A surprise profit warning from Spire Healthcare, triggered by “material uncertainty” over NHS volumes across the private healthcare sector, sent its shares down sharply.

The unscheduled trading update, issued amid a strategic review of the FTSE 250 company, weakened its share price by 16.6 per cent, or 37¼p, to 186½p in late-afternoon trade, their lowest since April.

Spire said the trends among self-paying customers had continued to improve since its half-year results in July and private medical insurance was “broadly unchanged”. However, these had not offset a recent slowdown in NHS commissioning activity to the private sector, caused by “budgetary restrictions”.

“We continue to work with local commissioners to navigate what we believe to be a near-term challenge,” Spire said.

The slowdown meant Spire expected its full-year adjusted earnings to be at the bottom end of its guidance range of £270 million to £285 million. It compared with consensus forecasts among City analysts of £275.5 million.

It expected adjusted earnings next year to be “broadly in line or slightly ahead of 2025”, which was also weaker than consensus forecasts of about £311 million.

A recent NHS consultation on 2026/27 payment scheme prices has proposed an annual tariff uplift which is “significantly short” of the rate of inflation.

Analysts at RBC told clients that it was a “substantial profit warning [and] implies greater uncertainty in 2026 than we had thought”.

The headwinds came at a sensitive time for Spire, which is in the midst of a strategic review, including a possible sale of the business.

The company, advised by Rothschild, announced in September that it had begun a process to hold talks with a number of parties after frustration from some large shareholders and the board over its valuation on the London Stock Exchange.

Updating on the process, the company, whose chairman is Sir Ian Cheshire, the City veteran, said it had begun talks with a “number of parties in relation to a range of potential options, which may include, but is not limited to, a potential sale of the company, value generation from the hospital property estate and increased strategic focus on private payors”. The process remained at an “early stage”, it said.

One large investor, speaking confidentially, said the profit warning was unhelpful for the process, but noted that the company remained underpinned by good assets.

Spire is one of Britain’s largest private healthcare companies. The group runs 38 hospitals and more than 50 clinics, medical centres and consulting rooms. It also operates a network of private GPs and provides occupational health services to more than 800 corporate clients. It provides services to private as well as NHS patients.

Spire’s chief executive is Justin Ash and its board includes Dr Ronnie van der Merwe, a representative of Mediclinic Group, another private healthcare company, which is Spire’s largest shareholder, owning just under 30 per cent of the company. Toscafund, the hedge fund, owns about 24 per cent, according to FactSet data, making the share register tightly held.

The company has been seeking to offset increased costs from inflation, the national minimum wage and employer national insurance contributions. It is set to generate £30 million of new savings this year.

It has also now agreed an 18-month extension to its £425 million banking facilities to August 2028 on unchanged terms.