Staff told to balance safety and efficiency.

Frontline workers at Auckland District Health Board are complaining of under-staffing, exhaustion and unpaid overtime.

The Herald on Sunday has obtained a Safe Staffing Healthy Workplace report, which includes nine recommendations for change.

Of the DHB's 10,000-plus staff, 685 took part in an online survey in July and August. About 70 staff also gave face-to-face interviews.

Almost half said the message they hear from the DHB is patient safety and quality of care must be balanced with achieving volumes, targets and budgets.

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Just 11 per cent felt there was always enough staff to get work done and 82 per cent said the effort to maintain service levels was exhausting or too hard.

The document also revealed "many interviewees considered that in a number of areas the DHB is operating with a very lean resource in clinical and support roles".

The survey revealed 68 per cent of staff said they had skipped meal breaks or worked overtime at least twice a week, and 44 per cent said they'd done so on three or more days a week. More than half did not claim overtime or time in lieu.

The report said the responses from Auckland were consistent with those at other DHBs.

Vice president of the New Zealand Nurses Organisation, Rosemary Minto, said it was a difficult problem mirrored nationwide. "There's not enough human resource or money to go around," Minto said.

An Auckland DHB spokesperson said it was working to implement recommendations from the report. The release comes as Labour Party deputy leader and health spokeswoman Annette King revealed the Ministry of Health owes almost $500 million in annual leave at its 20 DHBs.

The ADHB said its leave liability was increasing, but the rate of the rise was slowing down.

King claimed the figures were evidence of "dollar-mad bureaucracy over the safety and quality of care of patients".

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Health Minister Jonathan Coleman pointed to record funding on his watch.