Nineteen NHS trusts have been referred to the Health Secretary after auditors raised concerns about their financial viability, representing an almost four-fold rise from five last year. The Audit Commission reviewed 98 trusts running a combination of hospital, ambulance and community services, looking in-depth at only those trusts that have not achieved foundation trusts status, finding that 19 hospitals trusts not failed to break even in 2013-14, but were unable to convince auditors they could rectify the issues in the medium term. A Department of Health spokesperson said the government recognised there were challenges which was why the budget had been protected this parliament.