27 September 2022

Kooth Plc

("Kooth" or the "Company" or the "Group")

Half year results

Strategic momentum and demand; underlined by revenue growth of 13%

Continued expansion of Kooth Adult with 63% ARR growth

First major contract win in the US

Kooth (AIM: KOO), the UK's leading digital mental health platform, announces unaudited half year results for the six months ended 30 June 2022.  All figures relate to this period unless otherwise stated.

Strategic Highlights

·      Number one provider of mental health access for children and young people (CYP) to

NHS England

·      Kooth Adult contract wins increase access to 7.2 million people (2021: 3.0 million)

·      Kooth Work momentum with new contracts, focusing on frontline and key workers

·      Ongoing investment in business development, platform investment and US expansion

Financial Highlights

·     Revenues up 13% to £9.0m (2021: £8.0m)

·     Annual Recurring Revenue (ARR) up 11% to £18.5m (2021: £16.6m)

·     Strong gross margin of 68.4% (2021: 69.4%)

·     Adjusted EBITDA of £0.5m (2021: £1.1m) reflecting US setup and business development investment

·     Recurring Revenue 95% (2021: 94%)

·     Net Revenue Retention 107% (2021: 116%)

·     Robust balance sheet; net cash of £8.3m supports investment for long-term growth

Post-period end Highlights

·     Significant, strategic pilot contract (expected to be formalised in the coming days) awarded by the State of Pennsylvania, USA for $3 million, supported by new, in-market hires including counsellors, technology specialists and business development personnel

Financial headlines

 Tim Barker, Chief Executive of Kooth said:

"Kooth has strong momentum for its mission to make effective, personalised mental health care accessible to all. Our platform is now freely available to more than 15 million people in the UK providing early intervention support for adults and making us the largest single access provider for mental health support for under 18s.  This is a testament to the reach of our partnership with the NHS.  In the US, post period end, we have won our first major contract, a significant milestone within a year of establishing Kooth North America, as well as a growing pipeline of opportunities with State Governments and Medicaid providers in a market that has already announced in the year to date $6 billion of additional youth mental health funding.

Our pipeline and strong retention rates support our confidence that Group revenue for the full year will be in line with the range of market expectations. In the long-term, we anticipate that our robust balance sheet will continue to enable us to invest to meet increasing demand for Kooth's platform. We expect to continue our investment in talent and technology to scale up and help tackle the global issue of mental health, which remains one of the world's biggest challenges."

The information contained within this announcement is deemed by the Company to constitute inside information as stipulated under the Market Abuse Regulation (EU) No. 596/2014 as it forms part of UK domestic law by virtue of the European Union (Withdrawal) Act 2018 ('MAR'). Upon the publication of this announcement via a Regulatory Information Service ('RIS'), this inside information is now considered to be in the public domain. The person responsible for this announcement is Sanjay Jawa, CFO.

Enquiries:

About Kooth plc:

Kooth (AIM:KOO) is the UK's leading digital mental health platform. Our mission is to make effective, personalised mental health care accessible to all. Our platform is clinically robust and accredited to provide a range of therapeutic support and interventions. All our services are predicated on easy access to make early intervention and prevention a reality.

Our three services are:

·   Kooth: for children and young people

·   Kooth: for adults

·   Kooth Work: for employees

Kooth is a fully safeguarded and pre-moderated community with a library of peer and professional created content, alongside access to experienced online counsellors. There are no thresholds for support and no waiting lists. Currently, Kooth sees over 4,000 logins a day.

For adults, Kooth operates across distinct locations and serves specific cohorts, including parents, teachers, victims of crime, and those who have suffered from or continue to experience domestic violence. It is also offered as a benefit by a number of corporate organisations delivering anonymous digital mental health support services to employees.

Kooth is the only digital mental health provider to hold a UK-wide accreditation from the British Association of Counselling and Psychotherapy (BACP).

In 2021, Kooth was named 'Best Newcomer' at the European Mediscience Awards, winner in the category of 'Tech for Good' at the UK Tech Awards and recognised as the 'HealthTech Pioneer of the Year' at the UK Business Tech Awards for its role in 'Supporting the Nation's Mental Health'.

Chief Executive's Review

Delivering against our mission

Kooth continues to make strong progress in delivering our mission to make effective, personalised, mental health care accessible to all: growing our leadership position in supporting children and young people via the NHS, expanding our service to Adults, entering the US market to help tackle their youth mental health crisis, and helping build mentally healthy workplaces.

This is reflected in our revenue growth of 13% along with an increase in Annual Recurring Revenue of 11% to £18.5 million.

As a recurring revenue business, 95% of Kooth's contracts are for 12 months or more (2021: 94%). We continue to expand contracts with existing commissioners as we grow within a region, delivering a net revenue retention of 107%. As we saw a small number of COVID-19 projects come to a close and a resizing of some pilot contracts to better reflect demand in specific regions, contract retention reduced to 89% in the first half of the year.

Expanding access to Kooth across the UK is a key strategic priority.  In the last six months we have grown the number of people that can freely access Kooth's services by 39%, to 15.1 million people (excluding Kooth Work).

Our adult, workforce, and international businesses continue to gain momentum as we leverage our 20 years of operating experience into new markets, notably in the US where we have been awarded our first major contract.

Strategy

Kooth has a clear four-pillar growth strategy to support the increasing demand for mental health services in the public and private sectors, all underpinned by investments in our technology platform and clinical operating model:

1.    Continue to scale Kooth to support young people in the UK

2.    Replicate our success into the adult public sector market

3.    Expand into international markets, with an immediate focus on the US.

4.    Build mentally healthy workplaces

Children and Young People

Kooth continues to meet increasing demand from children and young people for fast and effective access to mental health support. NHS England data for 2021/22 shows that Kooth has now become the largest single access provider for mental health support for under 18s, a testament to the trust and reach that we have achieved in our partnership with the NHS.

62% (7.9 million) of the UK's 10-25 year olds now have access to Kooth, with 1-in-33 of that population using Kooth in the previous year. As we continue to work with stakeholders to raise awareness for Kooth within communities, our highest performing contract is now reaching 1-in-7 of the local population. We intend to replicate this across other areas of the UK.

In addition to the therapeutic outcome measures that Kooth has developed over recent years, the York Health Economics Consortium (YHEC) conducted an independent study of Kooth, showing a projected 3.16x direct cost saving when using Kooth.

Finally, following the reorganisation of NHS England from 135 Clinical Commissioning Groups (CCGs), to 42 Integrated Care Systems (ICS), we aligned our commercial and engagement teams to the new ICS model, organising into four regional teams with local leadership to better support our stakeholders and service users and to maximise our strategic impact. 

Adults

Momentum for Kooth Adult (also known as Qwell) continues, with five new whole population contracts in the first half of the year, growing ARR in adults by 63% to £2.7 million.

7.2 million adults now have access to Kooth Adult in the UK, a 140% increase from the 3 million at the start of the year, with new 'whole population' contracts in Devon, Greater Manchester, Norfolk, Northumberland, and Warwickshire.

A key focus in ensuring the success and growth of contracts is to work both locally and digitally to raise awareness for Kooth Adult with stakeholders and potential service users. Our recent focus on reaching and educating GPs has made good progress, with 19.7% of service users telling us they heard about Qwell from their GP. In addition, our focus on optimising for Google means 14.8% of service users find us via search, up from 7.9% in 2021.

Finally, a key priority for us in supporting whole population health is to ensure that we are delivering on our purpose to be an inclusive and welcoming service for all. We have made good progress in our Participation work this year to understand and support the needs of men from ethnic minority backgrounds, working in partnership with community groups to co-produce the 'future of Kooth'.

US

Within a year of establishing Kooth in the US, the credibility that we've earned in the UK is already opening doors for us, with the award of a pilot project by the State of Pennsylvania.

This $3 million pilot contract (awarded in September 2022 and to be formalised in the coming days) will make Kooth available to a school population of 150,000 students across 30 school districts in Pennsylvania State. The contract will run initially for the academic year and, if the pilot is successful, could be extended to include more of the State's 500 school districts.

The contract received bipartisan support in the State legislature, with the objective of expanding access to youth mental health care. As part of the pilot, Kooth will report on both the therapeutic and economic impact of its digital platform in providing early intervention and responsive support to the school population.

In addition, we secured our first project to support University students, working with the University of Pikeville, Kentucky.

Looking forward, we have a growing pipeline of opportunities with State Governments and Medicaid providers, which are indicative of the imperative, and investments being made at both a Federal and State level to tackle the youth mental health crisis.

For market context, more than $6 billion of youth mental health funding has been announced so far this year, including:

●     $300 million will be invested this year to expand access to mental health services in schools, as part of a comprehensive national strategy to tackle the youth mental health crisis.

●     An additional $1 billion will be invested over the next 5 years as part of a Bipartisan Communities Act.

●     The State of California has budgeted $4.7 billion to deliver the "Master Plan for Kids' mental health", including the planned provision of state-wide youth digital mental health services.

Workforce

Kooth Work is our platform for employers and employees to help build mentally healthy workplaces. Given the broad range of solutions available to companies - from meditation apps to medical insurance - we have narrowed our focus to frontline/key workers (33% of the UK workforce) to support employees working in high stress, stretched, and sometimes traumatic occupations.

With the recent launch of the Education staff wellbeing charter, and news that Ofsted inspections will include staff wellbeing, we are building momentum in selling to Academy Trusts to help support staff wellbeing. In addition, our recently launched 'Flourishing Assessment' enables us to benchmark the mental health of an organisation and measure improvements over time.

Our people

The Board wishes to thank its employees for the excellent support and commitment they are providing to our service users, customers and company.

In May 2022, Angela Kravets joined the Group as Chief People Officer, bringing new approaches and initiatives to our People strategy as we continue to focus on attracting, developing and retaining the most talented of individuals.

Kooth continues to progress its approach to diversity and inclusion with its established advocacy group with representation from across our organisation. The business is committed to creating a working environment that recognises diversity, supporting everyone to thrive.

Like many organisations, we saw a more challenging market in the first half of the year in recruiting and retaining talent across the business. In response, in the short term, we've grown our use of contract staff in both product/tech and practitioners. Post period end, the Group is over 400 employees, versus 376 at end of June 2022 (31 December 2021: 406, 30 June 2021: 352).

Investing for long-term growth

Kooth is investing in its talent and technology platform to drive its growth strategy and meet increasing demand for digital mental health support. This is intended to capture the long-term market opportunity available both in the UK and internationally.

Key progress in H1 2022 included:

·    Technical operations work to operate Kooth's technology in international data centres, with our first deployment in the US. 

·    Development of artificial intelligence technology to assist in the moderation of user generated content, surfacing risk faster, and reducing the cost and time to review content.

·    The development of our next-generation practitioner system to codifying clinical best practice into the platform, and enabling skill-based matching of practitioners with those requiring support.

·    To address the challenges of hiring software engineers, Kooth has partnered with a nearshore engineering company to augment our UK-based engineering team.  

Current trading and outlook

Kooth expects to continue to invest in its technology platform, systems and talent in the second half of 2022. This is part of Kooth's strategy to meet long-term demand for digital mental health services.

With the pipeline of contracts which are expected to be signed in the second half of this year, including the State of Pennsylvania contract, and with strong retention rates of existing business the Group remains confident of delivering revenue for the full year within market expectations.

We anticipate our robust balance sheet will enable us to continue to invest to meet long-term, increasing demand for Kooth's services. We will continue this investment in our talent and technology to enable us to scale up to tackle what is one of the world's biggest challenges.

Tim Barker

Chief Executive

Chief Financial Officer's review

Kooth delivered a solid performance in the period supported by an increase across revenue and annual recurring revenue as well as a continuing strong gross margin for the Group for the half year ended 30 June 2022 in comparison to the six months ended 30 June 2021. 

Key Performance Indicators

Total Revenue

As we continue to invest in and grow our business, revenue growth demonstrates the progress we are making.

Annual Recurring Revenue

Annual Recurring Revenue (ARR) is the annualised revenue of customers engaged or closed as at the period end and is an indication of the upcoming annual value of the recurring revenue. This is used by management to monitor the long term revenue growth of the business.

Gross Margin

Gross Profit as a percentage of revenue. Direct costs are the costs of our practitioners directly involved in the delivery of our services.  

Adjusted EBITDA

Earnings before interest, tax, depreciation and amortisation in the period, adjusted for share based payments and exceptional costs. This metric provides a more comparable indication of the Group's core business performance by removing the impact of non-trading items that are reported separately.

Number of customers

The total number of live contracts with customers. In 2021/22, as the NHS consolidates from 135 Clinical Commissioning Groups to 42 Integrated Care Systems, we are seeing a shift to larger contracts spanning the whole population within an ICS region We have subsequently seen the consolidation of existing contracts including North Central London and Humber Coast and Vale with the trend expected to continue across the NHS customer base.

Service user logins

The number of logins to Kooth from users, demonstrating uptake of our service.

Revenue

Revenue increased by 13% to £9.0 million (2021 H1: £8.0 million), Annual Recurring Revenue grew by 11% to £18.5 million (2021 H1: £16.6 million), with 22 new contracts obtained in the first half of 2022 across all service lines in addition to a number of contract uplifts.

Churn for the period was 11% giving net revenue retention (measured by the total value of on-going ARR at the period-end from clients in place 12 months earlier as a percentage of the opening ARR from those clients) for the period to 30 June 2022 of 107%. This has decreased from 116% recorded in H1 2021 as a result of an increase in churn as certain annual contracts won in H1 2021 have been resized on renewal to reflect demand in specific regions and contracts, the ending of some COVID-19 related contracts and partly by a slow down in uplifts as the NHS consolidates from a Clinical Commissioning Group (CCG) to Integrated Care System (ICS) structure.

Gross Profit

Gross Profit increased 13% from £5.5m to £6.2m but as a percentage of turnover decreased during the period by one percentage point to 68.4% as we see some of the savings during lockdown such as travel and in person training start to reverse.

Adjusted EBITDA

Adjusted EBITDA in the period decreased from £1.1m to £0.5m with increased gross profit offset by higher administrative expenses. This included the costs of establishing a team in the US, increased investment in business development, platform consulting and additional marketing costs due to targeted engagement spend on new adult contracts. This is in line with Board expectations.

The total charge for share based payments in the period was £0.02m (2021 H1: £0.3m). The decrease reflects grants forfeited by leavers and a reassessment of those grants subject to performance criteria.

Taxation

The overall tax credit for the six months ended 30 June 2022 and 2021 relate to Research and Development expenditure credits in addition to the movement in the deferred tax asset. 

Profit/Loss after tax

The Group loss after tax for the period was £0.3 million (2021 H1: £0.04 million profit).

Balance Sheet

The strength of the Group's balance sheet with net assets of £10.6m (30 June 2021: £11.2m), high levels of recurring revenue and strong cash generation from operating activities provide the Group with financial strength with which to execute on its investment strategy which continues to focus on business development, platform investment and US expansion.

Cash flow and financing

Cash generation during the six months was £1.2 million (2021 H1: £1.0 million), which benefited from good working capital management predominantly an increased number of customers paying in advance as well as receipt of an R&D government tax credit of £0.3m giving a net cash position at 30 June 2022 of £8.3m (2021 H1: £8.8m).

The focus on platform investment gave capital expenditure of £1.3 million (2021 H1: £1.5 million), with the reduction in the six months to 30 June 2022 relating to an external project incurred in the prior year and offset by increased capitalised investment by our Product and Technology teams.

Sanjay Jawa

Chief Financial Officer

Condensed Consolidated Statement of Comprehensive Income

For the six months ended 30 June 2022

Condensed Consolidated Balance Sheet

As at 30 June 2022

(Continued)

Condensed Consolidated Statement of Cash Flows

For the six months ended 30 June 2022

Condensed Consolidated Statement of Changes in Equity

For the six months ended 30 June 2022

Notes to the half year financial statements

1. General information

The unaudited interim consolidated financial statements for the six months ended 30 June 2022 and the six months ended 30 June 2021 do not constitute statutory accounts within the meaning of Section 434 of the Companies Act 2006. Statutory accounts for the year ended 31 December 2021 were approved by the Board of Directors on 28 March 2022 and delivered to the Registrar of Companies. The auditor's report on those accounts was unqualified, did not contain an emphasis of matter paragraph and did not contain any statement under Section 498 (2) or (3) of the Companies Act 2006.

These condensed half year financial statements were approved for issue by the Board of Directors on 27 September 2022

2. Basis of preparation

The interim condensed consolidated financial statements do not include all the information and disclosures required in the annual financial statements and should be read in conjunction with the Group's annual consolidated financial statements prepared in accordance with international accounting standards in conformity with the requirements of the Companies Act 2006 for the year ended 31 December 2021.

Trading for the half year ended 30 June 2022 is aligned with the Board's expectations and further details are given in the Chief Executive and CFO's overview.

The Group is in a net asset position of £10.6 million as at 30 June 2022 (2021: net assets of £11.2 million) and has no debt facilities in place. Management have prepared forecasts up until 12 months from the date of approval of these financial statements which have been approved by the Board, and after enquiry and review of these forecasts and other available financial information, the Directors have formed the conclusion that the Group has adequate resources to continue to operate for the foreseeable future and that it is therefore appropriate to continue to adopt the going concern basis of accounting in the preparation of these interim condensed consolidated half year financial statements.

The financial information is presented in sterling, which is the functional currency of Kooth plc. All financial information presented has been rounded to the nearest thousand.

3. Accounting policies

The accounting policies applied in these interim financial statements are the same as those applied in the Group's annual report and accounts for the year ended 31 December 2021. Current taxes on income in the half year period are accrued using the tax rates that would be applicable to expected total annual profits. Deferred taxes on income are calculated based on the standard rates that are enacted as at the balance sheet date.

4. Critical accounting judgements and key sources of estimation uncertainty

Any critical accounting judgements and key sources of estimation uncertainty that carry a significant risk of material change to the carrying value of assets and liabilities within the next year are the same as those applied in the 2021 Group Annual Report.

5. Principal risks and uncertainties

The 2021 Group annual report and accounts describes the principal risks and uncertainties that could impact the Group's performance. These risks primarily relate to cyber security and clinical safety, with any risks relating to COVID-19 deemed to be not material given the industry in which the Group operates and the Group's business model. These remain unchanged since the annual report was published and are not expected to change for the remaining six months of the financial year.

The Group actively manages these risks through risk management procedures and actions are taken to mitigate risk wherever possible.

6. Financial risk management

The Group is exposed to financial risks including market risk, credit risk & liquidity risk.

These interim condensed consolidated financial statements do not include all financial risk management information and disclosures required in the annual financial statements and therefore should be read in conjunction with the 2021 Group annual report and accounts.

7. Forward-looking statements

Certain statements in this half year report are forward looking. Although the Group believes that the expectations reflected in these forward-looking statements are reasonable, it can give no assurance that these expectations will prove to have been correct. Because these statements involve risks and uncertainties, actual results may differ materially from those expressed or implied by these forward-looking statements.

8. Segmental reporting

Operating segments are reported in a manner consistent with the internal reporting provided to the chief operating decision-maker. The chief operating decision-maker, who is responsible for allocating resources and assessing performance of the operating segments, has been identified as the executive directors that make strategic decisions. Kooth plc opened its first international subsidiary in the USA at the start of 2022. The Group continues to work on establishing its capability in the USA and has recently won its first pilot contracts in the region, which will go live in H2 2022. Segmental reporting of the USA operation is not deemed appropriate at this stage as no revenue has been generated for the six months ended 30 June 2022.

9. Reclassification of Promotional Costs

During the year ended 31 December 2021 the Group made the decision to reclassify its promotional costs from cost of sales to administrative expenses on an ongoing basis. This gives a more appropriate view of the financial statements, with regard to the criteria for the selection and application of the Group's accounting policies. As a result, the comparative period for the six months ended 30 June 2021 has also been reclassified so that comparability is not impaired.

The impact to the half year 2021 accounts as a result of the classification is demonstrated below. The amount relating to promotion spend included in the six months ended 30 June 2021 administrative expenses line is £0.5 million

10. Revenue analysis

Revenue has been derived from its principal activity wholly undertaken in the United Kingdom and relates to the provision of online counselling services.

11. Income tax expense

The income tax expense recognised reflects management estimates of the tax charge for the period and has been calculated using the estimated average tax rate of UK corporate tax for the financial year of 19% (2021: 19%). 

12. Earnings per share (EPS)

The calculation of basic and diluted EPS is based on the following earnings and number of shares:

13. Dividends

The Group's intention in the short to medium term is to invest in order to deliver capital growth for shareholders. The Board has not recommended an interim dividend payment in respect of the six months ended 30 June 2022 (2021: £nil) and does not anticipate recommending a dividend within the next year but may do so in future years.

 14. Development Costs