“I find it appalling…they never told me when I was paying into (the system) that they weren’t going to treat smokers or if I got obese they weren’t going to treat me and now they’ve gone and basically changed the guidelines.”

David Spencer, a 63-year-old Lincolnshire man, is in desperate need of a new hip. But his NHS trust says that he does not qualify for the operation because he smokes.

A 30-a-day habit started at the age of 10 may have nothing to do with the state of his joints, but the North Lincolnshire NHS Trust has told David that smokers must be excluded from some operations because of financial constraints.

And he is not alone. A growing number of patients are being denied treatment by the NHS because they smoke or are considered too fat.

In this programme, Tonight with Trevor McDonald reveals just how wide-spread this practice has become in the NHS and examines whether or not it is medically justified or merely a cost-cutting exercise.

Monday 1 October 2007 8:00pm - 8:30pm on ITV1.