Smokers 'pushed to rear of surgery queue'

Smokers who suffer from chest pain are less likely to be selected for vital heart surgery than ex-smokers or non-smokers, according to a study that says doctors may be unwilling to consider these patients for operations.

The study lends support to fears that unhealthy lifestyles are taking precedence over clinical need in determining who gets treated in a budget- conscious health service.

Shah Ebrahim, professor of clinical epidemiology at the Royal Free Hospital Medical School, London, said smokers might experience discrimination - despite having a greater need of surgery - because they had more coronary disease than ex-smokers.

The British Heart Foundation study, published in the June issue of the journal Heart, said smokers were 40 per cent less likely than ex-smokers to have a heart bypass for angina, and 20 per cent less likely than those who had never smoked. About 8,000 middle-aged men from 24 towns took part in the study and were followed up for more than 10 years

"There are three possible reasons why smokers are less likely to get surgery," Professor Ebrahim said. "The operation may not be offered because a doctor thinks a smoker won't benefit - which is not true. Or there is a long waiting-list and the smokers are at the bottom, or some doctors may withhold surgery as a means of persuading a patient to give up."

Many hospital consultants have operated an informal discriminatory policy against hardened smokers for years, and there are several anecdotal reports of patients' being refused surgery unless they quit smoking.

In 1993 the case of Harry Elphick, 47, who was refused treatment at the Wythenshawe Hospital, Manchester, unless he gave up his 25-a-day habit, made headlines. Mr Elphick, who did manage to stop smoking, died of a heart attack before his bypass could be carried out.

After his death, a group called Equal Treatment in the NHS campaigned to stop discrimination against "lifestyle deviants" - people who smoked, were overweight or drank heavily.

They said the cost of treating sport-related injuries was pounds 590m compared with pounds 440m for smoking-related illnesses.

The General Medical Council last year ordered doctors not to discriminate against patients with unhealthy habits such as smoking or excessive drinking, and the British Medical Association advises its members similarly.

Despite this, Forest - the smokers'-rights lobby group - says more smokers are being rejected for treatment because they won't or can't give up cigarettes. "It is quite appalling that doctors do this and it goes against the ruling of their own professional bodies," a spokesman said yesterday.

Professor Ebrahim said the founding principle of the NHS was to treat those in greatest need and that must be observed.