In reply to John of Edinburgh, it's not that the hip prosthesis is likely to break in someone who is obese (although it is more likely with the long term repetitive stresses placed upon it), it is that the prosthesis is more likely to become loose from the bone with the abnormal forces placed upon it. In addition people who have joint pain and are overweight will often get improvement in their symptoms from loosing weight so an operation becomes unnecessary and if an operation is necessary it becomes much safer once they have lost weight.

Oliver , Vancouver,

I totally agree with this. I think the important part is that they're encouraging people to take proactive steps in the lifestyle, such as loosing weight or quitting smoking to agree to any sort of surgery because otherwise an operation isn't going to have any long term benefits.

Rachael, Nottingham,

Yes, I think operations should be delayed if smoking or obesity are a factor in the patient's condition, or if they would compromise the patient's recovery from an operation. That is different from excluding those patients from the possibility of operations, and I really don't want to believe that that is happening!

Carol Parsons, Rochechouart, France

I do not understand this policy for replacement joints.

Any manufactured replacement joint is bound to be designed to withstand far greater loading than would be expected even from a heavy person.

Why, therefore, should a person's weight matter in this case?

John, Edinburgh,

Gee, and we Americans are supposed to follow Britain and give total control of our health care needs to a bunch of ideologues? What happened to freedom, do Brits no longer care that their liberties are being stripped away? And I can't believe there are people who support this move, you know what's coming next. They'll say that those who don't eat healthy foods also don't deserve to be treated. You'll have your government mandated breakfast, lunch, and dinner with the proper amount of nutrients and calories. Anyone who doesn't eat their government meal will not be treated. Next will come mandatory exercise, and a limit to the unhealthy watching of TV while on the couch. Man, how do you Brits stand it?

BiJian, Santa Monica, CA, USA

The obese and smokers use the NHS significantly more than other patient groups. They get more than their money's worth of health care as it is. Factoring taxation to usage would place many of this population group into penury.

Should current smokers receive lung transplants because they pay their NHS taxes?

Personal responsibility re-entering policy making is surely a welcome relief.

T Watson, Sydney, Aust

I agree that hospitals should have the right to refuse operations on certain patients.

I used to work in a cardiothoracic hosptial and the number of times a patient had heart surgery would came down with a nurse in tow to have a cigarette was unbelieable! they'd be pulling their drips behind them, gasping for breath but they had to have a cigarette.

I used to think to myself, 'the NHS (we) have just spent a good £20k on you and you think its not wasted?' People need to be saved from themselves sometimes.

Kim, London, England

As a smoker, and therefore without a voice in Nanny Britain, I say fine, withdraw NHS from us but equally, dont make me pay NI contributions and secondly stop taxing tobbaco - that way I can chose to pay for anything I need and am not forced to pay the health costs of those who want to live forever!!

brian talbot, London, England

Doctors who refuse to treat smokers and the obese are breaking the hippocratic oath and should be struck off by the GMC. Would these same doctors refuse to treat a terrorist who has just killed their son or neighbour ? No. So why are smokers and the obese worse than terrorists ?

Dr Patrick J. Salt, Walsall, UK

Ahhh, socialism! When will you Brits learn that private enterprise and competition is best. I know that there will follow the inevitable ad homonym/ill informed attacks on this position from other readers that Canada and Britain have better heath care for their citizens. But that’s not true. If one truly looks objectively at the facts, one discovers that even with its flaws, the American health care system is the best. And it is the best because it isn’t quasi-commie socialism.

Cheers mate!

Steve C., Swampscott, MA

Every working individual in this country is expected pay national insurance, whether they are obese smokers or not.. Is Patricia Hewitt prepared to reimburse a proportion of their NI contributions as compensation?

Also, who's next to be refused treatment?
Drug users?
People who self harm?

This attitude sets a dangerous precedent - perhaps (as always) the Dept. of Health could handled this a little better.

Paul Croft, scunthorpe,

People who have piad their tax and contributions should get the treatment they need;otherwise,abandon the NHS and be done with it.

Michael Rigby, Chorley Lancashire, England