The health minister has warned Stormont colleagues he will need to go over his budget by £400million to continue delivering effective services.
Robin Swann outlined the implications of the ongoing absence of an agreed Stormont budget in a letter to Finance Minister Conor Murphy, and seen by UTV, which was also circulated to other ministers in the zombie administration.
Stormont is currently without a properly functioning executive due to the DUP's decision to block its operation in protest at Brexit's Northern Ireland Protocol.
There is no first or deputy first minister in place, and while other ministers are in post they are limited in the decisions they can take.
A budget for 2022/23 had not been agreed by the Stormont parties prior to the Executive imploding in February. Prior to that, ministers had agreed in principle that any new spending plan would need to allocate increased funding to the region's crisis-hit health service.
Northern Ireland currently has the longest waiting lists in the UK.
In the absence of an executive, departmental funding is being distributed using emergency arrangements on the basis of last year's budget settlement.
That means the health department is not receiving the uplift it might have otherwise expected if an executive was in place.
In his letter Mr Swann said the lack of a 2022/23 budget meant he was facing three key funding pressures that added up to £400m.
These are £80m to address waiting list pressures; £200m to cover recommended salary increases for staff; and £120m created by issues such as energy price inflation.
Mr Swann wrote: "I know I hardly need remind you and colleagues that the health and social care system continues to face major challenges in all areas as the demand for service outstrips supply."
The minister said there was a need for sustained increase in funding, along with transformation of service delivery, in order to "bridge the gap between supply and demand".
"To live within the likely budget settlement is not feasible," he added. "In reality it would require a set of unacceptable actions that I believe no minister could countenance."
Mr Swann said not overspending by £400m would require him to actively stop some clinical activity, to halt additional recruitment, and not pay existing staff the 22/23 salary increase.
He made clear he would not take any of those steps.
"All of these measures would take us in the directly opposite direction to that which is required to address the major challenges in health and social care. To be clear, I will not be implementing them," he wrote.
The minister said he would continue to direct his department to deliver effective health care even though there was a "clear risk" of overspend.
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