Leading article: Patients should come before finances

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Is it right that someone who is a smoker or obese is treated differently by the medical profession from a person who falls into neither category?

This question – fundamental to our notion of what constitutes a civilised society – has been nagging away for some years. Now, we are being invited to confront it by family doctors from 50 GP practices in Hertfordshire, providing care to 450,000 patients.

These doctors have agreed to block patients who smoke or have a BMI of more than 30 from being referred for routine hip or knee replacement surgery without first being referred to a weight management or smoking cessation scheme. This step, we are told, is on purely medical grounds. An obese person or a smoker is, by definition, in less good shape for the operating theatre than someone who is neither. That means their operation may be more complicated, and it may take the patient longer to recover. This additional treatment costs money, and at a time when the NHS is having to make £20bn worth of savings over the next four years, something has to give.

Most people would take the view that, yes, we all have a responsibility to look after ourselves, but that, no, there can never be a case for relegating a smoker or an obese person to the status of second-class citizen. That said, the efforts of Government and other agencies to tackle obesity and reduce smoking cannot let up if the medical time bomb that these conditions represent is to be defused.

No smoker or obese person has been told by the Hertfordshire GPs that they risk being denied treatment. This is not an ultimatum but a measure designed to produce the best outcomes. Nonetheless, any suspicion that this is cost-saving based on moral judgements must be allayed, and at a time when GPs are deciding how NHS budgets are spent, the onus is on them to banish all doubt from patients' minds. Whatever the state of NHS finances, there can be never be any justification for preferential treatment.

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