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".