Image copyright Tim Zoltie

Nineteen NHS trusts have been referred to ministers after auditors raised concerns about their financial health.

The Audit Commission made the move after reviewing the health of 98 trusts running a combination of hospital, ambulance and community services.

The referrals have been made because the trusts have failed to break even and do not have robust enough plans to balance the books in the coming years.

The number represents nearly a four-fold rise from five last year.

It is another sign of the growing financial problems being seen in the health service. Earlier this month the Nuffield Trust warned that a quarter of trusts had finished the year in deficit, but that included nearly 250 trusts across the whole health service.

The Audit Commission looked in-depth at only those trusts that have not achieved foundation trusts status - given to the elite performers - and, as such, they tend to be the most financially-challenged organisations.

'Worrying'

Overall the watchdog had concerns about a third, but the 19 hospital trusts who got referrals are effectively the ones with the most deeply-rooted problems.

Not only did they fail to break even in 2013-14, but they were unable to convince auditors they could rectify the issues in the medium term.

The referral to Health Secretary Jeremy Hunt means the trusts will face closer scrutiny from the authorities.

One of those referred is Hinchingbrooke, which is the first hospital trust to be run by a private firm, Circle.

Audit Commission controller Marcine Waterman said the findings were "worrying".

A Department of Health spokesman said the government recognised there were challenges which was why the budget had been protected this parliament.

He added: "It is essential that trust chief executives have a tight financial grip and ensure they live within their means."

The 19 trusts are: Barking, Havering and Redbridge University Hospitals NHS Trust; Barnet and Chase Farm Hospitals NHS Trust; Epsom and St Helier University Hospitals NHS Trust; George Eliot Hospital NHS Trust; Hinchingbrooke Health Care NHS Trust; Ipswich Hospital NHS Trust; Leeds Teaching Hospitals NHS Trust; Mid Essex Hospital Services NHS Trust; Mid Yorkshire Hospitals NHS Trust; North Bristol NHS Trust; North Cumbria University Hospitals NHS Trust; North West London Hospitals NHS Trust; Shrewsbury and Telford Hospital NHS Trust; Surrey and Sussex Healthcare NHS Trust; The Princess Alexandra Hospital NHS Trust; United Lincolnshire Hospitals NHS Trust; University Hospital of North Staffordshire NHS Trust; Weston Area Health NHS Trust; Worcestershire Acute Hospitals NHS Trust.