Within a framework of reform, we must get the balance right between the administrative set up and medical service provision. When looking at the cost factor, one must remember that we cannot look at it like a business. We cannot get rid of people from the personnel department because it is top heavy. If one consultant does 1,000 hip replacements in Cappagh at a cost of €20,000 and his counterpart performs 1,000 at a cost of €30,000 in the Mater Hospital, the consensus might be to go with the consultant charging €20,000 per thousand, but that might not be good value for money. The more expensive consultant might be dealing with patients in their 90s who have a much higher cost factor in after-care. He may use a better product in the hip replacement procedures he carries out. He may be a better consultant or a better surgeon, putting greater thought and effort into the job. In a medical context, the fact that he is doing so at a less expensive rate is not necessarily the issue. In considering cost factors and cost-cutting measures, we need to be careful how we proceed. We must not always seek the cheapest option.