THE health service will need Northern Ireland's entire government budget to function in 20 years' time unless there is urgent reform, a powerful civil servant has warned.
Richard Pengelly, permanent secretary at the Department of Health, said the sector "cannot continue on this trajectory" in terms of hospital and community care.
The lion's share of the Executive's departmental budget is allocated to health, at around £5 billion per year.
Speaking in a BBC documentary Spend it Like Stormont - which breaks down the cost of public services in the absence of an assembly - Mr Pengelly said funding is only part of the problem and all services require change in how they are set up and delivered.
He pointed to the high number of acute hospitals - there are 11 A&E departments for a population of 1.8 million - and the "dilution" of medical expertise because services are spread too thinly.
A proposed shake-up of stroke and breast assessment services is currently out to consultation - a move that has been opposed by some campaigners in rural areas.
"We have enough (money) to run a world-class health service but we don't have enough money to run this health service," Mr Pengelly said.
"We cannot continue the way we are... at the moment to run the health service the way we did last year and next year, it's about six per cent growth per annum.
"...Within about 20 years, the health service will need virtually all the money that's available to the Executive".
Mr Pengelly, who is effectively the stand-in health minister, references an independent report carried out by a former English chief medical officer as to how services are duplicated across too many hospitals.
"Sir Liam Donaldson said we don't have a National Health Service, we have a National Building Service," he said.
The department's chief social worker, Sean Holland, also features in the programme and warns of the "new funds" required for social care due to an ageing population - with the public being asked to "contribute" to their own care.
Mr Holland suggests a cap being imposed as how much someone pays.
The case for re-introducing prescription charges - they were scrapped by former health minister Michael McGimspey in 2010 - is also made.
The programme, which will be aired tonight, also examines spending in the Departments of Justice and Education and asks three groups of people how they would allocate the Executive's £26 billion annual budget.
The Economic Policy Centre at Ulster University also examines ways in which money could be spent differently - such as scrapping university tuition fees or increasing rates bills.
