The National Audit Office has called for better bed management to cut record numbers of cancelled operations and reduce delayed discharges, which are now costing the NHS £1m a day.

In a report issued today, NAO head Sir John Bourn says the NHS has made 'significant improvements' in admitting and discharging patients and is treating a record number of people in a falling number of beds.

But he warns that there are 'significant signs of pressure', including cancelled operations, daily bed crises at 35 per cent of trusts surveyed for the report and delayed discharges.

Between September 1998 and September 1999, 57,000 patients had operations cancelled for non-medical reasons on the day of, or following, admissionthe highest figure since the introduction of the Patient's Charter.

More than 9,000 of these patients were not treated within a month of their cancelled operation, up 29 per cent on the previous year.

The NAO says trusts with average bed occupancy above 85 per cent 'are at risk of regular bed shortages and periodic bed crises' and are more likely to suffer outbreaks of hospital acquired infection.

In 90 per cent of acute trusts surveyed, bed managers had to rely on 'physical inspection and telephoning wards' to assess bed availability.

They 'characterised their work as permanent crisis management', despite their 'detailed operational knowledge' of admission and discharge patterns.

The NAO calls for greater investment in information technology and says the bed manager role should 'evolve to make better use of their knowledge to plan admissions and think strategically about the use of beds'.

The report also calls for better internal coordination and liaison with external agencies to prevent 'bed blocking'.

Using NHS figures, the report estimates that delayed discharge affects almost 6,000 patients aged 75 and over each day, at a cost to the NHS of£1m per day, resulting in the loss of 2.2 million bed days each year.

Sir John said: 'This winter has reminded us again of how crucial it is that hospitals manage their bed stock effectively. We have found significant variations in performance between hospitals.'

NHS Confederation policy manager Tim Jones said it would endorse the report's findings, but warned the recommendations on IT were 'not feasible in the current climate' because resources available for IT were likely to be spent supporting clinical governance.

Inpatient Admissions and Bed Management in NHS Acute Hospitals . Stationery Office.£13.10.