Managers are warning NHS services may have to be cut to solve the financial crisis as trouble-shooters prepare to go into the worst-hit trusts.
Managers say tough decisions need to be taken
The NHS Confederation poll of 35 trusts facing debts found most thought harsh action was the answer.
This could include ward closures, shorter hospital stays and consultants seeing patients in community settings.
The warning comes as ministers said hit-squads will be sent into the 18 trusts with the most problematic debts.
Health Secretary Patricia Hewitt said consultants had identified nine hospital trusts and nine primary care trusts which needed expert help to sort out their finances after reviewing over 60 trusts - 10% of the total in England.
The "turnaround teams" will work alongside trust staff, although another 23 trusts will be specially monitored by regional NHS bosses to make sure their deficits are reined in.
Ms Hewitt said health managers should be aiming to operate with surpluses by the end of the 2006-7 financial year.
The NHS is currently predicted to finish this year £620m in deficit, although ministers say the final figure will be much lower.
Ms Hewitt said: "Despite all the talk of a so-called financial crisis, the projected overspend, at the half-year stage, still accounts for less than 1% of the total NHS budget."
The health secretary also unveiled a new rule book for the NHS which has placed financial management as one of seven priorities alongside the likes of cancer care, sexual health services and waiting times.
She said achieving financial balance need not harm patient care.
But the NHS Confederation survey of health service bosses revealed they think more tough measures were needed to balance the books
Three quarters said the public had to move away from its obsession with hospitals and accept services may close, hospital stays shorten and more care may be done in community settings in a bid to make the NHS more efficient.
And a third said the solution may also lie in operating with fewer staff.
NHS Confederation chief executive Dr Gill Morgan said: "A fixation with buildings is preventing the development of new and imaginative services and we will have to work hard to convince the public that, with technological advances, the loss of beds does not necessarily equate to a decline in services."
Paul Miller, chairman of the British Medical Association's consultants committee, said: "The measures about redesigning services make a lot of sense and are something consultants have been trying to do for years. The problem is we are not always consulted with.
"Shorter stays in hospital save money, but are also good for the patient as they recuperate better at home."
Shadow Health Secretary Andrew Lansley said ministers had "lost control" of NHS finances, while Liberal Democrat health spokesman Steve Webb said the government was repeating past mistakes by trying to manage the health service from the centre.
The trusts getting hit-squads are: Hammersmith Hospitals, Barnet and Chase Farm, Mid Yorkshire, Royal West Sussex, Surrey and Sussex, Brighton and Sussex University Hospitals, University Hospitals North Staffordshire, Shrewsbury and Telford, George Eliot Hospital, Hillingdon PCT, Selby and York PCT, Cheshire West PCT, West Wiltshire PCT, Kennet and North Wiltshire PCT, Kennet and North Wiltshire PCT and the four Sheffield PCTs.