Give up or we won't operate, smokers told

Cash-strapped hospitals say patients will not be given treatments such as hip and knee replacements until they try to give up. Those who fail could be denied treatment all together.

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Managers in Norfolk and Newcastle, where trusts are millions of pounds in debt, say smokers are at a greater risk of complications and the move will help save them money on further care.

But critics accused them of putting its finances before the health of its patients - and warned it could lead to surgeons being "brow-beaten" into breaking the Hippocratic Oath.

The move will hit patients of Norfolk Primary Care Trust which is £50million in the red and provides healthcare to the residents of Norwich and surrounding towns and villages. Newcastle-Under-Lyme PCT in north Staffordshire, which is £1.4million in debt, has taken a similar decision.

Last year, health bosses in east Suffolk barred obese patients from the operating theatre until they tried to lose weight.

While urgent operations are not covered by the Norfolk policy, the treatments include hip and knee replacements as well as hernia operations.

Norfolk PCT said smokers were being targeted because they are at increased risk of complications and take more time to recover from surgery meaning they have longer - and more expensive - stays in hospital.

Stopping smoking will reduce the risk of complications - and cut the cost of their care. Simple saliva tests can quickly prove if a smoker is telling the truth about quitting.

Defending the move Dr John Battersby, the trust's director of public health, said: "The situation across Norfolk is that one in four people smokes and that is the same for the proportion of people coming through for surgery.

"There is increasing evidence that smokers have three times the number of complications as non-smokers.

"What we are proposing is that if someone who smokes is being referred for surgery, we would instead want them to be referred to a smoking cessation clinic and give them three months to stop smoking."

Dr Battersby added: "What we are doing is asking people to have a stab at giving up for three months and at the end we would review the situation. Some people will have stopped and will go on and have a referral for surgery. Others will not have stopped."

In those cases, decisions will be taken along the lines of clinical need.

The PCT says if smokers have tried hard and need the surgery, they may get it. But if it is felt they have not made a strong effort to stop and are at high risk from the proposed surgery, they may not be referred to the operation at that stage.

Dr Battersby said: "I am not saying there is an absolute block on smokers getting surgery but there is evidence that if they successfully stop smoking they have a much lower risk of developing complications and there will be a better outcome for them.

"There is a cost implication in terms of those complications. If they stop, it is going to have a positive impact on the health system."

The trusts are taking advantage of guidance from the Government's medical rationing body, the National Institute for Health and Clinical Excellence, which allows them to take patients' lifestyles into account when deciding if a treatment would be effective.

Smokers, however, claim they are being discriminated against. Neil Rafferty, of the pro-smoking pressure group Forest, said: "This is blackmail, pure and simple.

"Smokers pay their taxes like everyone else. In fact, because of the very high duty on tobacco, they probably pay a lot more tax than the average person.

"They are entitled to free healthcare and health trusts do not have the right to make up conditions."

Other critics say that while there are valid medical reasons for recommending smokers quit before an operation, finances, should not play a part in the decision to operate.

Michael Summers, of the Patients Association, said: "Finance has got nothing to do with making sure people are made well and every effort should be made to do it the best one can."

He added that managers doctors could be forced into breaking the Hippocratic Oath, under which they pledge to treat the ill to the best of their ability.

"The patient is the responsibility of the doctor or surgeon, not that of the manager of the PCT," he said. "The responsibility is a moral one. "Many of those doctors and surgeons will have taken the Hippocratic Oath and therefore they shouldn't be brow-beaten by managers over whether a patients should or should not have an operation."

Liberal Democrat Health Spokesman Steve Webb said: "If it is about making surgery more effective, that is quite legitimate.

"But if it is a back door way of trying to reduce demand and save money, it is picking on smokers.

"We all do things that are bad for our health and we shouldn't discriminate against one particular group."

Simon Lockett, secretary of the British Medical Association's Norfolk committee for GPs, said: "Clearly the PCT believes it has got to act as quickly as possible because of its financial position but I think GPs would be very concerned about this idea.

"GPs refer people when they think people need to have things done. Most people who smoke wish to stop anyway and we really do not think it appropriate that they should be disadvantaged by being forced to wait for important operations."

The ban comes as the NHS struggles to cope with mounting debt.

Officially, the deficit for the last financial year is £512million, however, it is claimed the true figure is near £1.3billion.

The Government says simple measures such as reducing staff turn-over and cutting down the amount of time patients spend in hospital before operations could save the health service £2.2billion a year.