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Eradicating hospital waiting lists in Northern Ireland could cost up to £1bn, the Department of Health's top civil servant has said.

Richard Pengelly was speaking as the department gave an update on the transformation of health and social care in NI - which began two and a half years ago.

Mr Pengelly said the public should not expect change to waiting times soon.

He said only "a very large injection of cash" could do that.

"We were very clear at the launch of the transformation strategy two and a half years ago that it will not eradicate waiting lists," he said.

"The only way we will do that is by a very large injection of cash and we would estimate that to be somewhere between £700m and £1bn.

"What the transformation agenda will mean, if we eradicate those waiting lists, we will never again accumulate such a wait."

It has been two and a half years since the publication of 'Delivering Together', the 10-year plan which aimed to change the way services are delivered.

Then health minister Michelle O'Neill said the plan would improve a system at "breaking point".

Speaking to ´óÏó´«Ã½ News NI on Wednesday, Mr Pengelly said that even having a minister in place would not make any difference to the waiting list figures.

"Even if the money was available, a minister still needs the tools at their disposal to be able to make a difference," he said.

"It will still take many years to resolve that problem."

The transformation process includes changing how breast assessment and stroke services are delivered across Northern Ireland.

Both are currently subject to public consultation.

Mr Pengelly said the department's mind is not already made up and could be changed. He urged the public to get involved.

"We will gather evidence throughout the consultation. We will take an evidence based decision. There will be no dogma in this," he said.

"I will not be convinced that change is not required to our system - our system is failing the public and we need to do things differently."

With talks involving nursing unions over pay due to get under way, Mr Pengelly said it wasn't a simple debate.

He insisted that unless money was taken from other areas of health and social care, some £20m - at present the money required to help reach a deal - was not available.

However he said nurses were working miracles keeping the system running.

"The staff have worked miracles to keep us going. We said two years ago to be fair to the staff and the public who deserve good health care that we need to transform the system," Mr Pengelly said.

"If we don't transform the system it will inevitably start to collapse.

"I can't say when or how, but collapse is inevitable."

The British Medical Association welcomed the update.

"Pressures in our system continue to increase and our waiting lists are still unacceptably long, so it is vital that the momentum and the commitment to changing our health system is maintained," said Dr Alan Stout, chairman of the BMA's Northern Ireland GPs' committee.

"There will be difficult and challenging conversations and debate about the best way for services to be delivered.

"This is to be welcomed as we need to be clear about how and where we deliver all services in the future."