Delayed discharges and not the private finance initiative lie behind bed shortages at Cumbria's flagship hospital, the Cumberland Infirmary, according to a report.

The£87m hospital has faced repeated claims that bed numbers were sacrificed in a bid to meet the costs of the PFI scheme, and senior medical staff are calling for the hospital to be expanded, 18 months after it opened with 100 fewer beds than its predecessor.

Although the North Cumbria Bed Utilisation Review, published last week, found there were shortages - with an extra 79 beds needed by 2005 to cope with rising demand - it argues that patients are being inappropriately placed.

The review's conclusion backs up the Change Agents report commissioned by North Cumbria health authority and Cumbria county council and published in July, which identified that 186 patients in acute beds could be looked after elsewhere.

North Cumbria bed utilisation review group chair John Unsworth said: 'The report found there are sufficient beds in North Cumbria to cope with demand now and for the next five years, if measures in this and the Change Agents report are fully implemented.

'Community hospitals provide this care in many towns but in Carlisle and Whitehaven/ Egremont there are no such facilities at present, which is one reason why the acute hospitals have a high percentage of inappropriately placed patients.'

Trust doctors remain sceptical, however. Dr Fergus Young, secretary of the trust's medical staff committee, said: 'The hospital is too small for the present workload, which we do not see reducing in spite of modern practices.'

And in a letter to the clinical director at the infirmary, consultant physician Dr Jim George said the figures produced by the review still made a strong case for expanding the hospital.

In a bid to tackle the bed-blocking, however, a shake-up of health and social care across Cumbria has been launched. Cumbria county council has been given a£1.2m grant to alleviate delayed discharge. It means 153 additional care packages will be funded between now and March next year.

North Cumbria health authority chief executive Robin Macleod said: 'We are working closely with social services to ensure people are given the right care in the right place at the right time. The report supports the actions already being taken and planned, which will go a long way to. . . meeting government targets.'