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

Open access


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.

If the inline PDF is not rendering correctly, you can download the PDF file here.

  • Bhattacharyya G. (2015). Crisis austerity and everyday life: Living in a time of diminishing expectations. London: Palgrave Macmillan.

  • Blyth M. (2013). Austerity: The history of a dangerous idea. Oxford: Oxford University Press.

  • Clarke N. Crowe S. Humphries N. Conroy R. O’Hare S. Kavanagh P. & Brugha R. (2017). Factors influencing trainee doctor emigration in a high income country: A mixed methods study. Human Resources for Health 15 66.

  • Dáil Éireann. (2012). Confidence in the Minister for Health: Motion (resumed) [private members]. Dáil Debates.

  • Dustmann C. (2003). Return migration wage differentials and the optimal migration duration. European Economic Review 47 (2) 353–69.

  • Elinder M. Jordahl H. & Poutvaara P. (2015). Promises policies and pocketbook voting. European Economic Review 75 (C) 177–94.

  • Erikson R. S. (1989). Economic conditions and the presidential vote. The American Political Science Review 83 (2) 567–73.

  • European Commission. (2012). Economic adjustment programme for Ireland summer 2012 review. Retrieved from [8 November 2018].

  • Fianna Fáil and Sinn Féin to table no-confidence motion in Health Minister James Reilly. (2012 September 4). Retrieved from [15 April 2019].

  • Fine Gael. (2011). Programme for government. Retrieved from [15 April 2019].

  • Garcia-Perez M. A. Amaya C. & Otero A. (2007). Physicians’ migration in Europe: An overview of the current situation. BMC Health Services Research 7 201.

  • Gerlach-Kristen P. (2014). Testing the permanent income hypothesis for Irish households 1994–2005. The Economic and Social Review 45 (4) 511–35.

  • Grossman R. S. (2013). Wrong: Nine economic policy disasters and what we can learn from them. New York: Oxford University Press. Hardiman N. & Regan A. (2013). The politics of austerity in Ireland. Intereconomics 48 (1) 4–32.

  • Healy A. J. Persson M. & Snowberg E. (2017). Digging into the pocketbook: Evidence on economic voting from income registry data matched to a voter survey. American Political Science Review 111 (4) 771–85.

  • Heffernan E. McHale J. & Moore-Cherry N. (2017). Debating austerity in Ireland: Crisis experience and recovery. Dublin: Royal Irish Academy.

  • HSE. (2012). ConsultantsImplementing the Public Service Agreement. Retrieved from [15 April 2019].

  • HSE. (2016). Towards successful consultant recruitment appointment and retention. Retrieved from [10 January 2019].

  • IMO. (2017). IMO submission to the Public Service Pay Commission. Retrieved from [4 January 2019].

  • Jackson J. E. & Kingdon J.W. (1992). Ideology interest group scores and legislative votes. American Journal of Political Science 36 (3) 805–23.

  • Joint Committee on Future of Mental Health Care. (2018 September 26). Health sector pay report: Public Service Pay Commission. Retrieved from [4 January 2019].

  • Joint Committee on Health and Children. (2011 October 20). Non-consultant hospital doctors: Discussion (resumed). Retrieved from [22 April 2019].

  • King A. & Crewe I. (2013). The blunders of our governments. London: Oneworld.

  • Lynch P. (2012). Profession’s unease at the new consultant ‘down’ grade. Retrieved from [15 April 2019].

  • O’Brien P. (2012). Labour: Reilly is weakest link in cabinet. Retrieved from [15 April 2019].

  • O’Shea B. (2011). GP slams ‘immoral’ consultant pay. Retrieved from [15 April 2019].

  • O’Sullivan K. P. V. & Kennedy T. (2010). What caused the Irish banking crisis? Journal of Financial Regulation and Compliance 18 (3) 224–42.

  • Public sector pay: A defining test for Paschal Donohoe. (2018 April 25). The Irish Times.

  • Public Service Pay Commission. (2017). Re: requested supplementary information and reply on public service pension matters. Retrieved from [8 November 2018].

  • Public Service Pay Commission. (2018). Report of the Public Service Pay Commission: Recruitment and retention module 1. Retrieved from [10 January 2019].

  • Shortall R. (2012). Moves afoot for reform of chaotic healthcare model. Retrieved from [8 November 2018].

  • Sinn Féin. (2018). Unmatched posts. Retrieved from [15 April 2019].

  • The eighth austerity budget. (2013 October 19). Retrieved from [15 April 2019].

  • Tweed S. (2012). New salaryConsultants [Letter]. Retrieved from [15 April 2019].

  • Vujicic M. (2004). The role of wages in the migration of health care professionals from developing countries. Human Resources for Health 2 3.

Journal information
All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 1978 1978 21
PDF Downloads 1263 1263 17