Patients cannot give "meaningful consent to treatment" because of the failure of healthcare professionals to involve or inform them properly, a healthcare watchdog warned today.
The Healthcare Commission made its summary conclusions after checking the NHS pulse in the second national patient survey.
Over 300,000 patients were asked about their experiences in 568 English NHS trusts.
Alongside a second round of monitoring the experiences of adult patients in primary care trusts, the Healthcare Commission gauged the views of young hospital patients (under 18 years), and users of mental health and the ambulance services.
The commission is particularly concerned by the results which show that healthcare professionals are failing to inform patients properly or to involve them adequately in planning their care - most notably in services for people with mental illness.
Under the Care Programme Approach (CPA), introduced in 1992, mental health patients are supposed to centrally involved in discussions relating to their care and treatment, backed up by a written plan. Yet 18% claimed their diagnosis had never even been discussed with them.
Almost half (44%) also felt they had insufficient say in their care and treatment.
Lack of information across services was a concern. Nearly half of adults in hospital said they were not sufficiently involved in decisions about their care, with one in five saying they had been given "too little information".
Many patients, particularly adults, are being discharged from hospital without enough information about how to cope at home, the surveys found.
Over a third of discharged patients left without being told the danger signals to watch for in the future, and a quarter of respondents said they had been left in the dark about who to contact if they had concerns following discharge.
Almost half (46%) of patients said they could not obtain a GP appointment within two working days, prompting the Healthcare Commission to point out "the large discrepancy" between the survey results and official government figures, which cite a figure of only 3% unable to secure an appointment within two days.
Government public health targets also appear to be undermined by shortfalls in services, with one in five smokers who want help in quitting unable to receive it.
Overall service delivery across the NHS fared better, however, with nine out of 10 adults and young people rating their acute hospital care as "excellent" or "good", rising to 98% for those who used the ambulance service.
Mental health service users were also fairly satisfied, with over three quarters praising their hospital experiences.
The Healthcare Commission's chairman, Professor Sir Ian Kennedy, warned that patients needed a greater say over decisions affecting their care. "In general, patients have given a 'thumbs up' to the care they receive from the NHS", he said.
"However, those patients who do not feel completely involved in decisions about their care and treatment are not able to consent to treatment in any meaningful sense."
