Dr Maurice Hayes chaired the review

Some of the main proposals include the rationalisation of hospital administration by replacing the four health boards with one "strategic commissioning authority" and merging the 18 hospitals trusts into three "integrated health systems".

This involves centralising acute services into nine main hospitals, while downgrading seven of the provinces remaining smaller hospitals.

It is the proposed removal of accident and emergency and maternity services from local hospitals which is causing most controversy.

'Omagh shock'

SDLP councillor Pat McDonnell said he was "shocked" by the plan to remove emergency services from the Tyrone County hospital in Omagh.

After what happened in Omagh, it's unthinkable something like this could happen

Michael Gallagher

"Omagh is the largest population centre south of Derry, west of Craigavon yet we're going to be relegated to a bee sting hospital," he said.

Chairman of Omagh District Council Liam McQuaid also expressed "shock and disappointment" that the report recommended that a new hospital to service the south west region was to be built at Enniskillen in County Fermanagh, rather than in Omagh.

Many of the hundreds of casualties of the 1998 Omagh bomb were treated in the Tyrone County hospital in Omagh immediately after the blast.

Michael Gallagher, whose son Aidan was killed in the bombing, said: "After what happened, it's unthinkable something like this could happen.

"Omagh doesn't need heart or brain surgeons, but an accident and emergency department is the most important of any hospital followed by maternity."

However, the report's author Dr Hayes said: "There was a bomb in Omagh and there was one in Enniskillen. You can't plan on the basis of a bomb.

"I understand emotions are high, but we had to take a rational decision and found that if the south west hospital had been sited in Omagh, it would not be able to meet the standard of getting a patient to emergency services in an hour for 16,000 people."

'Guarded welcome'

Sinn Fein assembly members Sue Ramsey and John Kelly gave the report a "guarded welcome".

In a statement they said it was "radical and comprehensive".

"It is clear a root and branch review of administration -Trusts and Boards - is required."

An acceptable health service can no longer be operated at present staff levels and unless we have a proper increase in our workforce any new plans, however worthy, will be destined to failure

Maurice Dunlop

Chairman of Northern Ireland Council of the British Medical Association Maurice Dunlop welcomed the "speed with which Minister de Brun set about initiating this exercise".

He said the BMA would study the report more fully before giving a full response.

But he said: "This document could very well lead the way to providing significant improvements in healthcare for Northern Ireland and indeed for all people on the island of Ireland."

He said it wanted a reduction in health service bureaucracy and the resulting financial savings reinvested in providing services to the public.

"We need more doctors, nurses and beds, particularly acute inpatient beds," he said.

Any expansion of the GP role must involve recognition that there must be a sufficient increase in the number of GPs to meet consequent additional demands

Dr Brian Patterson

Dr Brian Patterson, Chairman of the BMA's GPs Committee said the report's proposals to increase the number of hospital consultants and GPs were welcome.

But he added: "There must be a recognition that general practice is already struggling to meet demands.

"Any expansion of the GP role must involve recognition of this deficit, correction of it and a sufficient increase in the number of GPs to meet consequent additional demands."