Health systems around the world are facing the twin pressures of increasing demand for services, caused largely by the impact of the ageing population and medical science developments, and a lack of resources consequent on economic slowdown in many countries (Lewis et al, 2010). In these circumstances, it should not be surprising that there is an increased focus on the issue of variation in the provision, uptake and costs of health care (Corallo et al, 2013) a focus that anticipates health systems to act to identify and reduce unwarranted variation. Put simply, this means exploring differences in the cost or the way care is organised and provided from one area to another for the same condition or diagnosis, or a difference in the access to care for the same or similar conditions. This is neatly described by Sipkoff (2003) who claimed: “When the approach in one town is major surgery and in another, it’s watchful waiting, you know there’s a problem.” The concept of variation follows two distinct classifications. It is frequently described as being either “warranted” or “unwarranted” and it is difficult, but necessary, to attempt to distinguish between the two. Warranted variation is described as those differences that reflect patient centred care and clinical responsiveness, founded on the basis of assessed need for a population served (Department of Health [DH], 2010c). It needs to be considered separately from unwarranted variation, which is defined as “variation in the utilisation of health care services that cannot be explained by variation in patient illness or patient preferences” (Wennberg, 2010) and is considered unacceptable as it not only wastes valuable resources but is the hallmark of poor quality of health care (Hannan, 1999).