Northern Ireland's health and social services were 'challenged as never before' last winter, the Department of Health, Social Services and Public Safety has admitted.
A candid and damning report on the crisis appears to vindicate those who claimed the health service was 'grossly underfunded' despite ministerial rhetoric.
But while it acknowledges the need for more staff and more beds, managers have warned there is little in its recommendations to prevent the crisis recurring.
Facing the Future concedes that last winter the 'situation at times threatened to overwhelm services'.
Hospital activity was 'of ten more than 30 per cent above that in the winter of 1998-99 - itself a very busy time'.
A five-month old baby had to be transferred to Liverpool at one point because there were no intensive care facilities available in Northern Ireland.
The report says Northern Ireland's health service:
has the longest hospital waiting list in the UK, with more than 5,000 people waiting longer than standards set out in the Patient's Charter ;
runs 'too close' to full capacity throughout the year, leaving no slack in the system;
has fewer adult intensive care and high-dependency beds than the recommended minimum - and provision is falling;
finds it difficult to recruit and retain enough staff to 'maintain core full capacity in core functions'.
Dan Thompson, former chair of Eastern health and social services board, whose term of office was not renewed after a row with government over funding, said: 'It vindicates what I said on behalf of the Eastern board - services were at that stage grossly underfunded despite what the government said.'
Hugh Mills, chief executive of Sperrin Lakeland health and social care trust, said: 'This is not just about winter pressures, there are pressures all year round.'
Northern Ireland health minister George Howarth said 'decisive action' was needed to tackle the problems identified. He said a 'parallel' programme to modernise health and personal social services would run alongside the government's national NHS modernisation programme.
The report says additional resources are being allocated on a recurring basis to improve planning.
In the longer term, it says health and personal social services must improve use of current capacity, embrace modern working practices and exploit new technology.
Mr Mills said: 'Some of the trusts ran up deficits coping with difficulties, but there is no mention of costs being put back.'
Northern board director of service performance and development Iain Deboys said: 'The report doesn't mention the boards' acute strategies, which is surprising and very worrying. I don't think we need another document saying what the problems are.'
Facing the Future: building on the lessons of winter 1999-2000.