Northern Ireland's healthcare system must radically transform or it will collapse, an international expert has said in a stark warning to Stormont.
Professor Rafael Bengoa was speaking yesterday as his report was finally published, four months after it was delivered to Health Minister Michelle O'Neill.
Long waiting lists and chaotically busy hospital emergency departments have recently dominated the headlines.
And Professor Bengoa warned that either the health service embraces change or it will see services "deterioriate to the point of collapse over time".
The report from the expert panel he chaired - Systems, Not Structure: Changing Health and Social Care - points to rising demand, changing demographics, health inequalities and financial sustainability as compelling arguments for change.
It includes 14 recommendations such as "aggressively scaling up good practice" and the appointment of a senior manager to lead the change.
Ms O'Neill considered the contents of the report over the summer and yesterday published a 10-year plan called Health and Wellbeing 2016: Delivering Together, which aims to chart a roadmap through the change process.
It includes 18 time-specific actions which are based on recommendations from Professor Bengoa's report.
The minister's vision takes into account Northern Ireland's rapidly ageing population, noting that by 2023 30% of our population will be aged 65 or over - up from 24% in 2015. There is projected to be a similarly steep growth in the proportion of elderly people up to 50% in 2061.
Introducing the document to the Assembly yesterday, Ms O'Neill said if the current healthcare system does not change, by 2026 the health budget will need 90% of the entire Executive's funding.
Delivering Together proposals include a short-term plan to tackle waiting lists and says that by next spring every GP practice will have a named district nurse, health visitor and social worker.
Also announced was a roll-out of pharmacists at GP practices, and the number of GP training places will increase to 111, while more advanced nurse practitioners and further support for looked-after children is to be in place by late next year.
The plan also includes a focus on preventing poor health with the introduction of a new model of person-centred care. It is aimed at prevention, early intervention, supporting independence and wellbeing.
It concludes with a section of actions, including a design for new structures to support the reform of planning and administration of health and social care by next March, and proposals for both Elective Care Centres and Assessment and Treatment Centres.
Ms O'Neill told the Assembly yesterday that it was a good day for health.
However, she warned that the plan is "not a quick fix".
She said the change will be "planned, managed, incremental - this is not a 'Big Bang'".
While no costs are given in the report, Ms O'Neill told the Assembly: "I acknowledge the cost of transformation may be significant. But standing still is not an option - there are consequences if we don't deliver planned and managed change in our health and social care system.
"Even with the best efforts of HSC staff, waiting lists will continue to grow, expertise will continue to be diluted and the best possible outcomes for our citizens will not be realised."
The Sinn Fein minister also committed to update the Assembly every six months on progress.
The transformation plan has been endorsed by the Executive, as well as First Minister Arlene Foster and Deputy First Minister Martin McGuinness.
Ms Foster thanked Professor Bengoa and his colleagues for their work.
"Their report sets out a frank assessment of the existing situation and the need for change," she said.
"It represents a challenge to politicians, but it is a challenge this Executive is going to meet head on.
"We are committed to increasing our substantial investment in the health service year in and year out. However, it is clear the present configuration of services needs to change to ensure the best outcomes for patients," she added.
Mr McGuinness described yesterday as a "powerful example of the Executive working together", and said they "will deliver a Fresh Start for the health service".
"This is a time for leadership and this Executive is going to provide it," he added.