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The number of foundation trusts (FTs) in significant breach of their terms of authorisation at the end of the fourth quarter of 2011/12 (Q4) increased to 17 compared with 10 at Q4 last year; with 11 of the 17 having financial issues as one of the primary concerns.

FT regulator Monitor's report NHS foundation trusts: review of twelve months to 31 March 2012 into the 143 FTs that currently exist also showed most of them continued to be rated green for governance.

But 29 per cent were rated amber-red for governance, compared with 27 per cent in the same quarter last year.

FTs notched up improved performance against C difficile and cancer targets for Q4, but were worse against the 18 weeks referral to treatment and accident and emergency targets.

The FT sector delivered a £2.2bn operating profit for 2011/12; £77m above plan. However, the report states that margins in some parts of the sector, eg, small acute FTs, are at levels that might cause concern as to financial sustainability.

The Q4 average financial risk rating (FRR) of 3.4 was above plan (3.2), but below last year (3.5), where 5 equals lowest risk and 1 equals highest risk. The mental health sector average FRR of 3.5 deteriorated slightly from Q3 (3.7) but continued to outperform the acute sector, whose average FRR was 3.3, representing an improvement from Q3 (3.2).

Monitor's chief operating officer Stephen Hay said: 'Conditions will continue to be difficult in the coming years. As financial pressures continue in 2012, trusts will have to deliver robust plans if we are not to see more foundation trusts in significant breach for financial reasons.'