The civil servant in charge of the health service in Northern Ireland has warned that we are heading towards a 'full-blown crisis.'
According to Richard Pengelly, permanent secretary at the Department of Health and chief executive of Health and Social Care NI, we are in a 'defining period', with budgets under intense pressure while demand for care continues to grow.
He said: ''Something has got to give in that situation.''
Dire warnings about the state of the health service are nothing new, of course, and anyone on a waiting list or turning up at a busy emergency department or trying to get an appointment with a GP, will attest to the serious issues that are all too apparent.
However, Mr Pengelly's comments to a healthcare event in Co Antrim this week indicate a sense of exasperation at the top of the civil service which has been left to manage the NHS without a minister in place to set policy and make decisions.
There is no doubt that people at all levels of the health service are frustrated by the budgetary constraints and the gaps in staffing, which have a hugely negative impact on both patients and personnel who struggle with increased workloads.
As head of the health and social care system in the north, the senior civil servant is uniquely placed to see all aspects of the NHS, the management structures and the pressure points as well as the entire financial picture.
From this overarching position he is making the case for reform, as set out by the Delivering Together and Bengoa reports.
He points out that change is never easy in the health system, but it is essential, while difficult decisions cannot be ducked.
In the absence of Stormont, officials in all departments have been keeping public services ticking over but it was never envisaged that the impasse would last this long.
Standing still is not an option, and not only in health.
Education, roads, water services, infrastructure - all need to move forward or else they will fall behind, causing deeper problems in the future.
The health service is undoubtedly struggling and the word crisis is entirely justified when we consider the appalling waiting times for treatment.
The Stormont stalemate is not just a political issue but one that will have implications for years to come.
