The number of people waiting for hospital treatment in England has topped five million for the first time, the latest figures show.
The NHS England data showed 5.12 million people had been waiting at the end of April.
But the number facing waits of over a year has dropped for the first time since the pandemic began.
More than 385,000 patients were waiting that long, down by 50,000 on the previous month.
Before the pandemic, however, just 1,600 people were in this position.
Meanwhile, an analysis by consultancy Lane, Clark and Peacock found huge differences in the numbers waiting over a year across different areas.
Castle Point and Rochford, in Essex, had the highest proportion of people waiting over 52 weeks for care - 573 per 100,000, at the end of March - whereas in south-west London there were just 24.
Areas with worst long waits (number per 100,000 waiting over year)
- Castle Point and Rochford - 573
- Southend - 461
- Blackpool - 450
- Waltham Forest - 422
- Norfolk and Waveney - 419
The age of local populations will be a factor in this - those areas with some of the highest rates tended to have the oldest population, while those with the lowest rates had the youngest, who are less likely to need hospital treatment.
But Jonathan Pearson-Stuttard, who led the research, said the finding were still "extremely worrying".
"We know that for many of these conditions longer waiting times are associated with poorer long-term outcomes," he said.
"Without urgent action targeting areas with the highest unmet need, we risk a generation of patients living in poorer health."
But Prof Stephen Powis, medical director for NHS England, said despite the "extensive disruption" caused by the pandemic there were "encouraging" signs in the latest figures.
As well as the progress on long waits, he said the numbers being seen by cancer services and mental health were now back to pre-pandemic levels.