Patients 'at risk of harm without NHS turnaround'
There is a "high risk" of increasing patient harm and poor value for taxpayers' money if there is not an "urgent improvement and turnaround" in the Welsh NHS, according to a group of independent experts.
Waiting times, cancer treatment and emergency care were all cited as areas that needed addressing.
The Ministerial Advisory Group (MAG), established by Health Secretary Jeremy Miles in the autumn also wants a "new focus" on leadership and how the NHS is held to account by the Welsh government.
Accepting the report's 29 recommendations either completely or in part, Miles said it contained "some hard hitting messages" but insisted it was "essentially optimistic".
Too few consequences for NHS underperformance - Miles
'I thought I would die waiting for an ambulance'
The 68-page report was produced by experts who together have significant experience of working in the NHS in Wales and in England.
The group was led by former chief operating officer for NHS England Sir David Sloman, who warned Wales "starts from a challenging position".
He said this was due to its relatively old and sick population, worsening health inequalities, "historically high" waiting lists and a "very challenging" financial position.
He said it was clear performance in many areas needed "urgent attention" and "turnaround".
But the report insists these improvements should not be driven by new policies or targets but instead by a "relentless focus" on the delivery of existing commitments.
The report's recommendations revolve around:
Sharing best ways of working and reducing variation between health boards
Strengthening medical or clinical voices within the NHS and Welsh government
A commitment by the NHS to be more transparent and to "improve in public"
Sharper accountability and performance management
Reduction in bureaucracy
Narrowing of targets
Making extra funding from Welsh government conditional on performance
Sir David said if health boards could learn more from each other that could help drive up performance.
"The Welsh healthcare system is set up to succeed, and in many, many places it is," he added.
"But the issue is, it's going really well in everything somewhere, but not everything everywhere.
"And the key is how you generalise up and make everybody the same standard as the very best in terms of maybe performance."
He said another priority was for the Welsh government to strengthen its processes of holding the NHs to account, describing current oversight systems "complex" and "muddy".
"We do talk about in the report the need for a much clearer and sharper accountability framework," he said.
"And I think clarifying, sharpening that up will really, really help. What I would say is other systems around the world struggle with this as well. This is not a unique challenge."
While welcoming the expert panel's report, Miles admitted it did not always make comfortable reading.
"There are some, you know, some hard hitting messages in the report about performance and productivity across the NHS as a whole... there are some tough messages in there, but, it's essentially an optimistic report, because it spells out a path towards how we can get that level of performance to where we all want it to be so people get fast access to the best possible care," he said.
" I think it's a good report. I welcome it. It's challenging in many parts, but it also sets out, I think, a positive way forward, and I welcome it for that."
However, the health secretary denied that his decision to bring in external experts to take a "fresh perspective" at NHS performance suggested the Welsh Labour government, after 26 years in charge, had run out of ideas.
He argued instead, that it was a sign of a "government confident in its commitment to the NHS... that it's prepared to look to others to help us".
Meanwhile, the expert panel pointed out that significant improvement should be possible in the Welsh NHS, due to the way it is structured and some of the ideas that underpin welsh health policy.
In that respect the report argues "Wales should aspire to have the leading healthcare system in the world".
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