A record 4.5 million people in England were awaiting non-urgent hospital treatment in November and the number waiting for more than a year has soared, figures showed, underscoring the pressures on hospitals swamped by the COVID-19 crisis.

NHS England said essential services were maintained at the end of the year and cancer treatments and referrals were back to usual levels.

But there were 4.46 million patients waiting to start treatment in November, an all-time high although only slightly up from 2019 figures that pre-date the COVID-19 pandemic.

"These figures are a stark reminder that the NHS is facing an exceptionally tough challenge," said Stephen Powis, national medical director with the National Health Service (NHS).

"While still millions of people are getting care for non-COVID health problems... there is no doubt that services will continue to be under additional pressure until and unless this virus is under control."

England entered a second national lockdown on Nov. 5, with Prime Minister Boris Johnson citing the need to avoid a "medical and moral emergency" for the NHS.

A third, more restrictive national lockdown began last week after health officials warned that there was a risk of the health system being overwhelmed.

Of those awaiting treatment, 192,169 patients had been waiting more than 52 weeks, compared with just 1,400 a year earlier, Siva Anandaciva, chief analyst at health charity The King’s Fund, said.

A record 3,700 patients had to wait 12 hours or more in accident and emergency units before being admitted to hospital last week, he said.

"Even urgent operations are being cancelled in some parts of the country," Anandaciva said.

"Goodwill and hard work of frontline staff is not enough to overcome long-standing staff shortages and reduce waiting times which were rising well before the pandemic struck."