The scale of financial difficulty facing Northern Ireland's five health trusts was so severe in 2013 and 2014 that four failed to break even.
In a report, Auditor General Kieran Donnelly confirmed that the health and social care service was facing an unprecedented financial challenge.
This has led to trusts carrying forward an underlying deficit of £115m into 2014/15
However, only the Belfast trust broke even, as a result of the extra money it received.
According to the auditor, previous additional funding has "masked" rather than "addressed" underlying financial pressures.
The report acknowledges that as continued reliance on additional funding is unrealistic, sustainable solutions to the increasing financial pressures must be found.
With an ageing population the health and social services sector is likely to face further funding constraints in the future and can also expect to see a rise in demand for services.
While it has been given some financial protection it is recognised that the financial health of the various bodies is weak and declining.
The report says: "In the face of rising inflationary cost pressures, demographic pressures from an increasing and ageing population and the pressures associated with new treatments and patient expectations while at the same time delivering a challenging programme of efficiency savings."
The report also raises the issues of failed cancer treatment targets and tackling potential fraud.
Hospitals failed to meet the 62-day target for cancer patients to start treatment.
Overall, hospitals did not meet the target to ensure that 95% of patients began their first cancer treatment within 62 days, following an urgent GP referral in any month during the two-year period to 31 March 2014.
In the period under review, 446 negligence claims were settled costing more than £81m while the cost of 3,000 outstanding claims has been estimated at approximately £121m.
While fraud was not identified by the report, £5.7m of potentially inappropriate expenditure was found and this was sufficient evidence to proceed with disciplinary action.
On the issue of transforming your care, the auditor is to examine how it is being managed in more detail.
Mr Donnelly notes that the Chief Medical Officer, Dr Michael McBride, is also acting as chief executive of the Belfast Health and Social Care trust.
He says it is unlikely that the position will be permanently filled until later this year.