Bermuda shorts 8: howzat!

by Bill Shields

07 August 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.

Not that long ago, I was sitting in an Irish pub, in a British overseas territory, watching England lose to Croatia and exit the World Cup after a creditable campaign. As a Scot, I had mixed emotions. But I ended up supporting England – even if this was only in the vain hope of a repetition of Scotland’s 3-2, 1967 victory over the ‘auld enemy’, resulting in us becoming world champions for a year!

It feels like a lot has happened in the last two months, both in the UK and here in Bermuda:

  • The NHS has celebrated its 70th anniversary and received a significantly, more favourable funding settlement for the next five years. This was followed by the departure of the longest-serving Secretary of State for one of the great offices of state. Clearly, time will tell as to whether his successor will find this funding sufficient to deal with the ongoing fiscal challenges combined with ever-increasing patient demand and expectation.
  • The UK government has published its Brexit White Paper, the lead up to which saw two members of the cabinet resign and renewed speculation on the future of the prime minister and government. The eventual agreement will clearly impact on the NHS as well as the wider public sector and so, continuing challenges lie ahead.
  • I attended the annual HFMA US Conference in Las Vegas, more of which later.
  • Bermuda Hospitals Board appointed advisers to support the delivery of our service improvement programme and have selected Johns Hopkins Medicine as our preferred clinical affiliation partner.
  • We concluded discussions on the move to a relative-value resource-based system (RVRBS) for all outpatient activity with likely implementation in October of this year.
  • The board’s chairman stood for Parliament and was elected an MP in the ruling government. (While this is unusual, it is not unprecedented in Bermuda).
  • My son arrived in Bermuda to spend a fortnight’s holiday complete with his girlfriend and a suitcase full of dirty laundry (yes, honestly)!

Here in Bermuda, the Progressive Labour Party (PLP) government is celebrating one year in power. With the by-election referred to above, it has actually increased its majority and continues to develop policy aimed at improving access to employment and education for Bermudians, while ensuring the fiscal position improves to the point where the deficit is paid off.

The position is very similar for BHB. We have stabilised the financial position and now we are looking to move back to surplus from next fiscal year. This work will be supported by KPMG and will focus on delivery of the service improvement programme referenced above, verification of our financial recovery plan assumptions and testing its resilience.

The former will focus on the usual NHS suspects: length of stay reduction; optimising patient flow; operating room (theatre) scheduling; staff rostering and reducing delayed transfers of care. Additionally, we will focus on top-line revenue through optimising our revenue cycle management processes. This is even more critical than in the NHS given our contracts with government and commercial insurers have no tolerances and so are, effectively, 100% cost per case!

So what of Vegas? The HFMA US annual conference was a good event and, as before, my major interest was in getting as much information about how successful revenue cycle management works. I will not, however, be looking to replicate the Penn Medicine network of hospitals in Philadelphia, which employs 2,400 FTEs on revenue cycle, no matter how impressive their income recovery rates are!

For those of you who haven’t been, if you think of Las Vegas as being like Disneyland for adults with temperatures akin to sticking your head in an oven, you won’t be far wrong. Having managed to book myself into the wrong hotel, I quickly realised why I was the only person in the entire state of Nevada walking the relatively short distance to the convention centre. I have the sunburn obtained at 7.30am in the morning to prove it.

For once, I was genuinely grateful to get back to the relative mildness of 84 degrees with 100% humidity.

This month, my wife Avril and I are off to Alaska on a cruise, via San Francisco, as Bermuda becomes pretty unbearable with high humidity in August. This is when Cup Match takes place - a two-day public holiday which this year falls on August 2 and 3. This allows most of the island’s population to attend a two-day cricket game between Somerset from the west end of the island and St George’s from the east.

It is always unbearably hot, at least 25% of the game will be rained off and, for the last 10 years at least, Somerset usually win. My burgeoning interest in cricket following Scotland’s one day victory over England in June is not, alas, sufficient to encourage me to reschedule my vacation.

For this reason and also because August is a time when very little else happens on the island, I will be spending the first half of next month whale watching, enjoying wearing a big coat again and recovering from the effect of daily sunblock applications.

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