It has been clear for far too long that Northern Ireland's health service in its current form is unsustainable.
The statistics speak for themselves: More than a third of the population is on a waiting list. Five times more cancer patients are waiting over a month to start treatment than a decade ago.
In key areas, Northern Ireland's health service performance falls far behind the rest of the UK and the Irish Republic.
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Simply throwing more money at the system is not the solution. A recent Northern Ireland Fiscal Council report said spending per head on health in 2019-20 was already 7% higher in the region than in England.
Review after review has identified the problems and stressed the need for fundamental reform.
Rather than too many hospitals with services spread thinly, instead reorganise facilities into specialist hubs. It might mean travelling further, but the prize will be better overall patient outcomes.
The much-cited Bengoa report spoke of "systems, not structures". It prompted warnings that without reform, the health system would engulf 90% of the entire Stormont Executive budget within 10 years.
That was back in 2016, so we are now six years on and progress has been slow. As of the last financial year of 2021-22, the Department of Health accounted for 49% (£7 billion) of the Executive's resource spending.
With years of political failure to make the unpopular-but-necessary decisions, it is little wonder this week has seen pressures on hospitals pile up.
A major incident was declared at Antrim Area Hospital last weekend after the emergency department reached full capacity, with the Northern Trust telling the public "not to attend under any circumstances".
Similar pressures mounted at the Ulster Hospital, while days later Craigavon Area Hospital was said to be working "under extreme pressure" and "far beyond capacity".
And in a major move, emergency general surgery has been withdrawn from South West Acute Hospital in Enniskillen, Co Fermanagh.
The latter has caused outrage, with campaigners against the Western Trust's decision gathering on Thursday night outside Enniskillen Town Hall in protest.
It seems evident that communication of the "temporary" move has been poorly handled, with people in the locality fearing hospital services on their doorstep will be lost forever.
But the Western Trust has outlined how repeated difficulties in recruiting the necessary surgical staff meant retaining the service would have been unsafe.
Geraldine McKay, the trust's director of acute services, told reporters: "Put simply, we cannot provide an emergency general surgery service without a consultant surgical team in place to provide the required 24/7 cover."
Other services at the hospital will continue, while the facility is also set to become Northern Ireland's third elective surgical hub - a key measure aimed at tackling spiralling waiting lists.
A consultant colorectal and general surgeon spoke out to say he hoped the decision would not be temporary and "should have happened a long time ago".
Barry McAree said that had the Bengoa review been "properly implemented", the decision would have been made in a more controlled fashion.
"The fact is that surgeons and patients are better looked after in bigger units with longer travel times even taken into the mix," he told the BBC.
While Stormont parties have largely said they support health service reforms, some have been accused of already engaging in "parish pump politics" over the decision.
When Professor Rafael Bengoa delivered his review in 2016, he said Northern Ireland could either "embrace transformation" or "resist change and see services deteriorate to the point of collapse over time".
It appears Stormont is hurtling toward the latter.
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