RAB is on its last legs, but trusts must look to a future in surplus

Resource accounting and budgeting has no friends left and its days are numbered; we just do not know what that number is yet.

Many will be disappointed that NHS chief executive David Nicholson did not put it out of its misery on Monday. But it never seemed politically astute to kill the system off before being more certain about achieving financial balance.

And balance remains touch and go - best estimates suggest it is just about being hit when central budget allocations are taken into account, but more than one strategic health authority area is heading in the wrong direction. In that situation, it is hardly surprising that no-one wants trusts to relax just yet.

It is quite right that an organisation like the NHS Confederation gets angry about RAB's continuing presence but the danger for individual trusts is that they allow its long shadow to become a distraction.

That is because although RAB is a real problem for the NHS as a whole, and an utter disaster for a relatively small number of trusts, the fate of most organisations lies largely in their own hands. The NHS target of achieving a surplus of£250m by the end of 2007-08, which will be expressed as a target for individual strategic health authorities, is the major challenge on which to focus. Without the ability to plan for a surplus with a focus on cash flow, organisational plans carry too much risk.

Mr Nicholson admits that the case for aiming for surplus is an argument only half won. He needs to win that argument quickly over the next few months - those boards that remain unconvinced for too long will have little time to impose a real effect. Managers should remain hopeful that a decision on RAB will be announced by year end - but it would be a bad mistake to think that by itself it will deliver a financially stable future.