Bermuda Shorts 16: I’ve never heard of Leonard Skinner!

by Bill Shields

13 January 2020


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. 

In early December, I attended the HFMA annual conference in London for the first time in two years. I had forgotten what a fantastic event it is. I had also, clearly, forgotten about the NHS as most of the presentations I attended demonstrated how much it has changed in under three years!

It’s not until you leave the NHS that you realise how prevalent the use of acronyms and abbreviations is and I am thankfully, once again an expert on ICS, ACS, ACOs, STPs and a plethora of other equally baffling terms.

As well as catching up with many ex-colleagues and association members, I was also given the opportunity of running a workshop on healthcare funding changes in Bermuda. Thank you to the 20 or so curious attendees and ex-employees (who had very little choice) who turned up to hear me! I will reference a couple of the points made as they continue to demonstrate how very different health systems are facing similar challenges.

I have written at length on the government’s proposed reforms in Bermuda, but here I’d like to highlight a few other considerations. The median age in Bermuda is currently 44, one of the highest in the OECD. In the next 10 years, this will increase to 49, which will move it to the top of that particular table.

This would present problems for any jurisdiction, but where healthcare is funded through insurance, this means that the proportion of those contributing into the risk pool compared to those who use the funds generated is increasing to a level where there are questions over sustainability.

From an NHS perspective, one might think the answer is obvious: universal healthcare, free at the point of delivery. But elsewhere, this is often seen as limiting choice.

I can’t write without mentioning the general election in the UK. The outcome will be seen as positive or negative depending on whether one is a die-hard Remainer or ardent Brexiteer. But it is clear that the UK (although not necessarily Scotland and Northern Ireland) has provided the new government with a sufficient majority to proceed with the process of withdrawal from the EU.

The precise impact is impossible to predict. However whether this leads to a period of unprecedented growth or unrelenting fiscal restraint, it will have a deep impact on the public finances and the NHS. And this is regardless of whether funding increases are enshrined in statute.

Brexit will also impact the relationship between the UK and British Overseas Territories. Unlike Gibraltar, Bermuda is not a member of the EU, but it does tend to follow EU legislation and, given the predominance of international business and its contribution to GDP, Brexit is likely to have a significant impact.

Avril and I turned up in England with four suitcases feeling that this would be ample for any amount of conspicuous consumption. However, once again, we found ourselves  adding to our already extensive suitcase collection when we realised that the depressed value of sterling last month was just too attractive.

As I get to close to the end of my original contract in Bermuda, I find myself thinking about what will happen over the next three years. I am struck by how similar the determinants of health are all over the world and yet, how different the systems developed to tackle these are. This is often driven by perception and culture – although there are also a lot of misconceptions about different countries’ systems.

The NHS is no more a system where patients die waiting for elective treatment than US healthcare is one where patients can’t get into an ambulance without signing an insurance waiver. These perceptions are particularly relevant at present in Bermuda as the debate on the government’s proposed healthcare reforms continues.

The issue of perception and culture is one that struck me in a very different way while having a drink with a work colleague. As Freebird blasted out of a speaker near the bar, I commented that it featured the best guitar solo of any song (and, incidentally, something I will definitely be able to play well before I retire!). I was stunned when, in answer to who it was by, I received the answer: ‘I’ve never heard of Leonard Skinner’.  The band (Lynyrd Skynyrd), I’d thought, are surely a household name – although perhaps this is a generational thing. Anyway, the point is that things are not always as obvious or clear as one might think.

I hope you all had a good Christmas and wish you a prosperous New Year where financial balance is once again miraculously achieved by skilled chief finance officers and finance directors pulling that still-breathing rabbit from a hat.

Until the next time, good day!