It would be a bold stroke to pull off - delivering even a small surplus at the end of this financial year given the situation that NHS acting chief executive Sir Ian Carruthers inherited in March.

It would be a bold stroke to pull off - delivering even a small surplus at the end of this financial year given the situation that NHS acting chief executive Sir Ian Carruthers inherited in March. How safe is the new forecast of a£18m surplus at year end?

First, it marks a further tightening of ambition. Not only is it accepted that not all trusts will break even; now even a recurrent monthly run rate balance is expected only for 'as many as possible'. Will too many trusts start piling up their exceptional circumstances?

At the same time it promises the kind of transparency that the old system lacked - the overspending of individual trusts will remain exposed despite being covered at strategic health authority level. The figures suggest this exposure will be concentrated in a hard core of debtors - 22 trusts accounting for half the deficit compared to 35 last year.

But it is the reliability of forecasting and the management of risk around savings programmes that has traditionally let down many NHS organisations. Too often a good plan has stayed in the wrapper. The figures show strongly it was primary care trusts that showed the greatest difficulty in keeping their promises.

Collectively they predicted a shortfall of£298m this time last year, but actually overspent£476m. It will be a hard push for them to drag this back to the£366m deficit they now promise (and one that local government managers will view with heavy hearts).

The knock-on effect of this kind of variation can be seen in the performance of East of England SHA whose constituent SHAs forecast a combined 2005-06 deficit of£169m this time last year, but actually delivered a£215m shortfall.

This time it is forecasting a£125m deficit, the biggest of all. A repeat of last year's variation would push the NHS as a whole into the red.

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