But the Dudley Group NHS Foundation Trust board was told that despite ongoing challenges it was on track to reduce the 78-week backlog, mainly caused by the coronavirus pandemic, by next spring.
Trust chief executive Diane Wake told the meeting on Thursday that Mondays were particularly busy.
"We have seen pressures at our front door," he said.
"We have seen a big increase in activity. We have well above activity levels prior to Covid. Even on Monday on the day of the monarch's funeral every other trust in the area was quiet except Dudley.
"We are seeing over 500 to 600 patients daily. We are absolutely committed to getting this right. we have worked very hard to create additional space and capacity so we can unload ambulances.
"Staff are under relentless pressure. I have to commend them for their hard work," she said.
She reported that overall the number of patients waiting more than 62 days for procedures was "higher than trajectory". She insisted that reducing lists including for general surgery was a key focus and that reducing the number of patients waiting between one year and 78 weeks remained a challenge.
Efforts to tackle the issues includes the opening of two new minor procedure rooms to provide extra facilities to meet the demand for elective procedures and cancer appointments. And working collaboratively as "one trust" alongside the other three Black Country acute hospitals to share resources.
"Elective restoration and recovery remains strong," she continued. "During August the trust continued to deliver against the national requirement to ensure zero 104-week plus breaches for patients waiting for routine procedures, placing the trust joint first among the 20 Midlands trusts.
"There are no 104-week waits on our horizon. We have to reduce the 78-week plus backlog by March 2023 and we remain on track which is very positive for our patients."
Russells Hall Hospital is also among the best-performing health trusts for meeting cancer appointments.
"From the cancer perspective we are performing very well. We have achieved our target for the last eight weeks. This is an area of challenge. There were 368 patients waiting by March and now we have about 150. We are managing that very closely all over the Black Country," Mrs Wake said.
"We have a high performance rate for cancer. We are the second best in the region for cancer recovery. Being second is not good enough for us, we are striving to be the best.
"We are also good for elective recovery."
She said the trust's cancer two-week wait target was achieved for two months during summer.
Her report to Thursday's board meeting stated: "We have received regional recognition for our dedicated commitment and focus for reducing the longest waits for our patients in the Black Country. Through the hard work of our clinical and operational teams, our longest waiting patients are either treated or on a pathway to be treated.
"Post the Covid pandemic we continue to work collaboratively with colleagues across the system to support our recovery of elective, cancer and diagnostic services."
The meeting heard that there was a projected £15.3 million overspend at the end of the current financial year.
And that efforts were in hand to recruit more nurses, some from overseas, but there was a time lag while the new staff settled into the community.
She also explained that the four Black Country acute trusts were now in effect operating as "one trust" and functioning "as one big system" under a provider collaborative and Integrated Care Board as part of efforts to tackle ongoing NHS pressures. While the trust's new chairman Sir David Nicholson who took up the post this month was also chairman at Sandwell and West Birmingham NHS Trust.
"We are stronger together. We are functioning as one hospital. Having a shared chairperson across the four organisations is the direction of travel at the moment."
Sir David said: "From my perspective Dudley is in a fantastic position to influence how it works. We have a joint chair and we are working with Wolverhampton as well."