even today, anyone coming into the market won’t have that ready-made package of patients to go.”
The transition was seamless until March 2015, when a cash-strapped Stormont administration cut funding for the outsourcing of public patients as part of its austerity budget. “Overnight we were told to return all the patients [to the NHS],” Regan says. “How do you see that coming? Eighty per cent of your income gone, literally overnight.”
At that point, the group employed more than 300 staff. Although the policy was reversed within six months, it was “a jolt and a wake-up call”, he says. “We realised that we can never be so heavily reliant on a single payer group that is entirely public. We needed to hedge our bets much wider.”
The group looked south, initially drumming up business through the cross-border directive. In June 2015, it bought St Joseph’s Hospital in Sligo, known locally as Garden Hill, from a Nama-appointed receiver. It was once part of Mount Carmel Medical Group — owned by Gerry Conlon, the property developer — and the purchase price was €775,000, though its new owners have since invested more than double that on upgrades.
Regan says the idea behind the Sligo investment was to cater for people in the northwest of the Republic who were travelling to Galway or Dublin for treatment. The hospital has received investment on a “contain and hold basis”. Pending planning permission, the group is looking at a new £35 million hospital to be built on the grounds.
After raising capital from 57 Stars, a boutique American investment house, and Foresight, a UK private equity company, the group acquired the North West Independent Clinic in Co Derry in 2021, to accelerate its strategy for the region.
“It has everything that Sligo didn’t have in terms of laminar flow theatres, blood on site and excess of bed capacity,” Regan says. Within 12 months, Kingsbridge doubled surgeries and staff headcount. It also opened an office in Letterkenny, to refer patients to Sligo or Derry.
The group operates in two different healthcare markets. In the Republic, the government has committed huge resources through the NTPF to cut waiting lists. “You can see the graph is turning,” Regan says, as a result of “mature politics.”
In Northern Ireland, there has been no administration for five of the last seven years. Funding has been sporadic and waiting lists have reached chronic proportions. “Most surgeries now, unless they’re life threatening, will be in that two to seven-year bracket,” Regan says.
Private healthcare is also radically different. Although private medical insurance is growing in Northern Ireland, only about 15 per cent of the adult population have it, compared with 50 per cent in the Republic. In Northern Ireland, most of the growth is among younger, more affluent policyholders, less likely to be presenting with cataract or hip problems.
Across the Kingsbridge group, however, 70 per cent of revenues come from private patients. The biggest payer group are those in Northern Ireland who self-fund the entire cost of a procedure. Private healthcare is now “a mainstream choice”, Regan says. “When you look in our waiting room, the people there are not what they would have been 20 years ago. It’s a changing demographic.”
He cites the example of somebody who is 70 or 80 years old, who might live for another ten years and faces five years in pain waiting years for a hip replacement. “That is 50 per cent of remainder of your life,” he says. Families are making lifestyle choices to fund healthcare. “Do we change the car or do we do mum or dad’s cataracts?”
Kingsbridge will soon partner with credit unions to offer repayment plans. It will then stop quoting £13,500 (€16,000) for a hip replacement, unless that is asked for, and instead quote £300 a month over five years.
Regan rejects any idea that Kingsbridge’s success is based on the NHS or the HSE’s failure. He think it unfair to associate the word failure with the public system on either side of the border. Belfast has some of the best trauma surgeons and cardiovascular teams in the world, for example. There are brilliant physicians across the island. “Inside the door it is often world-class,” he says. “What they are not brilliant at is the waiting list outside the door.”
Kingsbridge looks to untangle the knots in the system, more efficiently than the public system probably ever can. Kingsbridge Belfast, for example, has four theatres doing three sessions from Monday to Friday, and two sessions on a Saturday and Sunday. “We’re getting 19 sessions per theatre, whereas the public sector would be lucky to get ten,” he says. The hospital has no porters, and nurses walk or push patients to theatre.
The Kingsbridge Diagnostic and Treatment Centre at Balmoral operates on “a seven-day promise” of diagnosis for patients with a red-flag cancer referral. In the public system, 70 per cent of patients wait 62 days or more to start treatment.
“A lot of that delay is in the diagnosis,” Regan says, adding that the anxiety for patients of waiting two months for diagnosis must be “horrendous”.
The group is making healthy profits, but it is also “helping remove people from pain”, Regan says. Even counting only those crossing the border, “that’s 60,000 people who have a better lifestyle because of an investment we have made or the very fact that we exist”.
As with rival private hospitals on the island, Kingsbridge leverages heavily off the public system and has even drawn some consultants from Britain. “Public consultants are contracted for a set number of hours,” he says. “When they fulfil those hours they are free to play golf, go shopping or sit and do nothing.
“They choose to take those skills and work in the private sector in helping patients, many of whom would end up on a public waiting lists. They are helping society and the NHS in their free time. I don’t have a problem with that.”
In their spare time, Tharma and Songra have created an extraordinary legacy. The Belfast hospital is a £100 million facility. Kingsbridge has a number of clinics that refer patients to the hospitals. It has a training academy that provides health and safety courses to retailers and other businesses. It set up a business that helps newly trained doctors and nurses to prepare properly for job interviews. The two founders also own H3, a private medical insurance business that sits outside the Kingsbridge group.
Regan has no plans to return to radiology, though he did x-ray a mummy at the Ulster Museum, helping a surgeon to extract DNA from the exhibit. Exponent’s arrival will kick-start the redevelopment of Kingsbridge Sligo. The group also has planning permission for a second hospital at the King’s Hall Health and Wellbeing Park in Balmoral, which will focus on minor injuries and increased capacity for surgery, scanning and diagnostics.
Compared with the crisis of 2015, Kingsbridge now has seven different “payer “ groups, public and private, north and south of the border, which, Regan says, substantially “de-risks” the business. “Each of those has its own significant opportunity for growth,” he says.
From September 1, there will be no more Blind Buses — the 150th ran in April — as the HSE reduces the refund on the procedure substantially. The HSE refund for hip or knee replacements is being increased to cover substantially the cost of the surgery. One door closes, another opens.
Age: 49
Lives: Belfast
Education: Radiology degree, Ulster University
Favourite Film: Schindler’s List
Favourite Book: If Disney Ran Your Hospital, 9½ Things You Would Do Differently, by Fred Lee
Family: Married to Cora, four children.
Working Day: I love my work. I love the job and I love the people I work with. So I tend to be here a lot. There is a great culture of people volunteering up to get things done. So my working day can be long, but like I say, I love it.
Downtime: It’s family time with four kids. I also like to make things, bird tables, pergolas and the like.