A wide-ranging review into Northern Ireland's health service has said that the region should have only four acute hospitals instead of ten for its 1.8m population.

The Northern Ireland Assembly heard today that one of the comments put to the expert review team was that "Northern Ireland needs more roads not more hospitals."

However, the review also drew attention to a 'two-tier service' of hospital care operating in Northern Ireland - the in-hours service and the out-of-hours service.'

The fact that specialised care was too spread too thinly throughout the region outside Belfast meant that it 'was not possible everywhere to deliver the same quality of service for an acutely ill person at 4am on a Sunday as at 4pm on a Wednesday afternoon.'

The review team was led by former Chief Medical Officer of England, Sir Liam Donaldson who conducted a major review of how effectively the Department of Health of Northern Ireland worked, the care of patients and the management of staff.

The review team made 10 recommendations for change, including that an impartial international team of experts should be appointed to reform Northern Ireland's struggling healthcare system.

Close local hospitals that cannot provide level of care needed 24/7.

Strengthen commissioning - system needs redesigned to make it simpler and capable of reshaping services for future

Transforming Your Care - action not words. Need new costed timetabled implementation plan that includes expanded role for pharmacists and paramedics in pre-hospital care.

Self-management of chronic disease. Establish programme to give people with long-term illnesses the skills to manage their own conditions

Better regulation - unannounced routine inspections should take place. Consider outsourcing role of Regulation and Quality Improvement Authority (possibly to Scottish regulator). RQIA to review current policy on whistle blowing

Making incident reports really count. The system of serious adverse incident and adverse incident reporting to be modified - currently falling well below its potential.

Make patient safety a beacon of excellence. Establish a NI Institute for Patient Safety.

System-wide data and goals. NI health and social care system has no consistent method for the regular assessment of its performance. Recommend establishing new measures for benchmarking service in areas of safety, quality and patient experience.

Technology - establish a technology hub to identify best innovations for quality and safety of care internationally, and look at adapting them to NI.

Stronger patient voice. More independents in complaints process, more independent Patients and Client Council.

The review report also said that pressure for politicians and the media to keep the salaries of top managers down was 'penny-wise and pound-foolish' as senior executives in Northern Ireland were paid much less than their counterparts elsewhere in the UK.

Speaking in the Assembly, Health Minister Jim Wells said he took some comfort from the conclusions.

Mr Wells said: "The message from Sir Liam is clear, we now need a mature debate and we need to strive for political consensus to empower us to collectively make the right choice."

Sir Liam Donaldson said that politicians should make an advance pledge to accept the panel's recommendations to transform the current middle of the road service into a world leading system.

Even though he identified long-standing and structural problems, Sir Liam said Northern Ireland was no worse than other parts of the UK.

"Northern Ireland is likely to be no more or less safe than any other part of the UK, or indeed any comparable country globally," his report said.

"This does not mean that safety can be disregarded, because it is clear from reading the incident reports and accounts of patients' experience that people are being harmed by unsafe care in Northern Ireland, as they are elsewhere. Northern Ireland, like every modern health and social care system, must do all it can to make its patients and clients safer."

Sir Liam was appointed to review how effectively the Department of Health (NI) and the health trusts have been performing.

The review was ordered last April by the then health minister, Edwin Poots, after a major incident was declared at the Royal Victoria Hospital in Belfast when a backlog in A&E signalled a crisis in the system.

Sir Liam, who has made 10 recommendations, said communities should not fear change including the closure of smaller hospitals in favour of more specialised centres or technology hubs.

Although he did not identify attempts to cover-up problems, Sir Liam called for tighter regulation and for families and patients to have a greater say on the way the service operates.

The report added: "The design of a system to provide comprehensive, high quality, safe, care to a relatively small population like Northern Ireland's needs much more careful thought.

"This applies to almost all aspects of design including the role of commissioning, the structuring of provision, the relationship between primary, secondary and social care, the distribution of facilities geographically, the funding flows, the place of regulation, the monitoring of performance, and the use of incentives.

"Nowhere is the old adage 'I would not start from here' truer than in the Northern Ireland care system today."

The review found that implementation of the Transforming Your Care - a policy advocating more community-based care - was not being done not quick enough.

It said: "We recommend that a new costed, timetabled implementation plan for Transforming Your Care should be produced quickly. We further recommend that two projects with the potential to reduce the demand on hospital beds should be launched immediately."

Belfast Telegraph