Smokers told to quit or surgery will be refused

Doctors will police the rule by ordering patients to take a blood test to prove they have not been smoking.

The ruling, authorised by Health Secretary Patricia Hewitt, comes after medical research conclusively showed smokers take longer to recover from surgery.

It is thought that 500,000 smokers a year will be affected.

However patients' groups argue that the move is about the NHS saving money rather than improving patient care.

They claim that health trusts do not want to operate on smokers because they stay in hospital longer, blocking beds and costing more to treat.

The ruling applies to routine operations such as hip replacements and heart surgery for conditions that are not immediately life-threatening.

If smokers refuse to give up, they are still likely to be treated but may have to wait longer.

Leicester City Primary Care Trust will become the first health authority to introduce the "quit or wait" rule this summer. Other health trusts are consulting on the idea.

Rod Moore, the trust's assistant director of public health, said: "If people give up smoking prior to planned operations it will improve their recovery. It would reduce heart and lung complications and wounds would heal faster.

"Our purpose is not to deny patients access to operations but to see if the outcomes can be improved."

Patricia Hewitt has described the ruling as "a perfectly legitimate clinical decision".

Yesterday her spokesman explained: "Trusts commission surgery services based on their assessment of the needs of their local population and availability of service capacity. "The provision and availability of a particular surgical intervention should be dependent on the clinical needs of the individual patient."

• The European Commission is considering a proposal to extend the forthcoming ban on smoking in enclosed public places to cover doorways.

Officials have been studying the Canadian province of Quebec, where smoking is banned within nine metres of the doorway into any healthcare-related building, school or social services building.

The experiment is thought to have shown positive health benefits.

A spokesman for the Department of Health said the Health Act 2006, which covers the July 1 ban, contains reserve powers to extend the law to outside areas. Sports stadia, bus shelters and train platforms are already classed as enclosed public spaces under the Act and it would not have to go back to Parliament to be extended to doorways.