Fundamental change is necessary to deal with a rise in chronic conditions, the head of the NHS in Wales has warned.
The number of people with chronic conditions is set to rise
A third of adults in Wales suffer from at least one chronic condition - those which cannot be cured - such as arthritis, diabetes or cystic fibrosis.
NHS Wales Director Ann Lloyd said about two thirds of people under 65 would develop such a condition at some point.
The World Health Organisation said they posed the greatest problem to health care systems in the 21st century.
"We do have this massive explosion of people who are going to be living longer with a chronic condition who need help and support," Mrs Lloyd said.
"They can't be cured, they have to be managed and they can be very difficult for people to live with."
She said part of the solution was moving facilities into the community rather than at large traditional hospitals and treating people at home instead.
While current pilot treatments and new techniques had been successful, she said the system was currently too "bitty".
"We need to give [patients] the confidence that they are going to get care in their own homes, or wherever it is most appropriate for them to receive care," she added.
"This will allow them to take greater control over their lives and the way in which they can manage their own conditions."
Powys Community Nurse, Julie Donnelly, said chronic conditions can affect virtually every aspect of the patient's life.
"They're not as mobile, they're restricted in what they can eat," she said.
"It is important to keep people at home and the greatest challenge is getting the resources to be able to keep them at home."
However, Ms Lloyd's calls for "fundamental change" may not be popular with campaign groups across Wales, who have fought against hospital reorganisation plans.
Earlier this month, First Minister Rhodri Morgan called a temporary halt to changes to hospital services, a move which was cautiously welcomed by opposition politicians and campaigners.
Reconfiguration of hospital services has prompted wide protests
But Ms Lloyd said: "We have got to have a much bigger and better campaign to show individuals who have chronic diseases what they can do to help themselves, and what alternatives we can now offer them, rather than just admitting them to a hospital.
"They will need assessment and treatment and management and an inpatient facility or a healthcare facility within their community might be the best place to provide that, but they don't need to be there all the time."
Medical advances in the last 20 years, she explained, had been "fantastic" but that the health service be better at picking up on good practices and adopting them.