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In 2002 the Irish Government announced the establishment of the National Treatment Purchase Fund (NTPF) as a means of addressing patients’ long wait times for public hospital treatment. A new health strategy published in December 2001 promised that ‘by the end of 2004 all public patients will be scheduled to commence treatment within a maximum of three months of referral from an outpatient department’. Qualitative methods, including documentary analysis and key informant interviews, were used to gain an understanding of this policy process. The findings were then analysed through the framework proposed for this special issue where ideas, institutions and politics interact. Using McConnell’s typology of policy failure, this research finds the NTPF to be an example of a policy failure because, even though tens of thousands of public patients have been treated under the NTPF, waiting times and numbers have persisted and escalated since the NTPF was established.