Patients refused treatment unless they change their lifestyles | Mail Online Too fat for surgery: Patients refused treatment unless they change their lifestyles NHS refuses 'undeserving' patients vital treatment in move branded 'discriminatory' Hip and knee replacements and even IVF among treatments being 'rationed' Health Service trusts insist restrictions are in people's 'best interests' By Sophie Borland The NHS has been accused of rationing vital treatments after refusing to help undeserving patients unless they lose weight or quit smoking. It is denying patients hip and knee replacements, cataract surgery or even IVF unless they agree to make radical changes to their lifestyle. An investigation has revealed that one in four health trusts in England bars certain operations or procedures for smokers or those deemed too fat. A fat fucker and a fat doctor Demands: Patients deemed to be 'undeserving', such as some who are overweight or those who smoke, are being denied NHS treatments unless they change their lifestyles They include NHS Hertfordshire, which has banned certain patients from any operation requiring a general anaesthetic other than lifesaving surgery on their hearts, brains or to remove cancer. Instead they are being sent on weight management courses or to stop smoking clinics and told to come back only when they lead healthier lives. MPs and senior doctors last night accused the NHS of withholding treatment from anyone whose lifestyle it disapproves of. However, managers at Health Service trusts insisted that such restrictions are in peoples best interests. Douglas Carswell, Tory MP for Clacton, said peoples' diets and whether they chose to smoke are all 'lifestyle choices' Dr Clare Gerada, chairman of the Royal College of General Practitioners, said: Its becoming the deserving and the undeserving. I think its discriminatory and I find it astonishing. The Government should determine what should be applied universally. Douglas Carswell, Tory MP for Clacton, said: What people eat, drink or whether they smoke is a lifestyle choice. Its wrong if it is being management-led. What we cant have is the state withdrawing treatment because it disapproves of the ways people live. 'They are still tax-paying citizens and they deserve services. My view is that if this is done for clinical reasons then it should be a decision taken by doctors. Freedom of Information requests obtained by Pulse, a magazine for GPs, from 91 trusts in England show that 25 have imposed some form of restriction since last April. In NHS Bedfordshire, anyone with a body mass index above 35 deemed to be severely obese is barred from having hip or knee surgery. This is equivalent to a 5ft 5in woman weighing 15 stone or a 6ft man weighing 18 and a half stone. Before they are allowed surgery they must lose 10 per cent of their body weight or reduce their BMI to below 35. NHS North Essex requires patients to lose 5 per cent of their body weight and ensure they keep it off for at least six months. A total of 11 NHS trusts barred smokers and the obese from hip and knee replacements, while nine denied them IVF. This includes the Peninsula Health Technology Commissioning Group, covering Cornwall, Devon, Torbay and Plymouth, which bars both men and women from undergoing IVF treatment unless they have been non-smokers for at least six months. Ben Troke, partner at Browne Jacobson LLP solicitors, warned that the measures could be regarded as discriminating against certain groups in society. Dr Clare Gerada argued that the NHS move was 'discriminatory' But those doctors and managers who have drawn up the restrictions insist they are medically justified. Smokers and the obese are more likely to develop breathing difficulties or suffer heart or kidney problems while under general anaesthetic. Hip and knee replacements also tend to be less successful in the obese while there is evidence they benefit less from IVF. However, there are concerns that many trusts are imposing the restrictions only to save money. Although the NHSs budget has not been cut, it has been ordered to spend its money more efficiently to save £20billion over the next three years. This will then be ploughed back into care. Faced with such strict targets, many health trusts have resorted to restricting certain treatments and services. Dr Nicolas Small, spokesman for NHS Hertfordshire, said: The measures we have introduced in Hertfordshire are for people who need routine surgery only. They do not apply when people need urgent or emergency surgery such as to treat cancer. 'There will also be times when it will be appropriate to offer surgery to a patient without following these measures.