Tough decisions lie ahead on acute service provision in Northern Ireland, the health minister warned as he indicated facilities were spread over too many sites.
Edwin Poots outlined the £177 million shortfall facing his department a day after the British Medical Association suggested the number of acute hospitals in Northern Ireland should be halved to ensure better services for patients.
Mr Poots did not explicitly identify sites that may close as he gave evidence to his Stormont scrutiny committee, but he said hard choices would have to be made.
"One major factor affecting our relative productivity is the fact that our acute sector resources are spread over proportionately more sites than other parts of the UK which means the time and capacity for our specialist staff is used less efficiently," he said. "As a region, as an Assembly we have a reality to recognise. Let's be absolutely clear about one thing - I am not going to shy away from the task that we face."
Mr Poots told the committee he wanted to hear suggestions from anybody who worked on the ground in the NHS, including hospital administrators, as he admitted his department has yet to formulate a spending plan to cover costs.
The minister told members of the health committee that if services were to be delivered as planned this financial year he faced a £300 million shortfall.
He said his officials had now reduced spending commitments to cover the inescapable pressures in the department and meet statutory obligations, but that still left him £177 million short.
Mr Poots said while a number of initiatives - such as sourcing generic drugs - would help save further money, he still needed to find more efficiencies.
"There are some measures which officials are working on which will reduce this gap but at this point in time the department does not yet have a savings plan to cover all the costs that appear to be unavoidable," he said. "Hence I have asked for further urgent work to be done to identify efficiencies and savings.
"What I do want to hear is ideas coming from the people on the ground," he said. "From the staff on the ground, from the doctors and the nurses, from the people who are just involved in the day-to-day running of the hospitals because every day virtually I am approached by someone who provides me with suggestions as to how money can be saved."