Public policy failure in healthcare: The effect of salary reduction for new entrant consultants on recruitment in public hospitals

Abstract

Policies fail or succeed for many reasons. These reasons include the decisionmaking process, which depends on the interplay of interests, as well as ideology and information. While bearing in mind that perception is often allimportant in deciding if a policy is a success or failure, this paper examines the policy failure of the 2012 decision to reduce salaries for new entrant consultants in Irish public hospitals. This salary reduction resulted in difficulties recruiting and retaining hospital consultants in the public sector. Firstly, the timeline and context of the decision are explored, taking into account the financial crisis at the time. This leads on to an examination of why this decision was made. It appears likely that self-interest on the part of the Minister for Health was a factor, and that self-interest on the part of the medical unions prevented reasonable discourse. The ideology of austerity was a predominant theme of government budgets in 2012; however, this ideology was also influential in creating an environment that allowed blame for public sector pay to be focused predominantly at public hospital consultants. Finally, I find problems with the information used in decision-making for the policy. This is evident from the irrational beliefs held by policymakers on the likelihood of recruiting consultants with lower salaries.