Video report by ITV News Correspondent Sally Lockwood

The NHS's target of seeing 95% of A&E patients within four hours will not apply next year, the medical director of NHS England has said.

Speaking to ITV News, Sir Bruce Keogh replied simply "no", when asked if the four-hour wait target would apply.

Sir Bruce's comments came as the head of NHS England also admitted that patients will also have to wait longer for non-urgent operations as he unveiled the National Health Service's blueprint for the next two years.

Longer waits are to be expected for pre-planned operations such as joint replacements, cataract removals, hernia operations and laparoscopies.

The NHS has a target that 92% of patients should be treated within 18 weeks of referral by their GP, yet this target has not been hit in more than a year.

Simon Stevens said the rise in waiting times would come as a "trade-off" for improvements in other areas of the NHS as he reviewed a five-year plan for the NHS that launched in 2014.

According to Health Secretary Jeremy Hunt these improvements will include "better cancer treatment, expanding GP access, and transforming mental health care".

This was reiterated by Mr Steven's speech on Friday morning in which he announced "huge investment" in mental health and cancer services.

"We're going to be seeing improvements in the way A&E services work; making it easier for people to get appointments with their GPs; big improvements on the way cancer services work and an expansion - probably the biggest expansion we've ever had - in mental health services," he announced.

"We get the fact that this is a time of real pressure in the NHS, and that is - in a way - not a surprise, with a growing population, an ageing population and many more treatments we can offer to the people of this country."

He also announced places in medical school would increase by 25% for the "doctors of the future" and the launch of "Nurse First", a model to fast track new graduates into areas of nursing of "particular need".

Video report by ITV News Presenter Julie Etchingham

Meanwhile, the proposed increase in waiting times for pre-planned operations has been attacked by the Royal College of Surgeons, who said the 18-week target had been "jettisoned in all but name".

While the "trade-off" was condemned by the council chairman for the British Medical Association, Mark Porter, who said: "The NHS is at breaking point from a combination of increasing demand and inadequate resources.

"Achieving one delivery promise only by missing another is a textbook example of rationing access to care. It should not be happening in today's NHS.

"The NHS, and its expert and professional staff, are working hard under extreme pressure, but fundamentally the failure to meet the access promises is a direct consequence of the Government's decision to allocate less resources to the NHS than other leading European countries."

Also announced in the plan for the NHS in England for the next two years was:

Hundreds of thousands of patients will no longer be referred to consultants by their doctor. Instead the GP will phone the consultant for advice.

Measures will be put in place to cut the number of people needing to be sent to hospital for care.

Hospital funding will be tied to improving health generally - with staff urged to have a "quiet word" with patients if they lead unhealthy lifestyles such as smoking and drinking too much.

Cutting prescriptions for medicines and items which are available over the counter for a fraction of the cost, for example paracetamol and cold and flu treatments. Prescriptions for sunscreen, travel vaccines and gluten-free foods could also be cut. It is hoped this would save the NHS £128 million per year.

Treatments judged to be of low clinical value, such as spinal surgery and injections for back pain, will come under scrutiny.

Commenting on the plan for the NHS, Sir Bruce said it was "the only game in town", since it "offers hope for the future".

He added that it was "really tough" for people working within the NHS, but that most people support the health service's "principles and values", and that "we should all rally round to make sure" the new plan "works".

Commenting on his plan for the NHS over the next two years, Mr Stevens admitted that choices had to be made with waiting times coming under pressure.

"We do expect there will be some marginal lengthening of waiting lists but this will still represent a strong, quick waiting times experience compared to 10 years ago, let alone 20."

He continued: "What we are saying is that we have a health service that is bigger year on year...

"What we also recognise is that a combination of a growing and ageing population, the number of new treatments that are coming on and the rise in demand being experienced means that we have to make some choices."

Measures are to be put in place to reduce the number of people requiring hospital care. Credit: PA

Mr Stevens declined to say "anything new" on whether he was happy with Government funding for the NHS, having told MPs in January it would be "stretching it" to say the NHS got more money than it asked for from ministers.

Instead Mr Stevens said: "We accept that the 2017/18 budget for the National Health Service is fixed, and so we've set out what we intend to do within the budget that's available."

Quicker to condemn the funding the NHS receives was Chris Hopson, NHS Providers chief executive, who said of the document: "The plan reinforces a simple, stark, truth: that you get what you pay for.

"If NHS funding increases fall way behind demand and cost increases, NHS services inevitably deteriorate. That is clearly now happening."

Doctors will be urged to have a 'quiet word' with patients leading unhealthy lifestyles. Credit: PA

Offering incentives for hospitals to tackle smoking and drinking would be effective, Mr Stevens said, "because the evidence shows that if you've had a heart attack or are in hospital for something, that's actually the moment when people are willing to think about making changes to their lifestyle."

The new document presented by Mr Stevens sets out how GP practices that are seen to refer too many patients to hospital for specialist care will have their referrals scrutinised more for whether they are clinically appropriate.

Prescriptions will be cut for items, such as omega-3 supplements, which are available over the counter. Credit: PA

All clinical commissioning groups (CCGs) will also review their "referral management processes", in some cases enabling direct referrals such as to physiotherapists for back pain.

GPs will also have an "advice and guidance option" where they can chat to a specialist "to avoid the need to default to an outpatient referral".

A Department of Health spokesperson said: "Patients will rightly expect that those who are most in need of urgent treatment are prioritised but the NHS must continue to make sure that those who need routine treatment receive it quickly.

"As the document says, we will continue to expand the number of operations offered in future, and just last year the NHS carried out more than 1.9 million more operations compared to 2010."

Clare Marx, President of the Royal College of Surgeons, welcomed some of the initiatives set down in the blueprint, but said there was a risk of returning to the days of "unacceptably long waits".

She said: "Some of the initiatives announced today will help with the pressures on planned operations.

"It is absolutely right to look at how beds in hospitals can be made available by supporting patients to receive care and support in the community.

"Patients value and need timely access to planned surgery, like hip and knee replacements, to relieve pain and discomfort, and to maximise the benefits of treatment.

"Alongside a lack of hospital beds and rationing of procedures to save money, today's announcement means more patients will wait longer and in more pain before planned surgery.

"We risk returning to the days of unacceptably long waits for elective surgical treatment."

Shadow health secretary Jonathan Ashworth slammed Mr Hunt for having "no plan whatsoever to help the NHS".

He said: "Reading between the lines this plan confirms that Theresa May's Government has broken its promise by failing to give the NHS the funding it needs.

"Sadly Jeremy Hunt has no plan whatsoever to help the NHS through the challenge of Brexit and is being enormously complacent about the impact for the NHS.

"The Government need to be much clearer about how they will guarantee there are enough staff in place in the health service to keep patients safe for the years to come."