Spire Healthcare, the UK's largest private hospital operator, has received a non-binding buyout proposal worth £1bn from Toscafund Asset Management, the activist hedge fund. The Spire board said it would be minded to recommend the 250p-per-share cash offer unanimously to shareholders should a firm bid materialise, sending the company's shares up 47p to 221p on Thursday.

Toscafund was founded in 2000 by Martin Hughes, a City veteran who has earned the nickname "the Rottweiler" for his assertive approach to dealmaking. Hughes already holds a significant position in Spire as its second-largest shareholder, making this an opportunistic move from within the register rather than an external approach. The fund has form in taking listed companies private, having acquired the telecoms group TalkTalk in a £1.1bn deal in 2021.

Spire operates 38 private hospitals and more than 60 clinics across England, Wales and Scotland, delivering care to 1.36 million patients in 2025. The business generates revenues from two sources: private patients, including a growing number paying out of pocket, and NHS-commissioned procedures such as hip and knee replacements. NHS work accounts for just under a third of total revenues. The group was established in 2007 through the acquisition and rebranding of 25 Bupa hospitals before floating on the London Stock Exchange in 2014.

Thursday's announcement follows a period of sustained deal activity around the company. Spire launched a formal strategic review last September, disclosing that it was in discussions with several parties about a potential sale. Those talks included private equity firms Bridgepoint and Triton, though the process collapsed when Triton withdrew in March. The 250p offer price carries a degree of historical resonance: Australian hospital group Ramsay Healthcare tabled an identically priced bid in 2021 that was accepted by the board but voted down by shareholders.

Spire's share price had fallen to a five-year low of 142p in March before Thursday's rebound. Miles Dixon, an analyst at Peel Hunt, said he would not be surprised to see the deal proceed, provided a formal offer at 250p was tabled. The board described itself as highly confident in its standalone strategy, though its willingness to recommend the Toscafund proposal suggests the offer is being taken seriously.

Under UK Takeover Panel rules, Toscafund must either announce a firm intention to make an offer or walk away by 11 June. The outcome will depend in part on the position of Mediclinic, Spire's largest shareholder with a stake of just under 30%. Mediclinic has not yet indicated publicly how it would respond to a formal offer. Should Toscafund proceed, it will need to secure sufficient shareholder support to take the company private, a process that will be watched closely given the 2021 precedent.

The bid arrives as the private healthcare sector faces sustained scrutiny over its relationship with the NHS. Wes Streeting, who resigned as health secretary on Thursday, had defended the expanding use of independent providers to reduce NHS waiting lists, though the policy has attracted criticism from those concerned about a two-tier health system. Consolidation in the wider healthcare infrastructure market has also been notable. Last August, NHS landlord Assura was acquired by Primary Health Properties in a £1.8bn deal, following a contest that also drew interest from the US private equity group KKR. Whether Spire follows a similar path to private ownership will become clear before June is out.