NICE chief executive Andrew Dillon admitted he was "disappointed" primary care trusts in North Staffordshire had failed to implement its guidelines opening the door for obese patients to have stomach surgery.

He had been told that a service was only just being set up at the University Hospital of North Staffordshire six years after the Institute ruled it should be allowed to people whose needs met agreed criteria. In the audience was Alan Kaminski, aged 56, of Abbey Hulton, who had been in hospital for 200 days as NHS bodies argued over the stomach reduction operation he needed for a hernia repair.

Speaking on his behalf, Ian Syme, leader of campaign group Healthwatch, said: "We are six years down the line from your guidelines being issued and we are still hitting a brick wall."

Mr Dillon replied: "When it is not implemented it is disappointing."