It's a really important question. We talk a lot about financial efficiency and savings, but, actually, what you're just describing is absolutely key, which is how do we get better use of the existing resources we're already deploying, whether those are physical resources, kit or whatever it is. You're right that there has been a lot of work done over the past couple of years with the NHS in Wales. There was a ministerial advisory group that reported about 18 months ago, which highlighted a number of areas of potential productivity growth, particularly around things like, 'Are we getting the maximum throughput in our theatres? Is everybody delivering the standard of eight cataracts on an operating list for cataracts?' And what you find is that there's quite a big degree of variation both within organisations and across organisations. So, there's a lot of opportunity around metrics such as that that actually are hard measures, if you like, of how many more we can get through with the existing resources.
The point you made, though, which I think is really important, was that this narrative can't be, 'We just need to work everybody harder', because, actually, that, as you rightly say, doesn't do anything to motivate or engage our staff. There's been some recent work done by the Health Foundation that highlights that the biggest productivity opportunity is actually through a greater degree of engagement with staff, because if staff feel engaged and motivated, they will often, understandably, feel more engaged, want to do their job better and will come up with the ideas of how they could do their job better. So, there is very much a balance that we're all trying to strike, which is around some of the conversations we've just been having about control of cost and making sure that that is managed property, but also supporting and engaging our staff to say, 'And what opportunities do you think we've got to make things better?' And, as you rightly say, many of our staff will come up with ideas and highlight things that they think are not supporting them to be efficient.
One of the things that comes up frequently is things like digital opportunities—how we could be using technology in a more efficient way to do our jobs. We've still got lots of our staff using paper-based systems, walking around with piles of notes. We've got vans driving around our communities with notes in the back of vans. In this day and age, I think we'd all acknowledge that that is not where we need to be and it's not an efficient use of people or time, but also that poses a risk in terms of the information not being readily available for a clinician when they need it. That's just one small example; there are lots and lots of examples where technology could massively enable our colleagues to be better.
Some of the other things that crop up are things like the physical estate not always being configured in the best way. When you have the opportunity to design a new facility, you design that productivity and efficiency into it. In many of our facilities, we're operating an estate that is older. It's having to be reshaped and reformed to meet today's needs, but is often not always that efficient. So, there's a combination, I think, of both the staff engagement, as you rightly describe—. Certainly, in my organisation, we've got a group of colleagues who support teams that want to do improvement work. They'll go out, work with them, help them conceptualise the idea, turn it into a reality, help them measure the impact and the success, and also then share that learning with other teams across the organisation, to say, 'Look, this team did this and it's probably got read-across into your area.' And I know other colleagues will have similar arrangements in their own organisations. So, absolutely, that staff engagement and learning and innovation coming from the ground is a really important part of the productivity conversation.