It is interesting to compare our European Top 100 private operators for 2014, which we published a few weeks ago, with the Top 100 Hospital groups we compiled back in 2009. How much has their culmalitive sales risen by in five years, do you think?

The answer is that the total has risen from €31.1bn to €71.6bn . We are not of course comparing apples and pears. Some groups have dropped out of the Top 100, others have entered it. And the latest Top 100 contains homecare, labs and nursing home groups, as well as hospitals. But even adjusting for this, we calculate that the Top 100 hospitals in 2014 had sales of €48bn, a rise of 55%.

That is quite hike in sales given that much of Europe has undergone a prolonged recession. The biggest risers are, of course, the most acquisitive. Interestingly, these tend to be the big quoted groups backed by so-called cautious institutional investors, rather than private equity. Helios should more or less double its 2009 sales, a rise of 129% to an impressive €5.5bn in 2014, thanks mainly to its acquisition of the Rhoen hospital portfolio. Ramsay has more than quadrupled sales to over €2.5bn in 2014.

Over this period, private healthcare in Europe has grown, but by nothing like as much as the Top 100. We suspect that the overall market in the hospital sector is probably 2-3% a year, with markets like France and Italy where there have been almost no rise in tariffs, equalling out faster Germany, Finland and Turkey.

The interesting question is, of course, where we will be in five years time? We don’t see the overall market growth stepping up hugely. You would be rash to forecast that governments around Europe will outsource to the private sector to any great extent. And there are limits to consolidation within countries. Helios already has 40% of the German market, for instance.

Nevertheless, it is clear there will be further consolidation and another 30% sales hike is probably easily achievable by the Top 100. The big story will be beyond Europe. We forecast that in five years time the biggest operators of hospitals in Europe will be companies headquartered elsewhere – and we don’t mean the Dutch Antilles!