Comment / Bermuda Shorts 25: paradise lost

It’s been a very long time since my last blog and that’s for good reason as I have been waiting for the formal announcement of my new role. As some of you will already know, I am very pleased to have been appointed as chief finance officer at Devon Integrated Care Board and will be rejoining the NHS in November.

I am really looking forward to the challenges. As well as catching up with so many of you at last year’s annual conference (which was the event that convinced me to return), I also enjoyed meeting many colleagues from Devon and further afield at my first HFMA key supporters’ dinner for many years. I shouldn’t actually have been there at all. But thanks to finally contracting Covid, my two-week break in the UK and Ireland turned into four weeks, due to Bermuda’s quarantine rules and lack of available alternative flights.

With three months left on the rock, I thought it might be good to look back on my time here in this and my final blogs. These have been rewarding and challenging years for me, both professionally and personally. I have grown and changed as a person since I came to Bermuda in 2017.

Back then, like many other Brits, I thought I was off to the Caribbean, rather than the North Atlantic. I had no idea the country was only 21 square miles with a population of just over 60,000.

Bermuda Hospitals Board (BHB) had a healthy balance sheet and substantial cash reserves built up over several years making significant surpluses. But, just as I joined, this golden age came to an end and I have subsequently found myself in a period of tight financial constraints. This has resulted in BHB seeing its income reduced and then capped., partly caused by a reduction in insurance plan premiums during Covid.

For Fiscal Year 21, BHB saw its revenue reduce by $30m in absolute terms and I was proud of my finance team in spearheading a cost improvement programme from month six onwards that led to a break-even being achieved.

Culturally, life on the rock has been very different from my expectations. As mentioned, the island is only 21 square miles and, while it is a British overseas territory, its proximity to the eastern seaboard of the United States can create a somewhat schizophrenic environment. This is evidenced by the fact that I have now learned how to watch premier league and American football in the same sports bar on different screens at the same time, without thinking this is in any way strange!

Personally, my life here has been one of physical and spiritual growth and change, which I believe has been more pronounced than the previous 30 years of my adult working life. I have developed a love of yoga, something I could never have imagined, and an obsession with running, something that no one who knew the Bill Shields who last worked in the NHS would believe!

I have not, however, managed to cure my accident-prone nature. The latest incident was when I managed to ground my car with one wheel in the air when dropping off a colleague on a track and then reversing into a wall 30 minutes later for good measure.

I have, at least, managed to curb my earlier tendency to be the emergency room’s most frequent flyer. I had three visits in the space of a month in 2020 after a bout of food poisoning, which ended with my first ever hospital inpatient stay.

I have also managed to experience the US health system at first hand, as this is where most tertiary care occurs for Bermudian residents. Both of my experiences were at Johns Hopkins in Baltimore. As I have said before, despite having worked in a London teaching hospital, I was overwhelmed by its customer service allied to a wealth of resources unknown in the NHS.

Bermuda has felt the full force of the pandemic. This has been mainly through the loss of foreign labour, which has not returned, and the impact on tourism, which, while not a major component of GDP, ceased to make any contribution for over 12 months from April 2020. This has, in turn, put sustained pressure on BHB’s revenue position. It led us to explore new ways of sustaining our financial position, including a waiver on the payment of payroll tax and suspension of work permit fees.

It is recognised, however, that a sustainable funding mechanism is required with a population-based payment system that incentivises integration and greater collaboration. BHB is continuing to work with the ministries of health and finance on its development.

Bermuda continues to surprise me, almost six years after first stepping off a plane for my interview for the chief finance officer role. The climate, culture, way of life and the many close friends I have made will not be forgotten and I am sure I will visit again once I have moved back to the UK. In my final blogs I will detail the lessons learned and how I hope these will help in the next stage of my career back in Blighty.

Until then, good day!

Bill Shields was chief financial officer at Bermuda Hospitals Board from April 2017 to November 2022. He is now chief finance officer at Devon Integrated Care Board.

All the blogs from this series can be accessed here