Dirty hospitals and a lack of information about medical treatment are among patients' top concerns about the NHS, according to a new report.
Other worries include a lack of involvement in decisions about medication and NHS care.
The Picker Institute report draws from the key findings of 15 surveys carried out in England between 1998 and 2005 to which 917,883 patients responded.
Only 54% of inpatients described wards as very clean last year, down from 56% in 2002.
Just 48% said the toilets and bathrooms were very clean in 2004, down from 51% in 2002.
The report states that growing concern about dirty hospitals may be due to greater awareness of MRSA rather than a downturn in standards but adds: "... standards of cleanliness are still poor in many NHS facilities."
Other concerns included a lack of information about medical treatment and its side-effects.
Last year 47% of inpatients, 30% of outpatients and 36% of A&E patients said they would have liked more say in treatment decisions.