The north's most senior health official has warned that the NHS is heading towards "a full-blown crisis" unless the system is urgently reformed.
Richard Pengelly, permanent secretary of the Department of Health, warned that health and social care services are facing their greatest-ever challenges.
Speaking at a Healthcare Financial Management Association event at the Dunadry Hotel in Co Antrim earlier today, Mr Pengelly said health budgets were "under intense pressure" as demand on services continues to increase.
He said NHS providers in England had already called for a "full, frank and open conversation about the severe pressures facing the health service".
“We are certainly in a defining period for health and social care in Northern Ireland," he said.
"Budgets remain under intense pressure. At the same time, demand for care continues to grow.
“Something has to give in that situation. We can see it in our growing waiting lists and the impact these have on public confidence in the system. And it’s also very evident in the rising tide of frustration within our workforce."
Mr Pengelly warned earlier this year that eradicating hospital waiting lists in Northern Ireland could cost up to £1bn.
He said his department had to operate within its budget but was still getting "almost daily" demands for additional spending.
"We simply don’t have the money to do everything we are being asked to do," he said.
“Our constant refrain is that we cannot spend money we don’t have. We need to go further than that, of course, and encourage debate on priorities and how best to use the limited resources we have."
He said an overhaul of the north's health service, as mapped out in the Delivering Together and Bengoa reports, needs to be progressed.
The overhaul includes changing how breast assessment and stroke services are delivered across the north.
"The way we organise services is outdated and needs to change for the sake of patients and staff," he said.
“Change is never easy in health but it is essential. I have no doubt there will be many difficult decisions ahead both on reforming services and on budgetary choices.
“We can’t duck those decisions. If we did, then we really will be heading over the cliff edge into a full-blown crisis.”
