Orthopaedic consultants at Sligo University Hospital say the hospital's orthopaedic operating theatre is no longer fit for purpose and patient safety is being compromised.
Numerous water leakages in recent years have disrupted the provision of orthopaedic surgery at the hospital.
Most recently, during heavy rainfall on 18 April, a leakage in the orthopaedic theatre's roof forced management to close the facility for eight days for cleaning and air sampling.
The theatre was cleared for use, again on 26 April. However, additional air monitoring is ongoing this week to ensure air quality is maintained.
Three orthopaedic consultants at the hospital have voiced their concerns about the ongoing issues hindering the provision of orthopaedic surgery.
SUH Consultant Trauma and Orthopaedic Surgeon John Kelly said the theatre was closed about five times in the past two years because of leakages.
"We are we are really, really frustrated. We want to provide safe, effective orthopaedic care to the people of the region, but we are unable to do so," he said.
"We are stopped from doing any elective operating for four to five months every year because of bed pressures and trolley crisis.
"It's hard enough to get patients into the hospital, but then when we get them in, we must deal with leaky roofs.
Watch: Consultants say people in the region deserve better
Mr Kelly said they are working in infrastructure that is no longer fit for purpose.
"It is falling down around us. The people of Sligo and the greater region deserve better.
"Management are doing their best, but they're not being resourced properly or funded properly by the Minister for Health or the officials in the Department of Health".
"We cannot guarantee those patients safety with this infrastructure. That is a major, major concern".
Consultant Trauma Surgeon Barry O Neill said they are acutely aware of the healthcare risks posed by the leakages.
"We cannot operate under those circumstances, because if one of our patients gets an infected implant, that's catastrophic, and we are responsible for it.
"We as a group are responsible for the healthcare of a large number of people in the northwest.
"We cannot guarantee those patients safety with this infrastructure. That is a major, major concern".
'Inadequate and run down theatre complex'
Consultant Orthopaedic Surgeon Robert Hurley said he moved home with his young family after training abroad and has found the work environment challenging.
"I'm here since September. I want to deliver high level, expert care to the people of Sligo and the north west and I'm being hindered from doing that due to lack of resources to get into theatre but also due to inadequate and run down theatre complex".
"I’ve worked around the world at this stage, and I’ve never been in that environment. At this juncture, I feel it’s unsafe to proceed," Mr Hurley said.
Mr Kelly said leakages result in a major patient safety issue as water enters what is supposed to be a sterile area thus compromises sterility which increases the chance of surgical patients getting infections.
"If a patient getting a hip or knee replacement develops an infection, they have worse outcomes than a new diagnosis of breast or colon cancer. Orthopaedic infections are entirely preventable," Mr Kelly said.
'State of the art services in archaic facilities'
The SUH orthopaedic theatres were built in 1980. Mr Kelly said the theatre complex is too small as they are providing "modern state of the art services in archaic facilities" in the oldest theatre complex in Sligo.
In a letter sent to local politicians in the north west about the matter, Mr Kelly detailed the challenges faced in the orthopaedic department.
He detailed, how fire doors installed recently were too heavy for the old walls; new theatre tables were too heavy for the floors and were tearing up the lino; and recent plumbing work was complicated because the original pipes could not support the water pressure required.
Mr Kelly said SUH has the only orthopaedic department in the country with half-day trauma theatre sessions, which results in 71% of trauma cases being performed outside of allotted theatre time.
He said the department has eight elective orthopaedic beds on the ward shared between six consultants. and added that they constantly struggle to keep those beds as they are often taken away for medical patients during the regular beds' crises.
Prepared to stop elective operating procedures
In his letter to politicians, Mr Kelly cited the example of Merlin Park Hospital in Galway that had a leak a number of years ago. He said colleagues in Galway stopped elective surgery for five years because of patient safety issues until new operating theatres were provided.
In his letter, Mr Kelly said he is prepared to stop elective surgery in Sligo as was done in Galway.
The €6.7 million facility in Galway included two state of the art theatres, patient recovery bays and staff accommodation, connected to the existing hospital.
Mr Kelly said a multiservice surgical block has been planned for nearly 30 years in Sligo.
He is concerned that it is not a priority at present and he believes a planned 42-bed block will not solve the theatre problems, nor will a surgical hub.
"It feels like Sligo hospital is being downgraded by stealth and budgetary neglect. Over the last few years - we have lost cancer services, pain services and cardiac services.
"The lived reality for us is that we're losing orthopaedic services. The hospital looks like it's going to be downgraded.
"We want assurances from the Minister and for the Department of Health, that's not the case.
"We need investment. We need a multi service block, and that will guarantee the future of surgical services for the north west".
Minister 'well aware of the difficulties'
While in Letterkenny yesterday, Minister for Health Jennifer Carroll MacNeill said she was "well aware" of challenges facing staff at the orthopaedic department.
Ms Caroll MacNeill said she was "well aware of the difficulties that the orthopaedic team have had to go through this year in Sligo, and that there has been a leak, particularly exacerbated during last week's heavy rain.
"They shouldn't need to deal with that. I know that there's a plan to fix it and to carryout remedial works. I've spoken to the regional director in relation to it and I expect to see progress".
When asked about if a multiservice surgical block is in the pipeline for Sligo, the minister said "surgical capacity has to be increased, increased generally in the North West".
The minister will visit the hospital later today, where she will turn the sod on a planned 42-bed unit.
In a statement, the HSE acknowledged there have been numerous water leakages in recent years which has caused service interruptions at the orthopaedic department at Sligo University Hospital.
They said plans are afoot to replace the flat roof. The acknowledged additional space for the storing of medical and surgical supplies is very challenging in this older part of the building.
An additional project for orthopaedic storage space is being considered under minor capital allocation in 2025. A design for this is being worked on currently by HSE Estates.
The statement said there is a concern about the increasing likelihood of surgical infections due to aging infrastructure and lack of space in theatre.
A meeting with members of the Regional Management team, HSE Estates, Consultant Microbiologist and Orthopaedic Consultants is planned to take place in the coming weeks to discuss these matters.
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Surgical hub business case submitted
The HSE statement said a business case supporting the implementation of a West and North West Surgical Hub was submitted to HSE in April 2025.
Within the business case a greenfield site has been identified as potential development location for a surgical hub.
They said the progression of a surgical hub for the north west will provide greater surgical capacity which will support the orthopaedic service for day case activity.
Issue 'has to be resolved' - Minister
Minister for Health Jennifer Carroll MacNeill said the issue with the orthopaedic theatre at Sligo University Hospital "has to be resolved".
"It has to be sorted out. There's no question about it. Here we are, having developed 26 beds. We're standing here in front of a site for 42 beds. We cannot have a leaky theatre. It simply just has to be resolved."
Minister Carroll MacNeill said HSE Regional Executive Officer Tony Canavan had a plan in relation to the issue and added she "does not expect to see it being a problem going into the winter".
Mr Canavan told RTÉ News they will be meeting with SUH orthopaedic surgeons in the next few weeks.
They intend to devise a plan to deal with the consultants' immediate concerns and to also look at a long-term plan for surgery within Sligo hospital.
"We’ve prepared a proposal to develop a surgical hub for the northwest, based in Sligo," he said.
Mr Canavan added: "We’ve identified a site for it that will be considered by the HSE senior leadership team in mid-May and then to the board of the HSE at the end of May."
A decision on the location of the hub will be made at departmental level.
Minister Carroll MacNeill has yet to receive a proposal on the planned surgical hub for the northwest region.
