Rafael Bengoa: Health system struggling but it’s still possible to blaze a trail others can follow
I'm delighted to be back in Northern Ireland today, catching up with old friends and finding out at first-hand about the latest developments in health and social care.
It is always an inspiration to see for myself the commitment and expertise of staff - and the widespread determination to make things better.
There is no doubt that the system is struggling, as demand for services keeps rising and budgets are squeezed.
However, there are grounds for confidence too, not least because we know what needs to be done to ensure a stable and successful future.
That's the main theme of my visit today - helping to celebrate the 70th birthday of the NHS and focusing on what is required and being done to help it endure and prosper.
The central problems being faced at present should not come as a surprise. We warned in our October 2016 report about the "burning platform" - that the current outdated system will increasingly be unable to cope as pressures and challenges intensify. Inevitably, demand will continue to increase sharply as people live longer lives.
At present, too many services are based around buildings rather than being centred on what people and communities need.
Much more care needs to be delivered in primary care settings, close to or in people's homes. That's the essence of transformation. I keep in close contact with Northern Ireland and I know there are some less than positive voices on the prospects for serious health reform.
I realise too that this viewpoint is connected to the political situation and the collapse of the devolved institutions not long after our report was published.
But I want to say that you don't have to give in to pessimism.
Always remember that the situation facing health and social care in Northern Ireland is far from unique. Citizens and policy makers across much of the developed world are grappling with the exact same fundamental issues.
Significantly longer life expectancy - the demographic revolution - is changing the face of society, often in very positive ways. It means health and social services have to change and that applies across different funding models.
In my own country, I sometimes worry that we are in collective denial about the enormous challenges in front of our eyes.
Working in the medium to long term is not always our strength in Spain. We are champions of short-term reaction. In the case of the demographic challenge and sustainability, the short term will not work for the health system. Like Northern Ireland, we in Spain have had severe winter pressures in our hospitals, not least due to flu.
If we don't transform, every month will eventually start to look like January and February.
That will not be because of the flu, but because of chronic diseases that affect older people all year round. Within a relatively short time, the health system will enter into crisis due to this natural demand.
The same applies to Northern Ireland and many other countries.
We can't keep relying indefinitely on hard-pressed staff to keep shoring things up.
They need to see that there is a willingness and determination to change, that there is hope for the future.
Here's the good news. That willingness and determination exists in abundance in Northern Ireland.
Of course there will be frustration and setbacks along the way.
Politics and policy-making do not tend to follow a smooth path anywhere in the world.
Transformation is a long-term process. That's why your last Health Minister Michelle O'Neill set out a 10-year vision in her "Delivering Together" report in October 2016.
There is still a strong consensus for change, a deepening understanding that you can't continue with the status quo.
I was very heartened back in October 2016 at the cross-party support for transformation and the widespread awareness of why it was needed.
Of course, that collective understanding does not guarantee success. But it provides a strong basis for moving forward.
Northern Ireland can still blaze a trail for others to follow.
So by all means celebrate the health service's 70th birthday with pride. But keep working to make sure it reaches 80 years in fine shape.
Professor Rafael Bengoa is a health reform specialist and the author of the Bengoa Report