The number of NHS trusts referred to the health secretary over financial concerns increased almost three-fold in a year, a report has revealed.

Nineteen were flagged up to Jeremy Hunt this financial year - compared with five in 2012-13 - as well as 24 Clinical Commissioning Groups CCGs, according to the Audit Commission.

Marcine Waterman, controller of audit, said auditors were reporting concerns about the financial resilience of a third of trusts this year, compared with a quarter for the previous 12-month period.

She added: “This level of reporting is worrying and reflects the increasing risks to the financial sustainability of individual NHS trusts as they continue to face sizeable financial pressures due to a rising demand for services and the necessary focus on quality of care, whilst balancing the need for continued cost savings.”

Among those referred to Mr Hunt for failing to meet their statutory break-even duty, were the University Hospital of North Staffordshire, Barnet and Chase Farm Hospitals and Ipswich Hospital Trusts.

Mid Essex Hospital Services, North West London Hospitals and Worcestershire Acute Hospitals Trusts were also on the list.

The report - entitled Auditing the Accounts 2013-14: NHS Bodies - covers the timeliness and quality of accounts, arrangements to secure value for money and auditors’ use of their statutory reporting powers at 101 NHS trusts and 211 CCGs.

It found timeliness and quality of trusts’ financial reporting had improved and that the majority of NHS bodies put in place proper arrangements for securing value for money.

But it also revealed that auditors at 34 per cent of NHS trusts issued a non-standard value for money conclusion relating to concerns about financial resilience, compared to 26 per cent last year.

Ten, including North Cumbria University Hospitals and Croydon Health Services Trusts, received “adverse” conclusions, meaning the auditor was not satisfied the body had made proper arrangements to secure economy, efficiency and effectiveness in its use of resources.