Bermuda shorts 10: Yes, we have no bananas!

by Bill Shields

12 December 2018

In April 2017, after 30 years working in NHS finance, former HFMA chairman Bill Shields moved to Bermuda as chief financial officer of the territory’s hospitals board. In this series of blogs, he documents his experiences.

Last month, while walking to work, I caught sight of my reflection in a shop window and thought how ridiculous the moustache I’d grown for Movember looked. I had to also accept that the canary yellow shorts and knee length socks probably added to the overall effect. Thankfully, for the local population at least, the razor has now done its job and the Bermuda shorts are back in the wardrobe until next spring arrives in March.

Sticking with yellow things, Bermuda is facing a banana shortage at present due to supplies imported from Central and South America being infected with mealy bugs. In addition, supplies of romaine lettuce have been found to be contaminated with E. coli. This would not normally be a big deal in the UK, as I’d just go to another store, or possibly even another town if I was really desperate. But when the nearest land is over 600 miles to the West, tossed salads and banoffee pie will be off the menu for a while!

The last few months have been very busy and this is likely to continue on both a professional and domestic basis for me throughout the winter. I’ve not long arrived back from the UK, where I celebrated my son Alex’s 20th birthday and, apart from a couple of heavy showers, managed to avoid most of the bad weather.

I’ve started the HFMA Advanced higher diploma in healthcare business and finance, with a plan to go on to complete an MBA next year and I’ve been packing up to move house in Bermuda for the third time.

Bermuda Hospitals Board (BHB) is close to completing the contract for its clinical affiliation agreement with Johns Hopkins International and the board has just approved the strategic outline case for redevelopment of its estate using a public-private partnership (yes the private finance initiative is alive and well in Bermuda!).

This is a major undertaking involving a $275m scheme to replace all of our mental health, learning disability, long-term care and ancillary services and will be one of the largest building projects ever seen on the island.

The government has also been busy and in the Throne Speech (our version of the Queen’s Speech and delivered by the governor), stated its intention to replace the current system of health insurance with one based on either a unified or dual fund.

At present, there are three commercial insurers and three public ones in Bermuda. Each is required to offer Standard Health Benefit (SHB) as a minimum, but this is then topped up with supplemental services including doctor’s office, radiotherapy and off-island care to produce a major medical policy. The range of cover being offered can differ widely, the cost of insurance is among the highest in the world and it is also felt that too many people have inadequate, or no insurance cover.

The creation of unified or dual funds would, effectively, move to a single or two risk pools (one private and one public) with the intention of reducing the cost of cover, increasing the risk appetite of insurers and, consequently, broadening the definition of SHB to include services currently outside its purview. The intention is to have everyone covered and everyone has to pay an insurance premium. So this could be seen to be moving Bermuda closer to universal coverage, although admittedly for a narrower level of service provision than that covered by the NHS.

The government sees reducing the cost of insurance premiums as an essential precursor to any further changes to the health system, including regulation of the system and greater accreditation of providers.

For BHB, these would be important developments. At present, we receive a fixed amount to cover treatment costs for all of those individuals who cannot afford the full cost of insurance. These include youth, indigent and aged categories and are referred to as ‘subsidy’ patients as the Ministry of Health pays a subsidy for their treatment.

In practice, this means BHB takes all of the risk on costs being higher than the fixed amount and the eligibility of those patients receiving care. The new arrangements would change this by means testing based on ability to pay, while providing patients with the means to pay for their care at the point of delivery.

I won’t be back in the UK until April and for the first time for many years, I have missed the HFMA annual conference in December. This was not an easy decision, but I had to attend an infrastructure conference in the Bahamas at the beginning of December as we look to learn from best practice in major public infrastructure projects.

I am sure you will all feel sorry for me being in Nassau rather than Edgware Road. However, I hope you have a very good Christmas and financially balanced New Year. For my part, I will be looking for some fresh bananas!

Until the next time, good day!

Read our other 'Bermuda shorts' blogs here:

Bermuda shorts 1: the heat is on
Bermuda shorts 2: a collection of firsts
Bermuda shorts 3: putting the focus on costs
Bermuda shorts 4: dark and stormy
Bermuda shorts 5:lost in the triangle
Bermuda shorts 6: flying a kite
Bermuda shorts 7: end of the beginning
Bermuda shorts 8: howzat!
Bermuda shorts 9: finding a way