Supposedly-elite NHS foundation trusts in England are running up an overall deficit for the first time, the regulator is expected to say later.
Monitor will release details on the performance of 147 trusts covering hospitals, mental health and ambulances in the first quarter of 2014-15.
The mounting pressures will be discussed at a board meeting next week.
It comes after it has been confirmed 33 of the 65 non-foundation trusts have gone into the red.
In the first four months, they have racked up £300m of deficit, but by the end of the year that is expected to rise to £409m, according to data published by the Trust Development Authority which oversees the parts of the NHS that have not been given foundation trust status.
The deficit run up so far is more than the entire one for the whole of last year.
'Tight financial grip'But it is the performance of foundation trusts that looks likely to raise the most questions.
They are meant to be the high-performing trusts - and as such they are given extra freedoms and do not have to balance their books each year.
However, this time last year they were £27m in surplus overall and Monitor is expected to warn the NHS - and hospitals in particular - are facing rising demand for services.
A Department of Health spokesman pointed out the NHS budget, which stands at over £100bn for the year, had been protected this Parliament.
He added: "We understand some trusts are facing challenges because of increasing demand but they must have a tight financial grip and ensure they live within their means.
"Delivering high quality services and balancing the books must go hand in hand and we expect trusts to deliver this during the course of the financial year."
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