Most public health services in Auckland and Northland, including emergency departments and cancer care, are under critical or major pressure, a confidential report by district health boards reveals.

The report is a submission by the four northern boards to the Health Ministry's national capital committee on long-term planning for facilities and services. It flags pressure points and suggests that part of the answer may be strengthening community-based care and creating "outreach" clinics for medical oncology in Auckland.

It was obtained by the National Party, whose health spokesman, Tony Ryall, said yesterday that it was "an appalling report card on nine years of neglect".

Labour's David Cunliffe, the Minister of Health, said he had not received nor been briefed on the submission but would be today, after which he would respond more fully.

"The Government is committed to meeting and improving service levels to all New Zealanders.

"Under this Government, over $2 billion has been invested in the largest hospital building programme in living memory."

An earlier submission outlined northern region approval bids totalling more than $281 million to add around 250 hospital beds and emergency department spaces and to build or replace 14 operating theatres.

In the latest submission, which looks collectively at the northern health region's services, only child health is under less than major pressure on all four criteria considered: demand, capacity, clinical and workforce sustainability, and access.

The most consistently stretched services are emergency departments and medicine, because of rising rates of chronic disease, like diabetes, and the ageing population.

The submission also notes the pressures from:

* The shortage of operating theatre capacity and/or support facilities like intensive care beds.

* Growing demand for medical imaging in the face of increasing workforce shortages.

* The shortage of radiation therapists "due to a private facility opening".

* The shortage of cardiothoracic intensive care nurses (which has previously been reported as a key reason for the declining rate of heart bypass and valve surgery in Auckland).

Shortages of these nurses, midwives, medical and radiation cancer specialists, kidney staff and other health workers left a number of services "challenged to deliver appropriate levels of service".