The expert called in to help reform healthcare in Northern Ireland has been in Belfast this week, celebrating the 70th birthday of the NHS but also trying to keep the focus on transforming our creaking system.
Professor Rafael Bengoa produced a report in October 2016 which was regarded as far-reaching in its scope and crucial to delivering the sort of changes required by a population living longer and making greater demands on health services.
Reforming a massive and complex institution is a major challenge but given the enormous pressures evident in parts of the service and the unacceptable waiting times for treatment, it is clear that the way we are doing things is not working.
Lurching from crisis to crisis, attempting to paper over the cracks while not dealing with the underlying problems, is not serving patients well.
Prof Bengoa warned in 2016 that the present outdated system will increasingly be unable to cope.
His view that there are too many services based around buildings rather than what communities and people need will be shared by many who recognise that the current model needs a serious overhaul.
There was cross-party support for the professor's reforms and then health minister Michelle O'Neill appeared determined to deliver change.
Unfortunately, within weeks of his report's launch, Stormont had collapsed and we have been without a health minister for a year and a half.
Speaking yesterday, Prof Bengoa insisted the absence of a devolved administration should not prevent transformation.
It is true that the health service cannot stand still while we await the return of devolution.
This week has seen welcome cash investments announced for Daisy Hill Hospital and GP services. But what happens when senior officials have to make a difficult decision on closing or moving services?
A fully functioning democracy needs to be underpinned by transparency and accountability.
Yes, we need to see reform but change that affects patients' lives must be discussed in an open and candid manner and driven forward by a minister making decisions that are in the best interests of all.
