Doctors say the NHS is struggling to meet demand in England as new data shows the waiting list for routine treatment increasing for the second month in a row.

An estimated 7.4m planned procedures were waiting to be carried out in July, up 34,000 on the previous month and the highest level since March.

NHS England said many more patients were coming forward for treatment and a doctors’ strike in July left 50,000 appointments cancelled.

The Royal College of Surgeons said the system was coming under severe strain and called for more money for new operating theatres in the autumn budget.

“Crumbling hospital buildings are leading surgeons to have to compete for space, directly contributing to delays and leaving patients waiting for the care they need,” said the organisation’s vice president Prof Frank Smith.

The latest monthly data also showed the number facing very long waits to start routine treatment had increased.

There were 1,429 patients waiting more than 18 months in July, up from 1,103 in June, though down sharply compared to last year.

Routine treatment includes anything booked in advance, from a consultation with a specialist to minor operations or major surgery.

The government has set a target of treating 65% of those patients within 18 weeks by March 2026 and 92% by March 2029.

In July just 61.3% of treatments were delivered in that time, down slightly on the previous month but up from 58.8% in 2024.

Tim Gardner, assistant director of policy at the Health Foundation, an independent thinktank, said: “The NHS waiting list often increases at this time of year, but the government is likely to be disappointed not to have made further progress on its commitment to ending hospital backlogs.

“While the NHS was able to maintain a relatively high volume of treatment in July, which included the five-day strike by resident doctors, this is the second consecutive month the waiting list has increased.”

The NHS said that it delivered 3% more planned treatments compared with last year with the number of patients joining the waiting list up by 5%.

It also saw its busiest August ever in A&E and for emergency calls to the ambulance service.

NHS Providers, which represents hospitals, ambulance services and other trusts, said staff were “running to stand still” given the increase in demand, and A&E units were also under “relentless pressure”.

“If we’re going to make a real dent in waiting lists and get more patients seen faster, we need to change how to deliver healthcare,” said the body’s chief executive Daniel Elkeles.

“The shift to seeing patients closer to home and preventing sickness needs to happen quickly.”

NHS England said that progress had been made on cancer care, which is measured separately from the waiting list for routine treatment.

The proportion of patients who had waited no longer than 62 days from an urgent suspected cancer referral to their first treatment was 69.2% in July, up from 67.1% in June.

The government has set a target date of March 2026 for this figure to hit 75%.

It comes as senior cancer doctors have told the BBC that excessive red tape means some patients are struggling to access the very latest treatments like immunotherapy drugs and advanced radiotherapy.

The government is due to publish its long-awaited cancer strategy for England by the end of the year.

Professor Meghana Pandit, NHS national medical director, said: “Industrial action in the NHS is never easy for patients, but despite the disruption record number of cancer patients got the care they needed.

“Ambulance response times were the fastest they’ve been in over four years – even as A&E and ambulance staff saw more patients than ever before.”

The health secretary Wes Streeting said the government had delivered on its promise of delivering two million extra NHS appointments in its first year of power.

“Our 10-year health plan will go even further, driving care out of our busy hospitals and into local communities as we deliver the radical transformation required to fix our broken health service,” he said.