Dr. Tony O'Connell:

If I could add another aspect of variance to the answer to Deputy Nolan's question. Hospitals do not have the same degree of complexity in the cases they are dealing with. If we stick with the tonsillectomy example, if a child is severely obese and has obstructive sleep apnoea exacerbated by large tonsils in their upper airway, that is a case where the clinician is going to be less comfortable. If a hospital tends to attract large numbers of that kind of case - children with obstructive sleep apnoea - it is going to be different to the practice of a hospital where the majority of tonsillectomies are just done on the indication of a few episodes of tonsillitis.