Tens of thousands of patients were waiting for routine treatment at the Wye Valley Trust in October, figures show.
A health think tank warns the NHS is under "severe strain" despite some progress in reducing the national backlog.
NHS England figures show 23,039 patients were waiting for non-urgent elective operations or treatment at Wye Valley NHS Trust at the end of October – down from 23,522 in September, but an increase on 20,652 in October 2022.
Of those, 1,645 (7%) had been waiting for longer than a year.
The median waiting time from referral at an NHS Trust to treatment at the Wye Valley Trust was 15 weeks at the end of October – the same as in September.
Nationally, 7.7 million people were waiting to start treatment at the end of October.
Nuffield Trust Fellow Jessica Morris said: “The slight fall in the number of people waiting for routine NHS treatment is welcome progress. NHS staff got record numbers of patients starting treatment in October, which will have helped finally start to reverse month on month growth of the waiting list.
"While this is good news, it is hard to look past the huge waiting list that remains in place. This drop is only a small fraction (54,000 people), with over 6.4 million people still waiting."
"Overall, the elective waiting list is 370,000 people higher than it was when the prime minister made his pledge to cut long waits at the beginning of the year," she added.
"The reality is that it will take time and a lot of hard work to sustain this momentum, particularly during the difficult winter months to come."
Separate figures show 1.6 million patients in England were waiting for a key diagnostic test in October – the same as in September.
At the Wye Valley Trust, 3,989 patients were waiting for one of 13 standard tests, such as an MRI scan, non-obstetric ultrasound or gastroscopy at this time.
Of them, 920 (23%) had been waiting for at least six weeks.
Other figures from NHS England show that 47 out of 95 cancer patients urgently referred to the Wye Valley Trust in October received treatment within two months of their referral.
A month previously – when 70 patients were referred – 46 were treated within 62 days.
In October 2022, 54 out of 71 patients were treated within this period.
Professor Pat Price, co-founder of the #CatchUpWithCancer campaign, said: "Despite the recent changes to cancer waiting times and focus on diagnosis, we are in a devastating cancer care rut."
The organisation is urging the health secretary to perform a "handbrake turn" on cancer.
"That means a dedicated radical new cancer plan, with a focus on tackling treatment delays and a monumental effort to get investment to frontline services," Professor Price added.
Prime Minister Rishi Sunak defended his Government's record on healthcare on Thursday.
He said: "We’ve made progress first and foremost on the longest waiters.
"We’ve practically eliminated the number of people waiting one-and-a-half years earlier this year, to people waiting two years last year, and we were making good progress tackling the backlog."
He expressed disappointment at threats of further industrial action from junior doctors.