Hospital's €48m deficit is 'actually underfunding' by the Government, PAC told

The Mater’s overall budget for 2025 was €615m, almost double the €315m allocated to the hospital as recently as 2019, with just over one third of the increase relating to national pay awards, according to the hospital's CEO. File picture: Arthur Carron

The head of one of the State’s largest hospitals has said that a financial deficit of close to €50m at the institution “looks like debt, but it’s actually underfunding”.

Josephine Ryan Leacy, chief executive of the Mater Misericordiae hospital in Dublin, said the €48.7m deficit only exists because “we weren’t funded for the services we deliver”.

The hospital told the Public Accounts Committee that adding to the deficit in any way would risk leaving it exposed to sanctions under company law.

Ms Ryan Leacy said that in April of last year the Mater had entered into a “risk-sharing agreement” with the HSE in order to help the hospital to break even financially and to “ensure that essential patient services did not need to be reduced or suspended”.

“We weren’t funded proportionately,” she said.

“Obviously we can’t close the door. So it’s an underfunding model. It actually looks like debt, but it’s actually underfunding. We can’t build on that because of company law and our directors’ fiduciary responsibilities.

“But just to reassure, it was all about patients getting access and it was because we weren’t funded for the services we delivered. We pride ourselves because actually the Mater could do more, and we’ll do more, but we need the funding to be commensurate with the activity that we deliver.”

The Mater’s overall budget for 2025 was €615m, almost double the €315m allocated to the hospital as recently as 2019, with just over one third of the increase relating to national pay awards, according to Ms Ryan Leacy.

Of the accumulated deficit, €18.8m was incurred in 2024. Ahead of the agreement struck with the HSE, the Mater had forecast a €33m additional deficit for 2025 based on its received budget allocation.

Hospital's location

Meanwhile, Ms Ryan Leacy noted that the Mater’s location in a less wealthy area of the city translates to a “documented life expectancy” for its patients of up to eight years less than for people living in south County Dublin.

“Like all Irish public hospitals, we have the same challenges of an ageing population, increasing presentations and complexity, and this, coupled with our unique demographic, presents very significant demands,” she said, while noting that as much as 13% of emergency department attendances at the Mater are people experiencing homelessness.

“We have 1,800 homeless people living on Gardiner Street, which is literally opposite the door, and we have 1,800 IPAS (international protection residents). These (people) rely on us and we absolutely have to be there to support them,” she said.

Ms Ryan Leacy said that in addition to the pressures of working at the hospital, staff on site have also been experiencing “massive incidents of antisocial behaviour”.

“Staff are actually getting attacked, and it’s just really hard to maintain that morale and to protect staff, which are the core of what we do,” she said.

“We have a very good relationship with the gardaí which we’re very lucky and fortunate to have. However, it’s just getting really really hard to retain staff in an environment that’s so hard.”

She added that while the hospital aims to protect staff “as much as we can with wellness and employee assistance”, it nevertheless remains “extremely challenging” to do so.