Figures showing a big jump in cancelled operations this year suggest that managers will struggle to comply with ministerial orders to keep them to a minimum this winter.
From April to June 1999, 12,313 operations were cancelled for non-medical reasons on the day the patient was due to be admitted. The same period this year shows an increase of 4,720 cancellations to 17,033.
During the same period, 3,733 people who had their operations cancelled were not subsequently admitted within the Patient's Charter one-month time limit - a rise of 1,349.
The worst blip in the figures occurred earlier in the year, suggesting that many cancellations were due to winter pressures.
Figures for the April to June quarter show a drop in cancellations of 3,110 over the January to March quarter.
Donna Covey, chief officer of the Association of Community Health Councils for England and Wales, said: 'This is a major increase that represents a serious cause for concern.
'Going in for an operation is one of the most stressful events in a person's life.
'It's the responsibility of the NHS to ensure that the experience is made as painless as possible. '
Conservative Party health spokesman Philip Hammond said: 'It's shocking that the figures have been growing strongly over the past couple of years and shows that Patient's Charter targets have become meaningless. '
Health secretary Alan Milburn said the figures confirmed that the NHS needed more beds and more staff.