Some of Northern Ireland's hospitals and A&Es could shut as early as next year after the Health & Social Care Board approved a draft plan which will dramatically change the way healthcare is delivered here.
The vision includes cutting the current number of 10 acute hospitals by up to half, reducing spending on wages by £40m, which equates to 2,000 jobs, closing local hospitals, treating more patients outside of Northern Ireland and slashing the number of care home places for the elderly.
John Compton, chief executive of the board, has refused to name which hospitals could close under the plans, but with four acute sites located near Belfast city centre, it is likely that at least one will be downgraded to a local hospital.
And while people in Enniskillen are looking forward to the opening of the new acute Erne Hospital, there are also concerns over the future of Causeway and Daisy Hill hospitals.
The number of local hospitals across Northern Ireland is also likely to be reduced as the draft report recommends transferring services to acute hospitals to ensure "greater cost effectiveness".
The proposed changes in health and social care in Northern Ireland could result in:
- Operations carried out on fewer sites with patients spending several days in acute settings before being transferred to a local hospital closer to home for recovery and rehabilitation.
- Tattoo removal and other cosmetic procedures no longer available on the NHS.
- Young people with serious mental health problems sent to specialist treatment centres outside Northern Ireland.
- Massive increase in the number of pensioners living in their own homes instead of care homes.
- More neurology and cardiac services being provided outside Northern Ireland.
However, there will be a £41m black hole in the health budget this year - even with the range of controversial proposals.
Mr Compton, chief executive of the board and the man who will head up a major review of acute services in Northern Ireland, warned this could rise to as much as £60m as a result of unplanned events, such as extremely harsh winter conditions or a serious infection outbreak.
He said trusts will be asked to identify savings over the next year which will probably lead to longer waits in some specialties, but admitted it may not be possible to plug the financial gap.
He also said the budget for dental services is likely to be as much as £7m short with a review under way to identify possible savings, including removing treatments from the NHS.
There were angry scenes ahead of the meeting in Belfast yesterday as union members jostled to be allowed in to view proceedings at board headquarters in Linenhall Street. The proposals will now go to the Health Minister for approval and the trusts will be asked to propose how they will deliver changes - for example, what services they will provide and which hospitals will close.
Mr Compton said: "We are struggling to make ends meet but it would be completely inappropriate to say there will be no health service. We commit more than £10m every 24 hours to support the delivery of services to the population of Northern Ireland."
He also played down fears over the future of midwife-led delivery units in Northern Ireland: "We are going to review this service just as we would with any service to ascertain how it is working. This will help us if we want to create more similar units."