Certain hospitals in the UK who have imposed a ban on smokers and the obese from receiving particular treatments have been defended for their action by the Health Secretary.
Patricia Hewitt says it is a perfectly legitimate clinical decision for primary care trusts (PCT) to set a collective policy to deny operations to certain patients.
Miss Hewitt's comments were made in response to a survey which found nine PCTs refused joint replacements to obese patients and four blocked orthopaedic surgery for smokers.
The minister says hospitals are entitled to get together with their doctors on any particular area of clinical judgement and decide which guidelines are put in place, and the issue is one for doctors to decide.
The National Health Service helps smokers quit and Hewitt says if that is the doctor's advice operations should be postponed until patients have stopped smoking.
The Health Secretary's comments are opportune as they have been voiced amid growing calls for the NHS to take a tougher line on heavy smokers and the seriously overweight.
A survey last year found that two in five hospital doctors believed that smokers should pay for bypass operations.
Hospital trusts which deny surgery to obese patients include North Staffordshire, Stoke, Lincolnshire, North Linconshire, Milton Keynes, Hereford, West Hertfordshire, East and North Hertfordshire, and Suffolk.
Those denying orthopaedic surgery to smokers are North Staffordshire, Lincolnshire, North Lincolnshire and Milton Keynes.