NHS chief executive Sir Alan Langlands has been grilled on why the NHS apparently struggles to make progress in areas the government wants to see tackled in its drive for modernisation.

Sir Alan was repeatedly challenged at the Commons public accounts committee on why examples of good practice cannot simply be rolled out across the NHS. He was answering questions on a National Audit Office report, which says better bed management is needed to cut record numbers of cancelled operations and reduce delayed discharges, which are now costing the NHS£1m a day.

MPs repeatedly asked why 'an award-winning real-time information system on bed utilisation' set by Royal Shrewsbury Hospitals trust could not be applied across the health service. Since it was introduced in 1997, it has achieved a 50 per cent reduction in admission cancellations.

In response, Sir Alan said he was arguing 'there is more than one way to skin a cat' and 'I honestly don't think you can argue there is one silver bullet for the whole of the NHS'.

He acknowledged that the results obtained in Shrewsbury were very important, but said there were other examples of best practice, repeatedly citing Aintree Hospitals trust, which has a 24-hour bed management system. 'The people of Aintree do not want the Shrewsbury system airlifted in, ' he said.

Sir Alan was also quizzed on delayed discharges and variations in waiting lists and care. Asked how he could justify 2.2 million bed days being lost each year because of the delayed discharge of older people, Sir Alan said that improving co-ordination with social care was crucial to improving the situation.

He said the Department of Health planned to reduce the figure by 30 per cent by 2003, but 'we will never get this figure to nothing'.

'The provision and pattern of services for older people is becoming the most important issue in the health service for the government, ' he said.

'The issue of long-term care has not been resolved.'

The NAO report acknowledges that the NHS is now treating a record number of patients, but says there are 'significant signs of pressure', including daily bed crises, at 35 per cent of trusts surveyed. Asked about this pressure on the service, Sir Alan said that a bed occupancy rate of 80 per cent 'means there is not enough slack in the system'.

However, he noted: 'If I was sitting here with a bed occupancy rate of 60 per cent, you would be saying I was wasting money.'

Sir Alan, who is leaving in September to head Dundee University, said efficiency savings had led to a situation where 'some people are having to work too hard' and 'there is no doubt that the search for greater throughput is not sustainable'.

Not all we're cracked up to be

Chris Pearce, director of nursing at University Hospital, Aintree, told HSJ he was surprised Sir Alan had highlighted its bed management system, saying: 'I am not that impressed with it.' He added: 'This week has been horrendous, with people sleeping in inappropriate wards.'

The trust has a senior clinician in overall charge of bed management 24 hours a day. But the system does not track occupancy in real time. Instead it predicts bed usage on past behaviour.

Sir Alan saw the system in action over Christmas.