The surgical waiting list has reached its highest level since records became available in 2017, even as the Regional Government reports more consultations, diagnostic exams and hospital activity—a paradox that reveals both greater access to healthcare and a system struggling to convert diagnosis into timely treatment.
There is a particular cruelty in waiting for healthcare because the calendar is never merely a calendar. A day on a surgical waiting list can be another day of pain, another night without sleep, another morning in which mobility is diminished, another postponement of work, independence or ordinary family life. Months cease to be units of time and become measures of uncertainty. And when the waiting stretches beyond a year, the statistic begins to describe something much larger than administrative delay: it describes a portion of a human life lived in expectation of treatment. In the Azores, nearly 14,000 people were waiting for surgery at the end of July 2026, the largest number recorded since the available statistical series began in 2017. According to the monthly bulletin from the Azores Central Unit for the Management of Surgical Registrations, 13,945 patients were on the surgical waiting list, an increase of 227 people, or 1.7 percent, from June and 1,070 people, or 8.3 percent, from July 2025. The trend is not entirely new: since May 2023, the number of Azoreans awaiting surgery has remained above the corresponding figure from the previous year. Yet the July total gives that trajectory a troubling distinction. Never, in the publicly available series, have so many people been waiting at the same time.
The numbers also reveal a healthcare system confronting a complicated paradox. The Regional Secretariat for Health and Social Security reports that hospitals are performing more consultations, examinations, treatments and day-hospital sessions, and that surgical activity has increased in important areas. Regional Secretary Mónica Seidi therefore argues that accessibility to healthcare is improving rather than deteriorating. Her explanation is important to understanding the apparent contradiction: more medical consultations lead to more examinations; more examinations produce more diagnoses; and more diagnoses inevitably generate additional proposals for surgery. “I have no doubt that we are improving accessibility to healthcare,” Seidi said. “More consultations allow more examinations to be carried out, more examinations lead to more diagnoses, and more diagnoses also translate into new surgical proposals.” The argument is statistically plausible within the information presented: a healthcare system that identifies previously undiagnosed conditions may increase its waiting list precisely because more people are entering the pathway toward treatment. But for the patient already inside that pathway, the distinction between greater diagnostic access and insufficient surgical capacity can become painfully academic. The ultimate question is not simply whether the system is finding more patients who need surgery. It is whether it can operate on them within a medically and humanly reasonable period.
Three Hospitals, Nearly 14,000 People Waiting
The burden is distributed unevenly among the Azores’ three hospitals. At the end of July, the Hospital do Divino Espírito Santo (HDES) in Ponta Delgada accounted for 9,223 patients awaiting surgery—approximately two-thirds of the regional total and by far the largest waiting list in the archipelago. The hospital, which continues to deal with the consequences of the devastating May 2024 fire, also recorded the largest year-on-year numerical increase: 806 more patients than in July 2025, a rise of 9.6 percent. The Hospital de Santo Espírito da Ilha Terceira (HSEIT) had 3,283 people waiting, an increase of 250 patients, or 8.2 percent, from a year earlier, while the Hospital da Horta recorded 1,439 patients, 14 more than in July 2025, an increase of 1 percent. The month-to-month movement, however, presents a somewhat different picture. Compared with June, HDES recorded the smallest proportional increase in its waiting list, at 0.8 percent, while Horta increased 2.5 percent and Terceira 3.7 percent.
Even those figures do not capture the entire volume of pending surgical care because some patients require more than one operation. Consequently, while 13,945 individual patients were awaiting surgery at the end of July, the total number of surgical proposals on the waiting list had reached 15,356, an increase of 1.3 percent from June and 7.6 percent from July 2025. During July, 713 surgeries were recorded across the three hospitals under the figures presented in the bulletin—89 more than in June, an increase of 14.3 percent, but 63 fewer than in July of the previous year, a decline of 8.1 percent. The Regional Secretariat cautions, however, that the bulletin records only additional surgical production performed within the CIRURGE program and does not include surgeries carried out during hospitals’ normal operating schedules. That distinction is essential: the 713 figure should therefore not be interpreted as representing all surgical procedures performed by the Azorean hospital system during July.
More Surgery—and a Queue That Continues to Grow
The Regional Government points to increased surgical capacity as evidence of progress, particularly at HDES. According to the Health Secretariat, the Ponta Delgada hospital performed 200 more surgeries during the first six months of 2026 than during the corresponding period of 2025, representing an increase of 10 percent. The improvement was attributed in part to the regular operation of a fifth surgical room, increasing the number in use from four to five following greater availability of human resources, particularly in anesthesiology. This is an important development for a hospital whose normal functioning was profoundly disrupted by the 2024 fire and whose central importance to the regional health system is demonstrated by the sheer proportion of Azorean surgical patients concentrated there.
But increased production has not yet been sufficient to reverse the waiting-list trajectory. During July alone, 1,151 new surgical proposals entered the system, 153 more than in June, an increase of 15.3 percent, and 33 more than in July 2025, a rise of 3 percent. There were also 276 surgical cancellations, 44.5 percent more than during the previous month and 38 percent more than a year earlier. These figures help explain why simply performing more operations does not necessarily produce a shorter waiting list. A hospital system can increase activity and still fall behind if new surgical needs are being identified faster than existing cases can be resolved, particularly when cancellations remove procedures that would otherwise have reduced the accumulated queue. It is this relationship between inflow and capacity—not any single monthly number—that will ultimately determine whether the record waiting list begins to decline.
498 Days: When a Statistic Becomes a Life
The most difficult number in the entire report may not be 13,945. It may be 498. At the end of July, Azorean patients had been waiting an average of 498 days for surgery—more than one year and four months. That was 38 days longer than the average recorded in July 2025. Behind the regional average are significant differences among hospitals. At HDES in Ponta Delgada, the average wait reached 547 days, 47 days longer than a year earlier. At the Terceira hospital, it stood at 397 days, an improvement of 15 days, while patients at Horta waited an average of 415 days, 76 days longer than in July 2025. At all three hospitals, average waiting times remained above the regulated Maximum Guaranteed Response Times (TMRG), under which a normal-priority surgical procedure should be performed within a maximum of 270 days.
There was, nevertheless, improvement in the proportion of July surgeries performed within those guaranteed response periods. 57.2 percent of the surgeries recorded during the month occurred within the TMRG, compared with 53 percent in July 2025—an improvement of 4.2 percentage points. That progress deserves recognition, particularly because waiting-list debates can become distorted if every positive indicator is ignored in favor of the most alarming number. But neither should the improvement obscure the larger reality: average waiting times across all three hospitals remain above the established maximum for a normal-priority operation, and the regional average of 498 days is almost twice the 270-day benchmark. A health system can therefore be improving some dimensions of performance while simultaneously confronting an accumulated backlog of historic proportions. Both realities can be true.
More Consultations, More Diagnoses, More People Entering the System
The Government’s argument becomes clearer when the broader activity of the Regional Health Service is considered. During the first six months of 2026, Azorean hospitals performed 166,945 medical consultations, 3.81 percent more than during the same period a year earlier. They also carried out 2,521,923 examinations and treatments, an increase of 3.4 percent, and 46,698 day-hospital sessions, 3.7 percent more than in the first half of 2025. These are substantial volumes of healthcare activity, and they reinforce Seidi’s contention that greater access upstream in the system is identifying additional patients who require surgical intervention. More medicine is being practiced; more people are being seen; more conditions are being detected. The difficulty is that every successful diagnosis that results in an indication for surgery becomes another demand upon operating rooms, anesthesiologists, surgeons, nurses, beds and the entire chain of hospital resources necessary to transform a diagnosis into treatment.
Seidi acknowledges precisely that challenge. “We need to continue strengthening human resources and working with the three hospitals to maximize the use of operating rooms and increase surgical capacity,” she said. That may ultimately be the central issue revealed by these statistics. The Azorean health system does not appear to suffer from inactivity. On the contrary, the numbers describe hospitals carrying out hundreds of thousands of consultations and millions of examinations and treatments while attempting to increase surgical production. What they also reveal, however, is a capacity problem: the demand being identified by the system continues to exceed its ability to resolve accumulated surgical needs rapidly enough to reduce the queue.
Healthcare Is Measured Differently by Those Who Wait
There is a danger in discussing healthcare entirely through competing statistics. Governments naturally point toward production: more consultations, more examinations, more surgeries, another operating room functioning, a greater percentage of procedures completed within regulated times. Critics naturally point toward outcomes that remain troubling: a record waiting list, longer average delays, cancellations and thousands of patients beyond guaranteed response periods. Both sets of numbers belong to the same healthcare system, and neither should be discarded merely because it complicates the preferred narrative of one side or another. The fairest reading of the July figures is therefore also the most difficult: the Azorean health system appears to be doing more, but the need for surgical care is still growing faster than the system has been able to resolve it.
For the people inside the statistics, however, institutional explanations eventually encounter the limits of patience. A person awaiting a hip operation does not experience those 498 days as an average. Someone waiting for a procedure that might relieve chronic pain does not live inside a percentage. A patient whose surgery is cancelled does not return home carrying a quarterly indicator. Healthcare is experienced through the body, and the body has its own calendar. Pain has a calendar. Anxiety has a calendar. So do diminished mobility, dependence upon relatives, absence from work and the uncertainty of not knowing when treatment will finally arrive.
That is why the record of 13,945 Azoreans awaiting surgery must ultimately be understood as something more than an administrative challenge. Behind that number are almost 14,000 individual lives, each with its own diagnosis, urgency, family and story. The increases in consultations, diagnostic capacity and surgical production are meaningful and necessary. If sustained and accompanied by greater operating-room capacity and adequate human resources, they may eventually begin to reverse the accumulated backlog. But the success of that effort will not finally be measured by how much activity a health system produces.
It will be measured by how long a person must remain ill while waiting for that activity to reach them. Because in healthcare, time is never merely time. For someone awaiting surgery, every additional day belongs not to a waiting list, but to a life—and when nearly 14,000 people are waiting, the most urgent statistic may be the human time disappearing behind the numbers.
Based on a story in Diário Insular-Photo from Hospital do Espirito Santo.