THE most senior civil servant at the Department of Health has warned that services would be at the point of "irreversible collapse" without NHS reform.
Richard Pengelly, who is permanent secretary and the most powerful administrator in the absence of a minister, pointed to spiralling waiting list delays and staffing pressures - and said change to the existing system was "vital".
His warning comes in the same week that a nursing trade union threatened strike action for the first time in its history due to poor working conditions and a pay dispute.
Patients in the north are enduring the worst waiting lists in the UK, with some facing five-year delays for hip replacements while 12 hour A&E breaches continues.
Mr Pengelly was speaking at the launch of a 'progress report' into a 10-year 'road map' plan to overhaul the health service.
It was published in 2016 by former health minister Michelle O'Neill.
The civil servant also outlined some improvements in the the sector through the introduction of new projects, including the transformation of some GP centres and and changes to how daycase surgeries are carried out for cataract and varicose vein patients.
"This report charts significant progress in the two and half years since the publication of Delivering Together...Without this push for change, the system would now be slipping over the edge into irreversible collapse," Mr Pengelly said.
"We clearly still have a long way go, with serious challenges right across Northern Ireland. Too many people are waiting too long for care and staff are under immense and growing pressure.
"These problems are serious symptoms of an outdated health and social care system that cannot keep up with growing demand. Without reform, they will get worse year on year."
Public consultations are currently being held into centralising breast and stroke assessment services so that more experts are under the one roof.
Reviews are also underway in other areas including A&E care, cancer services neurology, paediatrics, and day surgery.
"The long term answer to hospital waiting lists involves reshaping services to improve capacity and provide more diagnoses and treatments," Mr Pengelly added.
"Likewise, staffing pressures are clearly linked to services being spread too thinly across too many locations. Without reform, staffing challenges will keep growing and bills for agency and locum cover will continue to climb."
The report also points to the need for "political leadership and additional investment" to "enable" transformation.
A number of key strategies, include a suicide prevention strategy, require ministerial sign-off.
