They are also worried about a lack of involvement in decisions about medication and other NHS care.

The service has improved, in some cases markedly, says the report from the Picker Institute Europe, but only in areas directly targeted by the Department of Health.

In other areas the service has languished or even become worse, according to the views of nearly a million patients who have contributed to surveys conducted since 1998. Angela Coulter, chief executive of the charity, said: “The most disappointing thing is that all the rhetoric about creating patient-centred care hasn’t led to improvements across the board.

“Only where specific targets have been set — in waiting times and in cancer and heart disease — are we seeing big improvements.

“Where there are no targets, in areas such as cleanliness and access to a GP, the service has not improved and in some cases has got worse. Many aspects of patients’ experience still need urgent attention.”

The charity has designed a series of national patient surveys for the NHS for the past seven years. Data collected by NHS trusts has been issued in reports from the Commission for Health Improvement and its successor body, the Healthcare Commission.

Picker has now summarised the results in a new report — Is the NHS Getting Better or Worse? — in an effort, it says, to inject some facts “into the current poliical knockabout on the state of the NHS”.

Areas in which things have become worse include family doctor services.

In 1998, 87 per cent of GP patients said that they had sufficient time with the doctors, but by 2004 this had fallen to 74 per cent.

Between 2002 and 2004 the proportion of patients complaining about inconvenient opening hours had increased from 20 per cent to 22 per cent.

Professor Coulter said that she expected criticism to increase as the effect of the new GPs contract was felt. Reports from patients indicated increasing difficulties with getting an appointment at a convenient time. The disappearance of Saturday surgeries was a particular complaint, she said.

Hospital cleanliness is another problem. In 2004 only 54 per cent said that the ward they were in was very clean, 2 per cent less than in 2002. Only 48 per cent said that bathrooms and lavatories were very clean, 3 per cent less than in 2002.

There is little evidence in the report that the NHS is becoming more patient-friendly. More than a fifth of inpatients and a quarter of A&E patients said in the 2004 survey that staff did not always listen to what they said — which represents no improvement since previous surveys.

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