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However, the health regulator has warned trusts of the need to continue to improve how they operate - including making radical changes to how care is delivered - if they are to counter the intense pressure they鈥檙e under from an increased demand for care and a worst in a generation financial position.

Monitor鈥檚 analysis of trusts鈥� performance between April 2015 and June 2015 shows that England鈥檚 151 FTs (the majority of NHS providers) missed a number of national waiting times targets, including in A&E, for routine operations and some cancer treatments. Trusts also struggled to deal with an increase in demand for diagnostic tests, partly due to staff shortages and ineffectively organised services.

For the second successive financial year, the sector has recorded a deficit (-拢445m) in the first quarter. Trusts have cited higher than expected pay costs - after over-relying on expensive agency staff - as being the primary cause of this deficit.

This report covers the period before the recent action to limit the amount trusts spend on agency staff and management consultants. Since July 2015, Monitor has launched a series of initiatives aimed at helping trusts improve the quality of care, access to services and drive up their productivity.

Dr David Bennett, Chief Executive at Monitor, said:

Trusts are working hard to provide patients with quality care. However, today鈥檚 figures reiterate that the sector is under massive pressure and must change to counter it. The NHS simply can no longer afford operationally and financially to operate in the way it has been and must act now to deliver the substantial efficiency gains required to ensure patients get the services they need.

Monitor has already taken action to help the sector improve operationally and financially and continue to offer our support and guidance.

But the FT sector must realise that a radical and lasting change is required.

A report to Monitor鈥檚 board on the performance of the foundation trust sector - 3 months ended 30 June 2015 found:

• overall, the sector reported a deficit of 拢445m which is 拢90m worse than planned
• 118 foundation trusts (78%) ended the period in deficit of whom 75% were acute or specialist trusts
• the FT sector鈥檚 wages bill was 拢7,411m, 拢59m more than planned (拢7,352m)
• trusts made 拢232m worth of cost savings which was 拢64m less than planned
• the FT sector as a whole has missed the A&E waiting time target of seeing 95% patients within four hours
• the size of the waiting list for routine operations reached 1.9m, an 169,100 increase on the same period for 2014/15
• trusts treated 93.1% of non emergency patients within 18 weeks compared to a requirement of 92%
• 10,800 patients waited longer than the recommended 6 weeks for diagnostics tests
• 29,000 people waited on a trolley for more than 4 hours between the decision to admit them to A&E and their arrival on a ward due to reduced bed availability
• FT ambulance services meet the national waiting time for responding to the most critical and life threatening incidents between April and June 2015
• Monitor intervened or agreed regulatory action at 37 trusts (25% of the sector) because of operational or financial concerns.

has today also published the overarching financial position of .