After four years, in which he transformed Bupa with a £1.8bn M&A drive, the company announced that CEO Stuart Fletcher is to leave after failing to meet expectations. His departure follows 2015 results which saw a fall of pre-tax profits of 39% to £347m. Where does that leave his plans to build an international brand with strengths in services as well as insurance? What really went wrong? With 2015 sales of £9.8bn, Bupa still has heft. Outside the USA, it remains one of the two largest international private medical insurers, the largest international dentistry player, one of the largest care home groups and, probably, the largest player in outpatient care – certainly the only one with scale in four continents.