Mr. Michael Cullen:

Not that we are aware of.

As regards our annual spend, there is some information that is commercially sensitive. However, our annual accounts will show an annual turnover of €82 million.

We do not have preferential suppliers, but, having said that, a number of our clinicians have a preference for particular surgical instruments. In most cases, that brand would have an exclusive distributor in Ireland. Given that we are led by clinician choice, that restricts somewhat our ability to negotiate with individual suppliers. Having said that, we receive three quotes in all cases with regard to particular types of product. While the clinician might have a preference for brand A, we will obtain quotes for brands B and C to ensure that brand A was appropriately priced. If it was not, the clinician would be shown this and asked if there was a possibility of changing brand, or we would go back to the distributor of brand A to look for a more competitive price. This is a normal, everyday process that the employee in question would have been doing with a very wide range of products that the hospital purchases. That answers those questions.

I may have answered some of Senator Colm Burke's questions. I am happy to tell the Senator that our cost per patient has been decreasing over the past number of years, driven by a number of elements. One is the economic crisis, which forced a reduction in the reimbursements we receive from insurance companies. We received decreases of significant percentages from 2009 onwards, which forced us to be more aggressive in our purchasing. Our hospital and many others, both public and private, have driven the cost of care down through necessity. This has been a huge part of the management's activity both in purchasing and in senior management over the past number of years.

Senator van Turnhout asked about gratuities. We have a limit of €50, which is appropriate. More often than anyone in management or the supply chain, it is nurses and clinicians who are given gifts following the care of patients. We have a strict policy on this and we do not believe we have a problem in that regard. The investigation is looking at our stock levels and timing of orders, and I have previously talked about our preferred suppliers.