Improvements to Northern Ireland's health service require radical change and significant investment, a report has warned.
Sweeping changes to transform the stretched NHS services in the region are dependent on the necessary funding being made available, the Department of Health said.
A new report, published one year on from the initial plan for reform of elective care services, indicates that the intention is for money to be made available in the next two years through a £200 million transformation fund as part of the DUP's £1 billion confidence and supply arrangement with the Conservatives.
The progress report states: "While a number of initiatives have been taken forward within existing resources, significant investment is required to transform and modernise services in line with the vision for delivering a world class health and social care system for Northern Ireland, and to deliver sustainably shorter waiting times."
It said services remain under "significant pressure" and branded waiting times "unacceptable", adding: "Long-term sustainability will be achieved only through radical change, supported by investment".
A blueprint for transformation of the health service was agreed by the powersharing executive before its implosion at the beginning of last year.
Despite a lack of ministers, steps to implement the major change programme have continued.
Officials said their intention is to have new elective care centres - described as stand-alone units where large numbers of assessments and routine surgery can take place - up and running by the end of 2020.
It is admitted that some patients may have to travel further for treatment but the report states that, overall, people should see quicker assessment and care as well as better outcomes.
The report also references treatments, including minor surgeries, being performed in medical settings other than hospitals, stating that by the end of next month there will be a GP-led vasectomy service in at least one trust, with such services expected in other other areas in the next two years.
Other new approaches include dermatology photo-triage, where photographs of potential skin problems would be sent to consultants to assess, rather than an automatic hospital referral from a GP.
The report warns that funding must be invested in long-term transformative projects rather than used for short-term fixes.
Northern Ireland Secretary Karen Bradley, who has come under pressure from the DUP to appoint ministers to take decisions on public services including hospitals in the absence of an executive at Stormont, has said she intends to provide budget clarity and will update Westminster soon.