The NHS is being forced to break its founding principle by denying surgery to the obese and smokers

With one in five CCGs in the red financially, and all under extreme pressure, many are being forced to make difficult decisions

One in three NHS clinical commissioning groups are denying surgery to patients who are obese, or who smoke (Getty)

Three core principles were enshrined in the National Health Service that Aneurin Bevan created in 1948: it should meet the needs of everyone in the country, it should be free at the point of delivery, and it should be based on clinical need, not ability to pay.

It is the latter two that are probably best known. But the first is just as important, and also more challenging than it might seem on first glance.

It means that, as a patient of the NHS, you are treated equally whoever you are, whatever your condition, and crucially, howsoever you came to need medical attention.

Findings from a Royal College of Surgeons (RCS) study, which revealed that one in three NHS clinical commissioning groups are denying surgery to patients who are obese, or who smoke, therefore represent an affront to the foundational values of our health service.

The respected RCS and other expert medical organisations are clear: there is no clinical reason why someone who is obese, or who smokes, might not stand to benefit from routine surgery such as a hip or knee replacement.

Why then deny them? Are the health commissioners saying that smokers and the obese made themselves unwell, and therefore aren’t entitled to the same prompt treatment as others? Where does this logic lead us? Denying emergency surgery to a drunk man injured in a bar fight? A plaster cast to the woman who falls off her horse? No, when we walk through the door of a hospital, NHS principles say, value judgements should be left on the street outside.

In truth, most health commissioners are deeply uncomfortable about denying care on this basis.

But with one in five CCGs in the red financially, and all under extreme pressure, many feel they do not have a choice. What a terrible position we are in when the NHS has been so under-funded that its officials are being forced to break its founding principles.

And what an indictment on the Government for whom that under-funding is a political choice. The real physical pain of every individual denied surgery on this basis is the direct responsibility of politicians in Westminster. It is time they woke up to that fact.