The public's view of the NHS is far less positive than satisfaction ratings given by patients who use the service, a report has found.
GP services get high satisfaction ratings
The NHS Confederation says the public thinks the NHS is in crisis - but patients consistently report high levels of satisfaction with their care.
It blames disenchantment with the government for distorting perceptions.
Ministers said record investment had led to big improvements in the performance of the NHS.
A poll by Ipsos MORI found the combined patient and public satisfaction rating for the NHS overall was 63% in the winter of 2005 - but the public's rating was much more negative than that of patients.
A separate survey by Populus found that, on average, patients rate attributes of NHS care such as nursing care, cleanliness and waiting times 12% higher than the public as a whole.
The NHS Confederation report said a key to the difference in perception could be seen in the fact that both groups gave GP services a similar satisfaction rating - around 80%.
It says that this is probably because, unlike other NHS services, most people see their GP regularly. Thus the public can respond on the basis of their personal experience and not just on opinions from elsewhere.
The report says there is evidence to suggest political beliefs are the most important driver of public satisfaction with the NHS, followed by factors such as media coverage.
Nigel Edwards, director of policy at the NHS Confederation, which represents more than 90% of NHS organisations, said: "The public has become distrustful when confronted with evidence of improvement in the NHS.
"It would seem that disenchantment with the government translates into scepticism about the service."
Mr Edwards said significant improvements had been made in the NHS over recent years, but the government had failed to communicate health reforms effectively to the public.
Continuous reorganisations and the setting of "dogmatic" targets had alienated the public.
And the fact that many NHS staff were critical of the way the service was run might also have coloured public opinion, he said.
"It is clear that both the NHS and the government have a big mountain to climb in order to restore public and staff confidence in the NHS.
"It is only through the NHS and government working together to change the focus of the service back to the experience of the patient and the outcomes of their care that the perceptions gap will begin to close and the current poor image of the NHS will start to improve."
Health Minister Andy Burnham said the 2005 Healthcare Commission patient survey reported 92% of patients as happy with their NHS care.
"We understand that coverage of financial problems in a minority of trusts may have an effect on public perceptions of the NHS. But it's important to remember the facts.
"The NHS as a whole is performing well and currently forecasting a small surplus for the end of this year.
"We are confident that as finances continue to stabilise and NHS patients continue to get good services, the public perceptions will get better."