When a report revealed the NHS was £512 million in debt, there was a slight sigh of relief: the projected figure had been £633 million.

This is the view Sir Ian Carruthers, the acting NHS boss, takes of the current financial crisis.

Before addressing delegates at the three-day NHS Confederation conference at the International Convention Centre, he explained why the health service's financial woes had to be dealt with at a local level.

This is something he has first-hand experience in.

A year ago, after much success in his role at Dorset and Somerset, he was asked to turn around Hampshire's finances, where the trust had notched up debts totalling £120 million. By March 2006 he had slashed that deficit to £25 million.

So Sir Ian recognised the problems facing trusts across the Midlands, where over-spends have topped £81 million.

He said: "This has been a year of achievement but we've got a financial problem and we need to deal with that now.

"It's very easy to focus on the negative, but Birmingham has one of the lowest waiting lists in the UK and overall is one of the leading areas.

"I present a national picture in my speech but Birmingham and the Black Country has one of the most financially sound authorities with a good record of finance management, it's clearly a different case in Staffordshire and Shropshire.

"Despite the recent headlines about job cuts and deficits, it's worth remembering when Sandwell and West Birmingham announced 200 job cuts last year, the trust only made one redundancy.

"There's no single cause for these deficits and as such there's no single solution either, so the problem must be identified and tackled at local level." Yesterday Sir Ian told delegates that fears of a financial melt-down within the health service had been over-played by the media.

He added that seven out of ten NHS trusts had either broken even or recorded a surplus in 2005/06, while the NHS's ££512 million debt represents less than one per cent of its revenue budget.

"The current financial position must be kept in perspective," he said.

"Conversely 11 per cent of organisations account for 70 per cent of the deficit." On Wednesday the acting NHS boss had suggested some acute and general hospitals might have to close as part of "service reconfigurations" due to be drawn up by the new strategic health authorities.

However he added that merging primary care trusts, strategic health authorities and ambulance services into larger organisations would not spell the end for "local" services.

"I don't think these bigger organisations will spell the end of 'localness', there are elements larger bodies do well but they must keep in touch with their local communities," said Sir Ian.

He added there was a lot of good news for the NHS.

"Waiting times are at an all-time low, and many more lives have been saved. A whole range of services have improved, we are starting to embed reforms and the pace is picking up.

"Our workforce strategy has resulted in more staff, more training, new contracts and new structures."