THE hospital system in Wales is "seriously out of balance" and will remain so without urgent action to free beds and find alternatives to admission for thousands of patients.

A review on capacity in the NHS in Wales concludes the service is the equivalent of 479 beds short of requirements but it stresses that simply providing extra beds is not the answer.

Better management of admissions, increases in the number of patients treated as day cases, and big reductions in bed-blockers, or delayed transfers of care, are all vital measures. Providing more beds is only part of the solution.

The review was done for the Assembly by Bro Morgannwg NHS Trust. Its report, A Question of Balance, comes out as hospitals start to feel the pinch of winter pressures, with emergency medical admissions rising, and regular cancellation of elective surgery.

Such pressures have been felt in Gwent since August. On a couple of occasions recently the Royal Gwent Hospital in Newport has had more than forty patients waiting for a bed. Medical patients have taken up surgical beds, with the result that many operations have been cancelled, affecting waiting lists.

Bed-blocking is a major problem across Wales. More than 1,000 people are in hospital despite being passed fit for discharge, mainly because there is no money for local authorities to fund care home places.

The 260 bed-blockers in Gwent hospital beds create a major headache for managers. Most are in community hospitals, but more than 30 are in acute hospital beds, adding to the pressure.

The review report makes 46 recommendations. Glyn Griffiths, Gwent Healthcare Trust''s general manager for surgical services, said some - such as paediatric assessment - are already in place.

Work will begin soon on a £1m medical assessment unit for the Royal Gwent, which will allow patients to be assessed before a decision is made on whether they should be admitted or treated and cared for at home. "A significant proportion of things in the report are already in our plans to manage emergency admissions," said Mr Griffiths. "Those plans are not yet fully funded however, and further discussions will be necessary."