'Increasing Fitness for Surgery' is an initiative to provide support to help people stop smoking before having non-urgent surgery to give them the best chance of their operation being successful.

It means people who smoke will offered support to quit before they are referred for surgery at Queen Alexandra Hospital and Hospitals in Portsmouth and South East Hampshire, such as the St Mary's NHS Treatment Centre. Your referral will take place after your smoking cessation interventions have taken place. Some patients will be excluded from this initiative. See ( 7) below.

Cigarette smoke contains more than 4,000 chemicals - some of which have immediate effects that compromise the body's ability to heal and increase the risks associated with anaesthesia. Smoking up to the time of any surgery increases heart and circulation complications, impairs tissue healing and is associated with more wound infections.

The initiative has the support of the NHS across Portsmouth and South East Hampshire, including all the partner trusts - NHS Portsmouth and NHS Hampshire (the two local primary care trusts), the Portsmouth Hospitals NHS Trust (which runs Queen Alexandra Hospital), and the two organisations which provide smoking cessation services - Solent NHS Trust and Southern Health NHS Foundation Trust. But the plan has also been widely discussed by senior clinicians and professional health bodies such as the Local Medical Council.

This initiative is aimed at helping people who smoke to quit. But we are not treating smokers any differently from patients with other health conditions such as high blood pressure or weight issues who are offered public health and lifestyle advice. However we do want to help people who want to help themselves. The risks of smoking are well-publicised. Public attitude surveys tell us that 70% of smokers would like to quit - and our local NHS smoking cessation services enjoy a high success rate - also 70%.

If you're a non-smoker or ex-smoker, you're not affected by this initiative in any way - although your GP, or other healthcare professional, will be expected to ask you if you smoke before referring you for a non-urgent surgical procedure. Most GPs do this anyway.

If you smoke, the GP or health professional, will record this on your notes and advise you of the personal and surgical benefits of quitting.

If you agree, he/she will refer you to your local NHS specialist stop smoking service.

If you decline referral, your GP or other referrer can still refer you to the hospital - and it will be left to the clinician at hospital, or the St Mary's NHS Treatment Centre, to assess the benefit of the operation "outweighing the significant risks of smoking." If they feel the risks of smoking outweigh the benefit of you having the operation, they will refer you back to your GP for smoking cessation.

A number of checks and balances will ensure that anyone who really needs an operation will still receive it. This initiative is for planned or non-urgent surgery. Clearly anyone who needs urgent surgery or unscheduled care will receive it. In all cases, GPs will assess your condition, and if they think your benefit from the operation is greater than the risks outlined in (3) they will refer you to the hospital. A number of other patients will be excluded from this initiative including:

- cancer patients
- under 18s
- people with a serious mental illness
- people with learning disabilities
- any 'red flag' patient needing orthopaedic referral.

Sympathetic consideration will also be given to smokers who have made repeated quit attempts with a specialist service.

Your GP can still refer you - but, once referred, your clinician may still decide to refer you back to your GP for smoking cessation if they feel the benefits of you quitting outweigh the advantages of you having the operation.

This initiative is about improving your health and your fitness for surgery. It could help you go home faster. If, by quitting smoking, this means you spend less time in hospital recovering from your operation or a smoking-related complication, such as a wound infection, (see 3 above), it does mean we could free up urgently-needed beds for other patients more quickly.

Referrals will be made by your GP, consultant or health professional - you don't need to worry about it. The referral cards will give your name, date of birth and contact phone number. You will be contacted by an NHS Stop Smoking specialist within two working days Patients from postcodes PO1-6 will be referred to Pompey Quit, which is run by Solent NHS Trust. Other patients will be referred to NHS Hampshire's provider Quit4Life, run by Southern Health NHS Foundation Trust.

It lasts around seven weeks and is either delivered within group-based clinics, over the phone or in 1-1 clinics.

Yes - the providers of these services have capacity and are geared up to cope with the extra demand that we hope this initiative will generate. Smoking - or treating smoking-related illnesses - costs the NHS millions of pounds it can ill afford every year. We want to support every smoker who wants to help themselves.

You will be expected to inform your GP or other referrer of your quit status with written confirmation from the service. Once your quit status is confirmed with your GP, a referral will be made for your operation and the surgeon will be informed of your success.