Patients will have to wait longer for non-urgent operations, the head of the NHS has said.

Simon Stevens, chief executive of NHS England, said he expects waiting times to rise slightly as a “trade off” for improvement in other areas, such as hitting the four-hour A&E target and better cancer care.

Longer waits can be expected for pre-planned operations, which include things like hip and knee replacements, cataract removal, hernia operations and laparoscopies.

The Royal College of Surgeons expressed concern, saying the 18-week wait target has been “jettisoned in all but name”.

Philip Hammond claims the Tories are 'the party of the NHS' during Budget 2017

Unveiling a blueprint for the NHS for the next two years, Mr Stevens also said hundreds of thousands of patients would no longer be referred to a consultant by their GP.

Instead, GPs will be able to phone consultants to ask for advice, while other measures will be put in place to cut the number of people needing to be sent to hospital for care.

Hospitals will also be told part of their funding will be tied to improving health generally – with staff urged to have a “quiet word” in patients’ ears if they drink or smoke too much.

Other measures to save the NHS cash, already announced, include cutting the prescriptions bill for items such as sunscreen, fish oils, painkilling plasters, gluten-free foods and travel vaccines.

Mr Stevens admitted that waiting times were coming under pressure and that choices had to be made.

Everyone the Government blames for the NHS crisis – except themselves Show all 6 1 /6 Everyone the Government blames for the NHS crisis – except themselves Everyone the Government blames for the NHS crisis – except themselves The elderly “We acknowledge that there are pressures on the health service, there are always extra pressures on the NHS in the winter, but we have the added pressures of the ageing population and the growing complex needs of the population,” Theresa May has said. Waits of over 12 hours in A&E among elderly people have more than doubled in two years, according to figures from NHS Digital. Getty Everyone the Government blames for the NHS crisis – except themselves Patients going to A&E instead of seeing their GPs Jeremy Hunt has called for a “honest discussion with the public about the purpose of A&E departments”, saying that around a third of A&E patients were in hospital unnecessarily. Mr Hunt told Radio 4’s Today programme the NHS now had more doctors, nurses and funding than ever, but explained what he called “very serious problems at some hospitals” by suggesting pressures were increasing in part because people are going to A&Es when they should not. He urged patients to visit their GP for non-emergency illnesses, outlined plans to release time for family doctors to support urgent care work, and said the NHS will soon be able to deliver seven-day access to a GP from 8am to 8pm. But doctors struggling amid a GP recruitment crisis said Mr Hunt’s plans were unrealistic and demanded the Government commit to investing in all areas of the overstretched health service. Getty Everyone the Government blames for the NHS crisis – except themselves Simon Stevens, head of NHS England Reports that “key members” of Ms May’s team used internal meetings to accuse Simon Stevens, head of NHS England, of being unenthusiastic and unresponsive have been rejected by Downing Street. Mr Stevens had allegedly rejected claims made by Ms May that the NHS had been given more funding than required. Getty Everyone the Government blames for the NHS crisis – except themselves Previous health policy, not funding In an interview with Sky News’s Sophy Ridge, Ms May acknowledged the NHS faced pressures but said it was a problem that had been “ducked by government over the years”. She refuted the claim that hospitals were tackling a “humanitarian crisis” and said health funding was at record levels. “We asked the NHS a while back to set out what it needed over the next five years in terms of its plan for the future and the funding that it would need,” said the Prime Minister. “They did that, we gave them that funding, in fact we gave them more funding than they required… Funding is now at record levels for the NHS, more money has been going in.” But doctors accused Ms May of being “in denial” about how the lack of additional funding provided for health and social care were behind a spiralling crisis in NHS hospitals. Getty Images Everyone the Government blames for the NHS crisis – except themselves Target to treat all A&E patients within four hours Mr Hunt was accused of watering down the flagship target to treat all A&E patients within four hours. The Health Secretary told MPs the promise – introduced by Tony Blair’s government in 2000 – should only be for “those who actually need it”. Amid jeers in the Commons, Mr Hunt said only four other countries pledged to treat all patients within a similar timeframe and all had “less stringent” rules. But Ms May has now said the Government will stand by the four-hour target for A&E, which says 95 per cent of patients must be dealt with within that time frame. Getty Images Everyone the Government blames for the NHS crisis – except themselves No one Mr Hunt was accused of “hiding” from the public eye following news of the Red Cross’s comments and didn’t make an official statement for two days. He was also filmed refusing to answer questions from journalists who pursued him down the street yesterday to ask whether he planned to scrap the four-hour A&E waiting time target. Sky News reporter Beth Rigby pressed the Health Secretary on his position on the matter, saying “the public will want to know, Mr Hunt”. “Sorry Beth, I’ve answered questions about this already,” replied Mr Hunt. “But you didn’t answer questions on this. You said it was over-interpreted in the House of Commons and you didn’t want to water it down. Is that what you’re saying?” said Ms Rigby. “It’s very difficult, because how are we going to explain to the public what your intention is, when you change your position and then won’t answer the question, Mr Hunt”. But the Health Secretary maintained his silence until he reached his car and got in. Getty

The NHS has a target that 92 per cent of patients should be treated within 18 weeks of referral by their GP.

But the NHS has not hit this target since February 2016 and performance has been slipping since then.

Mr Stevens said: “We are saying that we expect that the number of operations that the NHS pays for will continue to go up, but we recognise that – right now about nine out of 10 people get their operations in under 18 weeks – in some parts of the country that will be under pressure.

“We won’t second-guess what that looks like, we want to try and keep short waits in the system where we can.

“We do expect and we do say here there is a trade off here ... 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.”

Mr Stevens said demand on the health service was growing, which had led to tough decisions.

He said: “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.”

Campaigners at a Hands Off Our NHS demonstration in December (Press Association)

Mr Stevens declined to say “anything new” on whether he was happy with Government funding for the NHS.

In January, Mr Stevens told MPs it would be “stretching it” to say the NHS got more money than it asked for from ministers.

Now, Mr Stevens said: “What we say here is that 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.”

Turning to incentives for hospitals to tackle smoking and drinking, he said: “There is going to be an incentive on hospitals to have a quiet word, 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 hospitals for specialist care will have their referrals scrutinised more for whether they are clinically appropriate.

Placards left outside the Houses of Parliament after a rally in support of the NHS (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”.

Mr Stevens said there was a “big variation between individual GP practices in different parts of the country” when it came to referrals, although referral rates more broadly have been lowered.

He said patients did not all need to go to hospital, adding: “It’s clearly going to be hundreds of thousands of patients at least for whom better alternatives which don’t involve being sent off to the outpatient department will be put in place.”

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