"There is increasing evidence that smokers have three times the number of complications as non-smokers. What we are proposing is that if someone who smokes is being referred for surgery, we would instead want them to be referred to a smoking cessation clinic and give them three months to stop smoking."

Dr Battersby added: "What we are doing is asking people to have a stab at giving up for three months and at the end we would review the situation. Some people will have stopped and will go on and have a referral for surgery. Others will not have stopped."

In those cases, decisions will be taken along the lines of clinical need.