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Business combinations - Schedule of PRA Health Sciences Inc Acquisition (Details) - USD ($) | Sep. 30, 2021 | Jul. 01, 2021 | Dec. 31, 2020 | Dec. 31, 2019
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Business Acquisition [Line Items] |  |  |  |
Goodwill | $ 8,935,212,000 |  | $ 936,257,000 | $ 883,170,000
PRA Health Sciences Inc |  |  |  |
Business Acquisition [Line Items] |  |  |  |
Cash & cash equivalents |  | $ 259,971,000 |  |
Accounts receivable and unbilled revenue |  | 934,308,000 |  |
Other current assets |  | 110,691,000 |  |
Fixed assets, net |  | 162,988,000 |  |
Operating lease right-of-use assets |  | 192,345,000 |  |
Goodwill |  | 8,013,878,000 |  |
Intangible assets, net |  | 4,875,000,000 |  |
Deferred tax assets |  | 172,229,000 |  |
Other assets |  | 35,094,000 |  |
Accounts payable |  | (50,259,000) |  |
Accrued expenses and other current liabilities |  | (342,552,000) |  |
Current lease liabilities |  | (38,371,000) |  |
Unearned revenue |  | (758,901,000) |  |
Non-current lease liabilities |  | (157,658,000) |  |
Non-current deferred tax liability |  | (1,313,599,000) |  |
Other non-current liabilities |  | (53,193,000) |  |
Net assets acquired |  | 12,041,971,000 |  |
Goodwill expected to be tax deductible |  | $ 0 |  |

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