Health ministry officials say major changes are needed in the health system to meet challenges ranging from funding to staff recruitment and upgrading information technology.
In the first of a series of briefing papers to Minister of Health Tony Ryall, officials say enhancing services will mean setting new priorities for existing cash.
The paper says bigger changes are needed than most people realise, and much better regional and national decision-making is needed to run a complex system efficiently.
It says inflation and population growth will eat increasingly into the new funding available.
The report says there are real challenges ahead in recruiting and current information technology systems, including broadband connectivity, are inadequate.
Mr Ryall says the papers reveal that he has inherited a mess.