Reading the ERS H2 2025 Surgery File — Cirurgias Cardíacas Hit Zero in the Hospitais Protocolados, the Oncologic Print Falls 30.8% and the Vale-Cirurgia Channel Executes 7.7% of the 3,493 Documents Issued

The Entidade Reguladora da Saúde dropped its second-half 2025 monitoring file on Monday morning, and the numbers walk into a sharper picture than the headline 7% drop in programmed surgeries at hospitais protocolados. Once the cardiac and oncologic lines are pulled out of the aggregate, the SNS's outsourcing channel is doing less work than at any point in the protocol regime's life — and the vale-cirurgia bridge that is supposed to redirect patients to the private and social sectors is executing on 7.7% of the documents issued.

The protocol-hospital aggregate prints 9,963 programmed surgeries in H2 2025, 1,870 fewer than the same window a year earlier. TMRG (Tempo Máximo de Resposta Garantido) non-compliance lands at 2.6% on a six-month average and 1.8% at the 31 December cut-off, both improvements on the prior period. The waiting-patients count at year-end sits at 3,316, down 3.4% — a number that looks reassuring until the specialty breakdown opens up.

Oncologic surgery in the protocolados channel collapses to 72 interventions over the six months, a 30.8% year-on-year contraction. Non-compliance with the legal time limits improves to 19.4% but only because the denominator has shrunk: 13 patients sit on the protocol oncologic queue on 31 December, 15.4% of them already past TMRG. Cardiac surgery on the protocol side is the cleanest signal — zero programmed procedures in the entire half. The destination hospitals, the public-network endpoints the ERS tracks separately, ran 13,312 programmed surgeries (+4.5%) and closed with 6,092 patients on the queue, but their TMRG breach rate worsened to 26.8% on the average and 16% at the cut-off.

The standalone cardiac-surgery file, published 28 April, is the part the H2 monitoring report does not soften. The waiting list closed 2025 with 2,703 patients, the worst print since the regulator started tracking. Nearly 330 patients died between 2021 and 2025 while on the queue. TMRG non-compliance for cardiac referrals has sat above 55% for six consecutive quarters, and on cardiology initial consultations the non-compliance band ran 85.5% to 91.8% across the year. The ERS notes that no vales cirurgia were issued in cardiac surgery in 2025 — institutions in the private and social network never declared availability, so the regulator's referral switch never fired.

The vale-cirurgia performance line is the report's quietest scandal. The SNS issued 3,493 vales and notas de transferência in H2 2025 to redirect patients beyond their original hospital. Only 7.7% of those documents resulted in an actual operation, a 3.5-percentage-point improvement on the prior period but still inside the dysfunctional band. Of those issued, 78% pointed at private hospitals and 22% at social-sector institutions. The bridge designed in 2017 to clear queues by leveraging the parallel network is moving fewer than one in twelve patients through it.

What This Means for Expats

• Cardiac surgery routing: If you have a coronary or valve case referred through the SNS, the 2025 file tells you the public-private bridge for cardiac procedures is closed — institutions did not declare availability, no vales were issued. The route to faster care is your own seguro de saúde or out-of-pocket private contracting, not the protocolados channel.
• Cancer pathways: The 30.8% drop in oncologic surgery at protocol hospitals is concentrated, not diffuse — the channel did 72 procedures in six months. Holders of voluntary insurance will get faster access through Lusíadas, CUF or Luz networks; tax residents inside the SNS-only path should expect the destination-hospital queue, where TMRG breaches widened to 26.8%.
• Vale-cirurgia is functionally inactive: If a hospital offers you a vale to redirect care to a private or social provider, only 7.7% of those documents convert into surgery. Plan as if the vale is a queue marker, not a referral.
• Watch the September decrees: The three SNS doctor decree-laws approved 7 May rewrite the urgência bonus and tarefeiro framework but do not touch the surgical-referral architecture. The Ministry's promised review of the cardiac-surgery network is the file to track.

The H2 2025 cut is the cleanest data the SNS has produced on surgical access in two years, and it lands a week after the Conselho de Ministros opened more than 2,500 specialist-doctor concursos and three weeks before parliament debates the Trabalho XXI labour reform. The regulator's report does not call the cardiac line a crisis — it just publishes a zero where the 2024 file printed scheduled procedures.