Monitor has reported sharp increases in the numbers of foundation trusts breaching accident and emergency targets or attracting the worst risk ratings for governance.

The foundation trust regulator’s latest quarterly report shows 14 FTs had missed A&E targets for the nine months to 31 December, up from just three at the end of September.

The figure also represents a steep year-on-year increase – for the same period in 2010-11 just six foundations were in breach of A&E targets, the report states.

The months covered by the report also saw a further rise in the number of foundation trusts with the worst governance risk ratings. There are now 59 foundations with red or amber-red ratings for governance from the regulator, or 42 per cent of all FTs.

The proportion has more than doubled in the past year – for the same period in 2010-11 it was just 19 per cent.

Monitor said the increase in foundations with poor governance ratings was something patients “should be reassured by”.

“Although more trusts are rated red or amber-red for governance this quarter (42 per cent compared to 35 per cent at quarter two), one of the main reasons for this is an increase in the number of Care Quality Commission inspections being carried out,” the report stated.

“This is something patients should be reassured by as it means regulation is working: problems are being picked up and foundation trusts are being held to account for fixing them.”

It added that the sharp decline in A&E performance was likely to have been connected to “trusts dealing with greater demand and addressing referral-to-treatment time backlog issues”.

On the key target for the proportion of admitted patients treated within 18 weeks of referral there was only a slight improvement during the quarter, with 12 FTs reporting breaches compared with 13 at the end of September.

Financially, foundation trust sector performance improved, with just 11 FTs attracting the highest financial risk ratings, compared with 14 at the end of the second quarter. Although foundations were 7.5 per cent behind on their cost improvement programme savings, “these plans are more ambitious and trusts are performing better against them than in the last two years (when they were 9 per cent behind plan at this stage,” the report states.

However, it also notes the “significant downward trend” in FT earnings before interest, tax, depreciation and amortisation (EBITDA) which were at 6.1 per cent – or £1.6bn – for the first nine months of the year, down from 7.5 per cent in 2008-09.

It adds: “Of the 15 foundation trusts in significant breach of their terms of authorisation (an increase from 13 in quarter two) 11 of these have financial issues as one of their primary reasons for their breach.

“There is a small number of trusts with a significant deficit.”

Foundation Trust Network chief executive Sue Slipman claimed: “Poorer performance on A&E targets shows the extent to which tackling this is the responsibility of the whole of the local health economy. Solutions to manage demand are in the gift of providers and commissioners working together.”

She insisted “the changes in governance risk ratings can be attributed to the impact of CQC ratings on Monitor’s regulatory activity”. Ms Slipman added: “It is vital that such ratings are an accurate and timely reflection of provider performance.”