The NHS waiting list for treatment referrals in England hit 7.6 million cases in April – a threefold rise since 2010.

The referral-to-treatment figures show the number of cases of patients waiting for elective care. As patients can be waiting for multiple treatments, the actual number of people on the list is lower – an estimated 6.3 million.

Of the 7.6 million cases, more than 302,500 involved waits longer than 52 weeks. About 50,400 cases were waiting for more than 65 weeks, and nearly 5,000 involved waits of more than 78 weeks.

The median waiting time was 13.9 weeks, up from 5.2 weeks in March 2010.

Accident and emergency wait times have risen, too, with the percentage of people seen within the four-hour benchmark falling from about 97 percent at the end of 2010 to 74 percent last month.

Waiting lists in Scotland, Wales and Northern Ireland, which have largely autonomous health systems and measure wait times differently, have also risen sharply.

The figures paint a striking picture of declining public services in the UK as voters go to the polls on July 4 in an election dominated by concerns about living standards and national decline.

With dissatisfaction with the status quo running high, the Conservatives appear to be headed for a drubbing at the hands of Keir Starmer’s Labour Party, which has for months led polls by about 20 percentage points.

Why has the NHS deteriorated?

The lion’s share of the backlog had piled up since the COVID-19 pandemic, when health systems in many countries were stretched to breaking point.

But the NHS waiting list had been rising steadily for years before the pandemic. As far back as December 2019, the waiting list stood at 4.6 million – about double the figure under the previous Labour government.

Much of the blowout in waiting times has been blamed on chronic underinvestment stemming from years of austerity implemented in the wake of the 2007-08 global financial crisis.

Though NHS funding has risen every year since 2010, the rate of the increase has slowed substantially. While spending increased by about 6 percent every year under Labour when adjusted for inflation, it has risen only about 2 percent under the Conservatives, according to an analysis by the Institute for Fiscal Studies (IFS).

Not only does that fall short of Labour’s investment, it is well below the 3.6 percent annual average going back to 1949-50, just after the NHS was founded in July 1948.

Furthermore, despite the overall increases in funding, NHS doctors’ and nurses’ pay has actually declined when adjusted for inflation, falling 9.3 percent and 10.5 percent, respectively.

Meagre pay and poor conditions have been blamed as key drivers of staff retention problems in the NHS, which saw a record 169,512 employees quit in 2022.

A report published by The King’s Fund think tank last year found that the UK had the second-worst rates of mortality from avoidable causes among 19 rich nations, in part due to below-average investment that resulted in fewer beds, staff and scanners than peer countries.

The Health Foundation think tank last week warned that the NHS would need far more investment than promised by either the Conservatives or Labour, suggesting that clearing the backlog and improving services in England would require 38 billion pounds ($48bn) more annually than planned.

Apart from funding issues, the UK’s population has also grown older and more obese, putting more pressure on existing resources and contributing to a steep rise in mortality from conditions like diabetes and dementia.

What about other public services?

The news isn’t much better. From local government to housing, services have deteriorated across the board.

Since 2018, eight councils, including the UK’s second-largest city, Birmingham, have issued 114 notices declaring that they cannot balance their books and are effectively bust.

Just two councils issued such a notice between 1988 and 2018.

Half of councils across the UK have warned they are likely to be forced to take the same action within the next five years.

According to an analysis by the IFS, per capita funding for councils is down 18 percent in real terms compared to 2010 as a result of spending cuts during austerity.

For prospective homeowners, buying a house has become significantly less affordable, with the average price last year reaching 8.3 times earnings, compared to 6.8 times earnings in 2010.

Homeownership rates in England for those aged 45 to 59 and 35 to 44 dropped 7.1 percentage points and 6.5 percentage points, respectively, although ownership rose slightly among those aged 25 to 34.

Rising unaffordability has been driven by a shortage of dwellings, which economists have blamed on an inflexible and unpredictable planning system.

England’s 434 homes per thousand inhabitants places it below the OECD average of 487, and far behind countries such as France and Italy with 590 and 587, respectively.

In education, spending per pupil has flatlined, while capital investment has plummeted by about one-quarter, according to the IFS.

“The rot goes back a long way, but has got a lot worse in the last 14 years of austerity,” John Muellbauer, a professor of economics at Nuffield College, University of Oxford, told Al Jazeera.

“Lack of investment in infrastructure when the government could have borrowed to invest at real interest rates close to zero was an act of continued vandalism,” Muellbauer added.

“The obsession with gross government debt to GDP [gross domestic product], ignoring the asset side of the government balance sheet, is a continuing problem and promises to handicap the new government as well.”

How do Britons feel about the state of things?

Britons have become increasingly disillusioned with how their country is run.

Just 67 percent of Britons said they were satisfied with their public services, infrastructure and environment last year, down 12 percentage points from 2011 (the first full year of Conservative government), according to Gallup surveys.

Britons’ satisfaction with the availability of quality healthcare registered the most dramatic decline, plunging from 92 percent in 2011 to 66 percent last year.

Satisfaction with housing affordability fell 18 points, while satisfaction with education and public transport dropped 5 points and 7 points, respectively.

“Britons are rational on this. Things are indeed getting worse,” Andrew Oswald, professor of economics and behavioural science at the University of Warwick, told Al Jazeera.

“Partly because of the astounding expense of funding half the country’s citizens through COVID, partly because of Putin’s invasion causing high inflation, and partly because there is still low productivity that began after the financial crisis of 2008, our nation is feeling an existential pinch. That shows up in lots of survey data.”

Isn’t the UK simply following the international trend of growing public discontent?

Yes and no.

Public trust in government has been declining across democratic countries for decades, particularly in the United Kingdom and the United States, said Oswald.

“After World War II, in both those nations, government officials and politicians were highly trusted – around 70-80 percent of citizens trusted the government. Now the figures are only approximately 20 percent of citizens,” he said.

“So the satisfaction number of 67 percent on infrastructure and public services and the environment is actually not too bad and it may be an overestimate of how good people feel in this country because currently we know that a lot of fed-up, disaffected citizens are refusing to answer survey questions, which is one reason why Brexit predictions went wrong.”

Even so, the UK has experienced an especially pronounced drop in satisfaction with the running of the country.

In 2011, the UK had some of the highest satisfaction levels with public services in Western Europe, tying with Germany and ahead of France, Belgium, the Netherlands and Austria, according to Gallup.

By 2023, the country ranked dead last among its Western European peers.

Other surveys have borne out the especially pessimist mood in the UK.

In an opinion poll released by the Pew Research Center earlier this month, 78 percent of respondents in the UK rated the economy as “bad” – the seventh highest share among 34 countries surveyed.

Meanwhile, 35 percent of Britons expressed an unfavourable view of both Labour and the Conservatives – higher than the 28 percent of Americans last year who said they viewed both the Republican and Democratic parties negatively.