Bermuda Shorts 21: 2020 hindsight

by Bill Shields

18 January 2021

Bermuda Hospitals Board’s chief financial officer reflects on a difficult nine months for all health systems and looks ahead to the immediate and longer-term challenges in 2021


It probably sounds hackneyed, but few of us are ever likely to see a year like 2020 again. The impact of the Covid-19 pandemic is the first truly global outbreak since Spanish Flu in 1918. And while it may not to date have caused as many deaths as that earlier pandemic, the economic impact and the societal shocks it has created are profound and will be felt for some considerable time.

The Pfizer/BioNTech vaccine was the first to be rolled out in the UK, with the Oxford/ AstraZeneca offering hot on its heels. More recently the Moderna vaccine has been approved by the UK regulator and further vaccines are also well advanced.  The development and roll-out of a vaccine in 10 months, rather than 10 years, is a great scientific achievement and owes much to the mapping of the human genome and the reality of genetic-level treatments.

But what of the virus’s economic impact? The developed economies have spent trillions of dollars supporting industry, furloughing employees, developing economic stimulus programmes. And, as the world comes out of suspended animation, the reality of how long it will take to recover this position will start to dawn.

In Bermuda, we are just experiencing a second wave of coronavirus and, like the rest of the world, this comes at a time when health systems are traditionally over-stretched due to winter pressures. For this wave, we are, thankfully, better prepared with greater ventilation, oxygen and personal protective equipment (PPE) capacity.

However, we also have a cohort of employees who are becoming very fatigued and have been working without the ability to take leave. The population, as in the rest of the world, are also becoming tired of restrictions, isolation and lack of social contact. Add to this the mental health impact arising from prolonged lockdown periods and it is clear we are all still in for a very challenging few months over the winter, regardless of the speed of vaccine roll-out.

2020 also saw many other momentous events. From a climate change perspective, here in Bermuda, we had three hurricanes in a season for the first time in many years – one of these being a direct hit. Fortunately, we were spared from Hurricane Iota, the latest occurring category five on record; this also being only the second time the Greek alphabet has been utilised.

Politically, Donald Trump joined Jimmy Carter and George HW Bush as a one-term president. Joe Biden takes up the presidency alongside the first African-American, Asian-American and female vice president in the form of Kamala Harris.

Clearly, one of the first tasks for the incoming administration will be how to get to grips with a second wave of coronavirus, which is leaving more Americans dead – more than 2,500 per day as a seven-day average at the beginning of January – than in the first wave back in April. Despite these alarming figures, there are still elements of the population who believe that Covid is a conspiracy theory.

In Bermuda, the governing Progressive Labour Party was returned to power after a snap general election in October with a much-increased majority and 30 of the 36 seats in the House of Assembly. Universal healthcare remains a key policy objective. However, this clearly does not come for free and the new government will need to balance this ambition against rebuilding an economy battered by the reduction in tourism caused by the pandemic.

Bermuda Hospitals Board (BHB) is engaged in this dialogue and is committed to the concept of integration; keeping people out of hospital if they don’t need to be there, regardless of whether or not they are insured, and facilitating early discharge to appropriate step-down facilities or back home.

As mentioned previously, this will require development of population-based payment mechanisms and a move away from fee for service. We’ll be working with government over the coming months to determine how this can be accommodated in an insurance-based health system where private providers will still be remunerated on an item-of-service basis and the barriers to market entry have, historically, been low.

To facilitate the changes lying ahead, BHB is looking to introduce a new electronic medical records system. For many of you, this will sound fairly routine. But in an organisation reliant on legacy systems and, in some cases, paper-based records, this will be a huge undertaking. But it is one that has real potential to revolutionise healthcare for the entire population of the country, not just hospital services. I will keep you apprised of developments.

On a personal front, having previously studied the HFMA advanced higher diploma in healthcare business and finance, I have now completed my MBA with BPP University – my final dissertation being on performance management in BHB. I have found the experience to be very beneficial and would encourage HFMA members to explore this programme.

From a very sceptical start, I have learned a great deal about management theory and been able to put this into practice in a work setting in a way I wouldn’t have expected. In the current Covid environment, it is also good to be able to study for and attain a qualification entirely online.

In closing, we have all had a challenging and surreal nine months. I’d like to wish you a happy and virus-free year in 2021.

Until then, good day!