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Exhibit 4(a)(iv)

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20 October 2025

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Smith & Nephew plc

Building 5, Croxley Park Hatters Lane

Watford Hertfordshire WD18 8YE

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Dear Sirs

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USD1,000,000,000 REVOLVING FACILITY AGREEMENT WITH SWINGLINE FACILITY DATED 20 OCTOBER 2023 ENTERED INTO BETWEEN, INTER ALIOS, SMITH & NEPHEW PLC AS THE COMPANY AND HSBC BANK PLC AS THE FACILITY AGENT (THE “AGREEMENT”)

We refer to the Agreement. Terms defined in the Agreement have the same meaning in this letter unless given a different meaning in this letter.

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We refer to the Extension Notice dated 1 September 2025.

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We confirm that each of the Lenders has agreed to the extension of the Final Maturity Date as requested in the Extension Notice. Accordingly, the Final Maturity Date will be extended to 20 October 2030 with effect from 20 October 2025 (being the effective date specified in the Extension Notice).

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Yours faithfully

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/s/ Natalie Gibbons

Natalie Gibbons

Authorised Signatory

HSBC Bank plc

As Agent for and on behalf of the Lenders

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HSBC Bank plc

Global Banking and Markets Issuer Services

Level 14, 8 Canada Square, London E14 5HQ

Tel: +44 20 7991 8888 Fax: +44 20 7991 4351

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