Waits for hospital care in the U.K. are among the worst of a group of 10 high income peer countries, a survey has found.

Some 19% of U.K. respondents reported waiting at least a year for a non-urgent procedure, an analysis of results from a Commonwealth Fund found. About 11% said they’d waited a year or more for a specialist appointment.

Access to specialist appointments has declined markedly over the last decade. In 2013, the U.K. had one of the lowest proportion of respondents waiting more than four weeks for a specialist appointment.

The country scored far better on access to same-day or next-day family doctor appointments, but worse than average on access to out-of-hours general practice care.

Around 21,100 people in Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland, the U.S. and the U.K. took part in the survey, 3,300 of which were in the U.K.

Canada was the only other country with comparably long waits for elective procedures.

“These findings show the UK consistently coming near the bottom of the pack on people’s experience of healthcare compared to other high-income countries,” said Ruth Thorlby, assistant director of policy at think tank The Health Foundation.

The Health Foundation think tank released their analysis of the Commonwealth Fund’s survey this week.

The results, she added in a statement, “shed yet more light on just how much work the government has to do” to get the country’s public health system “back on its feet.”

Waiting times for elective procedures soared during the pandemic as hospitals cancelled non-urgent care when Covid-19 infections peaked.

Before 2020, year-long waits for care were relatively rare. But the pandemic saw many hospitals report cases of patients waiting more than two years for elective procedures.

The latest official statistics show about 6.39 million people are currently waiting for at least one elective treatment in England alone. That’s more than 11% of the population. Around 300,000 were referred for treatment more than a year ago.

But the pandemic isn’t the only factor in delays. Waiting lists have been trending upwards since about 2013, when around 2.5 million referrals were waiting on treatment.

Experts say Covid-19 exacerbating existing problems caused by a decade’s worth of “political choices.” In other words, years of government underfunding and an unwillingness to invest in staff, hospital buildings and social care infrastructure.

Hospitals have been working hard to reduce the backlog by increasing capacity for elective procedures and paying private hospitals and insourcing and outsourcing agencies to perform additional surgeries.

But demand for care itself is also rising, making it even harder to reduce backlogs. There are many factors behind increasing demand for elective care in the U.K., including the fact the population is ageing rapidly.

Long waits for care leave many people are sicker by the time they’re actually seen than they would have been if they were treated earlier. Many patients will have more acute and complex illness, making their conditions harder to treat.

Socioeconomic factors, including increasing income inequality and a cost-of-living crisis is likely making it harder for many members of the population to stay in good health.

Successive reports into health inequalities in the U.K. have found health gaps between the richest and the poorest are getting wider.

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