The trustees were now faced with the more mundane task of actually running the hospital and board meetings consist of the day to day problems of hospital management. It appears that in the early years physicians were providing their services free of charge but a series of salary scales was then implemented for each grade of staff. In 1801 there are three physicians mentioned in the annual report, Francis Barker, William Stoker and George Hagan. In 1807 the senior medical staff now comprised seven people including four physicians, A Register, Apothecary and a Surgeon. The Register in that year also held the title of Purveyor and Collector. The Housekeeper was Leonara Boys. In 1811 the salary of Irene Leedom, Housekeeper and senior female staff member was set at £50 in the first year rising in yearly increments of £5 to a maximum annual salary of £70. This was agreed in order to encourage her good conduct. In 1821 in response to government queries on the hospital expenditure a complete list of salaries was prepared. The highest paid member of staff was the Register on a salary of £120 per annum followed by the Apothecary with £100 per annum. The six physicians were earning a similar salary. Irene Leedom was still Housekeeper now with a salary of £75 per annum. The head nurse, Margaret Topham earned £13-13s. There were thirty nurses employed each earning £6-16s per annum.The death of Dr O’Brien is mentioned in the 1846 minutes. He had worked there for 32 years. After his death his widow wrote to the board requesting financial help. She stated that for the past fourteen years he had been suffering from an incurable disease which inhibited his earning capacity. She was now left with four children, the youngest being only 12 years and ‘are left in a state of destitution.’ In addition to his duties in the hospital he had also acted as Librarian in Sir Patrick Dunn’s hospital. The board declined to assist her as they had no funds in their power for such circumstances.
Irene Leedom remained as the housekeeper until 1826.Her name is first mentioned in 1808. Thereafter housekeepers seem to leave with alarming regularity, at least two of them accused of dishonesty. The role of the housekeeper was set out in the annual report of 1809. She was specifically charged with care of the female patients. In addition she was responsible for all bed linen. She was responsible for the female staff in the hospital and was held responsible for their duties. Eventually the housekeeper was replaced by a Lady Superintendent or Matron. The position of head nurse appears to have been a relatively minor one. There is rarely direct mention of the various incumbents except to record their yearly gratuity. This gratuity appears to be a bonus on their salary. In 1809 the total staff compliment also included three porters, two whitewashers, nine nurses and seven female servants. A collector has now been appointed and the Register has shed one of his job descriptions. In 1852, following a series of enforced cutbacks at the hospital, the Matron’s starting salary was put at £40 per annum with a yearly gratuity of £5. She was also provided with accommodation, coal and candles. As she was responsible for the stock of the hospital a condition of her employment was that she was to provide a bond of £200 as security. This security was to be provided by her, and two bondsmen. In 1853 a John Purser who had recommended the appointment of a Mrs. Walsh as Matron was obliged to honour that security. His letter accepting his obligation to the board mentioned that she was the widow of a schoolmaster with a large family. A number of paupers had been arrested for having property of the hospital in their possession. The extensive list of items which Mrs. Walsh was alleged to have misappropriated included 128 night caps, 75 shirts, 107 pairs of stockings and 60 pairs of shoes. The total cost was put at £95 but the board agreed to accept £40 from Mr. Purser.
In 1809 the catchment area of the hospital was extended to include all areas south of the river Liffey and within the South Circular Road. This boundary was strictly enforced. In 1820 a letter from the combined parishes of Palmerstown/Chapelizod and Ballyfermot was received requesting the hospital to take in a family suffering from fever. The family was stated to be lying on the high road, between, Chapelizod and Palmerstown and was described as strangers and unknown to any members of the community. The Register of the hospital admitted the family to the hospital much to the annoyance of the board. The Registrar was called before the board and ordered to write to the parish admitting that he was guilty of an irregularity and insisting that any further cases were to be directed to the House of Industry on the north side.
In 1809 an additional government grant enabled the hospital to enlarge the hospital which now held accommodation for 140 patients. The population of this catchment area was reckoned to be 112,497. Funding for the hospital was now a constant problem and it was now surviving on a mix of charitable and state funding. A collector was employed to collect charitable donations and paid a salary plus a percentage of the collection. In 1808/1809 the annual report contains the names of all those who subscribed to the hospital. There were over seven hundred and sixty individual donations to the hospital that year. The majority of donations were less than £2. The largest donation was from David la Touche £22.15 while the Earl of Ross donated £20.00. The total collected was £1819 approx. In 1817 the hospital was again enlarged and the capacity was then stated to be 240 beds. In total from its opening until the year 1854, 168,645 patients were admitted to the hospital and the total government grant in that period was £202,996. This equates to an average of £1-4s per patient. This grant obviously fluctuated over the years and ignoring the years 1808 and 1809 when extra funds were provided for rebuilding, the grant was as low as £0-10s-4d in 1811 to a high of £1.17s-4d in 1824.