IT had to come: two health trusts are testing smokers to ensure they’ve quit before surgery takes place and operations are being denied to obese patients who refuse to lose weight.

Our very stretched NHS has reached a point where only surgery with the chance of positive outcomes may occur. Already, yardsticks for “rationing” certain operations have been applied. Now, two trusts have taken it a step further.

Sorry, but this may be the only way forward. People must make an effort to change their lifestyle and take their own health in hand before expecting surgeons to do the same.