The negative comments of medical and staff unions are 'damaging to the public confidence and staff morale,' NHS chief executive David Nicholson told delegates at the NHS Confederation annual conference.

He said that claims that the financial performance of the NHS was a 'tragedy' or a 'farce' were also 'factually incorrect'.

'Last year for the first time in living memory the NHS delivered in year financial surplus,' he said.

In a rousing speech to NHS managers, Mr Nicholson thanked managers for sticking to their task and delivering financial balance to the NHS.

He acknowledged however that the public's perception of the NHS appeared to remain negative and it felt 'uncomfortable'.

'The NHS depends on an alignment between patients, public and staff.. And while patients are clearly starting to feel the benefits of reform, this is out of balance with the perception of our public and staff.'

'We are actually involved in the most massive change [to the NHS] you can imagine,' he said.

'We are trying to shift from a top-down national monopoly to a patient-led plural service,' he added.

Mr Nicholson said the NHS was in its third phase of growth: adding increased capacity to strategic reforms to make the changes needed to 'transform' the NHS.

And he called on NHS leaders to think in terms of 'systems' and look at the 'longer-term horizons' to deliver a fundamental change.

'My message to NHS staff is to look out not up. The answers lie around you in your communities, not in Whitehall. You don't work for some huge bureaucracy, you work for your patients,' he said.